CVS/Respiratory/HEENT Exam
CVS
Introduce yourself
Ask for the patients name
Orient the patient on what you are going to do
Ask the patient to remove his shirt and lie down
on the bed
Remember
Examiners position is always on the right
Place the patient in left lateral decubitus
(LLDP)position if:
o There is no visible pulsations
o Assessing for the apex beat
o S3,S4 murmurs using bell of the
stethoscope
Use the bell of stethoscope:
o BP
o S3& S4 murmurs
o Bruit
Always start at the apex beat in using z pattern
to prevent confusion during practicals
Always report during or after every examination
being done. (of course wait for proper timing
before you report- yung iba kc huli ndi pa tapos
yung ginagawa ngrereport nah aha^_^)
INSPECTION/ PALPATION
Inspect for bulging or depression of the thorax
REPORT: There is no bulging or depression of the
thorax
Using a penlight inspect for visible pulsation in a
supine position, if there is no pulsation seen
turn the patient in left lateral decubitus
position
REPORT : There is no visible pulsations upon
tangential lighting in supine position, There is
visible pulsation upon tangential lighting in left
lateral decubitus position
Palpate using the tip your finger and locate its
apex beat(LLDP); determine the exact
anatomical location
REPORT: The apex beat is @ 5th LICS MCL
Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs
Palpate and inspect for other pulsations
specially in the parasternal areas and epigastric
area
REPORT: Adynamic Precordium with no other
visible pulsations
Palpate for lifts( finger tip),
thrills(metacarpophalangeal joint), Heaves
(Heel of the hand) in a Z pattern staring from
the apex beat going to the left parasternal line
up to the erbs point, then to the pulmonic area
and going to the right to the aortic area
REPORT: No thrills heaves lifts noted.
Inspect and palpate for masses,tenderness and
lesions of the thorax
REPORT: There is no lesions masses and
tenderness noted.
Neck
Elevate the head of the patient by 30 (in
practicals, just fold the pillow into half to
elevate the head)
Turn the head of the patient away from you.
Inspect and palpate the carotid pulse
REPORT: Carotid pulse is palpable strong and
bounding
Inspect for neck vein distention
REPORT: No neck vein distention
Check for JVP: (using a ruler and a tongue
depressor place the ruler at the top of the
Sternal angle of Louie. Measure the JVP (the
highest vein in the neck, page 351) using the
tongue depressor parallel to the ruler. (NOTE:
ask for the proctor if you need to do this,
especially if there is no neck vein distention,
minsan kasi ganito ang comment: Bakit ka nag-
memeasure ng JVP eh wala na ngang neck vein
distention!.. Pero sa iba gusto nila ipagawa pa
din yan for sake na alam mo pano gawin)
REPORT: JVP is 3 cm h20 (normal 3-4 but in
practical puposes be specific)
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 CVS/Respiratory/HEENT Exam

AUSCULTATION Bruit hint after this perform peripheral pulse

Let the patient lie down in supine position, turn
Auscultate the apex, assess for rate and rhythm the head of the patient away from examiner.
of the heart. Use the bell of the stethoscope in the carotid
REPORT: Heart rate is ___ bpm (1 minute) with artery.
normal rate regular rhythm, (tachy >100, brady REPORT: There is no bruit heared in the carotid
<60) artery (note: bruit + aortic murmur= aortic stenosis,
Auscultate chest from the apex beat going to pulmonary murmurs does not produce bruit in
the left parasternal line, then going up to the carotid artery)
erbs point then to the pulmonic area and lastly,
going to the aortic area Peripheral pulse
Assess:
o Carotid pulse
Dont palpate at the same
time
Report: carotid pulse palpable strong and
bounding
o Radial Pulse
o Brachial pulse
o Femoral pulse
Report: S1 is loudest @ the apex o Popliteal pulse
S2 is loudest @ the base o Posterior tibial pulse
Report: ___is pulse palpable strong and
Presence of s3 and s4 murmurs bilaterally equal
o Dorsalis pedis- maybe present or
Place the patient in left lateral decubitus absent
position, use the bell of the stethoscope and
lightly place it in the apex
REPORT: no s3 and s4, no extra heart sounds
heared

Assessing pulmonic mumurs, aortic murmur and

physiologic splitting

Place the patient in sitting position leaning

forward.
Use the diaphragm of the stethoscope. Place
the stethoscope in the pulmonic area. Ask
patient to inhale exhale then hold
Place the stethoscope in aortic area ask patient
to inhale exhale then hold
REPORT: no aortic and pulmonic murmurs heared.

