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

1. Physical Examination and
Diagnosis of the Head and Neck
Learning Unit III
Department of Surgery
College of Medicine
University 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 module
ROJ official retirement date from UPM: January 31, 2014

2. Physical Examination and
Diagnosis of the Head and Neck
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

3. Physical Examination and
Diagnosis of the Head and Neck
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

4. Physical Examination and
Diagnosis of the Head and Neck
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
*Given Specific Learning Objectives by Curriculum Makers

5. Physical Examination and
Diagnosis of the Head and Neck
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
*Given Specific Learning Objectives by Curriculum Makers

6. Physical Examination and
Diagnosis of the Head and Neck
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 ✔ ✔
*Given Specific Learning Objectives by Curriculum Makers

7. Physical Examination and
Diagnosis of the Head and Neck
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
*Given Specific Learning Objectives by Curriculum Makers

8. Physical Examination and
Diagnosis of the Head and Neck
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
*Given Specific Learning Objectives by Curriculum Makers

9. Physical Examination and
Diagnosis of the Head and Neck
Specific Learning Objectives:
5.Make a written record of findings of a physical
examination of the head and neck.
 Illustrative findings with description and explanation
*Given Specific Learning Objectives by Curriculum Makers

10. Physical Examination and
Diagnosis of the Head and Neck
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.
*Given Specific Learning Objectives by Curriculum Makers

11. Physical Examination and
Diagnosis of the Head and Neck
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

12. Physical Examination and
Diagnosis of the Head and Neck
Pictures of Teaching-learning Activities Done in the Past:

13. Physical Examination and
Diagnosis of the Head and Neck
Pictures of Teaching-learning Activities Done in the Past:

14. Physical Examination and
Diagnosis of the Head and Neck
Pictures of Teaching-learning Activities Done in the Past:

15. Physical Examination and
Diagnosis of the Head and Neck
Pictures of Teaching-learning Activities Done in October 3, 2014:

16. Physical Examination and
Diagnosis of the Head and Neck
Pictures of Teaching-learning Activities Done in October 3, 2014:
Medical recordings
with line drawings

17. Physical Examination and
Diagnosis of the Head and Neck
Pictures of Teaching-learning Activities Done in October 3, 2014:

18. Physical Examination and
Diagnosis of the Head and Neck
Pictures of Teaching-learning Activities Done in the Past:

19. Physical Examination and
Diagnosis of the Head and Neck

20. Physical Examination and
Diagnosis of the Head and Neck

21. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Findings
Anatomical (Structure)
Physiological (Function)
Diagnosis
Physical Diagnosis
Clinical Diagnosis

22. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Methods:
Inspection – Look - Eyes
Palpation – Feel – Fingers (gloved / non-gloved)
Auscultation – Listen - Stethoscope

23. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Methods:
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

24. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Purposes:
Screening-driven assessment
Patients
Self
Symptom-driven assessment

25. Physical Examination and
Diagnosis of the Head and Neck
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

26. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Diagnostic Algorithm for Masses
1. Location of mass
2. Possible / probable organ or tissue of origin
3. Pathology: General / Specific
General:
Inflammatory / infectious mass
Malignant mass
Non-malignant mass

27. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Diagnostic Algorithm for Pathology of Masses
1. Look for signs of inflammation / infection:
Pus; erythema; tenderness; warmth
1. 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
consistency
1. Look for sign of benignity:
Cystic nature of mass with no signs of
malignancy and no signs of
inflammation / infection

28. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Diagnostic 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

29. Physical Examination and
Diagnosis of the Head and Neck
Physical Examination of the Head and Neck
Diagnostic 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)

30. Physical Examination and
Diagnosis of the Head and Neck
Go to:
Pictorial Inquiry and Interaction on Physical
Findings on Head and Neck

31. 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

32. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

33. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

34. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease
Sudden onset
Asymptomatic

35. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

36. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

37. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

38. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

39. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

40. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

41. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease
Bony hard

42. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

43. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

44. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

45. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

46. Physical Examination and Diagnosis of the Head and Neck
PR = 120 / min
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

47. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

48. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

49. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

50. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease
By prevalence

51. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

52. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

53. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

54. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease
Perihyoid area

55. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

56. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease
Cystic
Present at birth

57. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease
With pus
Long-standing

58. Physical Examination and Diagnosis of the Head and Neck
With intermittent bleeding from the back of the nose
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

59. Physical Examination and Diagnosis of the Head and Neck
With masses in the axillary and inguinal areas
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

60. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease
Moves with
deglutition

61. Physical Examination and Diagnosis of the Head and Neck
What is your physical diagnosis based on the data & picture?
Unusual Findings /
Abnormality?
Location Disorder Disease

62. Physical Examination and
Diagnosis of the Head and Neck
Go to:
Online Learning cum Evaluation Test Exercises (OLETE)
Instructions on how to take the OLETE:

63. Physical Examination and
Diagnosis of the Head 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.”

64. Physical Examination and
Diagnosis of the Head and Neck
Go to:
Online Learning cum Evaluation Test Exercises (OLETE)
Instructions on how to take the OLETE:
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.

65. Physical Examination and
Diagnosis of the Head and Neck
Go to:
Online Learning cum Evaluation Test Exercises (OLETE)
Instructions on how to take the OLETE:
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.

66. Physical Examination and
Diagnosis of the Head and Neck
Learning Unit III
Department of Surgery
College of Medicine
University of the Philippines Manila
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
THE END
Feedback to: rjoson2001@yahoo.com