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Transcript
Checklist for Head and Neck Examination
(To be completed by the Trainer)
Place a
in case box if step/task is performed satisfactorily, and
or N/O if not observed.
if it is not performed satisfactorily,
Satisfactory: Performs the step or task according to the standard procedure or guidelines
Unsatisfactory: Unable to perform the step or task according to the standard procedure or guidelines
Not Observed: Step or task or skill not performed by participant during evaluation by clinical trainer
PARTICIPANT________________________ Date Observed___________
CHECKLIST FOR Head and Neck EXAMINATION
STEP/TASK
CASES
GETTING READY
1. Greet the patient respectfully and with kindness.
2. Tell the patient you are going to examine his/ her head and neck.
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3. Ask the patient to uncover his/her head. Ask the patient to sit on the
examining table with arms at sides.
4. Wash hands thoroughly and dry them. If necessary, put on new
examination or high-level disinfected surgical gloves on both hands.
A) Examination of the Head
1.
THE SCALP:
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Elicited History
Examined the scalp for hair distribution, a swelling, or an ulcer.
Examined a swelling :
-Inspection for the number, site , size, shape, color , surface,
edge, pulsation
-Palpation for hotness, tenderness, size, shape, surface, edge or
margin, consistency and mobility or fixity
-Special characters e.g. fluctuation, translucency, pulsation and
anatomical plan
- Regional Examination for :
a) lymph nodes enlargement
b)Circulatory sufficiency (arterial pulse , venous drainage ,presence of
varicose veins or lymphdema)
c)Nerve lesion ( motor or sensory deficits)
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Examined an ulcer for:
-Inspection for number, site, size, shape, floor, edge, discharge ,
surrounding area for associated abnormalities
-Palpation for tenderness, edge, base, mobility or fixity to underlying
tissue.
-Regional Examination( as before)
2. THE SKULL:
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Elicited History
Examined for the size ,shape
Regional Examination
3. THE CRANIAL NERVES: (look at CGL no…..)
4.THE EYE:
-Looked for Jaundice
-Examined for Exophthalmos
-Fundus examination (CGL no ...)
5. THE NOSE
Inspected for shape ,size , deformity
Skin changes over the nose (ulcer, nodule, etc..)
6.THE EAR
Looked for deformities( shape ,size, accessory auricle)
Inspected for swelling or ulcer
Otoscope (CGL NO?)
7.THE MOUTH:
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Examined the mouth wearing a glove
Used a good light and spatula
Retracted the lip to see the buccal mucosa
Pushed the cheek outwards to see the buccal side of the gum
Pushed the tongue away from the inside of the gum and the floor
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of mouth; then pushed it aside to see the lateral aspect of its
posterior third
Depressed the tongue to look at fauces, tonsils and pharynx
Palpated the structures in the mouth bimanually; one finger inside
the mouth and one outside.
a)Examination of the lip:
-Inspected and palpated the lips for any pigmentation, excoriation, scars,
ulcers, swellings (localized or diffuse) or other anomalies.
-Everted the lip fully to examine the mucous surface of its inner aspect and
the gingivo-labial fold
-Regional Examination( as before)
b)Examination of the cheeks:
-The angle of the mouth is retracted, and the interior is illuminated with a
torch
-Examined the interior of the cheek for pigmentations, ulcers, swellings
-If a parotid disease is suspected examine the orifice of the parotid duct.
c)Examination of the teeth:
-Asked the patient to open his /her mouth
-Inspected the teeth for their shape, color, dental carries and presence of
rough or broken edges.
-Looked for pulpless, impacted, non-erupted or missing teeth by counting
their number
-If patient wears denture asked for its removal before proceeding with the
examination, notice if it is smooth and well fitting.
d)Examination of the gum:
-Everted the lips fully to inspect the gums
-Looked for their color ,the crenated edges ,the relation to the necks of the
teeth, pigmentation ,ulcers , swellings
e)Examination of the tongue:
-Examined the tongue for size, shape ,color, surface ,mobility
-Determined the general condition of the mucous membrane; dry or moist,
clean or furred
-Notified if there is any swelling ( diffuse or localized)or ulcer or fissures
(described it )
-Palpated the tongue (relaxed and at rest within the mouth).
- Palpated the posterior quarter of the tongue,( asked the patient to open
his/her mouth widely. Holding all the fingers of the left hand stiff and
straight, pressed the fingers firmly into the cheek )
-Regional Examination(before)
f)Examination of the floor of the mouth :
-Asked the patient to open the mouth and to put the tip of the tongue on
the roof of the mouth and to bend the head slightly backwards.
-Inspected the floor of the mouth and the undersurface of the tongue
-Did bimanual palpation for any visible swelling
g)Examination of the fauces and the palate
-Asked the patient to tilt his /her head slightly backwards and to open the
mouth to its fullest extent
-In good light ,observed ,asked the patient to say AH, noticed the
movement of the palate
-Depressed the tongue with a spatula and through a light on the throat
-Inspected the tonsils,pillarsof the fauces the posterior pharyngeal wall
-Palpated he pharynx, the patient is seated on a stool and the examiner
stood on his/her right side. The head was hold firmly with the left hand,
the index finger of which is pushed in between the jaws. The right index
finger was then passed behind the soft palate to palpate the posterior nares,
nasopharynx and back of tongue.
