Head and Neck

Findings on Head and Neck Examination
Component Inspection Palpation Percussion Auscultation
General
  • Colour
    ↑ Mortality with:
    • Pallor
    • Cyanosis
    • Greyish-ness
  • Pseudo-cyanosis
Respiratory
  • ETT
    • Size
    • Depth
  • Tracheostomy
  • Tracheostomy scar
  • Tracheal tug
  • Tracheal position
  • Stridor
Cardiovascular
  • Xantholasma
  • Corneal arcus
  • Facial swelling
    SVC obstruction.
Neurological
  • Mydriasis
  • Meningism
Endocrine and Metabolic
Renal
Gastrointestinal
  • Scleral icterus
Haematological
Integumentary
Trauma
  • Conjunctival haemorrhage
  • Battle’s sign
  • Mastoid bruising
  • Haemotympanum
  • CSF otohorrhoea
  • CSF rhinorrhoea
Infective
  • Lymphadenopathy
Malignant
Toxic
Immune
  • Lymphadenopathy
Congenital
Obstetric

Features

General

  • Central cyanosis
    Blue-ish mucosa seen with:
    • Hypoxaemia (<80%)
    • Methaemoglobinaemia (>1.5%)
    • Sulfhaemoglobinaemia (>0.5%)
  • Pseudocyanosis
    Blue-ish mucosa in absence of hypoxaemia or other haemoglobinopathy, dur to:
    • Heavy metal intoxication
      • Silver
      • Gold
    • Drug therapy
      • Amiodarone
      • Minocycline
      • Chloroquine
      • Phenothiazines

Respiratory

  • Stridor
    High pitched, harsh, inspiratory sound due to partial upper airway obstruction.
    • >80% stenosis may be heard unaided, and signify severe airway obstruction
      Rapidity of onset indicates the aggressiveness of treatment required.
    • Lower-grade stenoses may be appreciated with a stethoscope

Neurological

  • Mydriasis
    Pupillary dilation may occur due to:
    • Optic nerve injury
    • Amaurosis
    • Isolated midbrain lesion
    • Intoxication
    • CN III compression
      • Uncal herniation
Unilateral Mydriasis

Bilateral Mydriasis

  • Meningism
    • Neck stiffness or pain on passive lateral rotation

Gastrointestinal

  • Spider naevi
    Central arteriole with radial spreading vessels, with local erythema. The naevi blanche on compression, and refill from the central arteriole. Spider naevi occur in:
    • Alcoholic liver disease
    • Other liver disease
      • Hepatitis C infection
    • Vasodilatory states
      • Pregnancy
    • Malnutrition
Spider naevi

  • Icterus
    Becomes evident when bilirubin >85-135μmol/L.
Scleral Icterus

Trauma

  • Conjunctival haemorrhage
    Capillary rupture due to ↑ venous pressure.

References

  1. Foot C, Steel L, Vidhani K, Lister B, MacPartlin M, Blackwell N. Examination Intensive Care Medicine. Elsevier Australia; 2011. (Examination series).
  2. Dünser MW, Dankl D, Petros S, Mer M. Clinical Examination Skills in the Adult Critically Ill Patient. Springer International Publishing; 2018.