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PHCL 313 Emtenan AlHarbi,MCs. Physical Assessment Head, Neck, and Skin. Introduction. Head & Neck. The HEENT , or Head, Eye, Ear, Nose & Throat Exam is usually the initial part of a general physical exam, after the vital signs - PowerPoint PPT Presentation
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Physical Assessment Head, Neck, and Skin
PHCL 313Emtenan AlHarbi,MCs
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Introduction
The HEENT, or Head, Eye, Ear, Nose & Throat Exam is usually the initial part of a general physical exam, after the vital signs
Like other parts of the physical exam, it begins with inspection, & then proceeds to palpation
It requires the use of several special instruments in order to inspect the eyes & ears, & special techniques to assess their special sensory function
Head & Neck
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Structure of the HeadHead & Neck
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Examination of The Head
Skull Hair Scalp & Face Neck Nose Ears Mouth & Pharynx Eyes
Head & Neck
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Skull
Inspection for size, contour,
shape & evidence of trauma
Palpation for lumps, bumps &
evidence of trauma
Head & Neck
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Hair & Scalp
Inspection for quantity, texture &
distribution of the hair Inspect scalp for lesions &
scales
Palpation for texture (fine, dry, oily)
Head & Neck
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Face
Inspect the face for expression, symmetry, movement, lesions & edema
Head & Neck
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Neck
Inspection Inspect the neck
for symmetry, masses, and enlargement of gland and lymph node.
Head & Neck
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Neck
Palpation Palpate the trachea with the
thumb on one side & the index & middle finger on other side of trachea, it should be midline
Palpate the lymph nodes for size, shape, mobility, and tenderness.
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Neck
Palpate the thyroid gland for size, shape, symmetry, tenderness, and nodules.
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Neck
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Neck
•Assess Jagular Venus Pressure (JVP)
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NoseHead & Neck
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Nose
Inspection Inspect external nose for symmetry,
inflammation & lesionsPalpation Palpate the frontal, ethmoid &
maxillary sinuses for tenderness
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Nose
Sinuses inspection
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EarsHead & Neck
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Ears
Inspection Inspect external ear for lesions,
trauma, & size Inspect ear canal & tympanic
membrane with otoscope Inspect the canal for foreign bodies,
discharge, color & edema Inspect the tympanic membrane for
color & perforationPalpation Palpate the external ear for nodules
Head & Neck
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Ears
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Hearing
Simple Assess the ability of the patient to
hear a sequence of equally accented words/numbers (3-5-2-4) whispered from a distance of a couple of feet
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Hearing
Other test:Rinne Test
Head & Neck
Weber Test
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Mouth & PharynxHead & Neck
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Mouth & Pharynx
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Mouth & Pharynx
Inspection Inspect the lips & mucosa for color,
ulcerations, hydration & lesions Inspect the teeth & gums for color,
bleeding, inflammation, caries, missing teeth, ulcerations & lesions
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Mouth & Pharynx
Inspection Inspect the tonsils for color,
exudates, lesions & ulcerations Inspect the sides of the tongue for
color, symmetry, ulceration & lesions Note the odor of breath (examples?)
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Mouth & Pharynx
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EyesHead & Neck
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Eye.. External structure
Inspection
Inspect the external & internal structures of the eyes
Inspect the pupil size, shape & symmetric
Assess iris for abnormal pigments or deposits
Sclera should be white Conjunctiva clear
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Eyes
Inspection Test pupil reaction to light
Dark condition ->> dilate Bright ->> constrict Normal response recorded as PERRLA??
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Eye .. External structure
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Eyes.. visual acuity
Inspection General acuity can be obtained by
reading a general sentence from any printed material
The Snellen eye chart provides more accurate assessment
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Eye.. visual acuity
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Eye.. Checking Visual Fields
Inspection Test peripheral
visual fields with the confrontation technique
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Eyes.. Assess extraocular muscles movement
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Eyes.. Assess extraocular muscles movement
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Eyes.. Internal structures
Inspection Inspect the retinal blood vessels &
optic disc,
Head & Neck
Skin
Skin Assessment
Skin is evaluated using inspection & palpation
Accurate assessment of a dermatologic presentation requires a complete patient history including : Past & current medical history Past & current medications Family history Occupation & hobbies
Skin Assessment
For assessment of suspected drug related dermatologic reactions , it is important to know: When the medication was started Distribution of skin lesions Any systemic symptoms (fever, malaise) Time course of progression of the skin
lesions
Subjective Information Tell me more about your skin problem? When did the condition start? Where on the body did the problem first appear? How did it spread? How have the lesions, rash, or skin color changed? Is there anything that appeared to trigger the reaction? What treatments have you tried? Does it itch? If yes, where does it itch? When did the itching start? Is it continuous or
intermittent? Do you feel tenderness or pain? When did it start?
Describe the pain. Are you experiencing nausea, dizziness, headache, or
fatigue
Objective InformationInspection Note the color of the skin and its uniformity.
If a lesion is found, note the characteristics of the lesion (location, type, color, shape, size, grouping, pattern)
Note whether the lesions localized or generalized e.g. limited to sun-exposed skin or are more widespread
Inspect nails and nail beds for clubbing, cyanosis or trauma
Objective InformationPalpation Palpate the area to see if it is movable, tender,
nodular, moist
Note temperature (warm, cool), texture (rough, smooth), thickness (thick, thin), mobility (immobile, mobile, hypermobile), presence of edema
Assess skin turgor by pulling up & quickly releasing a fold of skin In a well hydrated patient, skin quickly returns to normal If patient is dehydrated, it takes longer for the skin to
return to normal or ‘’tents’’ & stands by itself when released (Poor Turgor)
Objective InformationPalpation Assess edema by pressing tips of one or two
fingers into the skin & noting how long the indentation remains after fingers are removed
A plus scale (1+, 2+, 3+, 4+) is used to quantify the edema with 4+ denoting the most long-lasting indentations
Skin AbnormalitiesPoor Skin Turgor
It takes longer for pinched skin to return to normal or ‘’tents’’ & stands by itself when released
Present with dehydration or extreme weight loss
Skin Abnormalities Pruritus
Itching of the skin
Contact Dermatitis Refers to any rash that develops as a result of a
substance coming into contact with the skin. Divided into two types:▪ Irritant (nonallergic), caused by soap, detergent, cosmetics▪ Allergic associated with metals (nickel & cobalt found in
jewlery, latex, cigarette smoke, poison ivy) Charecterized by erythema, pruritus, vesicles,
scaling
Skin AbnormalitiesEczema (Atopic Dermatitis)
Chronic inflammatory disorder of the dermis & epidermis
Often appears during infancy or early childhood
Patients often have risk factors e.g. personal or family history of allergic rhinitis, asthma, hay fever
Signs and symptoms include pruritus, erythema
Skin Abnormalities Petechia
A small (< 2mm) hemorrhage (pinpoint hemorrhage)
Ecchymosis A large (> 1 cm) hemorrhage, commonly known as a bruise
Purpura Widespread blotchy hemorrhage
Skin AbnormalitiesClubbing
Increased angle ( > 180 degrees) between the base of the nail and nail bed
May be associated with COPD, endocarditis
Skin Abnormalities Onycholysis
Separation of the nail from the nail bed Associated with trauma,
malnutrition, & thyroid disease
Koilonychias Spooning of the nails Associated with iron deficiency anemia