Head and Neck Checklist

This criterion is linked to a Learning Outcome

1. Knocks on door and introduces self, explain purpose of exam, obtain consent

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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2. Washes hands properly

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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3. Head Exam Inspection/ palpation of the scalp

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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4. Palpates thoroughly the diﬀerent parts of head

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threshold: pts

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Yes

2.0 pts

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1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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5. Observe facial features for contour, shape, and symmetry

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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6. EARS Inspects externally bilaterally

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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7. Palpates auricles bilaterally and palpation over the mastoid bone

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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8. Auditory acuity tested with correct technique

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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9. Weber and Rinne tests to be performed

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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10. Otoscopic examination bilaterally

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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11. Otoscopic examination performed without pain

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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12. Auricles pulled superiorly, posteriorly, and away from patient

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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13. NOSE AND NASAL CAVITIES Tests for nasal obstruction

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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14. Otoscope used with nasal speculum to inspect nasal vault or may use otoscope ear speculum

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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15. Nasal speculum examination done without causing pain

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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16. Palpate frontal sinus for tenderness (medial brow left and right, be sure not too high)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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17. Palpate maxillary sinus for tenderness (correct position)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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18. Palpate ethmoid sinus (bridge of nose) for tenderness

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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19. MOUTH AND PHARYNX Inspect external surface of lips with light

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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20. Inspect mucosa of lips, teeth, gums, buccal surfaces with light

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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21. Inspect tongue and soft palate

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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22. Inspect floor of mouth (under tongue)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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23. Elevation of palate (“ah”) to inspect posterior pharynx, use tongue depressor

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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24. Examination done with minimal discomfort

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

--

25 NECK : Inspects anterior neck for symmetry

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

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26. Carotid arteries palpated (2 positions from each side upper and lower)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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27. Carotid arteries correctly palpated, singly, lower or upper neck (not mid-neck)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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28. Auscultation of carotid arteries (2 positions from each side upper and lower) bilaterally with bell

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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29. THYROID Inspects anterior neck for symmetry

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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30. Thyroid gland inspected from front with chin slightly elevated

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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31. Thyroid gland palpated from behind, chin is slightly flexed

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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32. Hands in proper position (below the cricoid cartilage)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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33. Palpates the isthmus and has patient swallow

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

--

34. Palpates the lobes and has patient swallow

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

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35. LYMPH NODES Preauricular (in front of the ear)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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Not done

0.0 pts

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pts

2.0 pts

--

36. Posterior auricular (behind the ear)

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threshold: pts

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Yes

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

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37. Occipital (below the occipital tubercle)

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

--

38. Tonsillar (angle of jaw)

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threshold: pts

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

--

39. Submandibular (mid-jaw)

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threshold: pts

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

--

40. Submental (under chin)

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threshold: pts

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

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41. Posterior cervical (posterior border of sternomastoid muscle)

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threshold: pts

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

--

42. Superficial cervical (on surface of the sternomastoid muscle)

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threshold: pts

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

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43. Deep cervical (deep in the sternomastoid muscle on medial border))

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

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44. Supraclavicular (above the clavicle)

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

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45. Thanks patient and ask if patient has any questions

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Full Marks

2.0 pts

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Partly

1.0 pts

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No Marks

0.0 pts

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pts

2.0 pts

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Description of criterion

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threshold: 5 pts

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Full Marks

5 pts

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No Marks

0 pts

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pts

5 pts

--

Head and Neck Checklist

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