HEENT
nd
“ Good morning po ma’am/sir, I am *name*, a 2 year medical student po of Our Lady of Fatima University.
Gagawin po natin ang HEENT exam po ngayon, ok lang po ba?”
“Ano pong pangalan niyo?”
“Sabihin niyo lang po kung hindi po kayo komportable habang ginagawa po yung examination. Start na po tayo?”
HEAD
A. Inspection
1. Head position
2. Skull size, shape, symmetry
3. Scalp lesions, scales
4. Hair color, distribution,
pattern
B. Palpation
5. Scalp tenderness, swelling,
abnormal prominence,
depression
6. Hair texture
FACE
7. Color, shape, symmetry
8. Lesions, edema, abnormal
facial movements
EYES
9. Eyes: symmetry/alignment
10. Eyebrows: texture, loss,
extraordinary, growth of hair,
seborrhea
11. Eyelashes: curves outward
(normal), note for infection in Hold lower lid of the patient. “Tingin po kayo sa taas”.
the glands (stye)
12. Eyelids: swelling, redness,
ptosis
13. Conjunctiva and sclera: color
and vascularity
14. Cornea and lens:
transparency and opacity
15. Iris: color, markings, shape
16. Pupils: size, shape, equality
17. Reaction to light (direct and
consensual) and reaction to
distance (accommodation)
“Magsimula po muna tayo sa Head Examination”
Use PENLIGHT for inspection (separate hair to expose scalp)
 The head is midline in position with no abnormal head movement. The
skull is normocephalic, oval in shape, and symmetrical. There are no
visible lesions, scales, and deformities. The hair is black, well distributed,
abundant and thick, and there are no patterns of baldness.
Warm the hands for palpation. Palpate the temporal artery.
“Palpate ko lang po yung banda dito niyo, sabihin niyo lang po if masakit”
 The temporal artery are not visible, but palpable with strong palpation.
Palpate the scalp and touch the hair.
 There is no tenderness, swelling, abnormal prominence, and depression.
The hair is smooth and dry.
Use PENLIGHT (wag itatapat sa mata ni patient)
 The face is brown in color, round/oblong/heart shaped, and symmetrical.
There are no visible lesions, no edema, no hypopigmentation and
hyperpigmentation.
“Ma’am/sir pwede po ba kayo ngumiti tapos sumimangot po?”
 There are no abnormal facial movements and expression.
 Eyes are symmetrical, (TOUCH) eyebrows are fine in texture, no loss,
negative in extra growth, no seborrhea, and well distributed. Upper
eyelashes curve upward and outward and lower eyelashes curve
downward and outward, no stye. (PALPATE, ASK IF MAY MASAKIT) There’s
no swelling in eyelids, no redness, and no ptosis.
Hold upper lid. “Tingin naman po kayo sa baba”.
 The palpebral conjunctiva and bulbar conjunctiva are pink in color, there’s
no swelling or hematoma. The sclera is white in color and well
vascularized.
Use PENLIGHT (shine at the SIDE of the patient!!!). Check BOTH SIDES.
“Ma’am/Sir, tingin po sakin ng diretso”
 Both cornea and lens are clear and transparent. Negative for opacities.
Both irises are brown in color, circular, and demarcated. Both pupils are 2-
3 mm in size, round in shape, symmetrical, and equal.
Use PENLIGHT (coming from the side, shine it slanted (mabilis lang) papunta
sa mata. Pero sabihin sa patient na SAYO NAKATINGIN at HINDI SA LIGHT)
“Ma’am/Sir, sakin lang po ang tingin”
 There is an immediate constriction of the pupil in the same eye, positive
for direct light reflex, and constriction of the pupil of the opposite eye,
positive for consensual light reflex.
Use PENLIGHT (as an object for accommodation lang, do not use the light.
Slowly ilapit kay patient yung object – convergence of the eyeballs)
“Ma’am/Sir tingin po kayo dito sa penlight, sundan niyo lang po ng tingin,
wag niyo po igagalaw yung ulo niyo po”
 There is convergence of the eyeballs. Positive for accommodation reflex.

18. Visual Acuity – near vision
19. Fundoscopic exam:
Use of ophthalmoscope
20. Proper position of patient
21. Red orange reflex
EARS
22. Size, symmetry, lesion,
nodules, deformities
23. Palpate the mastoid process
24. Press the tragus inward
25. Discharge, foreign body
26. Otoscopic Exam
Use of otoscope
27. Tympanic membrane: color,
intact
28. Tuning fork test
Repeat Weber’s Test 2 times.
Repeat Rinne’s Test 2 times
on BOTH ears.
Magtimer sa Rinne’s test kasi
cocompare mo yung AC and
BC.
NOSE
29. Inspect and palpate:
appearance, discharge,
flaring of ala nasi
30. Patency of nostril
Use JAEGER chart/magazine/newspaper (near vision)
“Pakicover po ng kanan/kaliwang mata tapos pakibasa po ito”
 The patient can read the smallest written text.
