Head and Neck Examination Flashcards
(28 cards)
Common presentations in Head and Neck disorders
Headache
Visual disturbances
History of fall / head injury
Dizziness
Neck pain, limiting the motion
History of neck surgeries
Suspected ear, nose, mouth and throat or thyroid
dysfunctions
Halitosis, dental decays, ulcers or lesions in the mouth
Difficulty swallowing
General Head Examination - Inspection
Frontal view
* Size and shape of the head
* Symmetry of the bony structures
* Symmetry of the muscular structure
* Skin condition and colour
* General appearance and facial expression of the person
Side view
* Shape of head and cervical region
* Shape of anterior neck particular to the thyroid
* Any swellings or deformities in the head and neck
General Head Examination - Palpation
General Palpation of the scalp, temporomandibular joint and mastoid processes (note any pain, tender spots, lumps, bumps, rigidity)
General Palpation of the sinuses
- Frontal sinus
- Maxillary sinus
- Ethmoid sinus
Peripheral pulses in head and neck
- Carotid pulse
- Temporal pulse
Location of Frontal, Maxillary and Ethmoid sinus
Frontal - above and medial to the eyes
Maxillary - below the cheeks, along sideway of nose
Ethmoid - between eyes
Examination - Lips
Symmetry
- facial muscles and nerves
Colour
- pale, inflammation, cyanotic
Moisture
- dryness or exudates
Cracks or Lesions
- trauma, infection, nutritional deficiencies
Examination - Teeth
Alignment
-Malocclusion or TMJ disorder
Discolouration
-Smoking, drug use, fluorosis, tartar
Cracks or cavities
-Grinding, tooth decay
Examination - Gums
Inflammation
- Gingivitis, infection, smoking, alcohol
Atrophy,
hyperplasia
- Chronicity of inflammation
Easy bleeding
- Gingivitis, anticoagulant therapy
Examination - Tongue
Colour & size
- Redness, pale, nutritional deficiencies, hypothyroidism
Dehydration, burns
Surface condition
- Infection, gastric reflux, candida
Coating
- Infection, gastric reflux, candida, Dehydration, effects of medication
Moisture
- Dehydration, effects of medication
Examination - Buccal
Colour
- Anaemia, jaundice, inflammation
Lesions
- Trauma, biting, ill-fitting dentures
Examination - Oropharynx
Pillars, tonsils, uvula
& posterior
oropharynx for
redness, pus, or
enlargement
- Redness, inflammation, exudate
suggests acute infection.
No or little inflammation with
enlargement of tonsil crypts suggests
chronic history of infection
Tonsil enlargement grading scale
1+ Visible
2+ Halfway to uvula
3+ Touching uvula
4+ (L) touches (R) tonsil
Examination - Ears
Always begin with thorough examination and palpation of external ear
- Pinna size, symmetry, swelling, piercings, lesions, colour change
- External auditory canal for inflammation, discharge
- Palpate lobule, helix and tragus for any pain or tenderness
- Palpate mastoid process and surrounding lymph nodes
Otoscope examination of Ears
- Lift pinna up and back for adults and older children
- Pull lobe down gently for infants and younger children
- Observe walls for any lesions, foreign bodies or discharge
- Observe tympanic membrane, manubrium, umbo and cone of light
Healthy Tympanic membrane
- shiny, translucent, pearly grey
- cone of light anteroinferior
quadrant (5 o’clock in right ear, 7 o’clock in left ear) - umbro, manubrium and short process visible
- annulus white and dense
Hearing Loss
Sensorineural - signifies pathology of the inner ear, cranial
nerve VIII, or the auditory areas of the cerebral cortex.
Conductive - involves a mechanical dysfunction of the external or
middle ear. may be caused by impacted cerumen,
foreign bodies, a perforated tympanic membrane, pus or serum in the middle ear,
and otosclerosis
Mixed
Acute Otitis Media
Early stage
-Absent light reflex
-Redness and bulging in superior part of drum first
-Earache and fever
Later
-Fiery red bulging of entire drum with deep throbbing pain, fever, transient hearing loss
Otitis Media with Effusion
Amber yellow eardrum
Air/fluid level with fine black line or air bubbles visible behind drum
aka serous otitis media or glue ear
Retracted eardrum
Landmarks look more prominent and well defined
handle of malleus looks shorter and more horizontal
Short process very prominent
Light reflex absent or distorted
Drum looks dull and lustreless
Perforated Eardrum
appears as a round or oval darkened area of the drum
may occur from trauma (slap to the ear) or untreated acute otitis media
Examination - Thyroid
Inspection with pen torch from front and side
Client drink water or swallow to inspect gland moving upward during
Posterior approach to palpate
- place fingers on either side of trachea, displace gland, feel lobes on each side
Note temperature, consistency, any nodules
Enlarged thyroid
Occurs in both over and under active thyroid
Can be nodular or diffused
Multinodular usually indicates inflammation
Singular nodule could indicate cancer
Bruit - soft, pulsatile, whooshing, blowing sound heard over lobes of enlarged thyroid gland; could indicate thyroid hyperplasia or over active thyroid
Simple Diffused Goitre (SDG)
endemic goitre
chronic enlargement
common in mountainous regions where soil is low in iodine
Multinodular Goitre (MND)
Multiple nodules, indicating
inflammation
Cause is
unknown
one of the most
common presentations.
Graves Disease (Hyperthyroidism)
Enlarged
thyroid, eyelid retraction and
exophthalmos
Autoimmune disease
Increased production of thyroid hormones
