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Head & Neck Examination of

A SURGICAL PATIENT

FAHAD BAMEHRIZ MDASS. Professor & Consultant Surgeon

College of Medicine, KSU

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PATIENTS PROBLEM

HOW TO SOLVE IT?

HISTORY CLINICAL EXAMINATION

CLINICAL DIAGNOSIS (dif-dx)

INVESTIGATIONS FINAL DIAGNOSIS

TREATMENT

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What are the five important points,

you have to do, beforeexamination-taking?????

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IMPORTANT POINTS BEFORE

EXAMINATION-TAKING Introduce yourself

Explain yourself

Take patient permission to do the examination

Ideal exposure

Define the Position of both

Treat with respect

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CLINICAL EXAMINATION

Four basic techniques:

I nspection

Palpation

Percussion

Auscultation

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CLINICAL EXAMINATION

Observe while history taking

General health

Intelligence

Attitude

Mental state

Posture/ Mobility Ask for a nurse when examining females

Patients permission

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Essential points in H &N

examination Exposure up to upper chest

Patient sitting

Stand in front of the patient (inspection)

Stand behind the patient (examination)

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GENERAL ASSESMENT Scalp

Ear/ Nose

Head &Neck: veins, swell ings ( thyroid,

lymph nodes)

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EXAMINATIONOF THE NECK

(INSPECTION)

Exposure up to upper chest

Patient sitting

Stand in front of the patient Anterior and posterior triangle

Site and number of the swelling

Discharge, sinuses, discoluration Does it move with swallowing

Midline swelling- does it move with tongue

protrusion

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How do we examine the trachea ?

Is it from the front or behind?

Is it by inspection, palpation, .?

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EXAMINATION OF THE NECK

( PALPATION )

Trachea- standing in front of the patient

Palpate with both hands standing behind the

patient and flex the neck anterior Determine: site, size,shape, number, tenderness,

temperature,consistency, attachment, movement,

pulsation, borders

Determine: if swelling moves with swallowing

Lymph nodes

Pulse

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EXAMINATION OF THE NECK

Percussion :over the upper manubrium orclavicles for retrosternal extension

(standing in front of the patient)

Auscultation :over the swelling ( ask thepatient to hold breath)

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GENERAL ASSESMENT Weight

Pulse rate

Blood pressure

Temperature Respiratory rate

General body lymph nodes

Nails, Skin

Mucous membrane/ Tongue

Anemia/ Jaundice

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EXAMINATION OF THE

ABDOMEN

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What are the essential pointsbefore examination-taking????

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IMPORTANT POINTS BEFORE

EXAMINATION-TAKING Introduce yourself

Explain yourself

Take patient permission to do the examination Ideal exposure

Define the Position of both

Treat with respect

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EXAMINATION OF THE ABDOMEN

Abdomen extends from the nipple level to

the bottom of the pelvis

Exposure: nipples to knees (ideal)

Patient lying flat on a pillow

Arms by the side ( not under the head!)

Sit or kneel beside the patient

Adequate light

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EXAMINATION OF THE ABDOMEN

(I nspection)

Asymmetry (from the foot end of the bed)

Movement with breathing

Scar, sinus, wound

Prominent veins

Shape of the umbilicus

Cough impulse ( groin, umbilicus, scar)

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EXAMINATION OF THE ABDOMEN

(Palpation)

Gentle palpation:for tendernessstart away from the area of pain

Deep palpation:for tenderness, masses, and organomegaly

Guarding:muscle contracted overlying the tender area

Rebound tenderness:sudden release causes sharp pain

Organomegaly:liver , spleen, kidneys

Other masses:site, size, tenderness, consistency, mobility,margins, pulsation, intra-abdominal, parietal)

Cough impulse

Defect at hernia site

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EXAMINATION OF THE ABDOMEN

Percussion

Organs and masses

Liver span

Ascites:fluid thrill, shifting dullness

Auscultation

Bowel sounds: normal, increased, absent

Bruit

Succussion splash

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Have we missed any important\

essential part to examine to

complete the abdominalexamination?

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EXAMINATION OF THE ABDOMEN

External geni tal ia

Rectal examination: left lateral position, hipflexed to 90 and knee flexed to less than 90

Inspection

Palpation

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GENERAL ASSESMENT Weight

Pulse rate

Blood pressure

Temperature Respiratory rate

General body lymph nodes

Nails, Skin

Mucous membrane/ Tongue

Anemia/ Jaundice