Head, Face & Neck

Question 0

Inspect and Palpate Temporal Area

Answer 0

Note any redness, swelling or deformity

Palpate temporal artery, which should feel soft and non tender

Palpate Temporal Mandibular Joint while patient bites down and opens mouth. Mouth should open smoothly and approximately 3-6 cm. there should not be deviation, tenderness, or significant crepitus

Question 1

Inspect and Palpate Skull

Answer 1

Shape - round
Size - proportional to body

Palpate noting lumps, depressions, abnormal protrusions. Should normally feel symmetrical and smooth. Frontal, occipital, parietal and temporal bones as well as mastoid process.

There should be no tenderness

Question 2

Inspect the Face

Answer 2

Look at facial structures

Facial expressions should be noted for its appropriateness for behaviour and reported mood.

Features should be symmetrical. Especially eyebrows, palpebral fissures, nasolabial folds, and sides of mouth

Note any coarse features, exophthalmos, changes in skin colour or pigmentation, any abnormal swelling and any involuntary facial tics.

Question 3

Inspect and Palpate the Neck

Answer 3

Inspect for symmetry. The head should be cantered on midline and accessory neck muscles symmetrical. Head should be held erect and still

Go through range of motion - flexion, extension, lateral bending, rotation. Should be smooth and controlled and without pain or tenderness. Note any regions with swelling as patient moves head

Test muscle strength and cranial nerve XI by having patient shrug shoulders and rotate head against your resistance

Palpate lymph nodes

Palpate trachea with finger at sternal notch, slipping finger to each side, feeling space on either side…which should be symmetrical

Tangentially illuminate thyroid to check for swelling

Auscultation thyroid on both sides of trachea to check for bruit. If bruit present, will hear whooshing sound with bell of stethoscope

Question 4

Sinus Cavities

Answer 4

Frontal (below eyebrow) palpable
Maxillary (below cheek bones) palpable
Sphenoid
Ethmoid

Question 5

Inspect and Palpate Nose

Answer 5

Inspect External Nose. Should be symmetrical, in midline, and proportional to other features

Test patency of the nostrils by pushing one nasal wing shut with your finger while asking the patient to sniff inward through other naris. Repeat on other side

Inspect nasal cavity. Use wide-tipped speculum on otoscope. Gently lift nose with finger before inserting. Inspect nose with head held erect and tilted back. Mucosa should be red, smooth, and moist.

Inspect septum, middle turbinate and inferior turbinate. Note any deviation of septum or swelling of turbinates.

Note any polyps if present

Question 6

Inspect the Mouth

Answer 6

Wear gloves!

Inspect lips. Look at colour, moisture, cracking, and for lesions. Retract lips using stick and note inner surface.

Inspect teeth and gums. Note any diseased or missing teeth. Teeth should be whitish colour, straight, evenly spaced and free of debris. Note bite, holding lips open while patient closes teeth. Expect back teeth to touch and slight over-bite. Normally gums are pink or coral with a stippled surface. Check for swelling, retraction of margins, discolouration, sponginess or bleeding.

Spect tongue colour, surface and moisture. It should be pink, the dorsal side often roughened from papillae and covered in a thin, white coat. The underside of the tongue is normally smooth, glistening, and shows veins. Saliva normally present

With gloved hand, use gauze to pull tongue to side while you illuminate mouth. Carefully inspect u-shaped area under the tongue behind the teeth. Note white patches, nodules, or lesions.

If patient is over 50, smokes or consumes alcohol, Palpate area under tongue with gloved hand while stabilizing jaw with other hand.

Inspect Buccal Mucosa by holding mouth open with wooden blade. Look at colour and check for nodules and lesions. Should be pink, smooth and moist. Stensen’s duct beside second molar and fordyce’s granules are brink normal findings.

Inspect palate by shining light on roof of mouth. Prosterior soft palate is pinker, smoother and upwardly movable. Hard palate is more anterior and white with irregular transverse rugae

Observe Uvula. Have patient say ahh, not uvula and soft palate rise on midline.

Make note of any halitosis (bad breath)

Question 7

Inspect Throat

Answer 7

Use light to inspect tonsils. Usually rough surfaced, pink or coral coloured, without exudate.

Normally visible to half way to uvula
Swollen if touching uvula or each other

Push down on one side of tongue with wooden blade to inspect pharyngeal wall. Look at colour and inspect for lesions or exudate

Have patient stick out tongue to test hypoglossal nerve. Tongue should protrude on midline