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?

 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

 Patient’s 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
Auscultation
• 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

 External genitalia

 Rectal examination: left lateral position, hip

flexed to 90º 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