HEENT EXAMINATION 1. HEAD o INSPECT Skull Scalp Hair Part the hair in at least 3 areas o Palpate scalp.

alp. Not for Tenderness Masses o Inspect face Facial expression Facial asymmetry Involuntary movements Edema Lesions Ears o Inspect The external ear Pinna Auditory canal with an OTOSCOPE Largest speculum needed Position head of patient to allow best insertion of otoscope Pull the auricle Up and back Hold otoscope between thumb and fingers Insert speculum gently Inspection o Auditory canal o Cone of light o Tympanic membrane o Hearing acuity Whisper test 1 to 2 feet away from the patient o Air and bone conduction Weber Lateralization Rinnes 3. Eyes o Visual acuity using a snellens eye chart 20 feet away Cover eye with a card and read the smallest line of print Repeat with other eye o Visual fields Look both eyes, 2 feet apart Hand confrontation o Inspect External eyes Position Alignment Eyebrows Eyelids Region of puncta, conjunctiva, sclera Patient look up, lower lids with thumb Cornea and lens Penlight shined obliquely across the eye Iris Pupil size Symmetry Pupillary reflex Accommodation Pupillary constriction? EOM Six cardinal gazes Opthalmoscope O diopter RRR / LLL Look slightly above yourshoulder 15 inches away from the patient Red orange reflex Optic disc? Retina? Nose o Inspect Anterior and interior surface Push gently on the tip of the nose Inside of the nose with an otoscope Tilt head slightly back Nasal septum Inferior turbinates Middle turbinates Frontal sinus Maxillary sinus 5. Mouth and pharynx o Inspect Lips Oral mucosa good light tongue blade gums teeth hard palate tongue put out the tongue floor of mouth put tongue to roof of mouth pharynx tongue in normal position AAAH Soft palate Tonsils Tongue blade Neck o Assess neck ROM Flexion Extension Rotation Lateral bending o Lymph nodes Preauricular Post auricular Occipital Tonsillar Submandibular Submental Superficial cervical Deep cervical Supraclavicular o Trachea Deviation Finger along one side of trachea Note space between it and SCM Compare o Thyroid gland Tip head back a bit Inspect region below cricoid cartilage Palpate Flex neck slightly forward Place fingers on patients neck o Just below crocoid cartilage o Ask patient to swallow

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