HEENT Assessment Flashcards
Health History Points
Head, Neck and Face
- headache
- head injury
- dizziness
- neck pain, limitation of movement
- lumps or swelling
- history of head or neck surgery
(pre)syncope
feeling experienced prior to falling caused by a decreased blood flow to the brain, or a heart irregularity causing decreased cardiac output
True Vertigo
a sense of true rotational spinning from a vestibular disorder of the inner ear
Subjective Vertigo
person feels like they are spinning
Objective Vertigo
person feels like the room is spinning
Physical Exam: The Neck
Head, Face and Neck
- Inspect and Palpate the Neck
a. Symmetry - head in midline (erect
and still), accessory neck
muscles symmetrical, trachea
and thyroid midline)
b. Range of Motion - movements
are smooth and controlled
CN XI (Spinal Accessory Nerve) - test with resistance exercises
Resistance Exercises Test CN:
XI - Spinal Accessory Nerve
(tests muscle strength)
Facial Expressions Test CN:
VII - Facial Nerve
Physical Exam: Head and Face
Head, Face and Neck
- Inspect and Palpate the Skull
a. general size and shape
b. temporal area - temporal artery, TMJ (open
and closed) - Inspect the Face
a. facial structures - note facial expression
(appropriateness), eyes are aligned
normally (no protrusion or sunken
appearance)
CN XII (facial nerve) - test with facial expressions
Headaches (2 types)
- Primary - headache is primary issue
a. tension
b. migraine
c. cluster - Secondary - headaches secondary to an injury or disorder
tension headache
primary headache
- occipital or frontal
- halo/ band-like tightness around the head
migraine
primary headache (vascular)
- supraorbital, retro-orbital, frontotemporal
- associated nausea, vomiting, and visual
disturbances
- chronic, genetic
cluster headache
primary headache (vascular)
- produce pain around the eye, temple, forhead,
cheek
- shorter in duration
Health History Points
Eyes
- Vision Difficulty
- Pain in/ around eyes
- Watering, Discharge
- History of Ocular Problems
- Medications
- Occupational Work Hazards
Floaters
indicate potential retinal detachment
Scotoma
blind spot in the visual field surrounded by an area of normal or decreased vision
Glaucoma
disorders of the optic nerve and visual pathway characterized by increased intraocular pressure
- causes decreased peripheral vision
- no pain associated
Diplopia
double vision
Strabismus
deviation in the anteroposterior axis of the eye (cross eye)
Photophobia
inability to tolerate light
Lacrimation
tearing
Epiphora
excessive tearing
Physical Exam: Vision Acuity + Fields
Eyes
- Snellen Eye Chart (acuity)
- Confrontation Test (field) - cover one eye, move
flickering finger into peripheral field
Physical Exam: Extraocular Muscle Function (3 tests)
Eyes
- Corneal Light Reflex
- Cover-Uncover Test
- Six Cardinal Planes Test
Corneal Light Reflex
assess symmetry of eye alignment by shining a light into patient eyes (30 cm away) while they look straight
→ reflection should appear in the same spot
bilaterally
Cover-Uncover Test
used to detect small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel
- Ask the patient to stare at you nose even when
their gaze is interrupted → move an opaque
card over one eye and hold there
a. Observe uncovered eye for movement →
normal response is a steady gaze
- abnormal: the eye jumps to fixate on the
point (nose) when covered, it was
misaligned before → test again with
other eye
b. Remove the card and observe the
previously covered eye for movement
- normal: steady gaze
- abnormal: the eye jumps to re-establish
fixation on the point (nose), eye muscle
weakness exists
Six Cardinal Planes Test
lead the eyes through the six cardinal positions of gaze to reveal eye muscle weakness upon movement
- Have the patient follow your finger or an
object (30cm away) with their eyes without
moving their head as you move through the
cardinal positions
Physical Exam: Anterior Eye Structures
Eyes
- Eyes - aligned in sockets, no protrusion or
sunken appearance - Conjunctiva - should be moist and glossy
- Sclera - white - grey/blue
PERRLA
Eyes
Pupils Equal and Round - normally round, regular,
and equal size (3-5mm resting)
Reactive to Light - observe pupil dilation and
construction in response to light
a. direct light reflex - constriction of observed
eye
b. consensual light reflex - constriction of
opposite eye
Accommodation - test the eye’s ability to change focus (near vs far)
a. far = dilation
b. near = constriction
Older Adult Considerations - Eyes
Eyes
- skin loses its elasticity, causing wrinkling and
drooping - Lacrimal glands involute, causing decreased
tear production = feeling of dryness and burning - Impaired visual acuity – decreases participation
in social and leisure activities and increases the
risk for injuries and accidents (falls)
a. Pupil size decreases → decreased ability to
adapt to darkness, more light is needed to
see
b. Lens loses elasticity → decreases ability to
