Podcast
Questions and Answers
What is the normal characteristic of the skull shape?
Which technique is primarily used for assessing the eyes and vision?
What is a deviation from normal regarding facial features?
Which abnormality indicates a possible issue with the skull?
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Which assessment technique involves checking the ears and hearing?
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What is a typical characteristic of myxedema facies?
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Which assessment is NOT included when evaluating the eyes?
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What does PERRLA stand for in eye assessment?
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Which condition can cause periorbital edema?
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Which feature indicates coordination in extra ocular muscle tests?
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What does the presence of xanthelasma indicate?
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What is the result of a glaucoma test regarding visual fields?
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What is assessed to determine the transparency and depth of the anterior chamber?
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What is the primary technique used to assess neck lymph nodes?
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Which neck muscle is involved in moving the chin to the chest?
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What should be observed when palpating the thyroid gland?
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Where is Virchow's node located?
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During a thyroid inspection, what indicates that the thyroid may be enlarged?
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What is indicated by large, rubbery lymph nodes?
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Which observation is crucial when assessing the trachea during neck examination?
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What symptom could indicate thyrotoxicosis during a thyroid assessment?
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What condition describes the involuntary rapid movements of the eyes?
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Which condition is associated with the loss of the lens's elasticity, affecting close vision?
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What is the primary feature of astigmatism?
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What does central cyanosis indicate?
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Which condition is characterized by the inflammation of the lacrimal sac?
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What is a common symptom of hordeolum?
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What does an increased intraocular pressure indicate?
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What condition is indicated by a sweet-smelling breath?
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Study Notes
Nose Assessment
- Look into each nostril using an otoscope or speculum
- Note the color, septum (medial), and turbinates (lateral)
Neck Muscles
- Inspect the neck muscles
- Observe head movements
- Move chin to the chest (sternocleidomastoid)
- Move the head so that the ear is moved toward the shoulder on each side (sternocleidomastoid)
- Turn the head to the right and to the left (sternocleidomastoid)
- Move head back so that the chin points upward (Trapezius)
- Assess the muscle strength
Thyroid
- Inspect and ask the patient to swallow while holding a glass of water
- Observe if there is a lump and if it moves upward on swallowing
- Palpate the thyroid bimanually
- Assess if the thyroid is of normal size, shape, and texture
- Normal thyroid is soft
- Assess if the thyroid is of normal size, shape, and texture
- If a goiter (swelling of the thyroid) is present, assess if the swelling is:
- Localized, e.g., thyroid cyst, adenoma, or carcinoma
- Generalized, e.g., autoimmune thyroiditis, thyrotoxicosis
- Multi-nodular
- A swelling does not mean the gland is under- or overactive
- The patient may be euthyroid
- The thyroid becomes slightly enlarged in pregnancy
- If there is a possibility of the patient being thyrotoxic, look for:
- Warm hands
- Perspiration
- Tremor
Lymph Nodes
- Palpate the entire lymph node for enlargement
-
Palpation Locations:
- In the neck:
- Above clavicle (posterior triangle)
- Medial to sternomastoid area (anterior triangle)
- Submandibular (can palpate the submandibular gland)
- Occipital: best felt by sitting the patient up and examining from behind
- A left supraclavicular node can occur from the spread of a gastrointestinal malignancy (Virchow’s node).
