Advanced Physical Diagnosis Online Companion

For obvious anatomical reasons, the HEENT (Head, Eyes, Ears, Nose and Throat) exam is often the first part of the comprehensive physical exam to be evaluated after assessing the patient's vital signs.  The HEENT acronym itself provides a simple and logical method for dividing this part of the physical exam. Healthcare providers should begin by observing the patient's head, paying attention to facial appearance (e.g. pleasant, grimaced, etc.) and noting any trauma or visible pathology.

Examination of the patient’s eyes then follows, including inspection of outward anatomy (lids, sclera, conjunctiva, iris, pupils), evaluation of vision (central and peripheral) and pupillary accommodation, appraisal of oculomotor movements (H-Test and convergence), and inspection of inner-globe anatomy with the aid of an ophthalmoscope. A convenient transition with the oto-ophthalmoscope in hand is to next inspect the ear, including the outer pinna and external auditory canal. Still keeping the oto-ophthalmoscope in hand, the provider may move to examining the patient’s nose, observing the external nasal anatomy (nasal bridge, nasal septum, supra alar creases, etc.) and inspecting internal structures with the aid of the ophthalmoscope. Examiners should then proceed to inspecting structures of the mouth (lips, gums, dentition, tongue, etc.), as well as the patient’s bite and tongue range of motion (noting deviation, asymmetry, etc.). Examiners should conclude this section by inspecting and palpating the structures of the neck, including major lymph node chains (eight total: preauricular, postauricular, submandibular, submental, anterior cervical chain, posterior cervical chain, occipital), thyroid and cricoid cartilages, and the thyroid gland itself.

Below are articles (organized by pathophysiology) and instructional videos for refining the musculoskeletal exam. 

Click to Access the Following Articles:

1. Thyroid volume changes during pregnancy and after delivery in an iodine-sufficient Republic of Slovenia

Click to Access the Following PDFs:

1: Relative Importance of Systemic Determinants of Retinal Arteriolar and Venous Caliber: The ARIC Study

2: Orbital Compartment Syndrome: The Ophthalmic Surgical Emergency

3: Meta-Analysis: Retinal Vessel Caliber and Risk for Coronary Heart Disease

4: The State of the Arteries in Bright's Disease

Click to Access the Following Articles:

1: Classification of Thyroid Size by Palpation and Ultrasonography in Field Surveys

2: Application of a Prediction Rule to Select Which Patients Presenting with Lymphadenopathy Should Undergo a Lymph Node Biopsy

Bates' Physical Examination Videos, Volume 7: Head, Eyes & Ears

Stanford Medicine 25: Fundoscopic Exam