Heent Clinical Exam

Question 1

General -6

Answer 1

General:
1-	Introduce yourself
2-	Verify pt. Name
3-	Explain purpose of visit
a.	“I understand we will be doing a HEENT exam, correct?”
4-	State you “Wash hands”
5-	Check Vitals: HR, BP, R, T, Ht, Wt
6-	Make general statement
a.	Pt. Is a healthy male/female and in no acute distress, alert and oriented x3.

Question 2

Skin-6

Answer 2

SKIN SYSTEM
____ Inspect: color, lesions, tattoos, scars
____ Exposes skin to inspect
____ Palpate temperature (dorsal surface-hands-bilaterally)
____ Turgor
____ Inspect hair for quantity and distribution
____ Part hair; examine - scales, lesion, nits

Question 3

Head-5

Answer 3

HEAD
____ Verbalize inspection head - size, shape, symmetry
____ Verbalize inspection facial features - symmetry, tics, atrophy, tremors
____ Palpate scalp / skull
____ Palpate TMJ
____ Assess ROM of TMJ

Question 4

Eyes-18

Answer 4

EYES
____ Visual acuity of eyes (each eye individually)
____ Check confrontation (peripheral vision fields)
____ Inspect orbits, eyebrows, eyelids, eyelashes with light
____ Palpate eyebrows
____ Palpate eyelids
____ Palpate orbits
____ Inspect lower conjunctiva (pull lower lids down)
____ Inspect Sclera, Iris, Pupil for size and shape (bilaterally)
____ Inspect Cornea with tangential light (bilaterally)
____ Inspect pupil – direct response (bilaterally)
____ Inspect pupil – consensual response (bilaterally)
____ Test for pupil convergence
____ Inspect pupil accommodation (near/far)
____ Perform swinging flashlight test (dim lights)
____ Check EOM’s through 6 cardinal positions (H)
____ Check for nystagmus - horizontal
____ Inspect corneal light reflection (Twinkle test)
____ Cover/uncover – drift / strabismus (bilaterally)

Question 5

Fundoscopic exam-7

Answer 5

FUNDOSCOPIC EXAM
____ Before exam, perform or state: “Room should be darkened”
____ Instructs pt to stare at a stable object in the distance
____ Examine right eye using traditional ophthalmoscope - Verbalize looking for red light reflex, optic disc, macula and vascular supply
____ Use traditional ophthalmoscope head properly (brow piece close to examiner’s brow, approach patient obliquely, protects patient, Right-eye to Right-eye)
____ Examine left eye with panoptic ophthalmoscope
____ Asks pt to look up, down, medially, and laterally to inspect the retina
____ Use panoptic head properly (hood on patient’s face)

Question 6

Ears- 9

Answer 6

EARS
____ Inspect external structures first (bilaterally) - lesions, erythema, edema
____ Palpate/traction pinnae (bilaterally)
____ Palpate tragus (bilaterally)
____ Percuss for mastoid tenderness (bilaterally)
____ Inspect canals and tympanic membranes with otoscope (bilaterally)
____ Use otoscope properly & protect pt
____ Check gross hearing with whisper test - occlude opposite ear (bilaterally)
____ Perform Weber test
____ Perform Rinne test

Question 7

Nose-4

Answer 7

NOSE
____ Inspect external structures first - discharge, ecchymosis
____ Palpate the external structures
____ Check patency of nares bilaterally
____ Attempt to visualize nasal mucosa, septum, and turbinates - edema, erythema, polyps

Question 8

Sinuses- 8

Answer 8

SINUSES
\_\_\_\_ Inspect frontal sinuses
\_\_\_\_ Inspect maxillary sinuses
\_\_\_\_ Palpate frontal sinuses
\_\_\_\_ Palpate maxillary sinuses
\_\_\_\_ Percuss frontal sinuses
\_\_\_\_ Percuss maxillary sinuses
\_\_\_\_ Transilluminate frontal sinuses and max

Question 9

Mouth-19

Answer 9

MOUTH / OROPHARYNX
____ Inspect lips (with light)
____ Inspect teeth (with light)
____ Inspect gums (with light)
____ Inspect Buccal mucosa (with light)
____ Inspect for Stensen duct (with light)
____ Inspect tongue – asks pt to stick out tongue
____ Inspects floor of mouth, under tongue (with light)
____ Inspect lateral tongue (use gauze)
____ Inspect for Wharton gland (with light)
____ Inspects hard palate (with light)
____ Inspect soft palate & uvula (with light)
____ Asks patient to say “ah”& verbalize looking for symmetrical rise of soft palate (with light)
____ Inspect tonsils
____ Palpate gums
____ Palpate Parotid bilaterally (from Stenson’s duct inside mouth and on cheek simultaneously)
____ Palpate tongue
____ Palpate floor of mouth
____ States would check for gag reflex
____ Uses tongue blade appropriately

Question 10

Neck-9

Answer 10

NECK
____ Inspect anterior neck (swallow)
____ Inspect for tracheal position
____ Inspect posterior neck - cervical curvature
____ Palpate thyroid (swallow, proper position)
____ Palpate tracheal position
____ Cervical - flexion
____ Cervical - extension
____ Cervical - lateral rotation
____ Cervical - lateral flexion

Question 11

Nodes-9

Answer 11

\_\_\_\_ Palpate pre-auricular nodes
\_\_\_\_ Palpate posterior auricular nodes
\_\_\_\_ Palpate occipital
\_\_\_\_ Palpate submental nodes
\_\_\_\_ Palpate submandibular nodes
\_\_\_\_ Palpate tonsillar nodes
\_\_\_\_ Palpate anterior cervical nodes
\_\_\_\_ Palpate posterior cervical nodes
\_\_\_\_ Palpate supraclavicular nodes