Physical Examination and Diagnosis of the Head and Neck - ROJoson - 14Oct3

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Physical Examination and Diagnosis of the Head and Neck

Learning Unit IIIDepartment of Surgery

College of MedicineUniversity of the Philippines Manila

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Been conducting this 3-hour preceptorial session (2-5 pm) since 2006 October 3, 2014 – created this teaching-learning moduleROJ official retirement date from UPM: January 31, 2014

General Learning Objectives:1.Systematically and proficiently perform a physical examination of the head and neck on adults.2.Correlate physical examination findings with anatomic and physiologic characteristics of the head and neck.

*Given General Learning Objectives by Curriculum Makers

Specific Learning Objectives:1.Describe the common methods of physical examination of the head and neck.

Inspection Palpation Auscultation

*Given Specific Learning Objectives by Curriculum Makers

Specific Learning Objectives:2.Identify the areas that should be included in the physical examination of the head and neck.

• Scalp• Face• External ears, nose, eyes• Lips, oral cavity, throat• Neck (thyroid and lymph nodes)• Nape

Specific Learning Objectives:3.Gather essential data from examination of the head and neck.

Inspection With eyes, look for anything unusual in structure and

function Palpation

With fingers, feel for anything unusual in structure and function

Auscultation With a stethoscope, listen for anything unusual in structure

and function

Specific Learning Objectives:4.State the basic parameters for a quality inspection, palpation and auscultation of the head and neck

Inspection Palpation Auscultation

Relevantly Complete ✔ ✔ ✔

Accurate ✔ ✔ ✔

Gentle ✔ ✔

Specific Learning Objectives:5.Make a written record of findings of a physical examination of the head and neck.

Line drawing of head and neck, whole or involved areas

Illustrative findings with description and explanation

Line drawing of head and neck, whole or involved areas

Illustrative findings with description and explanation

Specific Learning Objectives:6.Process data derived from physical examination of the head and neck to come out with a physical diagnosis.

Data from physical examination: Usual vs Unusual:

Nothing unusual – Normal Unusual but asymptomatic – Normal variant Unusual and symptomatic – Abnormal

Diagnostic label: name of disorder, involved area, organ or tissue

Descriptive label of unusual findings: if name of disorder is not known, state involved area, organ or tissue.

Teaching-learning Activities (3 hours) Facilitator’s inputs Demonstration and return demonstration on physical

examination of the head and neck (subjects: actual patients if available; students and facilitator) Taking note of quality parameters of complete, accurate, gentle.

Gathering of essential data and information Making of medical records with line drawings and illustration of

findings Processing of data and information to come out with a physical

diagnosis Reinforcement of learning on physical diagnosis using cases

with pictures Recap

Pictures of Teaching-learning Activities Done in the Past:

Pictures of Teaching-learning Activities Done in October 3, 2014:

Medical recordingswith line drawings

Diagnosis Physical DiagnosisClinical Diagnosis

Physical Examination of the Head and Neck

Findings Anatomical (Structure)Physiological (Function)

Physical Examination of the Head and NeckMethods:

Inspection – Look - EyesPalpation – Feel – Fingers (gloved / non-gloved)Auscultation – Listen - Stethoscope

Physical Examination of the Head and NeckMethods:

Inspection – Usual / Unusual: Comparison of Sides : ASYMMETRY; Abnormal Findings such as JAUNDICE / PALE CONJUNCTIVAE / etc.

Palpation – Usual / Unusual: Comparison of sides: MASS / TENDERNESS / THRILL / etc.

Auscultation – Usual / Unusual: Comparison of sides: BRUIT

Physical Examination of the Head and NeckPurposes:

Screening-driven assessmentPatientsSelf

Symptom-driven assessment

Clinical Diagnostic Processes:

Pattern Recognition •realization that the patient’s presentation conforms to a previously learned picture or pattern of disease

Prevalence•choice of a diagnosis is based on the frequency of occurrence of the disease in a certain locality, in a certain age and sex group, and in the affected organ and system

Physical Examination of the Head and NeckDiagnostic Algorithm for Masses

1. Location of mass2. Possible / probable organ or tissue of origin3. Pathology: General / Specific

General:Inflammatory / infectious massMalignant massNon-malignant mass

Physical Examination of the Head and NeckDiagnostic Algorithm for Pathology of Masses

1. Look for signs of inflammation / infection:Pus; erythema; tenderness; warmth

2. Look for signs of malignancy:Distant mass suspicious for metastasis;

regional mass (lymph node) suspicious for spread; signs of invasion (fixation); ill-defined border; hard

consistency3. Look for sign of benignity:

Cystic nature of mass with no signs of malignancy and no signs of

inflammation / infection

Physical Examination of the Head and NeckDiagnostic Algorithm for Pathology of Head and Neck Lymph Nodes

Differentials:•Reactive hyperplasia of lymph nodes•Tuberculous lymphadenopathy•Primary malignancy – Lymphoma•Secondary malignancy – Spread from a primary cancer

Physical Examination of the Head and NeckDiagnostic Algorithm for Pathology of Head and Neck Lymph Nodes

1. Look for clues for secondary malignancy – another mass nearby suspicious for malignancy

2. Look for clues for reactive hyperplasia – inflammation /infection nearby

3. Look for clues for primary malignancy – multiple regional lymph node enlargement

4. Look for clues for tuberculosis lymphadenopathy (cold abscess and TB elsewhere)

Go to:Pictorial Inquiry and Interaction on Physical

Findings on Head and Neck

Physical Examination and Diagnosis of the Head

and Neck

Pictorial Inquiry and Interaction

What is your physical diagnosis based on the data & picture?

Unusual Findings / Abnormality?

Location Disorder Disease

and Neck

Sudden onset

Asymptomatic

and Neck

Bony hard

and Neck

PR = 120 / min

and Neck

By prevalence

and Neck

Perihyoid area

and Neck

Cystic

Present at birth

and Neck

With pus

Long-standing

and Neck

With intermittent bleeding from the back of the nose

and Neck

With masses in the axillary and inguinal areas

and Neck

Moves with deglutition

and Neck

Go to:Online Learning cum Evaluation Test Exercises (OLETE)

Instructions on how to take the OLETE:

Get into the Internet. URL: http://quizstar.4teachers.org/

Under Student Login Page, click “Students, get started” Click “Sign-up”

Place your first name; last name - middle name; username; passwords.

Then, click “register.”

Then login your username and password. Then click “Search”

In the box, under quiz title, enter the following: Physical Examination and Diagnosis of the Head and Neck – UPCMLU3 – 2014

Click “exact match” then “register.”Then, “go to test” then “take.”

Then, take your test.

Note: You can see the results of your test (the score and your mistakes if any) immediately. If you did not get a perfect score on the first try (pretest), don’t feel bad as you are given 5 attempts to get a perfect score (posttest). You can retake the online test right after your first try, second try, third and fourth try, that is, if you still cannot get a

perfect score even up to the fourth try.

Learning Unit IIIDepartment of Surgery

College of MedicineUniversity of the Philippines Manila

Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

THE ENDFeedback to: rjoson2001@yahoo.com

Physical Examination and Diagnosis of the Head and Neck - ROJoson - 14Oct3

Health & Medicine