Head & Neck Examination of

A SURGICAL PATIENT
FAHAD BAMEHRIZ
MD

ASS. Professor & Consultant Surgeon

College of Medicine, KSU

PATIENTS PROBLEM
HOW TO SOLVE IT?

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

Introduce yourself Explain yourself Take patient permission to do the examination Ideal exposure Define the Position of both Treat with respect

CLINICAL EXAMINATION
Four basic techniques:
Inspection Palpation Percussion Auscultation

CLINICAL EXAMINATION

Observe while history taking General health Intelligence Attitude Mental state Posture/ Mobility Ask for a nurse when examining females Patients permission

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)

GENERAL ASSESMENT
Scalp Ear/ Nose Head &Neck: veins, swellings ( thyroid, lymph nodes)

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

How do we examine the trachea ?

Is it from the front or behind? Is it by inspection, palpation, .?

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

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

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

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

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)

EXAMINATION OF THE ABDOMEN

(Palpation)

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)

Cough impulse Defect at hernia site

EXAMINATION OF THE ABDOMEN

Percussion

Organs and masses Liver span Ascites: fluid thrill, shifting dullness
Bowel sounds: normal, increased, absent Bruit Succussion splash

Auscultation

Have we missed any important\ essential part to examine to complete the abdominal examination?

EXAMINATION OF THE ABDOMEN

External genitalia Rectal examination: left lateral position, hip

flexed to 90 and knee flexed to less than 90 Inspection Palpation

GENERAL ASSESMENT

Weight Pulse rate Blood pressure Temperature Respiratory rate General body lymph nodes Nails, Skin Mucous membrane/ Tongue Anemia/ Jaundice