Term
inspection techniques used in the examination of the head
Normal findings vs. abnormal findings? |
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Definition
Head:
Inspect: the head for size, shape, skin characteristics. Head should be normocephalic- symmetric and proportionate to the body, intact without lesions, redness, or flakes.
Facial structures (eyes, eyebrows, palpebral fissures, nasolabial folds, and sides of the mouth) should appear symmetric/proportional.
• Abnormal facial structures: coarse facial features, exopthalmus (eye bulging) changes in skin color or abnormal swellings. Other abnormal findings: tics in facial muscles.
Abnormal findings in the head:
Macrocephaly-abnormal large head
Microcephaly- abnormal small head |
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Term
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Definition
Palpate:
• Place fingers in pt’s hair and palpate scalp, the structures of the skull for contour, tenderness, and intactness.
• Skull should feel symmetric and smooth
• There should be no tenderness during palpation
• Cranial bones that have normal protrusions are forehead, lateral edge of parietal bones, occipital bone, and mastoid process behind each ear.
• Palpate temporal artery above zygomatic cheek bone, between eye and top of ear
• Palpate temporomandibular joint as pt opens and closes mouth |
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Term
| Inspection techniques used in the examination of the head |
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Definition
Inspect:
• head position is centered in midline, and accessory neck muscles should be symmetrical. Neck/head should be erect and still.
• Look for swelling below jaw, and thyroid gland
Check ROM- note any limitations of movement. Motion should be controlled and smooth |
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Term
Palpation sites of the neck
Palpation technique for assessment of the thyroid |
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Definition
Palpate:
Lymph Nodes: Using a gentle circular motion of finger pads
Trachea: palpate front back of pt’s neck with fingers, check for any tracheal shift.
Thyroid gland: check for enlargement, consistency when swallowing, symmetry, presence of nodules
Standing behind the patient, attempt to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch.
Move your hands laterally to try to feel under the sternocleidomstoids for the fullness of the thyroid.
Have the patient swallow as you palpate, feeling for the upward movement of the thyroid gland. |
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Term
Order of lymph node palpation:
Normal vs. abnormal findings |
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Definition
Order of palpation:
• preauricular
• postauricular
• occipital
• submantle
• submandibular
• submandibular
• juglodigastric
• superficial cervical
• deep cervical chain
• posterior cervical
• supraclavicular.
• Normal nodes should feel: moveable, discrete, can feel borders, soft, mobile, non tender
• Abnormal nodes: matted together, not mobile, not smooth, tender. If enlarged or tender, check area they drain: often relate to inflammation or new growth in the head and neck. If you can not find source of problem: deserves prompt attention |
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Term
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Definition
lymph nodes from the head drain down
lymph nodes from the chest drain up |
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Term
| Trachea abnormal findings |
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Definition
| any deviation/shift from the midline of the neck |
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Term
| Thyroid gland abnormal findings |
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Definition
| Abnormal: If enlarged, auscultate thyroid for presence of bruit (murmur). This is typically seen in hyperthyroidism/hyperplasia |
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Term
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Definition
•Eyebrows – mobility and symmetry
•Eyelids - symmetry and condition
•Eyelashes – evenly distributed
•Eyeballs – symmetry
•Conjunctiva – transparent and glossy revealing the color of the structure underneath
•Bulbar – clear membrane that reveals white sclera
•Palpebral – reveal pink lids
•Sclera – white, blood vessels
•Cornea & Lens – assess from the side with a penlight
•Iris - Flat, round in shape, evenly colored
•Pupil- assess pupil is 3-5 mm, round shape, both are equal |
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Term
| Eyelid abnormal findings: |
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Definition
Ptosis- the eyelid covers part of the pupil when eyes are open (drooping of eye lid)
Lid lag- lid and lashes retract back when eyes are open due to exophthalmos |
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Term
| Eyeball abnormal findings |
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Definition
Sunken = enophthalmos
Protruding = exophthalmos
Scleral icterus – yellowing of sclera indicating jaundice
Lacrimal Apparatus – inspect for redness, swelling
Excessive tearing may indicate clogged nasolacrimal duct |
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Term
| Abnormalities of the pupil: |
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Definition
Anisocoria = two different-sized pupils
Miosis- small pupils
Mydriasis- dilation of the pupil |
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Term
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Definition
| disorder in which eyes don’t look in the same direction at the same time |
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Term
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Definition
| Presbyopia- A gradual, age-related loss of the eyes' ability to focus actively on nearby objects. |
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Term
Inspection techniques of the ear
Abnormalities of ear: |
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Definition
Inspect: Size and shape of ears – equal bilaterally, no swelling
•Placement of ears- At or above eye level
•Skin condition-
•Check behind ears
•External auditory meatus- hole into ear canal- Note size, presence of discharge, redness
•Abnormal: Microtia < 4 cm vertically Macrotia > 10 cm vertically |
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Term
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Definition
• Tenderness – palpation of external ear should not produce pain
• Pinna, tragus, mastoid process
• External auditory meatus
• Note size, presence of discharge, redness
• Palpation of external ear should not produce pain |
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Term
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Definition
Otalgia: Ear ache, pain in ears
Myringotomy: Infection or chronic ear problems
Otorrhea: Discharge
Tinnitus: Ringing, buzzing
Vertigo: spinning sensation |
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Term
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Definition
Inspect: symmetry, proportional to facial features
• Internal nasal cavity- normal, red, moist |
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Term
| Abnormal findings of the nose |
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Definition
Rhinorrhea: Nasal discharge (watery purulent)
Epistaxis: nose bleeds |
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Term
| Tests for extra occular movements (EOMs) |
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Definition
Cover Test
6 Cardinal fields of Gaze/ Fixation
Accomodation |
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Term
Cover test
- how to perform
- normal vs. abnormal findings |
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Definition
•Cover one eye, FIRST look for steady gaze on uncovered eye.
