Lecture #96: DPR: History and Physical Examination of the HEENT System

What are the primary anatomical components of the HEENT region?

Head, Eyes, Ears, Nose, Throat, and Neck.

List common causes of head and neck complaints.

Migraine/tension headaches, sinus/ear/eye infections, thyroid disease, allergic rhinitis, vertigo, TMJ, and reflux.

What are common dermatologic head and neck findings?

Hair loss, scalp infections, lesions, and skin cancers.

List neurologic causes of head and neck symptoms.

Stroke, Bell’s palsy, migraine, and neuralgia.

List vascular findings associated with the neck.

Carotid bruits and jugular venous distention (JVD).

Describe key features of hypothyroidism in a patient with fatigue.

Dry skin, constipation, cold intolerance, weight gain, menstrual irregularities, myalgia, and enlarged thyroid (goiter).

What are general history considerations for HEENT complaints?

Occupation, trauma, sun exposure, medical history, stress, and pain patterns.

What are “red flag” headache symptoms?

Sudden “worst headache of life” or headache awakening from sleep (concern for hemorrhage).

What are key inspection points for the head exam?

Contour, symmetry, involuntary movements, edema, and masses.

What should be noted about the skin of the face and scalp?

Color, texture, and presence of rashes or lesions.

Define hyperopia.

Farsightedness – difficulty seeing near objects due to short eyeball.

Define myopia.

Nearsightedness – difficulty seeing distant objects due to long eyeball.

Define presbyopia.

Age-related loss of accommodation and near focusing.

What are common eye complaints?

Redness, discharge, itching, blurred vision, and pain.

What is the correct technique for ophthalmoscopy?

Use right hand/right eye, left hand/left eye; start 15° lateral and 15 inches away; find red reflex, then move in.

What structures are inspected in fundoscopic exam?

Optic disc (color, margins), retina (hemorrhages, exudates), arteries/veins, and macula.

What are key differences between a normal optic disc and papilledema?

Normal disc: sharp margins, pale center. Papilledema: blurred margins, engorged vessels, raised disc.

How is the ear pulled for otoscopic exam in adults?

Pinna up, back, and out.

How is the ear pulled for otoscopic exam in children <3 years old?

Pull earlobe down and out.

What are normal tympanic membrane findings?

Intact, translucent, pearly gray, normal cone of light, non-bulging.

List common TM abnormalities.

Perforation, tympanosclerosis, serous effusion, and acute otitis media (bulging, erythematous TM).

Differentiate conductive vs sensorineural hearing loss.

Conductive: external/middle ear; improves in noisy environment. Sensorineural: cochlea/nerve; worse in noisy environment.

Describe the Weber test.

Tuning fork on mid-forehead → lateralization to bad ear = conductive; to good ear = sensorineural.

Describe the Rinne test.

Base on mastoid → then near ear; Normal AC>BC; BC>AC = conductive; AC>BC but diminished = sensorineural.

List common nasal complaints.

Rhinorrhea, congestion, sneezing, epistaxis, anosmia, or pain.

What are the components of the nasal cavity?

Upper 1/3 bone, lower 2/3 cartilage, septum medially, turbinates laterally.

List common mouth/throat complaints.

Pain, sores, bad breath, bleeding gums, dry mouth, ill-fitting dentures, dysphagia, hoarseness.

What are risk factors for oral disease?

Tobacco, alcohol, sugar, poor oral hygiene, ill-fitting dentures.

List components of the mouth to inspect.

Lips, mucosa, gums/teeth, tongue, palate, and floor of mouth.

What is the correct technique for inspecting the oropharynx?

Have patient open mouth and say “ah”; use light and tongue depressor on middle third of tongue.

What are abnormal buccal mucosa findings?

Leukoplakia, ulcerations, or torus palatinus.

List abnormal findings of the palate.

Cleft palate, masses, ulcerations, or perforations.

What are signs of pharyngeal infection?

Erythema, exudate, enlarged tonsils, fever, and tender lymph nodes.

What are common neck complaints?

Swelling, pain, masses (thyroid, lymphatic, muscular, or vascular origin).

What are important points during neck inspection?

Symmetry, skin, tracheal deviation, visible masses, and thyroid movement with swallowing.

Describe proper thyroid palpation.

Posterior approach; ask patient to swallow; palpate both lobes for size, nodules, or tenderness.

What are abnormal thyroid findings?

Enlargement (goiter), nodules, tenderness, or asymmetry.

How are lymph nodes palpated?

Use finger pads in circular motion; assess for enlargement, tenderness, mobility, warmth, and fixation.

Which lymph node enlargement is most concerning?

Supraclavicular (especially left side – possible thoracic/abdominal malignancy).

What are major HEENT concerning conditions involving infection?

Acute: sinusitis, otitis, pharyngitis, meningitis. Chronic: mastoiditis, parotitis, or chronic sinusitis.