1. Head & Neck Examination of A SURGICAL PATIENT
FAHAD BAMEHRIZ MD
ASS. Professor & Consultant Surgeon
College of Medicine, KSU

2. PATIENT’S PROBLEM HOW TO SOLVE IT? HISTORY CLINICAL EXAMINATION
CLINICAL DIAGNOSIS (dif-dx)
INVESTIGATIONS
FINAL DIAGNOSIS
TREATMENT

3. What are the five important points, you have to do, before examination-taking?????

4. 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

5. CLINICAL EXAMINATION Four basic techniques: Inspection Palpation
Percussion
Auscultation

6. CLINICAL EXAMINATION Observe while history taking General health
Intelligence
Attitude
Mental state
Posture/ Mobility
Ask for a nurse when examining females
Patient’s permission

7. 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)

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

9. 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

12. How do we examine the trachea. Is it from the front or behind
How do we examine the trachea ? Is it from the front or behind? Is it by inspection, palpation, ….?

13. 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

16. 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)

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

19. EXAMINATION OF THE ABDOMEN

20. What are the essential points before examination-taking????

21. 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

22. 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

26. 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)

27. 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

31. EXAMINATION OF THE ABDOMEN
Percussion
Organs and masses
Liver span
Ascites: fluid thrill, shifting dullness
Auscultation
Bowel sounds: normal, increased, absent
Bruit
Succussion splash

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

33. EXAMINATION OF THE ABDOMEN
External genitalia
Rectal examination: left lateral position, hip flexed to 90º and knee flexed to less than 90°
Inspection
Palpation

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