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A comprehensive guide to the heent (head, eyes, ears, nose, and throat) exam, covering the step-by-step process and the key elements to be examined during each stage. It covers the examination of the hair, scalp, and skull, followed by the face, skin, eyes, ears, nose, mouth, tongue, and neck. Detailed instructions on how to perform each part of the exam, including the use of specialized tools like the ophthalmoscope and otoscope. It also covers the various tests and assessments that should be conducted, such as visual acuity, visual field testing, pupillary light reflex, and hearing tests. An invaluable resource for medical students, healthcare professionals, and anyone interested in understanding the heent exam in depth.
Typology: Exams
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What is the first step of the HEENT exam? - Answer ✔✔The hair-scalp-skull exam When examining the hair, what are we examining? - Answer ✔✔The thickness of the hair, the quality and quantity, any areas of hair loss How do we examine the scalp? What do we examine? - Answer ✔✔Part areas of the hair to expose the scalp. Note for any scaliness, lesions, or lumps. Next, we feel the scalp, for any deformities and ask patient to note for any feelings of tenderness as we press down on the scalp After completing the hair-scalp-skull exam, what comes next? - Answer ✔✔The face exam How do we perform the face exam? - Answer ✔✔We first examine the face noting for any signs of edema, lesions, involuntary movements. After completing the face exam, what comes next? - Answer ✔✔Skin exam How do we perform the skin exam? - Answer ✔✔Note the color of the skin, the texture of the skin, any signs of lesions or rashes After completing the skin exam, what comes next? - Answer ✔✔The eye exam
What comes first in the eye exam? - Answer ✔✔Note the position and alignment of the eyes. Then we examine the eyebrows. Look underneath to see if there is any scaliness and also note the distribution of the hair. Next look at the eyelids, noting any edema, bumps, or lesions. Also note the direction of the eyelashes. What do we do next in the eye exam? - Answer ✔✔Examine the conjunctiva and sclera. To do this, pull down on patient's eyes and ask patient to look up. Then pull up on patient's eyelid and ask patient to look down. As we are doing this, we are looking at the color and any lesions/nodules/discharges. We also look at the cornea to see if any cloudiness/opacities/rings After examining the conjunctiva/sclera/cornea, what do we do? - Answer ✔✔Test the patient's visual acuity How do we test the patient's visual acuity? - Answer ✔✔Grab the eye chart. Ask patient to hold the chart about 14 inches from eye at eye level. Ask patient to cover one eye and ask patient to read the smallest line that they can read. Repeat on other side. After testing for patient's visual acuity, what do we do next? - Answer ✔✔Test patient's visual fields How do we test patient's visual fields? - Answer ✔✔ask patient to cover one eye and ask patient to fix gaze upon your nose. Place two fingers on either side of the patient and ask patient to tell you when she can see neither, one, or both fingers. Do this horizontally, and diagnoally on both sides. Repeat on other side After testing for patient's visual fields, what do we test for? - Answer ✔✔Patient's extraocular muscle
How do we test for extaocular muscle? - Answer ✔✔ask patient to not move head. Ask patient to follow your finger with her eyes. Watch for smooth pursuit, any jerky eye movements. Then bring finger close to eye to test for convergence. After examining patient's extraocular muscles, what do we do? - Answer ✔✔Examine patient's pupils How do we examine patient's pupils? - Answer ✔✔First use eye chart to assess pupil size/shape/symmetry. Should be about 4mm on both side. Note shape and symmetry After examining patient's pupil, what do we do? - Answer ✔✔Note patient's direct and consensual light reflex How do we note patient's direct and consensual light reflex? - Answer ✔✔Shine light onto one eye, watch for pupil constriction of that eye. Then shine light onto the same eye again, and then this time watch for the other eye. After examining light reflexes of eye, what do we do? - Answer ✔✔Use opthalmoscope to look at back of eye. How do we use the opthalmoscope in the eye exam? - Answer ✔✔Ask patient to look at distant object in the room. Come in at a 15 degree angle from right side and then left side. As we hold the opthalmoscope, have one finger on the focus wheel. The lights should be dimmed. Shine opthalmoscope into eye, look for red reflex. Come in and look at the blood vessels, and follow them to the optic disc. Ask patient to look into the light to see the macula. Repeat on other side. Hold scope in left hand as examine the left eye. After using theopthalmoscope, what do we do? - Answer ✔✔The ear examination
What is the first step of the ear examination? - Answer ✔✔First note the ear positioning to make sure they are symmetrical on both sides. Then look at the ears to note for any lesions, erythema, and rashes. After inspection of the ear, what do we do? - Answer ✔✔Palpation of the ear How do we palpate the ear? - Answer ✔✔Palpate the auricle, tragus, and ask patient to note for any signs of tenderness. Then palpate mastoid process and ask for pain/tenderness. After palpation of the ear, what do we do? - Answer ✔✔Use otoscope to look into the ear. When using the otoscope, what is the first step? - Answer ✔✔Grab a tip and place it onto otoscope, making sure it is tight How do we hold the otoscope? - Answer ✔✔Place thumb and index finger close to the head of the otoscope, leaving three fingers to brace against the patient. How do we examine the ear using the otoscope? - Answer ✔✔Pull the auricle out, up and back. Place fingers against patient's face, and rest tip just inside the canal. Look inside What are we examining in the ear with the otoscope? - Answer ✔✔Looking at ear canal for signs of swelling, erythema. Visualize the tympanic membrane. Look at cone of light. Note for any redness or any exudates. Also note for any perforations of the tympanic membrane.
