Heent and neck

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Heent and neck

  1. 1. Introduction to Clinical Skills HEENT and Neck Universidad Iberoamericana UNIBE
  2. 2. Introduction to Clinical Skills <ul><li>Teaching Staff </li></ul><ul><ul><li>Dra Elizabeth Peralta </li></ul></ul><ul><ul><li>Dr Marcos Núñez </li></ul></ul><ul><ul><li>Dra Cristina Páez C </li></ul></ul><ul><ul><li>Dr Juan Carlos Mariñez </li></ul></ul><ul><ul><li>Dra Wayna Greo </li></ul></ul><ul><ul><li>Dra Yun Pey Lee </li></ul></ul>
  3. 3. Introduction to Clinical Skills <ul><li>Head Exam </li></ul><ul><ul><li>Skull </li></ul></ul><ul><ul><li>Face </li></ul></ul><ul><ul><li>Eyes </li></ul></ul><ul><ul><li>Ears </li></ul></ul><ul><ul><li>Nose </li></ul></ul><ul><ul><li>Paranasal </li></ul></ul><ul><ul><li>Oral cavity, Pharynx and Larynx </li></ul></ul>
  4. 4. Introduction to Clinical Skills <ul><li>Approach to the Physical Exam </li></ul><ul><ul><li>What we need to do it ? </li></ul></ul><ul><ul><ul><li>Penlight </li></ul></ul></ul><ul><ul><ul><li>Sthetoscope </li></ul></ul></ul><ul><ul><ul><li>Sphygmomanometer </li></ul></ul></ul><ul><ul><ul><li>HEENT set </li></ul></ul></ul><ul><ul><ul><li>Goniometer </li></ul></ul></ul><ul><ul><ul><li>Tune fork </li></ul></ul></ul><ul><ul><ul><li>Hammer </li></ul></ul></ul><ul><ul><ul><li>Pinwheel </li></ul></ul></ul><ul><ul><ul><li>Measure tape </li></ul></ul></ul><ul><ul><ul><li>Gloves </li></ul></ul></ul><ul><ul><ul><li>Isopropilic Alcohol </li></ul></ul></ul>
  5. 5. Introduction to Clinical Skills <ul><li>Head Exam. The Health History </li></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>How is your vision ? </li></ul></ul><ul><ul><li>Do yoy wear glasses ? </li></ul></ul><ul><ul><li>How is your hearing ? </li></ul></ul><ul><ul><li>Rhinorrea , Epsitaxis ? </li></ul></ul><ul><ul><li>Sore Throat </li></ul></ul><ul><ul><li>Hoarseness </li></ul></ul>
  6. 6. Introduction to Clinical Skills <ul><li>Head Exam. Health Promotion and Counseling </li></ul><ul><ul><li>Changes in vision: </li></ul></ul><ul><ul><ul><li>Cataracts, glaucoma , macular degeneration </li></ul></ul></ul><ul><ul><li>Hearing loss </li></ul></ul><ul><ul><li>Oral health </li></ul></ul>
  7. 7. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Hair </li></ul></ul><ul><ul><ul><li>Quantity </li></ul></ul></ul><ul><ul><ul><li>Distribution </li></ul></ul></ul><ul><ul><ul><li>Texture </li></ul></ul></ul><ul><ul><ul><li>Pattern of loss </li></ul></ul></ul><ul><ul><ul><li>Flakes of dandruff </li></ul></ul></ul>
  8. 8. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Scalp </li></ul></ul><ul><ul><ul><li>Scaliness </li></ul></ul></ul><ul><ul><ul><li>Lumps </li></ul></ul></ul><ul><ul><ul><li>Nevi </li></ul></ul></ul><ul><ul><ul><li>Other lesions </li></ul></ul></ul>
  9. 9. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Skull </li></ul></ul><ul><ul><ul><li>General size and contour </li></ul></ul></ul><ul><ul><ul><li>Deformities, depressions, lumps, tenderness </li></ul></ul></ul><ul><ul><ul><li>Irregularities in normal skull </li></ul></ul></ul><ul><ul><ul><ul><li>Between parietal and occipital bones </li></ul></ul></ul></ul>
  10. 10. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Face </li></ul></ul><ul><ul><ul><li>Facial expression and contours </li></ul></ul></ul><ul><ul><ul><li>Asymmetry </li></ul></ul></ul><ul><ul><ul><li>Involuntary movements </li></ul></ul></ul><ul><ul><ul><li>Edema </li></ul></ul></ul><ul><ul><ul><li>Masses </li></ul></ul></ul><ul><ul><ul><li>TMJ </li></ul></ul></ul>
  11. 11. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul>
  12. 12. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Face </li></ul></ul><ul><ul><ul><li>Craneal nerves V and VII </li></ul></ul></ul>
  13. 13. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Face palpation </li></ul></ul>
  14. 14. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Face </li></ul></ul><ul><ul><ul><li>Temporomandibular joint </li></ul></ul></ul>
  15. 15. Introduction to Clinical Skills <ul><li>Head Exam. Techniques of Examination </li></ul><ul><ul><li>The Skin </li></ul></ul><ul><ul><ul><li>Color </li></ul></ul></ul><ul><ul><ul><li>Pigmentation </li></ul></ul></ul><ul><ul><ul><li>Texture </li></ul></ul></ul><ul><ul><ul><li>Thickness </li></ul></ul></ul><ul><ul><ul><li>Hair distribution </li></ul></ul></ul><ul><ul><ul><li>Any lesion </li></ul></ul></ul>
