Physical Exam of Head and Neck

Question 1

Equipment needed for head and neck exam: (4)

Answer 1

1) Pen light or other light source
2) tongue blade/depressor
3) Gauze
4) glass of water

Question 2

Basic principles of examination (6):

Answer 2

1) inspection
2) palpation
3) external
4) internal
5) auscultation
6) maneuvers

Question 3

Scalp: (2)

Answer 3

1) Inspection: scaliness, dandruff, swellings (hard or soft)

2) palpation: swellings and tenderness

Question 4

Skull: (2)

Answer 4

1) inspection: size, shape, and symmetry of skull, scars, swellings, and deformities
a) increased size of skull or small skull (macrocephaly or microcephaly)
2) Feel the fontanelles (top of head) in children and babies
a) sunken fontanelles indicate dehydration, etc.
B) swollen fontanelles indicate inc. intracranial pressure

Question 5

Hair: (3)

Answer 5

1) hair distribution (difference between males and females), baldness either complete or patchy
2) Lice and nits
3) Coarse or fine hair (depends on race and certain disease types-Hypo and Hyper thyroidism can produce a change)
a) extra facial hair in women may suggest and endocrine dysfunction

Question 6

Oral Cavity: (3)

Answer 6

1) Examine external to internal
2) Mouth needs to be opened and tongue must be depressed lightly w/ tongue blade so can see whole oral cavity
3) Cheek needs to be retracted (tongue blade) to visualize buccal mucosa on each side

Question 7

Lip: (3)

Answer 7

1) Shape and symmetry, swellings, cracks, dryness, and bleeding
2) Acute swellings can be caused by injuries, allergies, insect bites, etc
3) Leukoplakia: A white patch that can’t be removed by scraping and could be a pre malignant lesion, occurring often in smokers

Question 8

Gums:

Answer 8

• Inflammation, redness, hyperplasia

- hyperplasia is usually seen in some chronic drug use (antiepileptic drugs like phenytoin)

Question 9

Teeth (3):

Answer 9

1) should be counted
2) Dental formula is 2123 (2 incisors, 1 canine, 2 premolars, and 3 molars)
3) Look for caries tooth (tooth decay/cavity) and other abnormalities like dental abscess or missing tooth

Question 10

Buccal mucosa

Answer 10

-Inflammation and/or redness, leikoplkia, ulcers (common in vitamin deficiencies)

Question 11

Hard and soft palate: (3)

Answer 11

1) open mouth wide and shine light towards hard palate at roof of mouth
2) redness leukoplakia, congenital abnormalities
3) torus palatinus is a harmless mid line swelling one might encounter

Question 12

Pharynx: (5)

Answer 12

1) Direct light towards pharynx w/ mouth fully open
2) tell patient to say “Ah” to see uvula better
3) Look at tonsils and pillars for inflammation or redness
4) uvula should move up and down
5) abnormal deviation of uvula to one side may suggest cranial nerve involvement

Question 13

Salivary glands: (4)

Answer 13

1) parotid duct opening is located opposite upper second pre-molar tooth on each side
2) look for inflammation or redness or swelling in this region
3) use tongue blade to retract buccal mucosa on lateral upper aspect so parotid duct can be seen
4) submandibular duct opening should be visualized underneath the tongue.

Question 14

Lymph nodes of head and neck: (11)

Answer 14

1) Posterior auricular (behind ear)
2) Preauricular (in front of ear)
3) Occipital (back of head)
4) Superficial cervical (lower ear and parotid)
5) Deep cervical (other nodes of head and neck, etc.-length of neck)
6) Posterior cervical (middle of neck and shoulder)
7) Supraclavicular (thorax and abdomen-near clavicle)
8) Parotid (between jaw and ear)
9) Tonsillar (back of jaw)
10) Submental (lower lip, floor of mouth, apex of tongue)
11) Submandibular (cheek, side of nose, lower lip, gums, anterior tongue

Question 15

How to exam lymph nodes: (6)

Answer 15

1) palpate carefully with 2-3 fingers in circular motion
2) occipital, pre and post auricular, tonsillar, sub-mandibular, and submental group
3) Superficial group of cervical lymph nodes, superficial to muscle and feel for muscle
a) run fingers in circular motion superficial to muscle and feel for any palpable lymph nodes.
4) deep to sterno-mastoid muscle for deep cervical group
5) in the posterior triangle anterior to trapezius muscle for posterior group
6) Supra-clavicular lymph nodes
a) secondaries from the chest or abdominal cavity
b) hard, palpable non tender lymph node in left supra clavicular region is very suspicious of intra-abdominal malignancy-if palpable is called “Virchow’s nodes”

Question 16

Regarding lymph nodes, what needs to be noted/observed? (7)

Answer 16

1) size
2) shape
3) consistency
4) location
5) tenderness
6) matted or discrete
7) relation to underlying structures

Question 17

Thyroid gland: Inspection (3)

Answer 17

1) just below cricoid cartilage, locate small structure which will move with swallowing-this is thyroid isthmus
2) observe gland move up and down on swallowing
3) look for swellings, nodules or inflammation

Question 18

Palpation of thyroid gland: (4)

Answer 18

1) Palpate gland just below cricoid cartilage with 3 fingers for
a) tenderness, swellings and nodes
2) feel as he/she swallows and observe movement
a) thyroid swellings is most likely to move up on swallowing-a thyroglossal cyst will move up on tongue protrusion
3) Palpate LATERAL lobes behind sternomastoid muscle like isthmus
a) for swellings and nodules. have patient swallow again and feel lobes for movement and nodules-note if any
b) cancerous nodules may feel hard and may be fixed
c) lateral lobes can also be felt from behind the patient
4) Auscultate for Bruits-bruits are heard in a hypervascular gland (e.g. Grave’s disease)

Question 19

Examination checklist: (16)

Answer 19

1) scalp: dryness, dandruff, scaliness, nits and lice, overall hygiene
2) hair: distribution, texture
3) Skull: shape, size and deformity, swellings-both hard and soft
4) Face: symmetry, expression, deformities, lesions, edema, eyebrows (loss of lateral third), inflammation and acne
5) Mouth: lips for color inflammation, ulcers, leukoplakia
6) Teeth: for number, caries, malocclusion
7) Buccal mucosa: color, inflammation, ulcers, leukoplakia
8) Tongue: color, ulcers inflammation, deviation and wasting
9) Gums: inflammation and hygiene
10) hard and soft palate: deformities and swellings
11) Tonsils: inflammation
12) Salivary ducts: inflammation (both Wharton’s and Stensen’s)
13) Uvula: inflammation, deviation, and movement
14) Pharynx
15) Thyroid Gland: (isthmus and lateral lobes)
a) neck for symmetry, swellings, nodules
b) isthmus in the midline
c) lateral lobes deep to sternomastoid muscle
d) examine from behind
16) lymph nodes examined in an order