Vitals and the HEENT Exam

Question 1

The Vital Signs

Answer 1

Heart Rate

Temperature

Blood Pressure

Respiratory Rate

O₂ Saturation

Question 2

Normal heart rate

Answer 2

60-100 bpm

Question 3

Normal breathing rate

Answer 3

8-12 breaths per minute

Question 4

Preparation for taking proper blood pressure

Answer 4

Quiet and comfortable environment

Sitting for at least 5 minutes

No caffeine or smoking prior

Arm free of clothing and supported

Brachial artery at heart level

Question 5

Method for taking blood pressure via palpation

Answer 5

1. Place BP cuff above the elbow
2. While palpating the brachial pulse, keep inflating until it disappears, then add 20-30mm Hg more pressure.
3. Deflate slowly until the pulse returns
4. Read the pressure at which the pulse returns. This is the systolic blood pressure.

Question 6

Method for taking blood pressure via auscultation

Answer 6

1. Place the cuff above the elbow
2. Inflate to 20-30 mmHg past where you can no longer hear the heart beat
3. Deflate slowly at a rate of ~2-4 mmHg per second
4. Record the pressure at which you hear two consecutive beats (Korotkoff sounds). This is the systolic pressure.
5. Continue to deflate.
6. Record the pressure at which the sounds muffle and then disappear. This is the diastolic blood pressure.

Question 7

Elevated blood pressure

Answer 7

120-129 / <80

Question 8

High blood pressure / Stage I Hypertension

Answer 8

130-139 / 80-89

Question 9

Stage II Hypertension

Answer 9

140-179 / >90

Question 10

Hypertensive Crisis

Answer 10

>180 / >120

Question 11

Normal Temperature

Answer 11

~98.6 degrees Fahrenheit

Question 12

Definition of Clinical Fever

Answer 12

Single reading >101 Fahrenheit

OR

>100.4 Fahrenheit for one hour

Question 13

____ can interfere with pulse oximeter reading.

Answer 13

Nail polish

Question 14

Format for Vital Signs

Answer 14

Question 15

Sphygmomanometer

Answer 15

blood pressure cuff

Question 16

Tachypnea

Answer 16

Increased breathing rate

>20 breaths per minute

Question 17

Bradypnea

Answer 17

Decreased respiratory rate

<8 breaths per minute

Question 18

Accomadation

Answer 18

As you move your finger towrads the patient’s nose, while they are following with their eyes, their pupils contract. As you move it away, they dilate.

Question 19

Testing light reflexes of the pupil

Answer 19

First without blocking, shine a light in each eye one at a time and observe contraction.

Then, while blocking light along the nose bridge with one hand, do the same, and this time note both eyes.

This tests ipsilateral and contralateral light reflexes.

Question 20

Examining the retina

Answer 20

Have the patient remove glasses

Using an opthalmoscope, have your patient look at a fixed point straight ahead of them (pick an actual object) and adjust the aperture to the size of their pupil. Adjust the diopter to see properly (you will not need glasses). Find an artery and follow it to the optic disc.

Question 21

Otoscope view

Answer 21

Question 22

“Say ahh” view

Answer 22

Question 23

A typical thyroid is ____g

Answer 23

A typical thyroid is ~25-30g

Question 24

HEENOT

Answer 24

Head

Ears

Eyes

Nose

Oral

Throat

Question 25

Answer 25

Ptosis

Question 26

Answer 26

Question 27

PERRLA

Answer 27

Pupils equal Reactive to Light Accomodation

Question 28

Retinal projection diagram

Answer 28

Question 29

Innear ear diagram

Answer 29

Question 30

Tinnitus

Answer 30

ringing of the ears

Question 31

Inner ear view (via otoscope)

Answer 31

Question 32

Teeth and gum view

Answer 32

Question 33

Neck muscles and lymph nodes

Answer 33

Question 34

Palpation of lymph nodes

Answer 34

Have the patient flex their head slightly forward. Notice: Size Texture (hard or soft) Flexibility (fixed or immovable) Large, hard, immovable lymph nodes suggest malignancy.

Question 35

Palpation for the supraclavicular node

Answer 35

Place hands at approximately the midclavicular point. Node's position should be superior and inbetween two muscles around this point. Any palpable node is a sign of GI tract malignancy.

Question 36

Lymph node findings and interpretation

Answer 36

Question 37

Local vs General Lymphadenopathy

Answer 37

Local: Local infection, inflammation, or malignancy General: Systemic infection, inflammation, or malignancy

Question 38

If you find lymphadenopathy in one lymph node. . .

Answer 38

check more!!!!

Question 39

The thyroid. Where the hell is it?

