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Head and Neck PLUS Cranial Nerves

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Head

Estimates visual acuity (VA) in each eye separately (CN II)
Tests visual fields by the confrontation method (CN II)
Tests the extraocular eye movements (CN III, IV, VI)
Inspects the pupils for size, shape, equality
Tests the pupils for reaction to light, reaction to accommodation and pupillary constriction (CN II, III)
Inspects the conjunctiva and sclera for color, nodules, edema, or visual sensitivity to light
Inspects the cornea and lens of both eyes for opacities

Demonstrates the proper technique of examining the eyes with an ophthalmoscope
Inspects the eyes with the ophthalmoscope identifying: red reflex, optic disc and cup, arterioles, veins, and macular area
Inspects the optic disc for clarity of outline, color, elevation
Inspects the retinal arterioles and veins for size, light reflex and character of AV crossings
Inspects the retina for lesions: hemorrhage, exudates, pigment, scarring or detachment

Inspects the nose for: deformity; asymmetry; inflammation.
Inspects inferior and middle turbinates and the middle meatus with the otoscope or nasal speculum for: color; edema; exudate; polyps.
Inspects the nasal mucosa and septum

Inspects the lips for: color; moisture; ulcers
Inspects the teeth for: number; caries; mobility; position & shape.
Inspects gingiva for: inflammation; edema; bleeding; discoloration.
Inspects and palpates the tongue/base of tongue for: color; papillae; smoothness; mass; asymmetry (CN XII)
Inspects the buccal mucosa and hard palate
Inspects pharynx, uvula and soft palate (CN IX, X)

Inspects & palpates the neck for: symmetry; masses
Inspects and palpates the neck for tracheal deviation; laryngovertebral crepitus
Inspects and palpates the thyroid gland
Auscultates the carotid arteries.
Tests trapezius strength – shoulder shrug (CN XI)
Palpates the lymph node groups
- Preauricular
- Postauricular
- Occipital
- Tonsillar
- Submandibular
- Submental
- Superficial cervical
- Deep cervical
- Posterior cervical
- Supraclavicular

Head – The skull is normocephalic/atraumatic (NC/AT). Pinnae & craniofacial structures normally formed and positioned. Hair with average texture.
Eyes – Visual acuity 20/20 bilaterally. Sclera white conjunctiva pink. Pupils are 4mm constricting to 2 mm, equally round and reactive to light and accommodations. Disc margins sharp; no hemorrhagesorexudates, noarteriolar narrowing.
Ears – Acuity good to whispered voice. Tympanic membranes (TMs) with good cone of light. Weber midline AC > BC.
Nose – Nasal mucosa pink, septum midline; no sinus tenderness.
Throat (or Mouth) – Oral mucosa pink, dentition good, pharynx without exudates.
Neck – Trachea midline. Neck supple; thyroid isthmus palpable, lobes not felt.
Lymph Nodes – No cervical, axillary, inguinal adenopathy

Head – The skull is normocephalic/atraumatic. Frontal balding.
Eyes – Visual acuity 20/100 bilaterally. Sclera white; conjunctiva infected. Pupils constrict 3mm to 2 mm, equally round and reactive to light and accommodation. Disc margins sharp; no hemorrhages or exudates. Arteriolar-to-venous ratio (AV ratio) 2:4; no A-V nicking.
Ears – Acuity diminished to whispered voice; intact to spoken voice. TMs clear.
Nose – Mucosa swollen with erythema and clear drainage. Septum midline. Tender over maxillary sinuses.
Throat – Oral mucosa pink, dental caries in lower molars, pharynx erythematous, no exudates.
Neck – Trachea midline. Neck supple; thyroid isthmus midline, lobes palpable but not enlarged.
Lymph Nodes – Submandibular and anterior lymph nodes tender, 1x1 cm, rubbery and mobile; no posterior cervical, axillary, or inguinal lymphadenopathy.