Assessment of the Head, Eyes, Ears, Throat and Neck (HEENT)
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Inspect the Head
o Normocephalic
 Microcephalic  abnormally small head
 Macrocephaly  abnormally large head
o Temporal artery
 Arteritis
o Temporomandibular joint
o Scalp
 Inspect for lesions, scaling, tenderness, and masses
o Inspect the face
 Symmetry
 Central brain lesion (CVA)
 CN VII damage e.g. Bell’s palsy
 Facial expression – anxiety, excessive smiling
 Abnormal facial structure
 Exophthalmus, changes in skin color
 Edema – periorbital or across the cheeks
 Tics
 Excessive blinking
 Grinding of the jaw
 Compare Eyebrows, nasolabial folds, sides of mouth
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Inspect the Neck
 Symmetry – head position midline
 Head tilt in muscular spasm
 Trachea in midline
 ROM
 Chin to chest
 Head to shoulder
 Turn head to R and L (say “no”).
o Person turns shoulders instead of neck
 Note pain, ratchety movement, limited ROM due to arthritis or inflammation
of neck muscles
Lymph nodes - Note:
 Size and shape
 Delimitation
 Mobility
 Consistency – hard or soft
 Tenderness (with acute infection)
 Lymph Nodes
 Preauricular:
 Posterior auricular
 Occipital: base of the skull
 Submental
 Submandibular: halfway between the angle and the tip of the mandible
 Jugulodigastric (tonsilar)
 Superficial cervical
 Deep cervical
 Posterior cervical
 Supraclavicular
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Thyroid Gland
 Goiter
Inspect the Eyes
o Inspect External Ocular Structures
o Facial expression – squinting
o Eyebrows
 Move symmetrically
 No scaling or lesions
o Eyelids/eyelashes
 Eyelids meet together
 The palpebral fissure
 Eyelashes should be evenly distributed
 Ptosis – drooping of upper lid
 Skin without redness, discharge or lesions
o Eyeballs
 Exophthalmos (protruding eyes)
 Enophthalmos (sunken eyes)
o Conjunctiva and sclera
 Conjunctiva - normal color – pink over lower lids, white over sclera
 Sclera – china white
o Assess for drainage, swelling, redness, asymmetry & lesions
 External & Internal hordeolum (stye)
 Ectropion
Conjuctivitis
 Arcus Senilis
Cataract
o PERRLA
 Contralateral Pupil Constriction
Inspect the Ear
o Inspection of the Ear
o Ears should be equal size
 Microtia – ears smaller than 4 cm vertically
 Macrotia – ears larger than 10 cm vertically
o Skin intact, same color as face, intact
 Tenderness
 Move pinna and push on tragus
 Assess for lesions, swelling, drainage
o Tympanic Membrane
 Otoscope – just for fun
 Note any redness, swelling, discharge, foreign bodies
 The tympanic membrane, or eardrum  translucent with a pearly gray color.
 Ear drum should be flat and intact
Inspection of Nose, Mouth and Throat
o Eternal nose
 Symmetric, midline
 No inflammation
 Test for patency
o Palpate sinuses
 Over frontal sinuses below eyebrows
 Over maxillary sinuses below cheekbones
o Nose
 Assess for lesions, swelling, symmetry, discharge
o Mouth
 Assess moisture, lesions, swelling, drainage, teeth and gums
 Lips – color, moisture, cracking (Cheilitis) or lesions
 Retract lips and note inner surface
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Teeth and gums
 An adult mouth has 32 teeth
 Diseased, missing, loose or abnormally positioned teeth
 Decayed teeth  caries
 Gingival hypertrophy
 Bleeding gums
Tongue
 Pink and even
 Dorsal surface rough with papillae
 Thin white coating
 Ask pt to touch tongue to roof of mouth
o Ventral surface should be smooth, glistening, showing veins
 Saliva is present
 Enlarged tongue abnormal
o Mental retardation, hypothyroidism, acromegaly
Mouth
 Dry mouth – dehydration
 Excessive drooling
 Look for lesions e.g. canker sores, white patches (thrush) (malignancies)
Uvula
 Ask person to say aahh
o Soft palate and uvula rise in the midline (CN X)
Throat
 Inspect for lesions
 Tonsils
 Acute infection
 White membrane covering tonsils  mononucleosis, leukemia, diphtheria
 Enlargement; Acute infection, 2+, 3+, or 4+
o 1+ - visible
o 2+ halfway between tonsillar pillars
o 3+ touching uvula
o 4+ touching each other