After using the otoscope to examine the ears, what is the next step? - Answer ✔✔Test gross hearing of patient How do we test gross hearing of patient? - Answer ✔✔Ask patient to close both eyes and cover one ear. Then make a sound and ask patient to note what the sound is. Repeat on the other ear After testing gross hearing of patient, what do we do next? - Answer ✔✔Using tuning fork to perform the Weber test How do we perform the Weber test? - Answer ✔✔Use 512 Hz tuning fork. We will place tuning fork at top of the head, and ask patient whehter they hear louder on the right of left ear. First activate the tuning fork by hitting it againt elbow. Place fork on top of paten After performing the Weber test, what do we do? - Answer ✔✔Perform the Rinne test How do we perform the Rinne test? - Answer ✔✔Strike the tuning fork, place it behind ear on mastoid process. Ask patient to tell you when you no longer hear the sound. Then move the fork to front of ear, and then ask patient if they hear it again? After testing hearing of patient, what do we do next? - Answer ✔✔Examine the nose When examining the nose, what are we looking for? - Answer ✔✔Symmetry, any trauma/swelling. Then palpate the nose from the top of the bridge to the tip of the nose and ask patient if they feel any tenderness
After examining the nose, what do we do? - Answer ✔✔Look at the nose using an otoscope How do we use the otoscope to examine the nose? - Answer ✔✔Hold otoscope the same way as we did when examining the ear. Ask patient to look up slightly, place tip into the nose. When using the otoscope to examine the nose, what are we looking for? - Answer ✔✔Nasal mucosa looking for exudates, bleeding, septal perforations, trauma After using the otoscope to examine the nose, what do we do? - Answer ✔✔Palpate the sinuses of the face How do we palpate the sinuses of the face? - Answer ✔✔Palpate the frontal sinuses and then maxillary sinuses. Ask patient if they feel any tenderness After palpation of the face sinuses, what do we do? - Answer ✔✔Inspect the patient's mouth When inspecting the patient's mouth what are we doing first? - Answer ✔✔Inspect the lips, looking for redness, cracking, ulcers, lesions After inspecting the lips, what do we do? - Answer ✔✔Use tongue blade to inspect inside the mouth. Then use otoscope to look inside, looking at the buccal mucosa on both sides. look at the teeth, gums, look at tongue and roof of the mouth. Then ask patient to say ahhhh, then look at the tonsillar pillars, uvula, and tonsils for erythema/exudates/size
After inspecting inside the mouth, what do we do? - Answer ✔✔Palpate the tongue and floor of the mouth How do we palpate the tongue/floor of mouth? - Answer ✔✔Open gauze pad to grab patient's tongue wearing gloves. Grab tip of the tongue, and feel on both sides for any bumps. Feel tip as well. Then hold tongue on one side so we can palpate the floor of the mouth, keeping thumb under the chin and first finger into the floor of the mouth to feel for any bumps. After palpation of the tongue/floor of the mouth, what comes next? - Answer ✔✔Neck examine What is the first step in the neck exam? - Answer ✔✔Palpation of lymph nodes via sweeping motion. Palpate preauricular nodes, postauricular, occipital, tonsilar, submandibular, submental, superficial cervical, posterior cervical, deep cervical, and supraclavicular AFter examining the lymph nodes, what do we do next? - Answer ✔✔Examine thyroid How do we examine the thyroid first step? - Answer ✔✔ask patient to take a sip of water and hold it in their mouth. Use light to shine tangenitally across the neck to visualize any nodules. Ask patient to swallow as we shine light and look for nodules that may shadow across the neck. Repeat on other side. What is the next step of thyroid exam? - Answer ✔✔Palpate thyroid How do we palpate the thyroid? - Answer ✔✔Palpate the isthmus and then each lobe individually via posterior approach. Palpate the thyroid cartilage, then go down to the cricoid cartilage. Just below that should be thyroid isthmus. Ask
patient to drink a little bit of water, swallow. Ask patient to flex neck slightly to relax muscles of neck. Then push from left side and palpate the right lobe of the thyroid. Ask patient to swallow water. Feel for nodules/lumps/abnormal sensations. Then displace to the right to palpate left lobe of thyroid. After thyroid exam, what do we do? - Answer ✔✔Palpate trachea How do we palpate trachea? - Answer ✔✔Go to sternal notch, and note equal spacing of trachea on either side