HEENOT Physical Exam SPBL

Question 1

general appearance

Answer 1

grooming, posture, affect, speech, breathing, level of comfort/distress - verbalize at least 2

Question 2

head inspection

Answer 2

look for asymmetry, facial features, lesions - verbalize all

Question 3

Eyes

Answer 3

• eyebrows: note thinning
• eyelids: note lesions (options: papules, pustules, discharge, erythema, scaling edema, stye, eversion/inversion)
• conjunctiva/sclera: pull lower lid down to inspect inside of eye/lids
• extraocular movements: follow finger in pattern w/ head still
• nystagmus: follow finger look for beating
• convergence/accomadation: watch finger come toward nose
• cover test: watch for movement
• visual fields by confrontation
• visual acuity: card at arms length test each eye
• direct/consensual: light in both eyes twice
• red reflex: note presence
• optic disc: note color/margins
• retinal arteries/veins: note copper wiring, AV nicking, pulsations
• macula: note hemorrhages/exudates

Question 4

Ears

Answer 4

• external ear: evaluate pinna and mastoid area, palpate external ear
• auditory acuity: finger rub test
• Weber: eyes closed, tuning fork in middle of head, ask if heard equally
• Rinne’s: tuning fork on mastoid, when no longer hear, move to EAC and if they still hear and if louder
• EAC: pull ear up and back and visual ear canal
• TM: visualize TM and note cone of light, color, and perfs if present

Question 5

Nose

Answer 5

Nares: pts head back, inspect mucosa, drainage, septum, turbinates
Nasal patency: occlude each nostril and have pt breathe
Palpate/transilluminate sinuses: maxillary and frontal; ck for tenderness

Question 6

Mouth/throat

Answer 6

• teeth: caries, breaks, etc
• gums: ck peridontal disease, lesions, masses,
• oral mucosa: inside of lips and cheeks
• hard and soft palate: verbalize
• uvula: look for deviation w/ elevation when pt says “ah”
• tonsils: note size in relation to pillars, exudates, erythema
• posterior oropharynx: look for PND, cobblestoning
• tongue: look for deviation

Question 7

Lymph nodes to palpate:

Answer 7

• palpate from behind
• anterior cervical
• posterior cervical
• occipital
• preauricular
• postauricular
• tonsillar
• submandibular
• submental
• supraclavicular