Head and Neck



Head and Neck



Equipment



• Tape measure


• Cup of water


• Stethoscope


• Transilluminator




EXAMINATION
Ask patient to sit.











































































































Technique Findings
Head and Face
Observe head position
  EXPECTED: Upright, midline, still.
UNEXPECTED: Tilted, horizontal jerking or bobbing, tics, nodding.
Inspect facial features

 EXPECTED: Variations according to race, sex, age, body build.
UNEXPECTED: Change in shape. Unusual features: edema, puffiness, coarsened features, prominent eyes, hirsutism, lack of expression, excessive perspiration, pallor, or pigmentation variations.

 EXPECTED: Slight asymmetry.
UNEXPECTED: Facial nerve weakness or paralysis, or problem with peripheral trigeminal nerve.
Inspect skull and scalp

 EXPECTED: Symmetric.
UNEXPECTED: Lesions, scabs, tenderness, parasites, nits, scaliness.
EXPECTED: Bitemporal recession or balding over crown in men.
UNEXPECTED: Random areas of alopecia or alopecia totalis.
Palpate head and scalp

 EXPECTED: Symmetric and smooth with bones indistinguishable. Ridge of sagittal fissure occasionally palpable.
UNEXPECTED: Indentations or depressions.
Palpate hair

 EXPECTED: Smooth, symmetrically distributed.
UNEXPECTED: Splitting or cracked ends. Coarse, dry, or brittle. Fine and silky.
Palpate temporal arteries
Note course of arteries. UNEXPECTED: Thickening, hardness, or tenderness.
Auscultate temporal arteries and over skull and eyes
image EXPECTED: No bruits.
Inspect salivary glands

 UNEXPECTED: Asymmetry or enlargement. Tenderness. Discrete nodule.
Neck
Inspect neck

 EXPECTED: Bilateral symmetry of sternocleidomastoid and trapezius muscles.
UNEXPECTED: Asymmetry, torticollis webbing, excessive posterior skinfolds, unusually short
  neck, distention of jugular vein; prominence of carotid arteries, or edema.

 EXPECTED: Midline placement.
UNEXPECTED: Masses.
Evaluate range of motion
Have patient flex, extend, rotate, laterally turn head and neck. EXPECTED: Smooth.
UNEXPECTED: Pain, dizziness, or limitation of motion.
Palpate neck

 EXPECTED: Midline position.
UNEXPECTED: Deviation to right or left.

 EXPECTED: Smooth. Moves during swallowing.
UNEXPECTED: Tender.

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