Physical Assessment- HEENT

Question 1

What is the structure and function of the head?

Answer 1

CRANIUM (skull) 
• rests on superior end of vertebral 
column 
• Protects brain from injury 
• Provides surface for attachment of 
muscles 
• EIGHT bones, immovable joints: 
sutures

Question 2

What is the structure and function of the face?

Answer 2

• Symmetrical structures
• Eyes
• eyebrows
• Nose
• Mouth

Question 3

What is the structure and function of the neck?

Answer 3

• 7 flexible cervical vertebrae
• Support the head
• Allows maximum mobility

Question 4

What is the neck structurally composed of?

Answer 4

– Muscles
– Ligaments
– Cervical vertebrae (C1 – C7)

Question 5

What is within the neck?

Answer 5

– Hyoid bone 
– Blood vessels (Not Shown) 
– Larynx (Not Shown) 
– Trachea 
– Thyroid Cartilage

Question 6

What are the most common lymph nodes?

Answer 6

Preauricular 
Postauricular 
Tonsillar 
Submandibular 
Submental 
Occipital 
Superficial Cervical 
Posterior Cervical 
Deep Cervical 
Supraclavicular

Question 7

What is the health history?

Answer 7

Common chief complaints:
Stiff neck, hoarseness, neck mass, headache, head injury.
PQRST

Question 8

What is the past history?

Answer 8

– Medical: specific ie. Headaches, meningitis
– Surgical: plastic surgery
– Medications : anticonvulsants

Question 9

What is the family history?

Answer 9

Thyroid, hypo/hyper/ectomy

Question 10

What is the social history?

Answer 10

– Diet
– Environment
– Home

Question 11

What equipment do you need for head,neck, face assessment?

Answer 11

– Glass of water
– Stethoscope
– Flat table/surface

Question 12

What do you inspect on the head and scalp?

Answer 12

– Face the patient with 
your head at the 
same level 
– Shape 
– Symmetry 
– Lesions 
– Masses 
– Hydration

Question 13

What do you palpate for in head and scalp examination?

Answer 13

beginning 
in the frontal area 
and continue over 
the parietal, 
temporal and 
occipital areas 
– Contour 
– Masses 
– Depression 
– Tenderness 
– Texture

Question 14

What do you inspect for in the skin of face?

Answer 14

– Colour/lesions 
– Assess facial symmetry 
– Eyes/eyebrows/nose/mouth 
– Shape and features 
– Involuntary movement

Question 15

How do you palpate the face?

Answer 15

– 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

Question 16

What do you inspect for symmetry in neck examination?

Answer 16

– The sternocleidomastoid muscle anteriorly
– The trapezii posteriorly
– Note any old scaring

Question 17

What movements to assess in neck examination?

Answer 17

• 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

Question 18

What to inspect for lymph nodes?

Answer 18

Inspect for any enlargement or inflammation

Question 19

How to palpate the lymph nodes?

Answer 19

– 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

Question 20

What to assess for in lymph node examination?

Answer 20

• Size,
• Shape,
• Delimination,
• Mobility,
• Consistency
• Tenderness

Question 21

What is past history for mouth, nose and ear examination?

Answer 21

– Medical: specific ie. earaches, nasal polyps, tonsillitis, deafness, speech
disorder
– Surgical: plastic surgery, tonsillectomy
– Medications : antihistamines, decongestants

Question 22

What is family history for mouth, nose and ear examination?

Answer 22

Hearing loss

Question 23

What is social history for mouth, nose and ear examination?

Answer 23

– Alcohol, tobacco, drug use

– Work/home environment: allergens, noise

Question 24

What equipment to use in mouth, nose and ear examination?

Answer 24

– Otoscope 
– Penlight 
– Tongue depressor 
– Gloves 
– Tuning fork 
– Watch

Question 25

What to inspect for in mouth examination (part 1)?

Answer 25

``` – 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) ```

Question 26

Mouth inspection (part 2)?

Answer 26

``` – 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 ```

Question 27

What to palpate in mouth examination (part 1)?

Answer 27

``` – Palpate any lesions for tenderness and consistency – Inspect and palpate surface of tongue, the fraenulum – Palpate both right and left sides using fingerpads ```

Question 28

Mouth palpation (part 2)?

Answer 28

``` – 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 ```

Question 29

What to inspect for nose and sinus examination?

Answer 29

``` – 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 ```

Question 30

What to palpate in nose and sinus examination?

Answer 30

``` – 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 ```

Question 31

How to do a whisper test?

Answer 31

``` – Occluding one ear stand behind the patient and whisper a two syllable word – Ask the patient to repeat the word – Repeat on other ear ```

Question 32

What to inspect in a ear examination?

Answer 32

– Position, shape – Colour – Symmetry

Question 33

What to palpate in a ear examination?

Answer 33

– Using thumb and index finger palpate each area – No pain or tenderness should be felt

Question 34

What is past history in eye assessment?

Answer 34

– Medical: specific ie. Cataract hypertension, diabetes, blurred vision, strabismus – Surgical: Laser surgery, retina repair – Medications : antihistamines, artificial tears

Question 35

What is family history in eye assessment?

Answer 35

Myopia, colour blindness, macular degeneration

Question 36

What is social history in eye assessment?

Answer 36

– Alcohol, tobacco, drug use | – Work/home environment: allergens, noise

Question 37

What equipment do you need for a eye assessment?

Answer 37

``` – Snellen chart – Penlight – Opthalmoscope – Vision occluder – Cotton tipped applicator – Gloves ```

Question 38

What do you inspect in a eye examination?

Answer 38

– eyelids, lashes, eyebrows – lacrimal apparatus – conjunctiva & sclera – corneas

Question 39

What do you palpate in a eye examination?

Answer 39

lacrimal apparatus