Head, neck, nose, shoulder

General health

overall first impression of a person

• helps decide what objective data to collect

• state of health→ acute or chronically ill, frail, fit, and robust

• level of consciousness→ awake, alert, responsive

• signs of distress→ pain, anxiety

• skin colour and obvious elsiosn

PAMFROSSTI

Past medical history

Allergies

Medications

Family history

Review of systems

Occupation

Social history

Safety

Travel/sick contacts

Immunizations

abdominal assessment sequence

1. inspection

2. auscultation

3. percussion

4. palpation

   • auscultate bowel sounds for at least 15 seconds in each quadrant using the diaphragm of the sthethscope

   • start with the lower right quadrant and move clock-wise

general survey memorization

Behaviour

Anatomy

Movement

Overall impression

Skin

(BAMOS-like bam os…)

lymph nodes

Small, bean-shaped structures that are part of the lymphatic system

• responsible for filtering lymph fluid and housing immune cells that help fight infection

• an enlarged lymoh node indicates inflammation that is “upstream from it”

• expected findings: non-tender soft mobile

Inspection of head, face, nose

inspect:

• hair

• lips

• frontal and maxillary sinuses

• nose→ anterior, inferior and profile views

  • inspect with speculum(septum, middle and inferior turbinate’s)

palpation head, face, nose

scalp and hair: feel from vertex to occiput including temporal regions→ any tenderness?

• palpate hair for characteristics

• assess newborns for fontanelles→ posterior closes 1st then anterior

• fontanelles should be flat, soft, squishy, not sunken → sunken fontanelle indicates dehydration not full

• temporal arteries with finger pads

• assess temporomandibular joint

• palpate entire length of nose→ including maxillary sinuses and frontal sinuses. Assess for tenderness, crepitus, or deformities.

inspection of neck and throat

entire neck, jugular veins, and carotid arteries

• assess jugular venous distension(the visible bulging of the jugular vein, often indicating increased central venous pressure)

• thyroid→ look at the position and distension should not be able to see someone’s thyroid

• spine and back of the neck

palpation

carotid arteries:

• feel separately at the level of the cricoid using thumb or index finger with middle finger

lymph nodes:

• move in circular motion with finger pads of the 2nd, 3rd, and 4th fingers

thyroid:

• palpate each lobe from behind

• thyroid should be smooth, rubbery, non-tender, symmetrical and barely palpable

common problems with the head, neck, throat

• lymphadenopathy→ swelling of the lymph node, ultrasound the lymph node if swollen

• changes in vision, hearing, taste, smell(red flags)

• headache→ e.g. icepick headache can be sign of vascular issue

red flags

• acute onset of severe headache in patient with no headache history→ except in newly menstruating female

• unrelenting headache

• headache associated with stiff neck/neck pain and feer

• headache associated with trauma, changes to mentation or level of consciousness

• persistent headache following trauma to the head

• changes in vision, dizziness, vomiting

• change in gait, balance, motor function

hyperthyroidism

• thyroid gland produces excessive amounts of thyroid hormones

• leads to symptoms such as increased metabolism, weight loss, and rapid heartbeat

hypothyroidism

too little T3 and T4 is released causing slowed metabolism, leading to fatigue, weight gain, and cold intolerance.

• Dry skin, hair thinning, and brittle nails due to reduced cell turnover.

• Bradycardia (slow heart rate) and low blood pressure from decreased cardiac output.

parotid gland

located in the cheek anterior to the bottom part of the near

• near the upper 2nd molars