HEENT Assessment

Exophthalmus

Palpable fissures

Weber Test

Rinne Test

involuntary movement of eye in horizontal vertical rotary or mixed direction

nystagmus

an eye that moves to focus after being uncovered

strabismus

loss of elasticity in eyes with age 

presbyopia

____________ _________ size is a symptom of underlying hypothyroidism.

enlarged tongue size

top number of 20/100

what patient can see at 20 feet

bottom number of 20/100

what general population sees at 20 feet

_______________ is a reflexion of underlying hyperthyroidism.

exopthalamus

dec. metabolism

dec. effect

weight gain

what do these symptoms indicate?

hypothyroidism

Present Health Status

noticed any __________?

Any ________ conditions?

current ___________

changes, chronic conditions, medications

Past Health History

any ______ or ________ to eyes, ears, mouth, or neck

injury, surgery

Family History

• ________ involving mouth or throat

• any _______, _______ or _________ conditions

cancer, vision, hearing, thyroid

Personal Psychosocial

• when was your last ______, ________, and ________ exams?

• do you wear ________ or contacts?

• any ____________ risk?

• any use of ________ products or ___________.

dental, vision, hearing, glasses, occupational, nicotine, alcohol

Common Chief Complaints

• dizziness

• ________

• headache

• _________ loss

• nasal _________ / nosebleed

• sore throat

• mouth _______

vertigo, hearing, discharge, lesions

What is the medical name for nosebleed?

epistaxis

spinning sensation revolving feeling in body

vertigo

Inspect Facial Features for ______, ____________, ___________ skin characteristics, and _______ __________.

size, shape, position

feeling of passing out or fainting

dizziness

Visual Acuity Test in a well-lighted room, 20 feet from chart, cover one eye at a time.

Snellen Chart

what is considered legally blind?

20/100

Bells Palsy is only specific to the face. Stroke affects _______ and paralysis of _______.

speech, limbs

Visual Acuity test where you read smallest line possible on newspaper or Rosenbaum card about 14 inches from the eye; age 40 and over. 

near vision

to test ________ vision and __________, sit 2-3 feet from provider, cover one eye and look directly at provider

• Use pencil – bring from periphery inward superiorly, inferiorly, temporally and nasally.

peripheral, confrontational

In Bells Palsy damage is seen on the _____ face along with the lower face (this doesn’t happen in a stroke)

upper

Bells Palsy effects CN ____.

7

If you have a stroke on the right side your paralysis will be on the _______ side of the ________ face.

left, lower

the white outer layer of the eyeball. At the front of the eye it is continuous with the cornea.

sclera

mucous membrane that covers the front of the eye and lines the inside of the eyelids.  Does not cover the cornea

conjunctiva

Inspect cornea for… (2)

transparency, surface characteristics

Inspect iris for… (2)

shape and color

a hole in a structure of the eye

coloboma

Inspect pupils for…

• ______

• ______

• reaction to ______, ____________ ___________, and _____________/PERRLA

size, shape, light, consensual reaction, accommodation

Inspect eyebrows, eyelashes, and eyelids for… (3)

symmetry, skin characteristics, discharge

Inspect Eyebrows/eyelashes/eyelids for ____________, _______ characteristics, and ___________.

symmetry, skin, discharge

eyelid is covering a portion of the pupil

ptosis

sclera is visible between upper lid and iris (hyperthyroid)

exopthalmos

Inspect conjunctiva for…. (3)

color, drainage, and lesions

Inspect sclera for… (2)

color and surface characteristics

eyelid and lashes are rolled in (trauma, congenital, syndromes)

enopthalmos

red conjunctiva with purulent discharge

conjunctivitis

____________ Test

patient stares straight ahead with both eyes open.  Shine a penlight toward the bridge of the nose about 12-15 inches away. Light reflections should appear _________ in both corneas. 

hirschberg, symmetric

If the light reflections appear at different spots in each eye in the Hirschberg Test  (asymmetrically), it may indicate…

weak extra ocular muscles 

Perform the ______-__________ test if the corneal light reflex is asymmetric. 

cover, uncover

• Ask the patient to stare straight ahead. Cover one eye at a time and observe the uncovered eye. The uncovered eye should not move. 