  16. 16. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Anatomy </li></ul></ul>
  17. 17. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Anatomy </li></ul></ul>
  18. 18. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Important areas of Examination </li></ul></ul><ul><ul><ul><li>Visual acuity </li></ul></ul></ul><ul><ul><ul><li>Visual fields </li></ul></ul></ul><ul><ul><ul><li>Conjunctiva and sclera </li></ul></ul></ul><ul><ul><ul><li>Cornea, lens and pupils </li></ul></ul></ul><ul><ul><ul><li>Extraocular movements </li></ul></ul></ul>
  19. 19. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Visual acuity </li></ul></ul><ul><ul><ul><li>Snellen chart </li></ul></ul></ul><ul><ul><ul><li>Position patient 20 feet from the chart </li></ul></ul></ul>
  20. 20. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Visual fields </li></ul></ul><ul><ul><ul><li>Temporal </li></ul></ul></ul><ul><ul><ul><li>Nasal </li></ul></ul></ul>
  21. 21. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Position and Alignment </li></ul></ul><ul><ul><li>Eyebrows </li></ul></ul><ul><ul><ul><li>Quantity, distribution </li></ul></ul></ul><ul><ul><li>Eyelids </li></ul></ul><ul><ul><ul><li>Width palpebral fissure </li></ul></ul></ul><ul><ul><ul><li>Color </li></ul></ul></ul>
  22. 22. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Conjunctiva, Sclera and palpebral conjunctiva </li></ul></ul><ul><ul><ul><li>Color </li></ul></ul></ul><ul><ul><ul><li>Vascular pattern </li></ul></ul></ul>
  23. 23. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Cornea and Lens </li></ul></ul><ul><ul><li>Iris </li></ul></ul><ul><ul><li>Pupils </li></ul></ul><ul><ul><ul><li>Size </li></ul></ul></ul><ul><ul><ul><li>Shape </li></ul></ul></ul><ul><ul><ul><li>Symmetry </li></ul></ul></ul><ul><ul><ul><li>Reaction to light </li></ul></ul></ul>
  24. 24. Introduction to Clinical Skills
  25. 25. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Extraocular Muscles </li></ul></ul><ul><ul><ul><li>Normal conjugate movements </li></ul></ul></ul><ul><ul><ul><li>Nystagmus </li></ul></ul></ul><ul><ul><ul><li>Lid Lag </li></ul></ul></ul><ul><ul><ul><li>Test for Convergence </li></ul></ul></ul>
  26. 26. Introduction to Clinical Skills <ul><li>Head Exam. The Eyes </li></ul><ul><ul><li>Ophthalmoscopic Exmination </li></ul></ul><ul><ul><ul><li>Fundi </li></ul></ul></ul><ul><ul><ul><ul><li>Optic disc and cup </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Macula </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Retinal vessels </li></ul></ul></ul></ul>
  27. 27. Introduction to Clinical Skills <ul><li>Head Exam. The Ears </li></ul><ul><ul><li>The Auricle </li></ul></ul><ul><ul><li>Ear canal and Drum </li></ul></ul><ul><ul><li>Auditory Acuity </li></ul></ul><ul><ul><li>Air and Bone Conduction </li></ul></ul><ul><ul><ul><li>Weber Test </li></ul></ul></ul><ul><ul><ul><li>Rinne Test </li></ul></ul></ul>
  28. 28. Introduction to Clinical Skills <ul><li>Head Exam. The Ears </li></ul><ul><ul><li>The Auricle </li></ul></ul>
  29. 29. Introduction to Clinical Skills <ul><li>Head Exam. The Ears </li></ul><ul><ul><li>Ear canal and Drum </li></ul></ul>
  30. 30. Introduction to Clinical Skills <ul><li>Head Exam. The Ears </li></ul><ul><ul><li>Ear canal and Drum </li></ul></ul>
  31. 31. Introduction to Clinical Skills <ul><li>Head Exam. The Ears </li></ul><ul><ul><li>Auditory Acuity </li></ul></ul>
  32. 32. Introduction to Clinical Skills <ul><li>Head Exam. The Ears </li></ul><ul><ul><li>The Air and Bone Conduction </li></ul></ul><ul><ul><ul><li>Weber Test </li></ul></ul></ul>
  33. 33. Introduction to Clinical Skills <ul><li>Head Exam. The Ears </li></ul><ul><ul><li>The Air and Bone Conduction </li></ul></ul><ul><ul><ul><li>Rinne Test </li></ul></ul></ul>
  34. 34. Introduction to Clinical Skills <ul><li>Head Exam. The Nose </li></ul><ul><ul><li>Examination Techniques </li></ul></ul><ul><ul><ul><li>Inspect anterior and inferior surfaces (symmetry) </li></ul></ul></ul><ul><ul><ul><li>Nasal vestibule </li></ul></ul></ul><ul><ul><ul><li>Test for nasal obstruction </li></ul></ul></ul><ul><ul><ul><li>Rhinoscopic exam </li></ul></ul></ul><ul><ul><ul><ul><li>Nasal mucosa </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nasal septum </li></ul></ul></ul></ul>
