1. Head, Neck, and Regional Lymph Nodes
Chapter 11
Head, Neck, and Regional Lymph Nodes

2. Competencies Identify the anatomic structures of the head and neck.
Identify the lymph nodes of the head and neck.
Describe the system-specific health history for the head and neck.
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3. Competencies
Demonstrate the physical examination of the head and neck.
Describe normal findings in the physical examination of the head and neck.
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4. Competencies
List common abnormalities found in physical examination of the head and neck.
Explain the pathophysiology of common abnormalities found in physical examination of the head and neck.

5. Anatomy and Physiology
Skull
Face
Neck
Thyroid
Lymph nodes
Blood supply

6. Health History
Determine presence or absence of age- and gender-specific diseases of the head and neck
Young adult
Older adult
Female
Male
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7. Health History Common chief complaints Stiff neck Neck mass Headache
Head injury

8. Evaluating Chief Complaint
Determine characteristics
Quality
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing

9. Past Health History Medical history Surgical history Medications
Communicable diseases
Injuries and accidents
Special needs

10. Family Health History Determine whether there is family history of
thyroid disease
headache

11. Social History
Alcohol use
Work environment
Home environment
Stress

12. Health Maintenance Activities
Sleep
Diet
Use of safety devices

13. General Approach to Head and Neck Examination
Greet patient, explain the examination
Environment
Warm
Private
Adequate lighting
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14. General Approach to Head and Neck Examination
Upright sitting position
Compare right and left sides
Systematic approach

15. Examination of the Head
Inspection
Shape
Symmetry
Normal findings
Normocephalic
Symmetrical
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16. Examination of the Head
Palpation
Contour
Masses
Depression
Tenderness
Normal findings
Skull is smooth, nontender, and without masses or depressions

17. Inspection and Palpation of the Scalp
Lesions or masses
Normal findings
Scalp is shiny, intact, without lesions or masses
Abnormal findings
Bleeding, lesions, masses, hematomas

18. Examination of the Face
Inspection
Symmetry
Shape and features
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19. Examination of the Face
Normal findings
Symmetrical features
Palpebral fissures equal
Nasolabial folds present bilaterally
Shape can be oval, round, or slightly square
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20. Examination of the Face
Abnormal findings
Deformed or absent structures
Asymmetry
More or less pronounced facial features
Diseases that may alter facial features: Bell’s palsy, Down syndrome, Graves’ disease, myxedema, cachexia, Cushing’s syndrome

21. Mandible
Palpate and auscultate the temporo-mandibular joint as patient opens and closes the mouth
Normal findings
No discomfort; joint articulates smoothly without clicking or crepitus
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22. Mandible Abnormal findings
Pain, tenderness, crepitus, clicking, or snapping sound

23. Neck Inspection Palpation Normal findings Abnormal findings
Full ROM, pain-free, symmetrical
Abnormal findings
Limited ROM, pain, asymmetrical muscles, masses

24. Thyroid Gland Inspection Palpation Auscultation
Auscultation if enlarged
Repeat on other lobe
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25. Thyroid Gland Normal findings Symmetrical movement with swallowing
Adam’s apple more pronounced in males
No masses, tenderness, or enlargement
No bruits
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26. Thyroid Gland Abnormal findings Mass Enlarged gland Goiter
Presence of a nodule or bruits

27. Lymph Nodes
Inspection
Palpation
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28. Lymph Nodes Location Preauricular Postauricular Occipital Submental
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29. Lymph Nodes Location (cont’d) Submandibular Tonsillar
Anterior and posterior cervical chains
Supraclavicular
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30. Lymph Nodes Normal findings Abnormal findings
Unable to palpate or see nodes
Abnormal findings
Enlarged nodes
Able to palpate or see nodes
Tenderness
Hard, tender nodes