Physical Exam HEENT HEENT stands for “head, eyes, ears, nose, and throat.” If someone is experiencing symptoms that affect those areas, such as sneezing, congestion, and a sore throat, they’ll likely receive a HEENT examination. A HEENT examination is a portion of a physical examination that principally concerns the head, eyes, ears, nose, and throat. The six examination methods used in a general physical exam include inspection, auscultation, palpation, percussion, mensuration, and manipulation. Documenting a normal exam of the head, eyes, ears, nose, and throat should look something along the lines of the following: Head – The head is normocephalic and atraumatic without tenderness, visible or palpable masses, depressions, or scarring. Hair is of normal texture and evenly distributed. HEENOT = head, ears, eyes, nose, oral, throat examination; HEENT = head, ears, eyes, nose, and throat examination. The oral examination includes an examination of the teeth, gums, mucosa, tongue, and palate. A comprehensive physical exam is sometimes referred to as an executive physical. This exam includes laboratory tests, pulmonary function testing, chest x-rays, audiograms, EKGs, full-body CAT scans, heart stress tests, mammograms or prostate exams, and a urinalysis Inspection Skin Color: erythema, ecchymosis, white, black Trophic changes (altered hair growth, sweat production) Scars Swelling Muscle tone: atrophy, hypertrophy Deformity: asymmetry, rotation, amputation Face should be symmetric Palpation Palpate for Effusion Clicking Snapping Crepitus Tenderness Temperature Masses Head and Face General Gross inspection Palpate scalp Points of interest Racoon eyes Battle sign Hemotympanum CSF Otorrhea CSF Rhinorrhea Mastoid process Temporomandibular Joint Eyes General External eye (conjunctiva, sclera, pupil, iris, eyelids, lacrimal ducts, etc) Inspect for symmetry of pupils, eyelids Extraocular Movements/Near Response Pupillary response Consider testing Visual Acuity Visual Fields Fundoscopy (Ophthalmoscopy Manometry (testing pressure) Fluorescein stain with woods lamp Slit lamp Ultrasound of the Eye Ears External ear Otoscopy including External auditory canal Tympanic Membrane Consider Hearing acuity Rinnes Test Webers Test Nose External nose inspection Otoscopy to evaluate nasal cavity including septum, turbinates Palpation of sinuses (frontal, maxillary) Oropharynx Dentition Tongue Hard and soft palate Uvula, tonsils Cranial Nerves CN I (Olfactory) Smell (not routinely tested) Can test with strong smells such as lemon, peppermint CN II (Optic) Pupil size, shape and symmetry Visual fields by assessing 4 quadrants in each eye Visual acuity using Snellen chart Direct pupillary reflex (shine light in eye, look for ipsilateral restriction) Consensual pupillary reflex (shine light in eye, look for contralateral restriction) Accommodation reflex (switch from near object to close object) Assess color using Ishihara plates CN III, IV, VI (Oculomotor, Trochlear, Abducens) Eyelids: look for normal, symmetric movement Pupillary light reflex Accommodation Extraocular movement tested in all planes (classically with movement in an H pattern) CN V (Trigeminal) V1: forehead V2: cheek V3: lower mandible Muscles of mastication (open and close mouth against resistance) CN VII (Facial) Symmetry Rise eyebrows Close eyes tight Blow out cheeks Smile CN VIII (Vestibulocochlear) Sound in each ear (can rub fingers together) Rinnes Test Webers Test Balance testing (needs to be updated) CN IX, X (Glossopharyngeal, Vagus) Cough or swallow Open and say “ahhh” CN XI (Accessory) Turn head (Sternocleidomastoid) Shrug shoulders (Trapezius) CN XII (Hypoglossal) Open mouth Stick tongue out and move side to side