You are on page 1of 8

CVS/Respiratory/HEENT Exam

CVS Palpate and inspect for other pulsations


specially in the parasternal areas and epigastric

Introduce yourself area

Ask for the patients name

Orient the patient on what you are going to do REPORT: Adynamic Precordium with no other

Ask the patient to remove his shirt and lie down visible pulsations
on the bed
Remember Palpate for lifts( finger tip),
Examiners position is always on the right thrills(metacarpophalangeal joint), Heaves
Place the patient in left lateral decubitus (Heel of the hand) in a Z pattern staring from
(LLDP)position if: the apex beat going to the left parasternal line
o There is no visible pulsations up to the erbs point, then to the pulmonic area
o Assessing for the apex beat and going to the right to the aortic area
o S3,S4 murmurs using bell of the REPORT: No thrills heaves lifts noted.
stethoscope
Use the bell of stethoscope: Inspect and palpate for masses,tenderness and
o BP lesions of the thorax
o S3& S4 murmurs REPORT: There is no lesions masses and
o Bruit tenderness noted.
Always start at the apex beat in using z pattern
to prevent confusion during practicals Neck
Always report during or after every examination Elevate the head of the patient by 30 (in
being done. (of course wait for proper timing practicals, just fold the pillow into half to
before you report- yung iba kc huli ndi pa tapos elevate the head)
yung ginagawa ngrereport nah aha^_^) Turn the head of the patient away from you.
Inspect and palpate the carotid pulse
INSPECTION/ PALPATION REPORT: Carotid pulse is palpable strong and
bounding
Inspect for bulging or depression of the thorax
REPORT: There is no bulging or depression of the Inspect for neck vein distention
thorax REPORT: No neck vein distention

Using a penlight inspect for visible pulsation in a Check for JVP: (using a ruler and a tongue
supine position, if there is no pulsation seen depressor place the ruler at the top of the
turn the patient in left lateral decubitus Sternal angle of Louie. Measure the JVP (the
position highest vein in the neck, page 351) using the
REPORT : There is no visible pulsations upon tongue depressor parallel to the ruler. (NOTE:
tangential lighting in supine position, There is ask for the proctor if you need to do this,
visible pulsation upon tangential lighting in left especially if there is no neck vein distention,
lateral decubitus position minsan kasi ganito ang comment: Bakit ka nag-
memeasure ng JVP eh wala na ngang neck vein
Palpate using the tip your finger and locate its distention!.. Pero sa iba gusto nila ipagawa pa
apex beat(LLDP); determine the exact din yan for sake na alam mo pano gawin)
anatomical location REPORT: JVP is 3 cm h20 (normal 3-4 but in
REPORT: The apex beat is @ 5th LICS MCL practical puposes be specific)

Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs Page 1
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 REPORT: Inspiration is longer than expiration with


effortless breathing, symmetric chest expansion.
Introduce yourself
Ask for the patients name
Orient the patient on what you are going to do. PALPATION
Ask the patient to remove his shirt
Anterior chest
Remember
Palpate for masses and tenderness
Examiners position is always on the right Report: There are no tenderness and masses noted
Always report during (inspection) or after every upon palpation
examination being done. (of course wait for
proper timing before you report- yung iba kc Palpate equal chest expansion using two hands
nahuhuli kasi hindi pa tapos yung ginagawa with thumb having symmetrical space in in
ngrereport na ^_^ like regular rate normal relation with the midline (page 298,306 bates)
rhythm nirereport eh hindi ka pa kumukuha REPORT: symmetrical lung expansion
cardiac rate)
Perform Palpation, Percussion and Auscultation Tactile fremitus: Place the hands on the 4 sites
in the anterior chest first then posterior chest in the chest found in page 298,306 of Bates and
or vice versa ^_^ tell the patient to say tres-tres everytime you
place your hand in his chest.
INSPECTION REPORT: Equal tactile fremitus on both lung fields

Inspect for visible contractions of accessory


muscles of respiration PERCUSSIONn
REPORT: There are no visible contractions of
accessory muscles of respiration. Percuss the lungs in its aucultatory locations
Inspect for the skin, subcutaneous blood vessels page 307
and muscle development REPORT: Resonant on all lung fields except on the
REPORT: Skin is brown in color, warm to touch. 3-5th LICS location of the heart and to 7th RICS MCL
There is no visible subcutaneous blood vessels @the back: resonant on all lung fields.
with normal muscle development.
AUSCULTATION
Inspect for the bony thorax shape, symmetry
and gross deformities, AP Diameter Page 301,303,307
REPORT: Bony thorax is elliptical in shape, Auscultate on the different auscultatory areas
symmetric with no gross deformities noted. note for breath sounds page 303 bates
AP diameter is 1/3 or 2/3 of transverse diameter. Report: vesicular breath sounds on all lung fields

Check for RR(1 min), rhythm, bulging and Auscultate on the different auscultatory areas;
widening of the ICS and chest lagging note for bronchopony, ask the patient to say
REPORT: RR of ___ bpm, with normal depth and tres-tres every time you place the stethoscope
rhythm; no bulging and widening of the ICS in an auscultatory area, sounds should be
without chest lagging. muffled
REPORT: sounds are muffled negative for
Inspect for the timing of inspiration and bronchopony
expiration and chest expansion

Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs Page 3
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
Pulsations in temporal artery
Introduce your self REPORT: Temporal arteries are not visible but
Ask for the patients name palpable with strong/ weak palpation
Orient the patient on what you are going to do.
FACE
Remember
Examiners position is always on the right Assess for symmetry, skin color, texture and
lesions.
Always report during(inspection) or after every REPORT: The face is symmetrical, skin is brown
examination being done. (of course wait for in color smooth with no lesions (if with
proper timing before you report- yung iba kasi pimples or scared pimple indicate if it is
nahuhuli, hindi pa tapos yung ginagawa papular lesion or round scar.)
ngrereport na ^_^ like regular rate normal
rhythm nirereport eh hindi ka pa kumukuha Assess for facies/ facial expression by asking
cardiac rate) the patient to smile or frown.
REPORT: There is no abnormal facies
Tip: for you to finish HEENT on time, you should
be able to know the sequence and what to Facial movements
assess next by just looking at the face of the REPORT: Face has no involuntary movements
patient
o if you forgot what to do next, dont stop, EYES
continue assessing your patient with Pattern
the next procedure that you have in Top going Down
mind. (remember time is running out Start from the hair at the top (eyebrow) going
^_^) down (eyelash).
o assess what you had forgotten if you Next is Eyelid going down to the periorbital area
had extra time later. going to the eye ball
Note: Maraming deviation sa normal
kadalasan sa HEENT, so be ready ^_^( lalo sa Eyebrow: color and distribution
mouth and ears) REPORT: eyebrows are black, well distributed

CRANIUM Eye lash: color and characteristics


REPORT: eyelash is black, short and present in
Assess for hair color, quantity distribution, both upper and lower eyelids
texture, condition of scalp
REPORT: The hair is black in color, abundant, Eyelids: lesions, width of palpebral fissure,
well distributed, smooth and has a dry texture, ptosis, retraction, relationship of upper and
Scalp is slightly movable along with the lower eye lid to the limbus (exopthalmos,
cranium, no lesions, no parasites(lice) enopthalmos, lid lag if + exopthalmos,
search n lang sa net lidlag and video)
Palpate size, shape, symmetry, deformities, REPORT: eye lid has no lesion no edema and
masses and tenderness negative for lid lag negative for exopthamos
REPORT: The cranium is normocephalic, and enopthalmos
symmetrical, and has no deformities.
No tenderness no masses
Transcribed by E.J. Cabanado and J.H. Caraveo of Silangan Boys ^_^ Gudluck sa Pracs Page 5
CVS/Respiratory/HEENT Exam

Palpebral fissure measure using ruler Visual acuity- reading material or a news
(measurement of the eyes from lateral paper ask the patient to read a the smallest
cantus to medial cantus or vice versa) letter in about 12 inches or 1 foot length
REPORT: palpebral fissure is about _cm in REPORT: The patient was able to read the
diameter. smallest font in a news paper print at a
distance of 1 foot.
Periorbital area- sunken, swelling, Visual field- confrontation test page 212
hematoma (ndi na pinagawa saamin)
REPORT: Periorbital area are not sunken, REPORT: no gross defects in visual field
swelling and no hematoma.
Fundoscopy- page 218 (observe proper
Evaluate eye ball tension by palpation technique only check for the red orange
REPORT: Upon palpation no tenderness of the reflex)
eyeball was noted. REPORT: upon fundoscopy + red orange
reflex
Out Going IN EARS
Inspect :
Conjunctiva External ear size, shape, symmetry,
REPORT: conjunctiva is pinkish/pale in color, deformity, lesions
no swelling and hematoma REPORT: External ear is triangular in shape
symmetrical no deformity no lesions
Sclera
REPORT: Sclera is dirty looking white in color, Palpate for tenderness over the auricles
no lesions (move the pinna and tragus if there is pain
+ TUG TEST = + OTITIS EXTERNA) and
Cornea mastoid
REPORT: Cornea is transparent, no opacities, REPORT: no tenderness over the pinna and
no ulcers, no foreign body mastoid area

Iris External auditory canal using otoscope


REPORT: Iris is round and black/brown in color page 225 bates patency, color of walls,
discharge, foreign body, tympanic
Pupil- measure the pupil in diameter. membrane( color bulging retracted,
Next- check if it is reacting to light (constrict intact/perforated)- central or peripheral
with light and dilates without light) and REPORT: External auditory canal is patent,
accommodation (dilate when object is near walls are pinkish in color, no discharges and no
pupil constricts when object is far it dilates foreign bodies.
page 210 bates) Tympanic membrane is pearly white in color
Next- measure the direct and consensual with good cone of light, no bulging, no
light reflex retraction, and no perforation.
REPORT: Pupils symmetrical, about _mm in
diameter upon constriction, round and Hearing test: Rub fingers
reactive to light and accommodation(PERRLA) REPORT: Patient can hear on both ears by
+Direct and + Consensual light reflex rubbing of fingers.

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 Page 6
CVS/Respiratory/HEENT Exam

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