Place the stethoscope in pulmonic area, this

time ask the patient to inhale and hold
REPORT: there is a positive/negative physiologic
splitting

Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs Page 2
 CVS/Respiratory/HEENT Exam
Respiratory
Introduce yourself
Ask for the patients name
Orient the patient on what you are going to do.
Ask the patient to remove his shirt
Remember
Examiners position is always on the right
Always report during (inspection) or after every
examination being done. (of course wait for
proper timing before you report- yung iba kc
nahuhuli kasi hindi pa tapos yung ginagawa
ngrereport na ^_^ like regular rate normal
rhythm nirereport eh hindi ka pa kumukuha
cardiac rate)
Perform Palpation, Percussion and Auscultation
in the anterior chest first then posterior chest
or vice versa ^_^
INSPECTION
Inspect for visible contractions of accessory
muscles of respiration
REPORT: There are no visible contractions of
accessory muscles of respiration.
Inspect for the skin, subcutaneous blood vessels
and muscle development
REPORT: Skin is brown in color, warm to touch.
There is no visible subcutaneous blood vessels
with normal muscle development.
Inspect for the bony thorax shape, symmetry
and gross deformities, AP Diameter
REPORT: Bony thorax is elliptical in shape,
symmetric with no gross deformities noted.
AP diameter is 1/3 or 2/3 of transverse diameter.
Check for RR(1 min), rhythm, bulging and
widening of the ICS and chest lagging
REPORT: RR of ___ bpm, with normal depth and
rhythm; no bulging and widening of the ICS
without chest lagging.
Inspect for the timing of inspiration and
expiration and chest expansion
Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs
REPORT: Inspiration is longer than expiration with
effortless breathing, symmetric chest expansion.
PALPATION
Anterior chest
Palpate for masses and tenderness
Report: There are no tenderness and masses noted
upon palpation
Palpate equal chest expansion using two hands
with thumb having symmetrical space in in
relation with the midline (page 298,306 bates)
REPORT: symmetrical lung expansion
Tactile fremitus: Place the hands on the 4 sites
in the chest found in page 298,306 of Bates and
tell the patient to say tres-tres everytime you
place your hand in his chest.
REPORT: Equal tactile fremitus on both lung fields
PERCUSSIONn
Percuss the lungs in its aucultatory locations
page 307
REPORT: Resonant on all lung fields except on the
3-5th LICS location of the heart and to 7th RICS MCL
@the back: resonant on all lung fields.
AUSCULTATION
Page 301,303,307
Auscultate on the different auscultatory areas
note for breath sounds page 303 bates
Report: vesicular breath sounds on all lung fields
Auscultate on the different auscultatory areas;
note for bronchopony, ask the patient to say
tres-tres every time you place the stethoscope
in an auscultatory area, sounds should be
muffled
REPORT: sounds are muffled negative for
bronchopony
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 CVS/Respiratory/HEENT Exam

Auscultate on the different auscultatory areas;

note for egophony, ask the patient to say E
every time you place the stethoscope in an
auscultatory area, sounds should be E not A

REPORT: sound heared as E, negative for

egophony

Auscultate on the different auscultatory areas;

note for Whispered Pectoriloquy; ask the
patient to whisper tres-tres every time you
place the stethoscope in an auscultatory area,
sounds should be not be clearly heared.

REPORT: sounds cannot be clearly heared,

negative for whispered pectoriloquy.

REPEAT: PALPATION, PERCUSSION,

AUSCULTATION @ the posterior chest.

Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs Page 4
 CVS/Respiratory/HEENT Exam
HEENT
Introduce your self
Ask for the patients name
Orient the patient on what you are going to do.
Remember
Examiners position is always on the right
Always report during(inspection) or after every
examination being done. (of course wait for
proper timing before you report- yung iba kasi
nahuhuli, hindi pa tapos yung ginagawa
ngrereport na ^_^ like regular rate normal
rhythm nirereport eh hindi ka pa kumukuha
cardiac rate)
Tip: for you to finish HEENT on time, you should
be able to know the sequence and what to
assess next by just looking at the face of the
patient
o if you forgot what to do next, dont stop,
continue assessing your patient with
the next procedure that you have in
mind. (remember time is running out
^_^)
o assess what you had forgotten if you
had extra time later.
Note: Maraming deviation sa normal
kadalasan sa HEENT, so be ready ^_^( lalo sa
mouth and ears)
CRANIUM
Assess for hair color, quantity distribution,
texture, condition of scalp
REPORT: The hair is black in color, abundant,
well distributed, smooth and has a dry texture,
Scalp is slightly movable along with the
cranium, no lesions, no parasites(lice)
Palpate size, shape, symmetry, deformities,
masses and tenderness
REPORT: The cranium is normocephalic,
symmetrical, and has no deformities.
No tenderness no masses
Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs
Pulsations in temporal artery
REPORT: Temporal arteries are not visible but
palpable with strong/ weak palpation
FACE
Assess for symmetry, skin color, texture and
lesions.
REPORT: The face is symmetrical, skin is brown
in color smooth with no lesions (if with
pimples or scared pimple indicate if it is
papular lesion or round scar.)
Assess for facies/ facial expression by asking
the patient to smile or frown.
REPORT: There is no abnormal facies
Facial movements
REPORT: Face has no involuntary movements
EYES
Pattern
Top going Down
Start from the hair at the top (eyebrow) going
down (eyelash).
Next is Eyelid going down to the periorbital area
going to the eye ball
Eyebrow: color and distribution
REPORT: eyebrows are black, well distributed
Eye lash: color and characteristics
REPORT: eyelash is black, short and present in
both upper and lower eyelids
Eyelids: lesions, width of palpebral fissure,
ptosis, retraction, relationship of upper and
lower eye lid to the limbus (exopthalmos,
enopthalmos, lid lag if + exopthalmos,
search n lang sa net lidlag and video)
REPORT: eye lid has no lesion no edema and
negative for lid lag negative for exopthamos
and enopthalmos
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 CVS/Respiratory/HEENT Exam
Palpebral fissure measure using ruler
(measurement of the eyes from lateral
cantus to medial cantus or vice versa)
REPORT: palpebral fissure is about _cm in
diameter.
Periorbital area- sunken, swelling,
hematoma
REPORT: Periorbital area are not sunken,
swelling and no hematoma.
Evaluate eye ball tension by palpation
REPORT: Upon palpation no tenderness of the
eyeball was noted.
Out Going IN
Conjunctiva
REPORT: conjunctiva is pinkish/pale in color,
no swelling and hematoma
Sclera
REPORT: Sclera is dirty looking white in color,
no lesions
Cornea
REPORT: Cornea is transparent, no opacities,
no ulcers, no foreign body
Iris
REPORT: Iris is round and black/brown in color
Pupil- measure the pupil in diameter.
Next- check if it is reacting to light (constrict
with light and dilates without light) and
accommodation (dilate when object is near
pupil constricts when object is far it dilates
page 210 bates)
Next- measure the direct and consensual
light reflex
REPORT: Pupils symmetrical, about _mm in
diameter upon constriction, round and
reactive to light and accommodation(PERRLA)
+Direct and + Consensual light reflex
Lens- lens opacity can be seen with the
previous exam you did in pupils
REPORT: both lens are transparent, no opacity.
Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs
Visual acuity- reading material or a news
paper ask the patient to read a the smallest
letter in about 12 inches or 1 foot length
REPORT: The patient was able to read the
smallest font in a news paper print at a
distance of 1 foot.
Visual field- confrontation test page 212
(ndi na pinagawa saamin)
REPORT: no gross defects in visual field
Fundoscopy- page 218 (observe proper
technique only check for the red orange
reflex)
REPORT: upon fundoscopy + red orange
reflex
EARS
Inspect :
External ear size, shape, symmetry,
deformity, lesions
REPORT: External ear is triangular in shape
symmetrical no deformity no lesions
Palpate for tenderness over the auricles
(move the pinna and tragus if there is pain
+ TUG TEST = + OTITIS EXTERNA) and
mastoid
REPORT: no tenderness over the pinna and
mastoid area
External auditory canal using otoscope
page 225 bates patency, color of walls,
discharge, foreign body, tympanic
membrane( color bulging retracted,
intact/perforated)- central or peripheral
REPORT: External auditory canal is patent,
walls are pinkish in color, no discharges and no
foreign bodies.
Tympanic membrane is pearly white in color
with good cone of light, no bulging, no
retraction, and no perforation.
Hearing test: Rub fingers
REPORT: Patient can hear on both ears by
rubbing of fingers.
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 CVS/Respiratory/HEENT Exam

