OPETA: HEENT (Head Ears Eyes Nose Throat)

HEENT (Head Ears Eyes Nose Throat)	Online PETA Home
View Entire Video Primary Exam Inspection Palpation Temporomandibular Joint Superficial Lymph Nodes Thyroid Gland External Eye Eye Movement External Ear Otoscopic Exam Nose Exam Mouth and Throat Exam Palpation of the Mouth Special Considerations Be able to identify the significance of a positive finding of any of these tests Deep Cervical lymph nodes Facial Tenderness Upper Eyelid Eversion Pneumatic Otoscopy Sinus Transillumination	Inspection Inspect for asymmetry, deformity, scars, lumps, involuntary movements, hair loss, or edema Palpation Palpate the head and neck for tenderness, deformity, and masses Temporomandibular Joint Place fingers in front of the tragus of both ears Ask patient to open and close their mouth Note any tenderness, crepitus, or loss of ROM Superficial Lymph Nodes Systematically palpate the following: Occipital, Postauricular, Preauricular, Tonsillar, Submandibular, Submental, Anterior Cervical, Supraclavicular Thyroid Gland Inspect for obvious enlargement Position self behind patient Palpate cricoid cartilage (landmark) Move downward two or three rings Palpate for the thyroid isthmus Move laterally to both thyroid lobes While palpating, ask the patient to swallow- provide a cup of water if possible External Eye Inspect for ptosis, exophthalmos, lesions, deformity, or asymmetry Pull down lower lid while asking patient to look up to inspect conjunctiva and sclera Spread lids while asking patient to look in 4 directions to inspect bulbar surface Repeat on other side Wash hands before and after this portion of the exam Eye Movement Inspect corneal reflections Stand 3-6 feet in front of patient Have patient hold head still and follow examiners finger with eyes in 6 cardinal directions Check convergence External Ear Inspect ears and surrounding area Palpate the mastoid processes Gently move each ear and asks about discomfort Otoscopic Exam Hold otoscope properly Pull ear upward and backward Insert otoscope to proper depth Examine canal and middle ear Nose Exam Insert otoscope avoiding the septum Start inspection at the "floor" and move upward Repeat on other side Mouth and Throat Exam Use otoscope or other bright light Ask patient to open their mouth Inspect the anterior structures Inspect the tongue and under Inspect the posterior oropharynx Ask the patient to say "Ah." Palpation of the Mouth Use a gloved finger inside the mouth Use other hand for counter pressure on outside Palpate anterior structures Palpate floor of mouth Pull tongue out using gauze and palpates Special Considerations: Deep Cervical lymph nodes Hook fingers around the anterior edge of the SCM muscle Ask patient to tilt head forward and toward side being examined Move muscle backward while palpating structures underneath Repeat on other side Special Considerations: Facial Tenderness Press under both eyebrows Press over both maxillary sinuses Special Considerations: Upper Eyelid Eversion Ask patient to look down Gently grasp upper eyelashes and pull out and down Place cotton applicator above lid edge Turn eyelid over Inspect conjunctiva Ask patient to blink to flip eyelid back Special Considerations: Pneumatic Otoscopy Proper grip with bulb Perform standard exam Pull ear down and back on a pediatric patient Gently presse bulb Observe tympanic membrane for movement Special Considerations: Sinus Transillumination Room must be dark Place bright light (otoscope) over maxillary sinus Ask patient to open mouth Compare "glow" on both sides
ONLINE PHYSICAL EXAM TEACHING ASSISTANT	The UF College of Medicine Harrell Center