TECHNIQUE |
FINDINGS |
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HEAD AND FACE |
Observe head position |
|
EXPECTED:Upright, midline, still. |
|
UNEXPECTED:Tilted, horizontal jerking or bobbing, tics, nodding,. |
Inspect facial features |
Shape
Observe eyelids, eyebrows, palpebral fissures, nasolabial folds, mouth at rest, during movement, with expression. |
EXPECTED:Variations according to race, sex, age, body build.
UNEXPECTED:Change in shape. Unusual features: Edema, puffiness, coarsened features, prominent eyes, hirsutism, lack of expression, excessive perspiration, pallor, or pigmentation variations. |
Symmetry
Note if asymmetry affects all features of one side or a portion of face. |
EXPECTED:Slight asymmetry.
UNEXPECTED:Facial nerve weakness or paralysis, or problem with peripheral trigeminal nerve. |
Inspect skull and scalp |
Size/shape/symmetry
Scalp condition
Systematically part hair from frontal to occipital region.
Hair pattern
Pay special attention to areas behind ears, at hairline, at crown. |
UNEXPECTED:Lesions, scabs, tenderness, parasites, nits, scaliness.
EXPECTED:Bitemporal recession or balding over crown in men.
UNEXPECTED:Random areas of alopecia or alopecia totalis. |
Palpate head and scalp |
Symmetry
Palpate in gentle, rotary motion from front to back. |
EXPECTED:Symmetric and smooth with bones indistinguishable. Ridge of sagittal fissure occasionally palpable.
UNEXPECTED:Indentations or depressions. |
Palpate hair |
Texture/color distribution |
EXPECTED:Smooth, symmetrically distributed. |
UNEXPECTED:Splitting or cracked ends. Coarse, dry, or brittle. Fine and silky. |
Palpate temporal arteries |
Note course of arteries. |
UNEXPECTED:Thickening, hardness, or tenderness. |
Auscultate temporal arteries and over skull and eyes |
|
EXPECTED:No bruits. |
 |
Inspect salivary glands |
Symmetry/size
Palpate if asymmetry noted. Have patient open mouth and press on salivary duct to attempt to express material. |
UNEXPECTED:Asymmetry or enlargement. Tenderness. Discrete nodule. |
NECK |
Inspect neck |
Symmetry
Inspect in usual position, in slight hyperextension, and during swallowing. Look for landmarks of anterior and posterior triangles. |
EXPECTED:Bilateral symmetry of sternocleidomastoid and trapezius muscles.
UNEXPECTED:Asymmetry, torticollis webbing, excessive posterior skinfolds, unusually short neck, distention of jugular vein; prominence of carotid arteries, or edema
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