1. Head & Neck  History Headache Head injury Dizziness Neck pain Lumps or swelling Head or neck surgery

2. The Head  Position Midline without movements  Size and shape  Palpate temporal artery  Palpate TMJ  Inspect the face Expression, symmetric

3. The Neck  Inspect & palpate for symmetry  Observe for proper ROM  Palpate 10 groups of lymph nodes  Trachea – straight, have swallow  Thyroid gland Posterior & anterior approach Fingers vs thumbs

4. Lymph Nodes Palpate lymph nodes with tips of fingers in a circular motion Lymph nodes of Head & Neck Palpate Submandibular & cervical nodes with chin down

5. Characteristics for Swollen Lymph Nodes  Location – name  Size  Consistency – firm/soft  Symmetrical  Fixed or Mobil  Tenderness  Redness  Heat  Increased Vascularity  Surface area over lymph node

6. Shotty Nodes  Common in children, indicative of a past infection. May see swelling for 2-3 months. < 1cm in size Mobil Nontender Without redness Without heat Firm

7. Lymph Nodes Indicative of Present Infection  > 1cm in size  Soft  Tender  Warm  Red

8. Common Neck Abnormalities  Lymphadenopathy Associated with throat infection, ulcers  Nontender Cervical Lymphadenopathy Consider Hodgkins Disease  Supraclavicular Lymphadenopathy Consider TB

9.  Left Supraclavicular Lymphadenopathy (Biroches) Consider Metastatic CA, Primary site: abdomen, esophagus or lungs  Small Diffuse Goiter Seen with early menstruation, pregnancy, hyper, hypothyroidism. Usually < 40 years of age

10.  Large Diffuse Goiter Seen with hyper, hypothyroidism A unilateral enlarged thyroid associated with malignancy Multiple thyroid nodules associated with CA – Thyroid adenoma