M10.05.04 Examination Techniques

Examination techniques for the head and neck are crucial components of a comprehensive clinical assessment. This section provides a detailed overview of the methodologies, essential steps, and clinical significance of examining the head and neck. It also includes a list of related abnormal conditions and key points to remember for medical students.

Inspection and Palpation

1. Inspection

• General Appearance: Observe the symmetry, shape, and alignment of the head and neck.
• Skin and Scalp: Look for lesions, rashes, discoloration, or abnormal hair distribution.
• Facial Features: Assess for asymmetry, involuntary movements, or abnormalities in facial structure.
• Eyes, Ears, Nose, and Throat (EENT): Inspect for signs of inflammation, discharge, or structural abnormalities.

2. Palpation

• Scalp: Palpate for tenderness, masses, or lesions.
• Lymph Nodes: Systematically palpate the preauricular, posterior auricular, occipital, submandibular, submental, superficial cervical, deep cervical, posterior cervical, and supraclavicular nodes for enlargement or tenderness.
• Thyroid Gland: Palpate for size, shape, consistency, and nodules.
• Salivary Glands: Palpate the parotid and submandibular glands for enlargement or tenderness.

Cranial Nerve Assessment

1. Cranial Nerve I (Olfactory Nerve)

• Test: Assess the sense of smell by having the patient identify familiar odors.

2. Cranial Nerve II (Optic Nerve)

• Test: Perform visual acuity tests, visual field tests, and inspect the optic fundus using an ophthalmoscope.

3. Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, and Abducens Nerves)

• Test: Assess extraocular movements and check for ptosis and pupillary reactions.

4. Cranial Nerve V (Trigeminal Nerve)

• Test: Assess facial sensation, corneal reflex, and the strength of the masseter and temporalis muscles.

5. Cranial Nerve VII (Facial Nerve)

• Test: Evaluate facial symmetry, muscle strength, and taste on the anterior two-thirds of the tongue.

6. Cranial Nerve VIII (Vestibulocochlear Nerve)

• Test: Perform hearing tests, such as the Rinne and Weber tests, and assess balance.

7. Cranial Nerves IX and X (Glossopharyngeal and Vagus Nerves)

• Test: Evaluate the gag reflex, palate elevation, and vocal cord function.

8. Cranial Nerve XI (Accessory Nerve)

• Test: Assess the strength of the sternocleidomastoid and trapezius muscles.

9. Cranial Nerve XII (Hypoglossal Nerve)

• Test: Observe tongue movements and check for atrophy or fasciculations.

Examination of the Eyes

1. Visual Acuity

• Test: Use a Snellen chart to assess distance vision and a near card for near vision.

2. External Structures

• Inspection: Check the eyelids, lashes, conjunctiva, and sclera for abnormalities.

3. Internal Structures

• Ophthalmoscopy: Examine the optic disc, retinal vessels, and macula.

Examination of the Ears

1. External Ear Inspection

• Observation: Look for deformities, discharge, or lesions.

2. Otoscopic Examination

• Technique: Inspect the ear canal and tympanic membrane for abnormalities.

3. Hearing Tests

• Tests: Perform the Rinne and Weber tests to assess hearing acuity.

Examination of the Nose

1. External Structures

• Inspection: Check for deformities, asymmetry, or lesions.

2. Internal Structures

• Technique: Use an otoscope or nasal speculum to inspect the nasal mucosa, septum, and turbinates.

3. Nasal Patency and Sinus Examination

• Test: Assess airflow through each nostril and palpate the sinuses for tenderness.

Examination of the Throat and Neck

1. Oral Cavity and Pharynx

• Inspection: Examine the lips, tongue, gums, teeth, and oropharynx for abnormalities.

2. Lymph Node Assessment

• Technique: Palpate for enlarged or tender lymph nodes.

3. Thyroid Examination

• Technique: Palpate the thyroid gland from behind the patient, checking for size, shape, and nodules.

Key Points to Remember

• Systematic Approach: Follow a systematic sequence to ensure thorough examination.
• Patient Comfort: Always prioritize patient comfort and explain each step of the examination.
• Documentation: Record findings accurately and concisely for future reference.
• Clinical Correlation: Correlate physical findings with patient history for a comprehensive assessment.

Related Abnormal Conditions

• Lymphadenopathy: Enlargement of lymph nodes.
• Goiter: Enlargement of the thyroid gland.
• Cranial Nerve Palsies: Dysfunction of one or more cranial nerves.
• Otitis Media: Inflammation of the middle ear.
• Sinusitis: Inflammation of the sinuses.
• Tonsillitis: Inflammation of the tonsils.
• Glaucoma: Increased intraocular pressure affecting the optic nerve.
• Bell’s Palsy: Acute peripheral facial nerve palsy.

Bibliography

1. Bates, B., & Dains, J. E. (2018). Bates’ Guide to Physical Examination and History Taking. Wolters Kluwer.
2. Macleod, J., & Mathew, R. (2015). Clinical Examination: A Systematic Guide to Physical Diagnosis. Elsevier Health Sciences.
3. Swartz, M. H. (2019). Textbook of Physical Diagnosis: History and Examination. Elsevier.
4. Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2018). Seidel’s Guide to Physical Examination. Elsevier.