HEENT (Head Ears Eyes Nose Throat)

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Inspection

  • Inspect for asymmetry, deformity, scars, lumps, involuntary movements, hair loss, or edema

Palpation

  • Palpate the head and neck for tenderness, deformity, and masses

Temporomandibular Joint

  • Place fingers in front of the tragus of both ears
  • Ask patient to open and close their mouth
  • Note any tenderness, crepitus, or loss of ROM

Superficial Lymph Nodes

  • Systematically palpate the following: Occipital, Postauricular, Preauricular, Tonsillar, Submandibular, Submental, Anterior Cervical, Supraclavicular

Thyroid Gland

  • Inspect for obvious enlargement
  • Position self behind patient
  • Palpate cricoid cartilage (landmark)
  • Move downward two or three rings
  • Palpate for the thyroid isthmus
  • Move laterally to both thyroid lobes
  • While palpating, ask the patient to swallow- provide a cup of water if possible

External Eye

  • Inspect for ptosis, exophthalmos, lesions, deformity, or asymmetry
  • Pull down lower lid while asking patient to look up to inspect conjunctiva and sclera
  • Spread lids while asking patient to look in 4 directions to inspect bulbar surface
  • Repeat on other side
  • Wash hands before and after this portion of the exam

Eye Movement

  • Inspect corneal reflections
  • Stand 3-6 feet in front of patient
  • Have patient hold head still and follow examiners finger with eyes in 6 cardinal directions
  • Check convergence

External Ear

  • Inspect ears and surrounding area
  • Palpate the mastoid processes
  • Gently move each ear and asks about discomfort

Otoscopic Exam

  • Hold otoscope properly
  • Pull ear upward and backward
  • Insert otoscope to proper depth
  • Examine canal and middle ear

Nose Exam

  • Insert otoscope avoiding the septum
  • Start inspection at the "floor" and move upward
  • Repeat on other side

Mouth and Throat Exam

  • Use otoscope or other bright light
  • Ask patient to open their mouth
  • Inspect the anterior structures
  • Inspect the tongue and under
  • Inspect the posterior oropharynx
  • Ask the patient to say "Ah."

Palpation of the Mouth

  • Use a gloved finger inside the mouth
  • Use other hand for counter pressure on outside
  • Palpate anterior structures
  • Palpate floor of mouth
  • Pull tongue out using gauze and palpates

Special Considerations: Deep Cervical lymph nodes

  • Hook fingers around the anterior edge of the SCM muscle
  • Ask patient to tilt head forward and toward side being examined
  • Move muscle backward while palpating structures underneath
  • Repeat on other side

Special Considerations: Facial Tenderness

  • Press under both eyebrows
  • Press over both maxillary sinuses

Special Considerations: Upper Eyelid Eversion

  • Ask patient to look down
  • Gently grasp upper eyelashes and pull out and down
  • Place cotton applicator above lid edge
  • Turn eyelid over
  • Inspect conjunctiva
  • Ask patient to blink to flip eyelid back

Special Considerations: Pneumatic Otoscopy

  • Proper grip with bulb
  • Perform standard exam
  • Pull ear down and back on a pediatric patient
  • Gently presse bulb
  • Observe tympanic membrane for movement

Special Considerations: Sinus Transillumination

  • Room must be dark
  • Place bright light (otoscope) over maxillary sinus
  • Ask patient to open mouth
  • Compare "glow" on both sides

ONLINE PHYSICAL EXAM TEACHING ASSISTANT

The UF College of Medicine Harrell Center