medical

1. H.E.E.N.T Examination
Dr.Beka A.

2. H.E.E.N.T. examination
• The cardinal steps are
• Inspection
• Palpation

3. HEENT
• Head – size, shape, area of tenderness, deformities, hair, fontanels
and sutures.
• Eyes- position, lids, conjunctiva, sclera, cornea, funduscopic
examination
• Ears-shape, size, and position, discharges, mastoid tenderness, tragus
tenderness, otoscopic examination
• Nose- shape patency, discharge, septum, sinuses…

4. Cont..
• Mouth and throat
• Lips –color, cleft lip, ulceration, cracked lips, buccal mucosa
• Tongue- papillary atrophy, thrush, dryness etc..
• Teeth- number, carries, gum hypertrophy
• Pharynx- hyperemia, swelling of tonsils, exudates…

5. Lymphoglandular system
examination

6. Technique of examining LN
• LN should be palpated by using the pads of your index and middle
finger
• Move the skin over the underlying tissue in each area
• Feel the accessible LN in sequence
• For head and neck extend the neck/ turn their neck to the side

7. Head and Neck
1. Preauricular
2. Posterior auricular
3. Occipital
4. Tonsillar
5. Submandibular
6. Submental
7. Superfical cervical
8. Posterior cervical
9. Deep cervical
10. Supracavicular

8. continued
• Axillary LN examination
• Epitrochlear LN
• Inguinal LN

9. Continued
• Note their size, shape, delination
• Note for mobility, consistency, tenderness
• Shotty LN can be found in normal person
• LN roll in two directions unlike muscle
and aa

10. Continued

11. Technique of examining glands
• Submandibular gland
• Parotid gland
• Thyroid gland
• Breast

12. Continued
• Inspection
• Physician should be directly in front of the patient
• Patient neck should be slightly extended
• Visualize for any enlargement, surface
• See if it moves with deglutition/protrusion of tongue

13. Continued
• Palpation
• The patient should slightly flex
their neck and sitting position
• Physician should stand from the back
• Feel the 2 lobes and the isthmus
• Size, shape, consistency, surface, move
With swallowing, mobility, border, temp.

14. Breast examination
• Female breast lies over the anterior
thoracic wall
• It extends from 2nd rib to the 6th rib and
from sternum to mid axillary line

15. Continued
• Breast is divided into 4 quadrants
• Most breast tissue is found in UUQ
• Axillay tail of spence  ant axillary
Fold
• Lymphatic from most of the breast
drains towards the axilla

16. Axillary LN
• There are 6 group of axillary LN
• Central LN are the most palpable
• Full exposure of chest is necessary

17. Continued
• Inspection
• Inspect breast and nipple with patient at sitting position
• Inspection should be at 4 views

18. Continued
A.Arms at sides
• Appearance of the skin
• Size and symmetry of the breasts
• Contour of the breast
• Characteristics of the nipple

19. Continued
B. Arms raised over head
• To bring out dimpling or retraction
That are invisible
• This cause contraction of pectorial
Major muscle

20. Continued
C. Hands pressed
against hips
D. Leaning forward
• Best to see asymmetry of breast
and nipple
• Nipple and areola retraction
CA

21. Continued
• Palpation
• Patient should be in supine position
• Use the pads of 2nd, 3rd and 4th fingers with slight flexion
• 2 techniques can be used for palpation
• Circular/wedge palpation
• Vertical strip pattern

22. Continued

23. Continued
• Consistency of the breast tissues
• Tenderness
• Nodules
Location, size, shape, consistency, mobility
Delimitation, tenderness
• Palpate for nipple and squeeze for discharge

24. Continued
• Examine the axilla
• Patient could be in sitting or supine position
• Inspect the skin of each axilla for rash, infection or unusual
pigmentation

25. Continued
• Palpation
• To examine left axilla, you should hold
the patient’s hand with your left hand and
Palpate by the right hand
• Keep your hands on the mm towards the
Mid clavicle and feel central group of nodes

26. Reading Assignment
General appearance and Vital signs