-Looked` for palatal deformity, defect , perforation, swelling, ulcer
8. THE SALIVARY GLANDS
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The parotid gland:
-Inspection( of the gland, the duct , the face)
Inspection of the gland( generalized or localized swelling),asked the
patient to clinch the teeth( contraction of the masseter muscle)
Inspection of the duct, retracted the cheek with spatula and looked for the
orifice of the Stenson`s duct opposite the second upper molar tooth.
Applied gentle pressure over the gland and noted any discharge or pus or
blood
Inspection of the face for any asymmetry and examined for facial nerve
paralysis (look at CGL no….)
Tested for the movements of the jaw
-Palpation
Palpated the main body of the gland .Assessed the swelling for hotness,
tenderness, surface , edge, consistency
Palpation of the duct:
-Its anterior part was palpated bidigitally, between the index finger inside
the mouth and the thumb over the cheek
-The posterior part is palpated by rolling the finger across the duct while
the patient clinches the teeth to contract the muscle.
Relations: Examined the two jaws, the temporomandibular joints, the other
salivary glands and the cervical lymph nodes on both sides
Did bimanual examination to determine if there is a deep lobe
enlargement.
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The submandibular salivary gland:
Inspection: inspected the submandibular triangle for a swelling
beneath and in front of the angle of the jaw.
Inspected the floor of the mouth( as before).Noticed if the orifice of
the Wharton's ducts on either sides of the fraenum lingue are red or
swollen
Applied steady pressure over the gland and see if purulent saliva
exudes from the orifices
Inserted a dry swab under the tongue and drop some lemon juice on
the dorsum. Removed the swab and looked for the flow of saliva from
the two ducts
Palpation:
Bimanual palpation; the patient's head was flexed and inclined slightly
to the affected side. Inserted the index finger into the mouth and
insinuated its tip between the alveolus and side of the tongue just
behind the last molar tooth. With the help of the fingers of the other
hand placed beneath the jaw, palpated the gland and the duct from
behind forwards
9.THE JAW and TEMPEROMANDIBULAR Joints
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Elicited history (loss of teeth, unilateral nasal obstruction,
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epiphora, or nasal discharge. Ask about trauma, irradiation, dental
sepsis ,sinusitis , tooth extraction or generalized bone ache and
joint disease )
Examined the upper jaw ( the maxilla) systematically
-The anterolateral surface
-The upper surface
-The inferior surface
-The medial surface
-The posterior surface
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Examined the cervical lymph nodes
Tested the integrity of the second division of the fifth cranial
nerve
Transillumination of the maxillary sinus
Examined the lower jaw
Inspected the mandible for the site and character of any swelling
and the condition of the overlying skin
Asked the patient to open the mouth and inspected the alveolar
margin, the gingivolabial folds and the floor of the mouth
Noted if a swelling affects one aspect of the bone or expands to
include both surfaces of the bone
Palpation of the body, angle and lower part of the ramus of the
mandible from within and from outside the mouth.
Bimanual palpation for the upper portion of the ramus and its
codyloid and coronoid processes
Examined all aspects of the bone and noted the characters of any
swelling
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Temporomandibular joints :
Asked the patient to open and close the mouth and noted any deformity ,
dental malocclusion ,or limitation of movement
Placed the finger over the joint while the patient opens and closes
his/her mouth; notice if there any crepitus or clicking.
B) EXAMINATION OF THE NECK
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Elicited History
Exposure :all clothing are removed as far as the nipple line
Inspection:
Observed the contour of the neck and reported any anomaly
Followed routine examination for a swelling
Asked the patient to swallow and noticed if there any
movement with deglutition( e.g. thyroid swelling )
Defined the anatomical site of any swelling
Looked for neck pulsations, dilated veins, any scare
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Palpation :
Swelling of the neck were examined from behind
The patient sat on a stool ; his/her head flexed passively with
one hand and palpate the swelling with the other hand
The head was flexed passively towards the side of the
swelling
Lumps were examined with muscles relaxed and contracted
( the sternomastoid and the trapezius)
The relation to the trachea was examined : the movement
with swallowing
The relation to the hyoid bone was tested : the movement
with the protrusion of tongue
Palpation of the cervical lymph nodes was done( Can be
done either from the front or behind the patient)
Examined all the groups systematically( superficial and deep,
upper and lower)
Thyroid swelling was examined for the relation to:
The skin
The sternomastoid
The larynx and trachea
The Carotid vessels: At the upper border of the thyroid
cartilage, examined one side at a time.
The suprasternal notch
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Percussion : percussed over the manubrium sterni in order
to rule out retrosternal extension( dull on percussion)
Auscultation; over the thyroid gland ( mainly over the
superior thyroid artery)