•Remove cover & look for movement
Normal - eye should stare straight ahead.
Abnormal- eye moves, Weakness = phoria |
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Term
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Definition
| Tropia (always deviated) v phoria (sometimes deviated/weakness) |
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Term
6 Cardinal Fields of gaze/ Fixation test
-how to perform
-abnormal findings |
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Definition
changes in reflex direction of eye toward an object attracting a person’s attention, following the tip of a pen.
•Image fixed in center of visual field, the fovea centralis.
•Consists of rapid ocular movements through the six fields to put target back on the fovea, and somewhat slower movements to track target and keep its image on fovea.
Normal- eyes follow pen through 6 fields of vision in a smooth motion.
Abnormal- nystagmus - tremor-like movement. Best seen near iris.
•Note any lid lag (lid stays up when looking down, common in protruding eyes) or (ptosis)- drooping of eyelid
•These ocular movements are impaired by drugs, alcohol, fatigue, and inattention. |
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Term
Accomodation
-how to perform
-normal vs. abnormal findings |
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Definition
Pen is held away at a distance from the patient, the pen is then brought forward all the way to the patient's nose
Normal- eyes should converge towards the bridge of the nose
-pupils should constrict as object (pen) gets closer |
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Term
| Distinguish between pupillary light reflex, consensual reflex, and corneal light reflex |
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Definition
Pupillary light reflex:
-Direct: one eye is exposed to direct light, pupil should constrict
- Consensual: simultaneous constriction of other pupil, both pupils gets smaller at the same time
Hirschberg’s test/ Corneal Light reflex for symmetry:
•Normal position of eyes and eyelids. The symmetric light reflection in both cornea is a normal finding. White dots on cornea are aligned when pen light is shining on the bridge of the nose |
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Term
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Definition
Snellen
Jaegar or Rosenbaum card
Confrontation |
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Term
Snellen test
-how to perform
- normal reading |
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Definition
SNELLEN:
20 ft, eye level
Test one eye/time (OD, OS, OU),
Wear corrective lenses (remove reading glasses)
Record as fraction,
Normal Limits (20/20), If pt missed a letter (20/20 -1). Is called Snellen E or shape chart. |
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Term
JAEGER or ROSENBAUM CARD
-how to perform
-normal reading |
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Definition
Tests near vision in patients over 40
• Hold card screener 14 in. from eye.
• Test one eye at a time.
• Normal = 14/14 |
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Term
CONFRONTATION
-how to perform
-normal findings |
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Definition
• Quick measure of peripheral vision (PV)
• Compare pt’s PV with your own
• Test Right & Left fields for one eye at a time.
-object should be in pt's field of vision and your vision at the same time |
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Term
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Definition
| PUPILS EQUAL ROUND REACTION TO LIGHT AND ACCOMODATION |
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Term
| Variations in infants/children upon examination: |
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Definition
| Infants and children: fontanels-gaps in skull or soft spots that allow for brain to grow during the first year |
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Term
| Variations in the aging adult upon examination: |
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Definition
-facial bones and orbits appear more prominent, facial skin sags resulting from decreases elasticity, decreased fat, and decreased skin moisture.
-temporal arteries may look twisted and prominent
-mild rhythmic tremor of head may be normal
-lower part of face may look unusually small if teeth have been lost, with mouth sunken in
-neck may show concave curve to compensate for kyphosis of the spine
-gums may recede *may indicate gum disease |
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Term
| Aging adults may also experience xerostomia = ___________ |
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Definition
| dry mouth or difficulty chewing/swallowing food |
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Term
| Variations in pregnant females upon examination: |
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Definition
| Pregnant females- thyroid gland may be palpable due to increased tissue during pregnancy. |
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Term
| Differentiate between caput succedaneum and cephalhematoma |
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Definition
Caput Succedaneum *CROSSES SUTURES*
-edematous swelling and ecchymosis of presenting part of head caused by birth trauma; gradually resolves during first few days of life and needs no treatment
Cephalhematoma *ON ONE SIDE OR ANOTHER
-Sub-periosteal hemorrhage, a result of birth trauma, appears several hours after birth and gradually increases in size; will be reabsorbed during first few weeks of life without treatment. |
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Term
| Normal mucosal variations for darker skinned individuals |
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Definition
-Darker oral pigmentation/ patchy brown pigmentation of the gums.
-There may also be a dark melanotic line along the gingival margin |
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Term
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Definition
Tension
Cluster
Migraine
Post- traumatic |
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Term
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Definition
| Most common type of headache, Tight band around their head |
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Term
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Definition
Most painful of primary headaches.
intense episodes of excruciating unilateral pain (burning, boring or stabbing pain behind one eye) |
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Term
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Definition
Starts with aura (sense that headache is coming on) from vasospasm of intracranial arteries.
Throbbing unilateral distribution of the headache pain. Depression, restlessness, irritability, N/V |
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Term
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Definition
| Dull, generalized head pain. Lack of ability to concentrate, giddiness or dizziness |
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Term
| Health History Questions to further assess a headache |
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Definition
OLD CARTS
Do you have other illness or take any meds?
Any family history of headaches?
How frequent do you get them?
For females, when do they occur in relation to menstrual cycle?
What seems to help them?
Coping strategies?
Any injury or blow to your head?
Dizziness?
Neck pain?
Lumps or swelling?
History of head/neck injury? |
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Term
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Definition
| pain behind brow bone or cheek bones |
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