  35. 35. Introduction to Clinical Skills <ul><li>Head Exam. The Nose </li></ul><ul><ul><li>Examination Techniques </li></ul></ul><ul><ul><ul><li>Inspect anterior and inferior surfaces (symmetry) </li></ul></ul></ul>
  36. 36. Introduction to Clinical Skills <ul><li>Head Exam. The Nose </li></ul><ul><ul><li>Examination Techniques </li></ul></ul><ul><ul><ul><li>Nasal vestibule </li></ul></ul></ul>
  37. 37. Introduction to Clinical Skills <ul><li>Head Exam. The Nose </li></ul><ul><ul><li>Examination Techniques </li></ul></ul><ul><ul><ul><li>Test for nasal obstruction </li></ul></ul></ul>
  38. 38. Introduction to Clinical Skills <ul><li>Head Exam. The Nose </li></ul><ul><ul><li>Examination Techniques </li></ul></ul><ul><ul><ul><li>Rhinoscopic exam </li></ul></ul></ul><ul><ul><ul><ul><li>Nasal mucosa </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Nasal septum </li></ul></ul></ul></ul>
  39. 39. Introduction to Clinical Skills <ul><li>Head Exam. Paranasal Sinuses </li></ul><ul><ul><li>Examination Techniques </li></ul></ul><ul><ul><ul><li>Palpation and percussion of the Sinuses </li></ul></ul></ul><ul><ul><ul><li>Transillumination </li></ul></ul></ul>
  40. 40. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques </li></ul></ul><ul><ul><li>The Lips </li></ul></ul><ul><ul><li>The Oral mucosa </li></ul></ul><ul><ul><li>The Gums and Teeth </li></ul></ul><ul><ul><li>The Roof of the Mouth </li></ul></ul><ul><ul><li>The Tongue and The Floor of the Mouth </li></ul></ul><ul><ul><li>The Pharynx </li></ul></ul><ul><ul><li>The Larynx </li></ul></ul>
  41. 41. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Lips </li></ul></ul>
  42. 42. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Oral Mucosa </li></ul></ul>
  43. 43. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Gums and Teeth </li></ul></ul>
  44. 44. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Roof of the Mouth </li></ul></ul>
  45. 45. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Tongue and Floor of the Mouth </li></ul></ul>
  46. 46. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Tongue and Floor of the Mouth </li></ul></ul>
  47. 47. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Tongue and Floor of the Mouth </li></ul></ul>
  48. 48. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Oropharynx </li></ul></ul>
  49. 49. Introduction to Clinical Skills <ul><li>Head Exam. The Oral Cavity, Pharynx and Larynx </li></ul><ul><ul><li>Examination Techniques: The Larynx </li></ul></ul>
  50. 50. Introduction to Clinical Skills <ul><li>The Neck Exam </li></ul><ul><ul><li>Landmarks </li></ul></ul><ul><ul><ul><li>C6, C7 </li></ul></ul></ul><ul><ul><li>Triangles </li></ul></ul>
  51. 51. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>General Inspection </li></ul></ul><ul><ul><ul><li>Symmetry </li></ul></ul></ul><ul><ul><ul><li>Masses </li></ul></ul></ul><ul><ul><ul><li>Scars </li></ul></ul></ul><ul><ul><li>Lymph nodes </li></ul></ul><ul><ul><li>The Trachea and Thyroid gland </li></ul></ul><ul><ul><li>The Carotid Arteries and Jugular Veins </li></ul></ul><ul><ul><li>The Barchial Plexus </li></ul></ul><ul><ul><li>ROM </li></ul></ul>
  52. 52. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>General Inspection </li></ul></ul><ul><ul><ul><li>Symmetry </li></ul></ul></ul><ul><ul><ul><li>Masses </li></ul></ul></ul><ul><ul><ul><li>Scars </li></ul></ul></ul>
  53. 53. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>Lymph nodes </li></ul></ul>
  54. 54. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>The Trachea and Thyroid gland </li></ul></ul>
  55. 55. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>The Trachea and Thyroid gland </li></ul></ul>
  56. 56. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>The Carotid Arteries and Jugular Veins </li></ul></ul>
  57. 57. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>The Brachial Plexus </li></ul></ul>
  58. 58. Introduction to Clinical Skills <ul><li>Neck Exam. Techniques of Examination </li></ul><ul><ul><li>ROM </li></ul></ul>
  59. 59. Introduction to Clinical Skills
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