HEENT Part 2

Examination of the Head and Neck

1. examine the hair/scalp/skull

2. inspect the skin on the head+face

3. palpate cervical lymph nodes

4. examine the trachea

5. palpate the thyroid gland

6. examine the carotid arteries+jugular veins

Hyperthyroidism vs Hypothyroidism

hyperthyroidism

CM:

• nervousness

• weight loss

• excessive sweating

• heat intolerance

• palpitations

• frequent bowel movements

• tremors

• proximal muscle weaknesss

DX:

• warm+smooth+moist skin

• increased systolic BP+decreased diastolic BP

• tachycardia

• atrial fibrillation

• tremor

• proximal muscle weakness

hypothyroidism:
CM:

• fatigue

• lethargy

• with anorexia→modest weight gain

• swelling of face/hands/legs

• weakness

• muscle cramps

• arthralgias

• paresthesias

• impaired memory+hearing

DX:

• dry+coarse+cracked skin

• nonpitting myxedema

• low-pitched speech

• bradycardia

• late stages→hypothermia

• decreased systolic BP+increased diastolic BP

• somnolence

• impaired hearing+memory

• peripheral neuropathy

• carpal tunnel syndrome

Examination of the Ear (General)

1. examine external ear+palpate tragus and mastoid

2. examine
   -ear canal
   -TM
   -malleus

3. test for auditory acuity

4. test for conductive vs sensorineural hearing loss

Examination of the Mouth+Pharynx

1. inspect lips+oral mucosa

2. palpate oral mucosa

3. inspect gingiva+teeth

4. inspect roof+floor of mouth

5. inspect tongue

6. test hypoglossal nerve

7. palpate tongue

8. inspect
   -soft palate
   -A+P pillars
   -uvula
   -tonsils
   -pharynx

9. test vagus nerve

Oral Health Statistics

vital for overall health+well-being

cavity in permanent tooth

• adults (20 y/o+)→90%

• teens (12-19 y/o)→54%

no teeth (edentulous) adults→11%

peridontal dx→40% non-edentulous adults

RF: low income
male
smoker
DM
poor PO hygiene
infrequent dental visits

Patient Education: Oral Health

adopt daily hygine of brushing+flossing

fluoride-containing toothpaste

annual dental care

avoid high amounts of starches+refined sugars

avoid tobacco

limit alcohol

drink more water

mx reduce salivary flow→chew sugarless gum

Pharyngeal Cancer Risks

male

tobacco

alcohol

alcohol use in previous year

marijuana

HPV
-highest→35-39 y/o
-highest→50-54 y/o

high # of lifetime sexual partners

PO sex

suspicious PO mucosal lesion→specialist referral→biopsy