C h a p t e r
7
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The Head and Neck
215
Anatomy and Physiology and Techniques of Examination
examples of abnormalities
Techniques of Examination
Because abnormalities covered by the hair are easily missed, ask if the patient
has noticed anything wrong with the scalp or hair. If you detect a hairpiece
or wig, ask the patient to remove it.
Examine:
The Hair.
Note its quantity, distribution, texture, and any pattern of loss.
You may see loose flakes of dandruff.
The Scalp.
Part the hair in several places and look for scaliness, lumps,
nevi, or other lesions.
The Skull.
Observe the general size and contour of the skull. Note any
deformities, depressions, lumps, or tenderness. Learn to recognize the ir-
regularities in a normal skull, such as those near the suture lines between the
parietal and occipital bones.
The Face.
Note the patient’s facial expression and contours. Observe for
asymmetry, involuntary movements, edema, and masses.
The Skin.
Observe the skin, noting its color, pigmentation, texture, thick-
ness, hair distribution, and any lesions.
THE EYES
Anatomy and Physiology
Identify the structures illustrated at the
right. Note that the upper eyelid covers a
portion of the iris but does not normally
overlay the pupil. The opening between
the eyelids is called the
palpebral fissure.
The white sclera may look somewhat buff-
colored at its periphery. Do not mistake
this color for jaundice, which is a deeper
yellow.
Fine hair is seen in hyperthyroidism;
coarse hair in hypothyroidism. Tiny
white ovoid granules that adhere to
hairs may be nits (lice eggs).
Look for redness and scaling that
may indicate seborrheic dermatitis
or psoriasis; soft lumps that may be
pilar cysts (wens); pigmented nevi.
An enlarged skull may signify hydro-
cephalus or Paget’s disease of bone.
Palpable tenderness or step-offs
may be present after head trauma.
See Table 7-5, Selected Facies,
p. 264.
Acne is found in many adolescents.
Hirsutism (excessive facial hair)
occurs in some women with
polycystic ovary syndrome.
Lateral canthus
Upper eyelid
Medial canthus
Pupil
Limbus
Iris
Lower eyelid
Sclera covered
by conjunctiva
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