• Remove the card for the covered eye; observe if the eye moves to try to focus.

cover, uncover test

An eye that moves to focus after being uncovered indicates _____________, which is caused by weak extra-ocular muscles. 

strabismus

What does PERRLA stand for?

pupils equal, round, react to light, and accommodation

Pupils constrict when focusing on a _______ object

Pupils dilate when focusing on a ________ object

close, distant

_________ _______ test

Patient occlude 1 ear. While standing 1-2 feet in front of or bedside whisper one or two syllable words.  Patient should hear 50% of words. Repeat with other ear.

whisper voice 

_______ ________ Test

Patient close eyes. While holding your fingers 3-4 inches from the patient’s ear, briskly rub your index finger against your thumb. Patients with high-frequency hearing loss may not be able to hear the noise.

finger rubbing 

Strike and place midline on patient’s skull. Should hear equally.

weber test

Weber Test

• If conduction loss, sound lateralizes to the _________ ______ because it is traveling through bone

• If sensorineural loss, sound lateralizes to the ___________ ______

defective ear, ueffective ear

Strike fork, place on mastoid process until can’t hear vibrations, then place vibrating end in front of ear canal

Rinne test

Rinne Test

• Tone in front of ear should last ______ as long as tone when on the mastoid process AC> BC by 2:1

• If conduction loss, hears ______ longer than air

• If sensorineural loss, hears _____conduction longer than bone (but less than 2:1)

twice, bone, air

Nasal Discharge Colors

Bloody: 

Watery:

Purulent:

Foul Smell:

trauma, allergies, infection, foreign object

Inspect External Nose for ____________, _________, and ___________.

• smooth intact skin

• no lesions or edema

• match color of rest of face

• nostrils symmetric, no flaring or narrowing

• no discharge

appearance, symmetry, discharge

Inspect Lips for… (4)

color, symmetry, moisture, texture

Pale lips could indicate…

anemia, shock

Cyanotic lips could indicate…(2)

hypoxia, hypothermia

dry, flaking or cracked lips could be because of… (2)

dehydration, wind exposure

Lip cracks and erythema in corners could be caused by…

vitamin B deficiency

Edematous on lips could indicate…

allergic reaction

A child ___-___ can use Snellen E chart.

3,6

Inspect teeth, gums for ________, ______, _________ characteristics, __________, and _________

condition, color, surface, stability, alignment

If dentures, observe ______ line and below

gum

Eyelid and lashes are rolled in

enophthalmos

What are 3 causes of Enophthalmos?

trauma, congenital, and syndromes

Inspect tongue for … (4)

movement, symmetry, color, surface characteristics

How do you test CN XII Hypoglossal?

have patient stick out tongue

Atrophy or Deviation of the tongue on one side could indicate…

neurologic disorder

Smooth, beefy-red, edematous tongue with a slick appearance could indicate…

vitamin B deficiency

irregular patches or map-like appearance on the tongue

geographic tongue

Hairy tongue with yellow-brown to black, elongated papillae could be due to…(3)

antibiotic therapy, superinfection, or pipe smoking

What 2 things could be the cause of an enlarged tongue?

down syndrome, hypothyroidism

Inspect Buccal Mucosa and anterior/posterior pillars for..,(3)

color, surface characteristics, odor

white, round or oval ulcers with a red halo on buccal mucosa

aphthous ulcers

White patch or plaque on oral mucosa that can’t be scraped off

leukoplakia

Red patch on oral mucosa

erythroplakia

What may cause excessive mouth dryness? (3)

blocked salivary gland, medications, stress

What does Acetone odor from the mouth mean?

DKA

What does Fetid odor from the mouth mean? (2)

gum disease and sinusitis

Inspect palate, uvula, posterior pharynx, tonsils for (4)

texture, color, surface characteristics, movement

How do you test Cranial Nerve X Vagus?

have patient say Ah

How do you test Cranial Nerve IX Glossopharyngeal?

• observe if _____ _______ rises _____________ with uvula in _______

soft palate, symmetrically, midline

Inspect Neck __________

• observe ________ or __________ movements

• tics or spasms

• tracheal deviation

position, tremors, rhythmic 

Inspect neck for skin ____________ and presence of ________/_________.

characteristics, lumps/masses

________ gland shouldn’t be visualized on the neck.

thyroid

(enlarged thyroid) may be seen as fullness in the neck 

goiter

Infant Head

• Anterior Fontanelle closed by _____ months, doesn’t exceed ___-___cm in infants less than ____ months

• Posterior Fontanelle closes by ___ months

• Head Circumference measured until age ____

18, 4,5,6,2,2

Infant Eyes

• _______ from _____ ______ or reactions to ___________

edema, birth trauma, ointments

Infant Ears

• pull pinna _____ and ______

• hearing screening recommended for all _________

down, back, newborns

Infant Nose and Mouth

• examine when infant is _______

• with gloved finger check strength of _____ and for intact _______

• only use ______ to inspect inside nares

crying, suck, palate, light

Infant Neck 

• _____ __________ off the table and ______ should lag until ____ weeks

lift shoulders, head, 20

What ages should use Snellen Chart?

7-8 years old

What age should use Snellen E Chart?

3-6 years old

Allen Picture Card for visual acuity is used for ages…

2.5-3

Toddler and Children Ears

• examine _________ ______ with child on parents lap

• If less than age ____: pinna should be pulled ______ and _____

• If older: pinna should be pulled ____ and _______ as an adult

auditory canal, 1, down, back, up, back

Toddler and Children Nose and Mouth

• on parents lap

• ________ on tip of the nose to improve visualization

thumb