Answer 39

Question 40

Example thyroid presentation

Answer 40

Thyroid gland elevates symmetrically with swallowing. No nodules, enlargement or tenderness

Question 41

scleral icterus

Answer 41

Jaundiced (yellow) sclera

Question 42

Conjunctiva

Answer 42

clear mucous membrane that covers the anterior eyeball and the eyelids.

Question 43

Miosis

Answer 43

constriction of the pupil (\<3mm). This can be caused by many drugs. One example is opiates.

Question 44

Mydriasis

Answer 44

dilation of the pupil (\>5mm). This can be caused by many drugs.

Question 45

Extra Ocular Movements

Answer 45

this tests the 6 extra ocular muscles that control the eyes and these are controlled by 3 cranial nerves **(III, IV, VI**).

Question 46

Visual acuity

Answer 46

expressed as two numbers (20/40.) The **first number indicates** the **distance of the patient from the Snellen eye chart** (ie 20 feet) and the **second**, the **distance at which a normal eye can read the line of letters**. 20/40 means that at 20 feet the patient can read the read the print that someone with normal vision could read at 40 feet. ## Footnote **The larger the second number then the worse the vision.**

Question 47

Nasal septum

Answer 47

This is a wall of cartilage and bone that separates the nose into a right and left airway. If crooked (deviated) it can impact the nasal airway.

Question 48

Nasal turbinates

Answer 48

These cylindrical shaped bones covered in a mucosal lining act as the **humidifiers of the nose**. They have **a lot of vascular tissue** and are responsible for several properties of nasal physiology including, but not limited to, **congestion and decongestion of the nose** as well as **helping to filter the air.**

Question 49

Hard palate

Answer 49

bony portion of the roof of the mouth, separating the nose from the mouth.

Question 50

Soft palate

Answer 50

soft tissue that makes up the roof of the mouth. This is situated **posterior to the hard palate** and includes several muscles responsible for closing off the nose from the mouth during acts of swallowing and speaking. It **contains the uvula.**

Question 51

The thyroid isthmus sits right below the. . .

Answer 51

Circothyroid cartilage

Question 52

Nodule

Answer 52

a growth within the thyroid gland which may be “**hot**” (producing **excess hormone**) or “**cold**” (not **producing excess hormone**). Nodules can be **solid**, fluid-filled (**cystic**), or have mixed components. They can be **malignant or benign**. Assessing for nodules is done by both inspection AND palpation of the thyroid gland. **Thyroid nodules are very common**.

Question 53

Goiter

Answer 53

**Enlargement of the thyroid gland**. This can be associated with **overproduction, underproduction, or normal production of thyroid hormone**. It is associated with several different conditions; therefore, is **NOT a diagnosis** of the condition, but rather a finding. Small goiters rarely cause symptoms; however, **large ones can lead to symptoms of coughing, hoarseness, difficulty swallowing, or difficulty breathing.**

Question 54

Hyperthyroid/Hyperthyroidism

Answer 54

Disorder in which the thyroid gland produces too much thyroid hormone (“overactive” or “**high thyroid state**”). Symptoms and signs can include u**nintentional weight loss**, **palpitations secondary to tachycardia**, **arrhythmia** (atrial fibrillation), **anxiety**, **tremor**, **sweating**, **heat intolerance**, **changes to the menstrual cycle**, **skin thinning**, **brittle hair**, **increased bowel movements**, **weakness**, **hyperreflexia**. A goiter may also be present depending on the cause.

Question 55

Hypothyroid/Hypothyroidism

Answer 55

Disorder in which the thyroid gland does not produce enough thyroid hormone (“underactive” or “**low thyroid state**”). Symptoms can include **fatigue, cold intolerance, muscle weakness, constipation, weight gain, dry and thick skin, increased body hair, irregular menses. Signs can include bradycardia and delayed relaxation of or “hung up” reflexes**. A goiter may also be present depending on the cause.

Question 56

Submandibular lymph node

Answer 56

Under the mandible and are usually small and smooth compared the submandibular gland.

Question 57

Anterior cervical lymph node

Answer 57

superficial to the sternocleidomastoid muscle

Question 58

Posterior cervical lymph node

Answer 58

along the anterior edge of the trapezius muscle

Question 59

Supraclavicular lymph node

Answer 59

Deep in the angle formed by the clavicle and the sternocleidomastoid muscle. (An enlarged supraclavicular lymph node on the left can be a sign of a metastasis from a thoracic or abdominal malignancy.)

Question 60

Blood pressure cuff sizing

Answer 60

* **Width** of the inflatable bladder of the cuff should be approximately **40%** of the arm circumference * **Length** of the inflatable bladder of the cuff should be approximately **80%** of the arm circumference * **If the cuff is too small (narrow), the blood pressure will read higher** than the patient’s actual pressure; **if the cuff is too large (wide), the blood pressure will read lower** than the patient’s actual pressure. * The patient should avoid smoking, caffeine, or exercise for 30 minutes prior to measurement.