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

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





and Neck





and Neck




Sudden onset

Asymptomatic


and Neck





and Neck





and Neck





and Neck





and Neck





and Neck





and Neck




Bony hard


and Neck





and Neck





and Neck





and Neck





and Neck




PR = 120 / min


and Neck





and Neck





and Neck





and Neck




By prevalence


and Neck





and Neck





and Neck





and Neck




Perihyoid area


and Neck





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.”

http://quizstar.4teachers.org/




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: [email protected]

Health & Medicine

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