Assessment of the Head, Eyes, Ears, Throat and Neck (HEENT)

Inspect the Head o Normocephalic Microcephalic abnormally small head Macrocephaly abnormally large head o Temporal artery Arteritis o Temporomandibular joint o Scalp Inspect for lesions, scaling, tenderness, and masses o Inspect the face Symmetry Central brain lesion (C A! CN II damage e"g" #ell$s palsy %acial e&pression ' an&iety, e&cessi(e smiling Abnormal facial structure )&ophthalmus, changes in s*in color )dema ' periorbital or across the chee*s Tics )&cessi(e blin*ing +rinding of the ja, Compare )yebro,s, nasolabial folds, sides of mouth o Inspect the Nec* Symmetry ' head position midline Head tilt in muscular spasm Trachea in midline -.M Chin to chest Head to shoulder Turn head to - and / (say 0no1!" o 2erson turns shoulders instead of nec* Note pain, ratchety mo(ement, limited -.M due to arthritis or inflammation of nec* muscles /ymph nodes 3 Note4 Si5e and shape 6elimitation Mobility Consistency ' hard or soft Tenderness (,ith acute infection! /ymph Nodes 2reauricular4 2osterior auricular .ccipital4 base of the s*ull Submental Submandibular4 half,ay bet,een the angle and the tip of the mandible 7ugulodigastric (tonsilar!

Superficial cer(ical 6eep cer(ical 2osterior cer(ical Supracla(icular o Thyroid +land +oiter Inspect the )yes o Inspect )&ternal .cular Structures o %acial e&pression ' s8uinting o )yebro,s Mo(e symmetrically No scaling or lesions o )yelids9eyelashes )yelids meet together The palpebral fissure )yelashes should be e(enly distributed 2tosis ' drooping of upper lid S*in ,ithout redness, discharge or lesions o )yeballs )&ophthalmos (protruding eyes! )nophthalmos (sun*en eyes! o Conjuncti(a and sclera Conjuncti(a 3 normal color ' pin* o(er lo,er lids, ,hite o(er sclera Sclera ' china ,hite o Assess for drainage, s,elling, redness, asymmetry : lesions )&ternal : Internal hordeolum (stye! )ctropion Conjucti(itis Arcus Senilis Cataract o 2)--/A Contralateral 2upil Constriction Inspect the )ar o Inspection of the )ar o )ars should be e8ual si5e Microtia ' ears smaller than ; cm (ertically Macrotia ' ears larger than <= cm (ertically o S*in intact, same color as face, intact Tenderness Mo(e pinna and push on tragus Assess for lesions, s,elling, drainage o Tympanic Membrane .toscope ' just for fun Note any redness, s,elling, discharge, foreign bodies The tympanic membrane, or eardrum translucent ,ith a pearly gray color" )ar drum should be flat and intact Inspection of Nose, Mouth and Throat o )ternal nose Symmetric, midline No inflammation Test for patency o 2alpate sinuses

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Nose Mouth

.(er frontal sinuses belo, eyebro,s .(er ma&illary sinuses belo, chee*bones Assess for lesions, s,elling, symmetry, discharge Assess moisture, lesions, s,elling, drainage, teeth and gums /ips ' color, moisture, crac*ing (Cheilitis! or lesions -etract lips and note inner surface Teeth and gums An adult mouth has >? teeth 6iseased, missing, loose or abnormally positioned teeth 6ecayed teeth caries +ingi(al hypertrophy #leeding gums Tongue 2in* and e(en 6orsal surface rough ,ith papillae Thin ,hite coating As* pt to touch tongue to roof of mouth o entral surface should be smooth, glistening, sho,ing (eins Sali(a is present )nlarged tongue abnormal o Mental retardation, hypothyroidism, acromegaly Mouth 6ry mouth ' dehydration )&cessi(e drooling /oo* for lesions e"g" can*er sores, ,hite patches (thrush! (malignancies! @(ula As* person to say aahh o Soft palate and u(ula rise in the midline (CN A!

Throat Inspect for lesions Tonsils Acute infection Bhite membrane co(ering tonsils mononucleosis, leu*emia, diphtheria )nlargementC Acute infection, ?D, >D, or ;D o <D 3 (isible o ?D half,ay bet,een tonsillar pillars o >D touching u(ula o ;D touching each other