HEENT (head, eyes, ears, nose and throat)

General sequence of physical exam

-inspection

-palpation

-percussion

-auscultation

Head: focused exam (inspection)

-skull: shape, size, symmetry, deformity

-scalp: skin change (redness, scaliness)

-hair: qty, distribution, parasites

-face: symmetry, involuntary mvmts, color, shape

Head: focused exam (palpation)

-head: contour lumps, deformity, tenderness

-scalp: mobility, lesions

-hair: texture

-face: TMJ ROM, pain

-neck: tracheal deviation, thyroid size, tenderness, mobility, lymph node size and mobility

Eyes: focused exam

-eyebrows: hair loss, scaly skin

-eyelids: swelling, redness, scaly skin

-conjunctiva: paleness, inflammation

-sclera: ictera, redness

-cornea (ant. chamber): opacities

-lens: opacities

-pupils: size, shape, equality, reactivity to light

Eyes: physical exam

-pupillary rxn (pen light)

-pupil accommodation

-extra-ocular mvmts

Ear: focused exam (inspection)

-auricle (ant and post): positions, deformities, trauma, foreign objects

Ear focused exam (palpation)

-pull on pinna: reproduction of pain

-otoscope exam

-external canal: cerumen, discharge, foreign bodies, swelling

-tympanic membrane: color, landmarks, bulging, perforation

Ear focused exam (hearing acuity)

-whisper test: stand behind and whisper

-Weber test (forehead or cranial vertex): tuning fork-should hear equally. If not-->hearing loss

-Rinne test (mastoid process): tuning fork-should hear equally. If not-->hearing loss

Nose: focused exam (inspection)

-external nares: asymmetry, deformity

-internal nares (with otoscope): swelling, turbinates, septal deviation, perforation, discharge, blood, crusting, ulcers, polyps

Nose: focused exam (palpation)

-frontal sinus: forehead

-maxillary sinus: either side of nose

-ethmoid sinus: corners of eyes

Throat: focused exam (inspection)

-lips: lumps, cracks, moisture, ulcers

-mucose: color, moisture, lesions

-teeth: loose, missing, dental caries, implants, dentures, jaw or facial pain

-gums: inflammation, swelling, bleeding, discoloration

-tongue: lesions, symmetry, salivary ducts

-palate: lumps, lesions

-tonsils: presence, size, color, pus, lesions

-uvula: symmetry, inflammation

Allergies

-rhinorrhea: runny nose

-coughing and sneezing

-nasal stuffiness and pressure

-ear pain and pressure

-

common allergens are

-environmental (pet dander, pollen, dust mites)

Allergy tx involves

-supportive interventions

-mitigation of environ factors

Cancer

-3-5% of all cancers are HEENT

-squamous cell carcinoma

-larynx, upper and lower pharynx, salivary gland, oropharyngeal

Common symptoms and signs of head and neck cancer

-lump in nose, neck or throat

-persistent pharyngitis

-dysphagia

-unexplained wt chng (+/- 10% in 4 wks)

-frequent coughing

-chng in voice or hoarseness

-ear pain or trouble hearing

-headaches

Common risk factors for head and neck cancer

-alcohol abuse

-epstein-barr virus infection

-excessive sunlight

-HPV

-tobacco use

pharyngitis

-bacterial: group A beta-hemolytic streptococcus, tx with antibiotics to prevent rheumatic fever

-viral and allergic are self-limiting

Centor criteria

-hx of fever over 100.3

-tonsillar exudates

-absence of cough

-tender anterior cervical lymphadenopathy

Rapid strep test done for adults with _____out of 4 positive centor criteria, unless positive tonsillar exudates

-2

When are antibiotics given to adults suspected of having strep?

-only with a positive rapid test

In kids with a negative rapid strep test what is done

-full culture

-antibiotics started on clinical presentation, but discontinued if full culture comes back negative

hyperthyroidism (Grave's disease)

-exopthalamos

-goiter

-fatigue

-memory deficits

-sweating

-cardiac arrhythmia

-tachycardia

-muscle weakness

-tremors

-headaches

hypothyroidism

-alopecia

-bradycardia

-delayed reflex rxn

-depression

-dry skin

-hoarse or deep voice

-unable to concentrate

-memory impairments

-muscle weakness

-puffy eyes and face