Physical Assessment- HEENT Flashcards
What is the structure and function of the head?
CRANIUM (skull) • rests on superior end of vertebral column • Protects brain from injury • Provides surface for attachment of muscles • EIGHT bones, immovable joints: sutures
What is the structure and function of the face?
- Symmetrical structures
- Eyes
- eyebrows
- Nose
- Mouth
What is the structure and function of the neck?
- 7 flexible cervical vertebrae
- Support the head
- Allows maximum mobility
What is the neck structurally composed of?
– Muscles
– Ligaments
– Cervical vertebrae (C1 – C7)
What is within the neck?
– Hyoid bone – Blood vessels (Not Shown) – Larynx (Not Shown) – Trachea – Thyroid Cartilage
What are the most common lymph nodes?
Preauricular Postauricular Tonsillar Submandibular Submental Occipital Superficial Cervical Posterior Cervical Deep Cervical Supraclavicular
What is the health history?
Common chief complaints:
Stiff neck, hoarseness, neck mass, headache, head injury.
PQRST
What is the past history?
– Medical: specific ie. Headaches, meningitis
– Surgical: plastic surgery
– Medications : anticonvulsants
What is the family history?
Thyroid, hypo/hyper/ectomy
What is the social history?
– Diet
– Environment
– Home
What equipment do you need for head,neck, face assessment?
– Glass of water
– Stethoscope
– Flat table/surface
What do you inspect on the head and scalp?
– Face the patient with your head at the same level – Shape – Symmetry – Lesions – Masses – Hydration
What do you palpate for in head and scalp examination?
beginning in the frontal area and continue over the parietal, temporal and occipital areas – Contour – Masses – Depression – Tenderness – Texture
What do you inspect for in the skin of face?
– Colour/lesions – Assess facial symmetry – Eyes/eyebrows/nose/mouth – Shape and features – Involuntary movement
How do you palpate the face?
– Locate the temporomandibular joint on both sides
– Observe smoothness of the movement and ask if there
is any discomfort
– Listen for any sounds with the bell of the stethoscope
What do you inspect for symmetry in neck examination?
– The sternocleidomastoid muscle anteriorly
– The trapezii posteriorly
– Note any old scaring
What movements to assess in neck examination?
• Ask the patient to touch a) chin to the chest b) Chin to each side c) Chin to each shoulder • Assess for limitation of movement
What to inspect for lymph nodes?
Inspect for any enlargement or inflammation
How to palpate the lymph nodes?
– Conduct assessment simultaneously on both sides of the neck
– Using the pads and tips of the middle 3 fingers rotate in small circles using
gentle pressure
– Systematic sequence
What to assess for in lymph node examination?
- Size,
- Shape,
- Delimination,
- Mobility,
- Consistency
- Tenderness
What is past history for mouth, nose and ear examination?
– Medical: specific ie. earaches, nasal polyps, tonsillitis, deafness, speech
disorder
– Surgical: plastic surgery, tonsillectomy
– Medications : antihistamines, decongestants
What is family history for mouth, nose and ear examination?
Hearing loss
What is social history for mouth, nose and ear examination?
– Alcohol, tobacco, drug use
– Work/home environment: allergens, noise
What equipment to use in mouth, nose and ear examination?
– Otoscope – Penlight – Tongue depressor – Gloves – Tuning fork – Watch
What to inspect for in mouth examination (part 1)?
– Colour of lips, moisture, swelling – Symmetry – Smell breath – Ask patient to stick out tongue then move from side to side, up and down (CN XII)
Mouth inspection (part 2)?
– Ask patient to press tongue to each inside cheek, provide resistance and compare both sides – Ask patient to remove any dentures – Observe for tooth loss and discoloration
What to palpate in mouth examination (part 1)?
– Palpate any lesions for tenderness and consistency – Inspect and palpate surface of tongue, the fraenulum – Palpate both right and left sides using fingerpads
Mouth palpation (part 2)?
– Use tongue depressor and torch to assess inner cheeks, gums, hard & soft palate – Placing the tongue depressor on the middle third of the tongue ask the patient to say ‘ah’, observe position, size and appearance of tonsils and uvula – Note the movement and presence of the gag reflex
What to inspect for nose and sinus examination?
– Inspect shape and symmetry – Ask patient to occlude one nostril and breathe in and out, repeat on other side. – Tilt patients head back – Place hand firmly on forhead and with thumb lift the tip of the nose – Gently insert an otoscope with nasal speculum. – Inspect each nostril spearately
What to palpate in nose and sinus examination?
– Standing face to face – Gently press thumbs under bony ridge of upper orbits – Observe for presence of pain – Apply gentle pressure in area under intra orbital ridge using thumb and or middle finger – Observe for presence of pain – Percuss both areas
How to do a whisper test?
– Occluding one ear stand behind the patient and whisper a two syllable word – Ask the patient to repeat the word – Repeat on other ear
What to inspect in a ear examination?
– Position, shape
– Colour
– Symmetry
What to palpate in a ear examination?
– Using thumb and index finger
palpate each area
– No pain or tenderness should
be felt
What is past history in eye assessment?
– Medical: specific ie. Cataract hypertension, diabetes, blurred vision,
strabismus
– Surgical: Laser surgery, retina repair
– Medications : antihistamines, artificial tears
What is family history in eye assessment?
Myopia, colour blindness, macular degeneration
What is social history in eye assessment?
– Alcohol, tobacco, drug use
– Work/home environment: allergens, noise
What equipment do you need for a eye assessment?
– Snellen chart – Penlight – Opthalmoscope – Vision occluder – Cotton tipped applicator – Gloves
What do you inspect in a eye examination?
– eyelids, lashes, eyebrows
– lacrimal apparatus
– conjunctiva & sclera
– corneas
What do you palpate in a eye examination?
lacrimal apparatus