change shape to accommodate for near
vision
c. Debris can accumulate in the vitreous
humor (floaters) because this fluid is not
continuously renewed - Aging increases the risk of developing:
a. Macular Degeneration - breakdown of cells
in the macula of the retina, loss of central
vision but peripheral vision is unaffected
→ cause of blindness
b. Cataracts - lens opacity/ cloudiness due
to proteins clumping in lens
c. Glaucoma - increased ocular pressure
damages optic nerve resulting in gradual
loss of peripheral vision
d. Diabetic Retinopathy - when a person’s
blood sugar is too high, this causes the
blood vessels in the retinal to become
damaged or blocked and eventually lead
to vision loss
Health History Points
Ears
- Earache
- Infection
- Discharge
- Hearing Loss
- Environmental Noise
- Tinnitus
- Vertigo
- Self-Care Behaviours
Otalgia
pain in the ear
Otorrhea
Discharge from the ear → note quality (colour) and odour, relationship with ear pain
Physical Exam: External Ear
Ears
Palpate and Inspect the External Ear
a. size and shape - same size bilaterally, no
swelling or thickening
b. skin condition - consistent with facial skin
colour, no lumps or lesions
c. tenderness - pinna and tragus should be firm,
no pain
d. External Auditory Meatus - note the size of
opening, swelling, redness, discharge
Physical Exam: Otoscope
Ears
Inspection with an Otoscope
a. External Canal - note redness or swelling,
foreign bodies, discharge
b. Tympanic membrane - normal eardrum is
shiny and translucent, pearly grey, intact
Physical Exam: Auditory Testing
Ears
a. Whispered Voice Test - stand an arm’s length away from the patient from behind, mask hearing in opposite ear by pushing the tragus into the auditory meatus (to prevent sound transmission around the head)
- Inability to hear whisper is an indication of
hearing loss (initially high pitched sounds)
Older Adult Considerations
Ears
- Hearing acuity usually declines with age
- The cilia lining the ear canal become coarse
and stiff → may impede sound waves
traveling to the eardrum = decrease in
hearing - Earwax become drier (due to atrophy of
apocrine glands) → cilia stiffening causes it
to accumulate and oxidize = decrease in
hearing
- The cilia lining the ear canal become coarse
- Early losses (which start in young adulthood), involve primarily the high pitched sounds, but gradually, losses extends to sounds in the middle and lower ranges
Health History Points
Nose
- Discharge
- Frequent Cold
- Sinus Pain
- Trauma
- Epistaxis
- Allergies
- Alterned Smell
Rhinorrhea
discharge from the nose
- note quality (colour), odour
Epistaxis
nosebleeds
Health History Points
Mouth and Throat
- Sores or Lesions
- Sore Throat
- Bleeding Gums
- Toothache
- Sugar Consumption
- Bruxism
- Hoarseness
- Dysphasia
- Altered Taste
Bruxism
teeth grinding
Physical Exam: Nose
Nose
a. External Structures - should be midline, symmetrical, and in proportion to features
- test patency of nostrils
b. Nasal Cavity - note swelling, discharge, bleeding or foreign body, nasal septum deviation or polyps
Physical Exam: Sinuses
Nose
press over the frontal sinuses below the eyebrows and over the maxillary sinuses below the cheekbones → patient should feel firm pressure but no pain
- Sinus areas tender to palpation with chronic
allergies and acute infection (sinitus)
Physical Exam: Lips, Teeth, Tongue
Mouth and Throat
a. Lips - colour, moisture, cracking, lesions
b. teeth/ gums - assess quality of teeth and gums
c. tongue - check for colour, surface characteristic, moisture
Physical Exam: Oral Cavity, Pharynx
Mouth and Throat
a. Buccal Mucosa - normally pink, smooth and
moist
b. Palate - the anterior hard palate is white with
irregular transverse rugae, the posterior soft
palate is pinker, smooth, and upwardly
movable
c. Uvula - midline
d. Throat - tonsils (colour should be the same as
oral mucosa) → grade
e. Mouth - assess for breath odour
Halitosis
breath odour
Grading for Tonsils
1+ = visible (normal)
2+ = halfway between tonsillar pillars and uvula
(normal)
3+ = touching the uvula, midline of throat
(abnormal)
4+ = touching each other (abnormal)
→ medical emergency, can obstruct airway,
difficulty swallowing, pain
Older Adult Considerations
Nose, Mouth and Throat
- Oral Cavity
a. Soft tissues atrophy and the epithelium
tissue thinks (cheeks and tongue) = loss of
taste buds and reduction in taste functioning
b. Decreased salivary secretion = decreased
taste functioning, reduces the mouth’s self-
cleaning property, and decreases
c. Teeth may wear down, become abraded, or
fall out due to periodontal disease
→ loss of smell + taste + periodontal
disease = risk of malnutrition, change of
eating habits - Nose
a. Subcutaneous fat is gradually lost during
later middle adult years, making the nose
appear more prominent in some people
b. The sense of smell may diminish
progressively after the age of 60 years due to
a decreased number of olfactory nerve fibres
