HEENT And Neck Exam

Ophthalmoscope

Has three dials:

• Light source - Controls the light intensity. Medium is usually fine.
• Aperture - Use the medium circle (green indicator)
• Refractive index - Adjusts for corrective factor. Leave setting at 0 for no glasses.

Otoscope

Has two dials:

• Light source (same as ophthalmoscope)
• Focus knob (green line indicates neutral position)

Surface Anatomy

Place finger on middle of patient's chin and move down.
1st structure = thyroid cartilage
2nd structure = cricoid cartilage
3rd structure = isthmus of the thyroid (just inferior to cricoid)

Palpating the thyroid

1. First, ask patient to swallow and feel the movement.
2. Next, place both hands on isthmus from behind
3. Slightly rock the cartilage back and fourth, feeling each lobe
4. Use one hand to fix the thyroid in place and walk fingers down lobe. Once for left and right

Head exam

1. Inspect head
2. Inspect scalp and hair

Eye exam

1. Pull down lower lids and ask patient to look up. Note any abnormal coloration of conjunctivae, sclera, and pupils.
2. Dim lights and prep ophthalmoscope
3. Ask patient to focus on fixed point in distance
4. Stabilize your hand on forehead and position yourself arms length away
5. Approach nearer to patient's eye from slight lower angle until eye cup touches patient's brow
6. Identify blood vessels and optic disc. Note spots, damaged blood vessels, and abnormal vessel formation

Ears

1. Inspect ears, noting lumps or fluid
2. Place speculum tip on otoscope
3. Straighten patient's ear by gently pulling up the pinna
4. Insert the tip and inspect patient's tympanic membrane. Note if membrane is not pearly gray, translucent, and shiny
5. Repeat for other ear

Nose

1. Place speculum top on otoscope and ask patient to tilt back head
2. Insert otoscope into each nostril (naris) and inspect mucosa, septum, turbinate for inflammation
3. Palpate sinuses and ask if the patient feels any pain

Mouth

1. Use light source and tongue blade to inspect gums, teeth, tongue, and oral mucosa
2. Ask patient to lift tongue and inspect subglossal area
3. Ask patient to stick out tongue say "Ah" while pressing down on tongue

Lymph nodes

1. Inspect lymph nodes
2. Palpate six regions: tonsillar, submandibular, submental, anterior cervical, posterior cervical, supraclavicular. Note swelling or tenderness.