University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

338

Pages:

2
Author:

Mariam A. A.

Examinations of Head and Neck C1 – C 5 • • • • Corneal reflex: lightly touch the cornea with a wisp of cotton wool brought to eye from the side - Normal: reflex blinking - Pathological: absence of corneal sensation -> corneal ulceration Fascial sensation: test with the sharp end of a new disposal pin for pain sensation. The pain should be cold for temperature sensation - Pathological: feel the metal as being dull and warm - The area of the pathological sensation should be mapped out Motor division of nerves - Inspect for muscle wasting - Ask patient to bite forcefully on a wooden tongue depressor with molar teeth - The depth of the marks on each side gives an indication of the relative strength of the muscles Jaw jerk or masseter reflex - Ask the patient to let the mouth fall open slightly; place your finger on the tip of the jaw and tap it lightly with a tendon hammer - Normal: on reaction or a small closure of the mouth - Pathological: in upper motor lesions above the pons there will be an exaggerated reaction. This is a common sign of pseudobulbar palsy C7 • • • Fascial asymmetry -> nerve palsy Muscle power -> as the patient to look up so that the forehead and wrinkles - Look for loss of wrinkling and test for muscle strength Ask patient to tightly shut their eyes - Compare how deeply the eyelashes are buried on the two sides and the try to force open each eye C8 • • If the patient complains of vertigo then an oculomotor exam should be undertaken Do ear and hearing examinations • • • Ask patient to open their mouth and inspect the palate with a torch Note ad displacement of the uvula Test for gag reflex C9 C11 • Test for shoulder muscle weakness - Ask the patient to shrug their shoulders - Feel the trapezius muscles and attempt to push the shoulders down C12 • • Inspect the tongue at rest on the floor of the mouth Normal: little movement • • • Pathological: can identify muscle wasting Ask the patient to stick out their tongue, which may deviate towards the weaker side if there is a unilateral lower motor neuron lesion Pathological: abnormal movements L2, L3 and L4 • • • Test for weakness of knee extension Hip flexion weakness Absent knee jerk L4, L5, S1 and S2 • • • Test for loss of power below the knees -> foot drop Test for knee flexion weakness Test for sensation on the posterior thigh