Head and Neck
EXAMINATIONAsk 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 | |
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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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