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MindMap Gallery Head and neck physical examination

Head and neck physical examination

#大三MEDICAL Biological diagnosis, including head, neck, blood pressure measurement, lymph node examination, etc. Hope this mind map helps you!

Edited at 2024-03-05 22:58:37

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Head and neck physical examination

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Outline

Head and neck physical examination

head

skull

Use a soft tape to measure head circumference: from the eyebrows around the back of the skull to the occipital tuberosity (Newborn: about 34cm)

Abnormal head size and shape: such as small skull, square skull, etc.

Abnormal head movement: cervical spondylosis

Eye

eyebrows

Eyebrow loss sign suggests: hypothyroidism, leprosy

Eyelids

ptosis

Bilateral eyelid ptosis suggests: myasthenia gravis

Unilateral blepharoptosis suggests: oculomotor nerve palsy

eyelid closure disorder

Bilateral tips: hyperthyroidism

Unilateral tip: Facial nerve palsy

Eyelid edema tips

Heart/liver/kidney dysfunction

anemia

Malnutrition

eyeball

shape

Protruding eyes suggest: hyperthyroidism

sunken eyeballs

Bilateral reminder: severe dehydration

Unilateral prompt: Horner syndrome (also known as infantile cervical sympathetic palsy syndrome)

sports

Purpose of examination: Check the motor function of six extraocular muscles (superior, inferior, medial and lateral rectus muscles and superior and inferior oblique muscles)

Inspection method: Place your fingers 30 to 40cm in front of the subject's eyes. The patient's head should be fixed and the eyeballs should move in the direction of the target. Generally, the word "meter" moves, left → upper left → lower left, right → upper right → lower right.

Nystagmus: a series of regular, rapid back-and-forth movements of the eyeballs on both sides

Nystagmus examination method: The patient's eyeball moves several times in the direction of the doctor's finger to observe whether spontaneous nystagmus occurs.

conjunctiva

Examine the upper eyelid conjunctiva: flip the eyelid

sclera

yellow dye

Jaundice: Yellow staining of the sclera that is shallow on the inside and deep on the outside

Long-term use of drugs containing yellow pigment: scleral jaundice is shallow on the outside and deep on the inside

cornea

Pay attention to clouds, white spots, etc.

iris

pupil

size

Normal diameter 2~5cm

dilated pupils

Physical condition: teenagers, excitement, darkness

Pathological conditions: trauma, optic atrophy, drugs atropine/cocaine

miosis

Physiological conditions: young children, the elderly, bright places

Pathological conditions: organophosphorus poisoning, drugs pilocarpine/morphine

Bilateral pupils are unequal in size

Indicates craniocerebral lesions: brain trauma, brain tumors

shape

reflection

Convergence reflex: The patient looks at a target 1m away, and then gradually moves the target closer to the eyeball. Normal people can see that the eyes are converging and the pupil is constricted.

Ear

auricle

Shape, size

Nodules suggest gout

external auditory canal

Check whether the skin is normal and whether there is any discharge

Mastoid

Mastoiditis suggests suppurative otitis media

auditory acuity

nose

shape

rosacea, saddle nose

Nose

Nasal ale flap: The nostrils open when inhaling and retract when exhaling. It is seen in febrile diseases accompanied by dyspnea, bronchial asthma, and cardiac asthma attacks.

nasal septum

Common nasal septum deviation

nasal cavity

Check for exudates such as mucus

sinuses

frontal sinus

ethmoid sinus

maxillary sinus

Single fingers do not press at the same time

sphenoid sinus

mouth

odor

lip

tooth

gums

tongue

Whether it is in the middle position when extended, otherwise it will prompt a stroke

Mucous membrane

tonsil

Between the lingual and palatine arches and the pharyngeal and lingual arches

Examination method: The patient sits with his head tilted back and his mouth wide open. Use a tongue depressor to press the back 1/3 of the patient's tongue to make the patient make an "ah" sound.

Tonsil enlargement grading

Degree I: no more than the pharyngeal and palatine arches

Degree II: beyond the pharyngeal and palatine arches

III degree: reaches or exceeds the midline of the posterior pharyngeal wall

parotid gland

The parotid duct opens into the buccal mucosa opposite the maxillary second molar.

neck

shape

sports

eg. Torticollis

skin, mass

spider nevus

tuberculosis

scar

swollen lymph nodes

trachea

Usually located in the middle

Pneumothorax compresses the trachea to the opposite side; atelectasis pulls the trachea to the same side

Thyroid: sight and hearing

Inspection

It is difficult for normal people to see and feel out

May increase slightly during puberty

The person being examined makes swallowing movements, and the thyroid gland moves up and down with swallowing (generally difficult to touch)

palpation

Anterior palpation: The thumb of one hand applies pressure to the thyroid cartilage on one side to push the trachea to the opposite side. The other finger pushes the lateral lobe of the thyroid forward on the posterior edge of the sternocleidomastoid muscle on the opposite side, with the thumb in front of the sternocleidomastoid muscle. Palpate the edge and cooperate with swallowing movements.

Palpation from the back is the same as the front

auscultation

Thyroid enlargement grade

Degree I: Cannot be touched

Degree II: Visible and palpable, but within the sternocleidomastoid muscle

III degree: beyond the outer edge of the sternocleidomastoid muscle

neck blood vessels

Normal: The jugular vein collapses when sitting, and the occipital jugular vein fills when lying flat (but not more than the lower 1/3)

Jugular venous distension and positive hepato-jugular reflux sign: seen in right heart failure ➡️ Liver congestion and swelling

Jugular venous pulsation: seen in tricuspid valve insufficiency and normal people after strenuous activities

Blood pressure

step1: The subject can sit in a chair with his arms on the table

Step 2: The lower edge of the cuff is wrapped around the upper arm 2-3cm above the cubital fossa. The midpoint of the cuff is level with the heart. The cuff should not be wrapped too loosely or too tightly. It is appropriate to insert 1-2 fingers into the cuff. .

Step 3: Place the stethoscope under the cuff at the most obvious pulsation point in the cubital fossa (brachial artery) without inserting it into the cuff.

Step 4: Open the watermark valve, tighten the balloon bonnet, start to inflate slowly, pressurize until the pulsating sound in the stethoscope disappears, continue to increase the pressure by 20-30mmHg to stop inflating, then loosen the bonnet, and drop 3-4mmHg per second. When the stethoscope hears the first clear sound, it is high pressure (systolic blood pressure). The mercury column gradually decreases until it disappears, which is low pressure (diastolic blood pressure).

lymph node examination

Superficial lymph node distribution

Three finger swipe touch

Head and neck*8

preauricular lymph nodes

lymph nodes behind ear

Occipital lymph nodes

submandibular lymph nodes

submental lymph nodes

anterior cervical lymph nodes

cervical lymph nodes

supraclavicular lymph nodes

Upper limbs*6

Axillary lymph nodes (top, front, inner, back and outer)

central

axillary tip

outside

subscapular lymph nodes

pectoral lymph nodes

supratrochlear lymph node

Lower limbs*3

suprainguinal complex

infrainguinal complex

popliteal lymph nodes