Chapter 6: Head and Neck

Common or Concerning Symptoms HeadHeadache, history of head injury EyesVisual disturbances, spots (scotomas), flashing lights, use of corrective lenses, pain, redness, excessive tearing, double vision (diplopia) EarsHearing loss, ringing (tinnitus), pain, discharge NoseDrainage (rhinorrhea), congestion, sneezing, nose bleeds (epistaxis) OropharynxSoreness, gum bleeding, hoarseness, Neck Thyroid Lumps, pain, stiffness Temperature intolerance, excessive sweating

Head – Inspection and Palpation Inspect –Hair distribution, quantity –Scalp – scaling, nevi –Skull – size, contour –Face – expression, contours –Skin – color, pigmentation, hair distribution, lesions Palpate –Hair texture –Skull – lumps –Face – sinuses –Skin – texture, temperature

Eyes - Inspection Position and alignment of eyes Eyebrows –Quantity, distribution Eyelids –Width of palpebral fissures –Edema, color, lesions –Condition and direction of eyelashes Lacrimal apparatus Conjunctiva and sclerae –color, vascular pattern Cornea and lens –opacities Iris Pupils – size, shape, symmetry

Eyes – Tests of Function Visual acuity –Snellen eye chart or near vision card Visual fields Extraocular movements –Six cardinal directions of gaze Tests cranial nerves III, IV, VI Pupils - direct and consensual reaction to light Ophthalmoscope

Tips for Using the Ophthalmoscope Darken the room and have the patient look off in the distance Switch the ophthalmoscope light and turn the lens disc to the large round beam of white light Turn lens disc to the 0 diopter Hold the ophthalmoscope in your right hand to examine the patient’s right eye and in your left hand to examine the patient’s left eye Stand directly in front of the patient, 15 inches away and start at an angle of 15 degrees lateral to the patient’s line of vision Shine the beam of light onto the pupil and look for an orange glow – this is the red reflex Follow the red reflex and move inward towards the nasal aspect of the visual field

Ears – Inspection, Palpation, and Tests of Hearing Inspection –Auricle for lesions –Ear canal for lesions –Tympanic membrane for landmarks, fluid Palpation –Auricle for lumps Auditory Acuity –Whisper test Air and Bone Conduction –Weber Lateralization of sound; if present, then suspect conduction loss –Rinne Compare time of air vs. bone conduction If bone conduction is equal or greater than air conduction, then suspect conduction loss If air conduction is more than twice as long as bone conduction, then suspect sensorineural loss

Stop Here to Review Video Clip “Use of the Otoscope”

Nose & Sinuses - Inspection & Palpation Inspection –Anterior and inferior surface – asymmetry or deformity –Inside of nose Mucosa – color, swelling, bleeding, or exudate, ulcers, or polyps Septum – deviation, inflammation, or perforation Palpation –Sinuses – frontal and maxillary

Mouth and Pharynx - Inspection Lips –Note color, moisture, lumps, ulcers, cracking, or scaliness Oral mucosa –Note color, ulcers, nodules Gums and teeth –Note color, presence and position of teeth Roof of mouth –Note color Tongue and floor of mouth –Note color and texture, ulcers, nodules Pharynx – soft palate, anterior and posterior pillars, uvula, tonsils, pharynx –Note color, symmetry, presence of exudate, swelling,ulceration or tonsillar enlargement

Neck – Inspection and Palpation Inspection –symmetry, masses, scars, enlarged glands or lymph nodes –Trachea – position, alignment –Thyroid gland - symmetry Palpation –Lymph Nodes (size, shape, delimitation, mobility, consistency, tenderness) Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical chain, supraclavicular –Thyroid gland: consistency, masses, tenderness

Stop Here to Review Video Clips “Examination of the Lymph Nodes of the Head and Neck” and “Anterior Approach to Examination of the Thyroid Gland”