Head, Face, Neck and Lymphatics

Question 0

What are you looking for on inspection of the face?

Answer 0

Note facial expression and appropriateness for mood/behaviour.
Symmetry of eyebrows, palpebral fissures, nasolabial folds, and sides of the mouth.
Note abnormal facial structures (coarse features, exophthalmos, changes in skin colour/pigmentation, abnormal swelling, involuntary movements (tics))

Question 1

What are you looking for on inspection of the skull?

Answer 1

Looking for general size and shape.

A normocephalic skull is round and symmetrical

Question 2

What are you looking for upon inspection of the neck?

Answer 2

Head position is centred in midline, accessory neck muscles should be symmetrical, head held erect and still.

Question 3

How do you palpate the skull?

Answer 3

Run your fingers through the patient’s hair and palpate the scalp - should be smooth and symmetrical.
Palpate cranial bones with protrusions (forehead, lateral edge of parietal bones, occipital bone, and mastoid process behind ears)
There should be no tenderness on palpation.

Question 4

How do you palpate the temporal area?

Answer 4

Palpate temporal artery above the zygomatic (cheek bone), between the eye and the top of the ear
Palpate the temporomandibular joint while patient opens mouth - should be smooth with no limitations or tenderness.

Question 5

How do you test neck for range of motion?

Answer 5

Note any limitation of movement during active movement

1. Touch chin to chest - flexion (45 degrees)
2. Turn head to right and left (__ degrees)
3. Touch ear to shoulder (__ degrees)
4. Extend neck backwards (55 degrees)

Question 6

How do you test muscle strength and status of cranial nerve xi?

Answer 6

Resist patient’s movements with hands as patient shrugs shoulders and turns head to each side.
As patient moves, look for any abnormalities - enlargement of glands, lumps, swelling, etc.

Question 7

What are the lymph nodes? (10)

Answer 7

1. Preauricular
2. Posterior auricular
3. Occipital
4. Tonsillar
5. Submandibular
6. Submental
7. Superficial cervical
8. Posterior cervical
9. Deep cervical chain
10. Supraclavicular

Question 8

How do you palpate the lymph nodes?

Answer 8

Palpate with a circular motion of fingertips.
Palpate with both hands to assess both sides.
If nodes are palpable, note their location, size, shape, delineation (discrete or clumped together), mobility, consistency, and tenderness.
Normal nodes feel movable, discrete, soft, and nontender.
It is normal not to palpate the lymph nodes in a healthy individual.

Question 9

How do you palpate the deep cervical chain nodes?

Answer 9

Tip the patients head to the side being examined to relax the ipsilateral muscle.

Question 10

How do you palpate the supraclavicular nodes?

Answer 10

Have patient hunch shoulders and elbows forward to relax the skin

Question 11

How do you palpate for tracheal shift?

Answer 11

Normally trachea should be midline.
Place index finger in the trachea on the sternal notch, and slip it off to each side.
Note any deviations from the midline.

Question 12

What is the purpose of auscultation of the thyroid gland?

Answer 12

If the thyroid is enlarged (can be seen by shining penlight laterally across the trachea), you are auscultating for the presence of bruits.

Question 13

What are bruits?

Answer 13

Soft, pulsatile, whooshing, blowing sounds, heard with the bell of the stethoscope.
Normally are not heard. Indicative of turbulent blood flow, can be existence of clot or blockage.