So we're going to do the first part of head, ears, eyes, nose, and throat, which is the head and neck. So the first thing you're going to want to do when you're assessing a patient is inspect. So the first thing I'm going to do is look at her head. Now I'm looking for any deformities, lumps, or lesions.
I'm looking at a hair pattern here and I'm looking at the size of her skull. So to have a normosophallic skull would be our normal finding. If she had macro or micro, that would mean there's a smaller skull or a larger skull. my assistant has a lovely skull and it is enormous about I don't see any lumps lesions or deformities it's very round I'm also coming down to her face next to check for symmetry I'm going to note any asymmetry along the face along the jaw line and also what her facial expression says so we're going to look for any anxiety and fear any aggression maybe with this by some grinding of the teeth and the tightness in the jaw, but she seems very relaxed, pretty good mood.
So we're going to determine for any asymmetry along the face. So any drooping of the eye, of the cheek, of the mouth that could be representative of a brain lesion from either stroke or false palsy. I don't see any asymmetry in the face at all. Her nose is midline, her mouth is midline, her eyes are the same size, and her brow line is symmetrical across her forehead.
Very nice. I'm also going to come down and inspect the neck finally. I'm looking for the symmetry of the trachea. You want to make sure that your trachea is midline and it's not deviated to one side.
The main deviation could mean things like the pneumothorax, chloral effusion. Okay, trachea is very midline. She doesn't seem to have any problems breathing, so we're good for that.
Next I'm going to palpate. So I'm palpating the skull again trying to feel any deformity. that I might not have seen. Looking for any pattern hair loss.
Very thick hair. Next I'm going to palpate on the chin and cheeks. I don't feel any bumps or messes. I'm just going to look at the symmetry of the ears. And finally I'm going to come and assess her lymph nodes.
I'll do these turned towards me. We're going to palpate every lymph node. And your lymph nodes should be soft and then tender if you feel the middle.
They should be able to move under your finger. You should not feel any firmness, any swelling, and the patient should have no pain when you're calculating this. Any of these symptoms could mean things like lymphedema, HIV, infection. So we're going to start with the pre-auricular.
post-auricular, occipital, which is back by the base of the skull, the parotid, which is over the parotid gland, the submandibular, which is under the mandible bone, and submental under the chin. Then we have the superficial cervical chain, the deep cervical chain, the posterior cervical chain, and the supraclitoral. the clavicular, and the tonsillar.
So all of these lymph nodes are named for where they're located on the body. So for example, preauricular is in front of the ear, posterior in the back, occipital along your occipital bone, superficial cervical chain on the light part of the neck, deep, you're just going a little bit deeper for palpation, posterior cervical chain along the back of the neck, supraclavicular, which is above the clavicle. submandibular under the mandible and submental under the chin.
And like I said before, your parotid, which is your parotid gland. Okay, so her lymph nodes feel fine. Do they have any pain? No. So no tenderness noted.
I don't have any swelling. They all feel movable. I don't feel many of them, which is a good sign. Go ahead and swing back around for me.
The last thing on her palpate is her thyroid gland. So someone said... thyroid gland should not really be palpable.
If you do feel it, it's going to feel like a little butterfly wing on your fingers. So I'm going to do it from a posterior approach. I'm going to have the patient tilt her head back just slightly. I'm going to come from behind and gently place my fingers on her neck.
You go ahead and swallow for me. And I don't feel anything. If you did feel something, you could have hyperthyroidism. It would usually feel like a giant donut, okay? You might even be able to see it on someone's neck if they had an inflamed or enlarged thyroid gland.
She does not, and it feels perfectly fine. I could also do this from anterior. Thank you.
So with the same approach. So she's going to again raise her chin just slightly, and I'm going to now watch for it. Go ahead and swallow. Again, I see nothing on my fingers, I don't even feel anything. It's just a perfect thyroid gland.
The last thing I'm going to do is auscultate. Again, this is just for head, face, and neck. So I'm going to be listening now for a bruit, which is turbulent blood flow. So I'm actually going to listen on her thyroid for any whooshing sound.
So this is near carotid, so you're thinking you're listening to the carotid artery. And in fact you are, you're actually listening for it over the heart. over the thyroid.
So your thyroid is enlarged, it's going to cause that turbulent blood flow. And I hear nothing. So it's perfect.
And that is the head, face and neck. That's it.