Health Assessment Quiz 2 (HEENT)

• —Hair (distribution, quantity)
• —Scalp (scaling, nevi)
• —Skull (size, contour)
• —Face (expression, contours)
• —Skin (color, pigmentation, hair distribution, lesions)

• —Hair texture
• —Skull (lumps)
• —Face (sinuses)
• —Skin (texture, temperature)

• Position and alignment of eyes
• Eyebrows
• - quantity, distribution
• Eyelids
•  -—Width of palpebral fissures (distance between eyebrow)
•  - —Edema, color, lesions
•  - —Condition and direction of eyelashes
•  - —Adequacy of closed eyelids
• Conjunctiva and sclera
•  - —Color, vascular pattern
• Cornea and lens
•  - opacities
• Lacrimal apparatus
•  - —Lacrimal gland and sac for swelling
• Iris
• – markings clearly defined
• Pupils
• – size, shape, symmetry, reaction to light (direct and consensual)

• —Central vision:
• -Snellen eye chart; position patient 20 feet from the chart
• -Patients should wear glasses if needed
• -Test one eye at a time

• —Near vision:
• -hand-held card (can use news paper or magazine)
• -hold 14 inches from patient’s eyes

• Normal conjugate movements
• —Nystagmus
• —Lid lag

—Auricle for redness, lesions, note piercings

• —Earcanal
•   o Discharge,foreign bodies, redness, swelling

• —Tympanic membrane
•   o Color, contour

—Auricle for lumps, tenderness

sound from the external ear through the middle ear. Disorders in these areas cause conductive hearing loss.

sound involving the cochlea and cochlear nerve. Disorders in these areas cause sensorineural hearing loss.

—Test one ear at a time

—Whisper test, standing 1-2 feet beside patient, softly say “nine-four,” “baseball” or “1, 2, 3 “

If hearing is diminished try to distinguish  conductive from sensorineural loss. You will need a tuning fork between 512 or 1024 Hz

• Lateralization of sound. Should be heard on both ears so no lateralization
• -Place the base of the lightly vibrating tuning fork on top of the patient’s head or on the mid-forehead.
• -Ask where the patient hears it- on one or both sides. Normally the sound is heard equally in both ears*
• *Because people with normal hearing can lateralize, this test should be restricted to
• those with hearing loss

• Compare time of air vs. bone conduction. Normally the sound is heard longer through air than through bone.  AC>BC
• -Place base of vibrating tuning fork on the mastoid bone, when the patient can no longer hear the sound, quickly place the fork close to the ear and assess if the sound can be heard. Normally the sound is heard longer through air than bone (AC>BC)

Infants and Adults

adults,  young children

• —Anterior and inferior surface – asymmetry or deformity
• —Inside of nose
•  o  Mucosa – color, swelling, bleeding, exudate, ulcers, or polyps
•  o Septum – deviation, inflammation, or perforation
•  o Turbinates – use otoscope to view middle and inferior turbinates

• Lips (Note color, moisture, lumps, ulcers, cracking, or scaliness)
• Oral mucosa (—Note color, ulcers, and nodules)
• Gums and teeth (—Note color, presence, and position of teeth)
• Roof of mouth (—Note color)
• Tongue and floor of mouth (—Note color and texture, ulcers, nodules)
• Pharynx: soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx (—Note color, symmetry, presence of exudate, swelling,  ulceration, or tonsillar enlargement)

—

• Symmetry
• Range of Motion
• Neck muscles
• Lymph Nodes
• Thyroid Gland
• Trachea

• —Lymph nodes (size, shape, delimitation, mobility, consistency, tenderness)
•  o Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical chain, supraclavicular

• Flex neck slightly forward
• Place fingers of both hands with index fingers just below the cricoid cartilage
• Ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable)
• Displace trachea to the right and palpate laterally for the right lobe of the thyroid;
• repeat on the left side
• Note the size, shape, and consistency
• Identify any nodules or tenderness
• If enlarged, listen over lateral lobes to detect a bruit

eustachian tube cannot equalize the air pressure in middle ear with that of outside air. Occurs w/URI, flying, diving. Amber fluid behind eardrum.

purulent effusion caused by bacterial infection. Sx include fever, ear pain, hearing loss. TM is red, loses landmarks and bulges

inserted to relieve middle ear pressure and prevent recurrent middle ear infections in children

drooping of upper lid

Lower lid is loose and rolls outward

Lower lid is loose and rolls inward

Pterygium: scar tissue from  cornea

arcus senilis

Chalazion – usually points inside the lid

Pinguecula – harmless yellow triangular nodule on either side of the iris

leakage of blood outside of the vessels, generally not painful and does not affect vision, may result from trauma or a sudden increase in venous pressure such as heavy coughing

cataract

• the vein appears to stop abruptly on either side of the artery.
• Associated with hypertension

TRUE

White or grayish ovoid lesions with irregular “soft” borders. Seen in hypertension and many other conditions.

• Moderate- disc is swollen with margins blurred 
• Severe – physiologic cup and disc are not visualized

• Molding resolves by 2 days
• caput succedaneum (across suture): days
• to resolve
• Cephalehomatoma: (not across suture line) wks/months to resolve *wear a hat :)

• —Posterior Fontanel:  birth-2nd month of life
• Anterior Fontanel:  12 -19 months
• Persistent overriding suture lines 

—Palpate for size, level of tenseness and pulsations

small HC or abnormal shaped head -development of the brain and sensory organs is hindered