NOSE
Size and shape
REPORT: Nose is Symmetrical and blunt
Movement of ala nasi
REPORT: There is no flaring of the ala nasi
Examine vestibule, patency, mucosa,
secretions, bleeding points, nasal septum,
position, perforation- close one nostril of the
patient then ask the patient to sneeze, do this
in the other side
Rhinoscopy page 229-230 bates
o Technique
Turbinates
REPORT: Nasal vestibule is patent pinking in
color with no secretions and no bleeding, nasal
septum is straight at the midline and no
perforation.
Turbinates are _?_ in color no edema no
swelling no secretions.
Paranasal sinus- palpate for tenderness of the
paranasal sinuses page 231 bates. Perform
transillumination of the frontal and maxillary
sinus
REPORT: There is no tenderness of the paranasal
sinuses upon palpation and there is no clouding of
the paranasal sinuses upon transillumination test
MOUTH & THROAT
Observe proper techniques in examination page 234
bates sequence outer to inner (practical exams
purpose)
Lips
Report: Lips are pink in color, symmetrical, dry,
with no lesion.
Gingiva
REPORT: Gingiva are pinkish, no bleeding, no
gingival recession, no hypertrophy or atrophy.
Tongue- instruct the patient to protrude
tongue move upwards downwards, laterally
and retract.
REPORT: Tongue is pink in color no lesion no
hypertrophy and atrophy, Tongue is in the midline
in position upon protrusion and retraction, can
move without difficulty.
Palate
REPORT: Palate is pinkish with no lesions has
symmetrical elevations uvula is in midline.
Tonsils
REPORT: Tonsils are small and pink, no
enlargement, no secretion, no exudates.
Pharyngeal wall
Report: Posterior pharyngeal wall is pinkish with no
lesions, no swelling, no exudates.
NECK
Describe skin
REPORT: Skin is brown in color
Architecture, Palpate for tenderness and
muscle tone
REPORT: no deformity, neck is symmetrical,
Trapezius and sternocleidomastoid are well
developed.
ROM- ask the patient to flex, extend, lateral
bending, neck rotation.
REPORT: no deviation of movement patient was
able do perform ROM without difficulty.

Buccal mucosa Trachea position and deviation page 240 bates

REPORT: Buccal mucosa is Pinkish and moist, no REPORT: Trachea is in the midline.
lesions no swelling.
Palpate for the thyroid page 242 bates position
Teeth o examiner@ the back of the patient ask
REPORT: Complete set of Teeth, no dental carries, the patient to swallow
no malocclusion.
Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs Page 7
 CVS/Respiratory/HEENT Exam

REPORT: Thyroid gland is not visible but palpable

with no tenderness

Lymph node( Impt.name all the lymphnodes)

o Examiner @ the back of the patient
o Start with submental lymphnode end
with supraclavicular

REPORT: (while palpating the lymphnode) There is no

Submental, submandibular, tonsilar, pre-auricular,
posterior auricular, occipital, superficial cervical, deep
cervical, posterior cervical, and supraclavicular
lymphadenopathy.
(page 239) (pattern of arrangement anterior to
posterior then downwards).

(while palpating the lymph node, name the nodes that

have no lymphadenopathy while skipping the enlarged
lymph nodes)

Example: If tonsillar lymph nodes are enlarged while the

other lymph nodes are normal.

REPORT: There is no submental, submandibular, pre-

auricular, posterior auricular, occipital, superficial
cervical, deep cervical, posterior cervical, and
supraclavicular lymph adenopathy.
There is a tonsillar lymphadenopathy.
(page 239) (pattern of arrangement anterior to
posterior then downwards).

Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs Page 8