Transcript 6-HEAD AND NECK EXAMINATION.ppt

Head & Neck Examination of
A SURGICAL PATIENT
FAHAD BAMEHRIZ
MD
ASS. Professor & Consultant Surgeon
College of Medicine, KSU
PATIENT’S PROBLEM
HOW TO SOLVE IT?
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HISTORY
CLINICAL EXAMINATION
CLINICAL DIAGNOSIS (dif-dx)
INVESTIGATIONS
FINAL DIAGNOSIS
TREATMENT
What are the five important points,
you have to do, before
examination-taking?????
IMPORTANT POINTS BEFORE
EXAMINATION-TAKING
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Introduce yourself
Explain yourself
Take patient permission to do the examination
Ideal exposure
Define the Position of both
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Treat with respect
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CLINICAL EXAMINATION
Four basic techniques:
• Inspection
• Palpation
• Percussion
• Auscultation
CLINICAL EXAMINATION
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Observe while history taking
• General health
• Intelligence
• Attitude
• Mental state
• Posture/ Mobility
Ask for a nurse when examining females
Patient’s permission
Essential points in H &N
examination
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Exposure up to upper chest
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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, swellings ( thyroid,
lymph nodes)
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EXAMINATIONOF THE NECK
(INSPECTION)
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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
How do we examine the trachea ?
Is it from the front or behind?
Is it by inspection, palpation, ….?
EXAMINATION OF THE NECK
( PALPATION )
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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
EXAMINATION OF THE NECK
 Percussion
: over the upper manubrium or
clavicles for retrosternal extension
(standing in front of the patient)
 Auscultation
: over the swelling ( ask the
patient to hold breath)
GENERAL ASSESMENT
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Weight
Pulse rate
Blood pressure
Temperature
Respiratory rate
General body lymph nodes
Nails, Skin
Mucous membrane/ Tongue
Anemia/ Jaundice
EXAMINATION OF THE
ABDOMEN
What are the essential points
before examination-taking????
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
(Inspection)
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)
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Gentle palpation: for tenderness start 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)
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Cough impulse
Defect at hernia site
EXAMINATION OF THE ABDOMEN
Percussion
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Organs and masses
Liver span
Ascites: fluid thrill, shifting dullness
Auscultation
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Bowel sounds: normal, increased, absent
Bruit
Succussion splash
Have we missed any important\
essential part to examine to
complete the abdominal
examination?
EXAMINATION OF THE ABDOMEN
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External genitalia
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Rectal examination: left lateral position, hip
flexed to 90º and knee flexed to less than 90°
• Inspection
• Palpation
GENERAL ASSESMENT
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Weight
Pulse rate
Blood pressure
Temperature
Respiratory rate
General body lymph nodes
Nails, Skin
Mucous membrane/ Tongue
Anemia/ Jaundice