- In the axilla:
- Abduct arm, insert your hand along the lateral side of the axilla, and adduct arm, thus placing your fingertips in the apex of the axilla. Palpate gently
- In the epitrochlear region: medial to and above elbow
- In the groins: over the inguinal ligament
- In the neck:
Generalized Large, Rubbery Nodes
- Suggest:
- Lymphoma
- Sarcoidosis
Localized Hard Nodes
- Suggest:
- Carcinoma
Head
-
Parts:
- Skull & Face
- Eyes & Vision
- Ears and Hearing
- Nose and Sinuses
- Mouth and Oropharynx
-
Techniques:
- Inspection
- Palpation
- Percussion
- Auscultation
Skull and Face
-
Characteristics:
- Size, shape, and symmetry
- Nodules, masses, and depressions
- Facial features
- Symmetry of facial movements
- Eyes for edema
-
Normal:
- Rounded (normocephalic)
- Symmetrical
- Smooth skull contour. Smooth uniform consistency
- Absence of nodules or masses
- Symmetrical or slightly asymmetrical facial features—symmetric nasolabial folds
- Symmetrical facial movements
- No edema
-
Deviation from normal:
- Lack of symmetry
- Increased skull size
- Sebaceous cysts
- Local deformities from trauma
- Masses and nodules
- Increased facial hair
- Thinning of eyebrows
- Asymmetric features; asymmetric nasolabial folds. Exophthalmos, myxedema facies, moon face
- Periorbital edema
- Sunken eyes
- Asymmetric facial movements, Drooping of eyelid, Involuntary facial movements
Eyes & Vision
-
Assessment of eye includes:
- External eye structures
- Visual fields
- Extra ocular muscle tests
- Visual acuity
Eye Brows
-
Characteristics:
- Hair distribution and alignment
- Symmetry
- Skin quality
- Movement
Eye Lashes
-
Characteristics:
- Evenness of distribution
- Direction of curl
Eye Lids
-
Characteristics
- Position in relation to the cornea
- Ability to blink and frequency of blinking
- Lesions/edema/stye/signs of infection
- Xanthelasma: white/yellow deposit
- Puffy eyelids: general edema, e.g., nephrotic syndrome
Conjunctiva
-
Characteristics
- Color
- Texture
- Presence of lesions
Lacrimal Gland
-
Characteristics
- Edema
- Tenderness and Evidence of tearing
Cornea
-
Characteristics:
- Clarity and texture
- Perform corneal sensitivity test
Anterior Chamber
-
Characteristics:
- Transparency
- Depth
- Sclera, icterus: jaundice
Pupils
-
Characteristics:
- Color/shape/symmetry of size
- PERRLA (pupils are round and react to light and accommodation)
Visual Fields
-
Normal:
- When looking straight ahead, the client can see objects in the periphery
-
Deviation from normal:
- Visual field smaller than the normal (possible glaucoma)
- Half vision in one or both eyes (possible nerve damage)
Extra Ocular Muscle Tests
-
Normal:
- Both eyes coordinated, move in unison, with parallel alignment
-
Deviation from normal:
- Eye movements not coordinated or parallel
- Strabismus (cross eye): abnormal alignment of the eyes; the condition of having a squint
- Nystagmus: rapid involuntary movements of the eyes
Visual Acuity
-
Snellen’s chart:
- Used to test visual acuity
Refractive Errors
-
Myopia:
- Nearsightedness
-
Hyperopia:
- Farsightedness
-
Presbyopia:
- Loss of elasticity of the lens and thus loss of ability to see close objects
-
Astigmatism:
- An uneven curvature of the cornea that prevents horizontal and vertical rays from focusing on the retina
Inflammation
-
Conjunctivitis:
- Inflammation of the bulbar and palpebral conjunctiva
-
Dacryocystitis:
- Inflammation of the Lacrimal sac
-
Hordeolum (sty):
- Redness, swelling, and tenderness of the hair follicle and gland that empty at the edge of the eyelids
-
Iritis:
- Inflammation of the iris
Contusions or Hematomas
- “Black eyes” resulting from injury
Cataracts
- Opacity of lens and its capsule
Glaucoma
- A disturbance in the circulation of aqueous humor, which causes an increase in intraocular pressure
Mouth
-
Tongue
- Look at the tongue: cyanosed, moist or dry
- Cyanosis is a reduction in the oxygenation of the blood, with more than 5 g/dl deoxygenated hemoglobin.
- Central cyanosis (blue tongue) denotes a right-to-left shunt (unsaturated blood appearing in systemic circulation):
- Congenital heart disease, e.g., Fallot’s tetralogy
- Lung disease, e.g., obstructive airways disease.
- Peripheral cyanosis (blue fingers, pink tongue) denotes inadequate peripheral circulation.
- A dry tongue:
- Salt and water deficiency (often called ‘dehydration’)
- Also occurs with mouth-breathing.
- Look at the tongue: cyanosed, moist or dry
-
Teeth:
- Look at the teeth: caries, and poor dental hygiene
-
Gums:
- Look at the gums: bleeding, swollen
-
Throat:
- Look at the throat: swelling, redness, ulceration of tonsils or pharynx
-
Smell:
- Smell the patient’s breath:
- Ketosis is a sweet-smelling breath occurring with starvation or severe diabetes.
- Hepatic fetor: is a musty smell in liver failure.
- Smell the patient’s breath:
Nose Assessment
-
External Structure:
- Observe external structure for symmetry
-
Air Movement:
- Check air movement through the nostril separately.
-
Smell (CN 1 – Olfactory):
- Not usually assessed but use coffee grounds or other distinctive odor to test.
- The person should be able to detect the odor when presented at 10cm.
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Description
This quiz covers essential techniques for head and neck assessments, including nostril inspection, neck muscle evaluation, and thyroid examination. Participants will gain essential knowledge about the anatomical structures and their clinical relevance. Perfect for medical students and healthcare professionals.
