Lecture Notes: Head and Neck Examination

Introduction

• Presenter: Rachel, student at Nova Southeastern University
• Focus: Demonstration of a head and neck examination

General Survey

• Inspect patient for distress, mood, cyanosis, discomfort
• Ensure patient is prepared: remove obstacles (glasses, hats)

Head Examination

Inspection

• Symmetry, shape, contour, deformities
• Hair: distribution, texture, even growth
• Scalp: inspect for infestations, scaling, lesions

Palpation

• Cranium for tenderness and masses
• Temporal artery: check for tenderness
• Sinuses: palpate maxillary and frontal sinuses
• Parotid glands: inspect and palpate for enlargement, nodules

Temporomandibular Joint (TMJ)

• Palpate TMJ, check for crepitus and tenderness
• Assess jaw movement: open, close, side to side, protrusion

Cranial Nerve Assessment

Cranial Nerve V: Trigeminal

• Muscles of mastication: palpate during clenching

Cranial Nerve VII: Facial

• Facial movements: raise eyebrows, close eyes, show teeth, frown, puff cheeks

Eye Examination

Inspection

• General appearance, eyebrows, eyelashes, lids
• Look for lesions, discolorations, edema, ptosis, exophthalmos

Visual Fields

• Use Rosenbaum chart for near vision
• Confrontation test for peripheral vision

Eye Movement

• Use pen light for tracking: check for rotary or vertical nystagmus
• Check convergence and accommodation

Anterior Chamber

• Inspect with pen light for depth, opacities, crescent shadows

Alignment and Reflexes

• Corneal light reflex for alignment
• Strabismus check with eye occlusion
• Pupil reaction to light and accommodation

Fundoscopic Exam

• Use of ophthalmoscope: adjust light, filters
• Examine optic disc, cup, arteries, veins, macula

Ear Examination

Inspection and Palpation

• Auricles: inspect and palpate for tenderness, lesions
• Tragus and mastoid: check for tenderness

Otoscopic Exam

• Inspect external canal and tympanic membrane

Auditory Acuity

• Whisper test or watch tick test for hearing
• Use tuning fork for Weber and Rinne tests

Nose Examination

Inspection

• Check for patency: occlude nostrils and breathe test
• Inspect septum and turbinates

Olfactory Nerve (Cranial Nerve I)

• Test each nostril for scent recognition

Oral Examination

Inspection

• Lips, buccal mucosa, palate, tongue, gingiva
• Check for lesions, ulcers, discoloration

Cranial Nerve IX and X

• Check uvula movement on phonation
• Test gag reflex (not demonstrated)

Cranial Nerve XII

• Tongue protrusion and symmetry

Palpation

• Palpate Stenson's and Wharton's ducts, floor of mouth

Neck Examination

Inspection and Palpation

• Inspect trachea for position and mobility
• Inspect skin for lesions, moles, scars

Lymph Nodes

• Palpate occipital, pre/post-auricular, tonsillar, submandibular, submental, cervical, supraclavicular nodes

Thyroid Examination

• Palpate from behind patient, check for nodules, swelling

Neck Range of Motion

• Flexion, extension, rotation, lateral bending

Cranial Nerve XI: Accessory

• Test shoulder shrug and sternocleidomastoid strength against resistance

These notes outline the procedures and key points from Rachel's demonstration of a comprehensive head and neck examination, which includes inspection, palpation, cranial nerve testing, and special tests for various structures.