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Physical Exam HEENT

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Inspection

  • Skin
    • Color: erythema, ecchymosis, white, black
    • Trophic changes (altered hair growth, sweat production)
    • Scars
  • Swelling
  • Muscle tone: atrophy, hypertrophy
  • Deformity: asymmetry, rotation, amputation
    • Face should be symmetric

Palpation

  • Palpate for
    • Effusion
    • Clicking
    • Snapping
    • Crepitus
    • Tenderness
    • Temperature
    • Masses

Head and Face

  • General
    • Gross inspection
    • Palpate scalp
  • Points of interest
    • Racoon eyes
    • Battle sign
    • Hemotympanum
    • CSF Otorrhea
    • CSF Rhinorrhea
    • Mastoid process
    • Temporomandibular Joint

Eyes

  • General
    • External eye (conjunctiva, sclera, pupil, iris, eyelids, lacrimal ducts, etc)
    • Inspect for symmetry of pupils, eyelids
    • Extraocular Movements/Near Response
    • Pupillary response
  • Consider testing
    • Visual Acuity
    • Visual Fields
    • Fundoscopy (Ophthalmoscopy
    • Manometry (testing pressure)
    • Fluorescein stain with woods lamp
    • Slit lamp
    • Ultrasound of the Eye

Ears

  • External ear
  • Otoscopy including
    • External auditory canal
    • Tympanic Membrane
  • Consider

Nose

  • External nose inspection
  • Otoscopy to evaluate nasal cavity including septum, turbinates
  • Palpation of sinuses (frontal, maxillary)

Oropharynx

  • Dentition
  • Tongue
  • Hard and soft palate
  • Uvula, tonsils

Cranial Nerves

  • CN I (Olfactory)
    • Smell (not routinely tested)
    • Can test with strong smells such as lemon, peppermint
  • CN II (Optic)
    • Pupil size, shape and symmetry
    • Visual fields by assessing 4 quadrants in each eye
    • Visual acuity using Snellen chart
    • Direct pupillary reflex (shine light in eye, look for ipsilateral restriction)
    • Consensual pupillary reflex (shine light in eye, look for contralateral restriction)
    • Accommodation reflex (switch from near object to close object)
    • Assess color using Ishihara plates
  • CN III, IV, VI (Oculomotor, Trochlear, Abducens)
    • Eyelids: look for normal, symmetric movement
    • Pupillary light reflex
    • Accommodation
    • Extraocular movement tested in all planes (classically with movement in an H pattern)
  • CN V (Trigeminal)
    • V1: forehead
    • V2: cheek
    • V3: lower mandible
    • Muscles of mastication (open and close mouth against resistance)
  • CN VII (Facial)
    • Symmetry
    • Rise eyebrows
    • Close eyes tight
    • Blow out cheeks
    • Smile
  • CN VIII (Vestibulocochlear)
  • CN IX, X (Glossopharyngeal, Vagus)
    • Cough or swallow
    • Open and say “ahhh”
  • CN XI (Accessory)
  • CN XII (Hypoglossal)
    • Open mouth
    • Stick tongue out and move side to side

See Also


Created by:
John Kiel on 11 August 2021 14:41:17
Authors:
Last edited:
13 May 2022 08:19:58
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