Question

Discuss the components and purposes of a head and neck assessment and include normal physical findings in an infant/child and an adult.

Answer 1

Examination of head and neck is a fudamental part of the standered physical examination

examination of head -for checking meningism

inspect skull and face

inspect skin and scalp

palpate skull

face -for assessing cranial nerve palsies and ischemic stroke

assess facial sensation and motor function - trigeminal nerve function-lightly touch the forehead of the patient on both sides and upper and lower areas of cheeks with index finger ask the patient whether this feels same on both sides of the face

facial nerve function- assessment-ask the patient to furrow their forehead ,close the eyes ,show their teeth ,and inflate their cheese

EXAMINATION OF EARS-for assessing hearing loss and ear infection

inspect external ear and note any skin abnormalities or discharge

encourage the patient to take otoscopy if their is any abnormalities

weber test can be performed if sound is heared louder in one ear than the other[test for lateralization]

Rinne test for assessing air conduction vs bone conduction   in the examined ear

FOCUSED EXAMINATION OF EYE for assessing graves disease,cranial nerve palsies ,hyperlipidema,vision and jaundice

INSPECTION AND PALPATION-inspect for symmetry of the eyes and eyelid,inspect colour,vascular pattern,and whether there is any swelling

pupil size -generally between 3-5 mm

check visual activity by snellen chart-the patient from a predetermined distance from a snellen chart ,covers one eye and reads rows of letters out loud.Each row corresponds to a specific level of visual acuity

CHECK FOR EXTRA OCULAR MOVEMENTS-ask the patient to follow the tip of pen with their eyes-this part of examination assess the cranial nerve involved in ocular motility

prepare the patient for fundoscopic examination if their is suspected intracranial hypertension or stroke

EXAMINATION OF NECK-for assessing volume overload,heart failure,goiter,throid cancer

inspection and palpation

inpsect for any obvious deformities ,asymmetry,massess,tracheal deviation

palpation of lymph nodes of the head and neck

palpation of parotid gland

assessment of range of motion of the cervical spine-ask the patient to tilt their chin so that it is resting against their chest or to flex their neck

evaluate for jugular vein distention

EXAMINTION OF THYROID  

INSPECTION-the thyroid gland is located below the thyroid cartilage and is normally not visible

ask the patient to swallow

-the thyroid should slide beneath the fingers

-the normal thyroid is not palpable

not any asymmetry or enlargement

NOSE to assess breathing pattern

examin the external nose -patient ability  to breath by covering one at a time

examine inner nose by otoscope

THROAT check for enlarged lymph nodes ,tonsilitis and mouth infections

INSPECT TONSILS,soft palate ,posterial pharynex and tongue,mouth

infants normal findings

head circumference 14in [35 cm]

sutures -mobile,face-symmetrical,ears -normal,nose -patent, mouth-normal, tongue-normal,,ears and palate-normal,tongue-normal,chin-normal,

the soft spots between the  bones of the skull frontanels -normal in size and shape

-heaing- check for hearing loss

adult normal findings

head -rounded ,symmetrical ,smooh skull contour

symmetry of facial movements-symmetric

eyes-no edema

eyes-normal visual fields

ears -normal hearing[weber -negative,positive-Rinne]

mouth-normal

neck- no lymph nodes,normal muscle strength