EXPLAIN lang sa part na to  FUNDOSCOPIC EXAM
 For this exam, you want to inspect the presence of red orange reflex. Hold
the ophthalmoscope with a right hand, use the right eye if you’re going to
examine the right eye of the patient, and left eye if examining the left eye
of the patient.
 Ask the patient to look straight ahead and to try not to move his/her eyes.
From an angle/side of the patient, shine towards the pupil and look
through the viewing hole. Once the red orange reflex is noted, move
closer and try to look for the optic disc.
“Examine naman po natin yung ears”
Use PENLIGHT for inspection (examine BOTH ears!!!)
 Both ears are C-shaped and symmetrical. No visible lesions, nodules, and
deformities seen.
Palpate mastoid process and tragus inward toward the ear canal.
“Sabihin niyo lang po if may masakit po sa gagawin ko ha”
 Negative for mastoid process and tragus tenderness.
 External auditory canal has no discharge and no foreign bodies.
Hold the otoscope with the examining hand (parang nagsusulat gamit pen)
and extend yung three fingers towards the face of the patient (to support).
Thumb and index finger sa kabilang kamay gagamitin to pull the concha
UPWARDS AND BACKWARDS
“Sisilipin ko lang po yung tenga niyo po ha”
 Tympanic membrane is pearly white in color and intact.
Note: 2 times sasabihin kasi both ears eexamine
Weber’s Test: lateralization of vibration
Before doing the test, ask the patient if may problema ba sa pandinig.
“May problema po ba kayo sa pandinig sa kaliwa o kanan na tenga?”
Instruct the patient sa gagawin na procedure.
“Ma’am/Sir, ito po ilalagay ko po sa taas ng ulo po niyo. Sabihin niyo po
saang parte niyo naririnig, kung sa kaliwa po ba o kanan, o kung pantay po”
Hit sa knuckles or flick yung drum. Remember na sa handle hahawakan.
Then place sa ulo ni patient. Then ask the patient again saan naririnig.
 The patient heard the vibration equally in both ears. No lateralization.
Rinne’s Test: air conduction vs bone conduction
Instruct the patient sa gagawin na procedure.
“Ilalagay ko po to sa ganito po niyo (turo yung mastoid) tapos sabihin niyo
po if wala na po kayo marinig tapos ililipat ko naman po sa tapat ng tenga
niyo then sabihin niyo po ulet if wala na po kayo marinig.”
Stimulate the drum tapos iplace sa mastoid then sa tenga.
 Air conduction is greater than bone conduction.
“Sa nose examination naman po tayo”
 The nose is triangular in shape, symmetrical, and blunt. No discharge. No
flaring of ala nasi.
For patency, kuha ng tissue tapos instruct si patient na iclose isang nostril
tas blow dahan dahan sa kabilang nostril, and vice versa.
“Ma’am/Sir, next po natin na gagawin isasara niyo po yung isang butas ng
ilong po niyo tapos dahan dahan po kayo suminga ng mahina lang po sa
kabilang butas” …….. “sa kabila naman po”
 The nose is patent, no secretions, no bleeding, no obstruction.
 31. Nasal septum position
32. Nasal mucosa: color,
discharge, inflammation
33. Paranasal sinuses (Frontal
and maxillary):
Transillumination
ORAL CAVITY
34. Lips: color, moisture,
symmetry, lesions
35. Buccal mucosa and gums:
color, moisture, lesions
36. Teeth: # of teeth missing or
present, color, caries
37. Tongue: size, position,
tremors, coating, lesions
38.Floor of mouth, soft and hard
palate: bony protuberance,
masses, lesions
39. Uvula: position
40. Tonsils: technique of
exposure, size, color, any
inflammation, exudates
41. Pharynx: exposure, mucosa,
inflammation, exudate, color
NECK
42. Range of motion
43. Lymph nodes: technique,
completeness of
examination, size,
consistency, tenderness
44. Thyroid gland: technique,
size, consistency, tenderness
45. Trachea: position
 Nasal septum is straight at the midline, no deviation, no perforation.
Use PENLIGHT with the right hand tapos use thumb at the tip of the nose
then 4 fingers sa forehead. Itilt si patient backwards.
“Titignan ko lang po yung loob ng ilong niyo”
 The nasal mucosa is pinkish in color, no discharge, no inflammation.
Start with sinus tenderness. Palpate sa frontal and ask if may masakit,
palpate sa maxillary and ask if may masakit.
 No tenderness upon palpation
Use PENLIGHT for transillumination (ideally off dapat ilaw)
Frontal sinus: place the penlight sa ilalim ng eyebrow sa medial side tapos
pataas ang light (BOTH eyebrows itest)
Maxillary sinus: place the penlight sa ilalim ng cheekbone tapos instruct si
patient na iopen ang mouth tapos tignan mo yung hard palate (BOTH sides)
 No clouding of the paranasal sinuses upon transillumination test.
EXPLAIN lang sa part na to.
 For the mouth examination. We will start from the outside, going inside.
But for safety purposes, we will only examine the outside and explain the
procedure for the examination of the oral cavity.
Use PENLIGHT to examine the lips
 Lips is pinkish in color, moist, symmetrical, and no lesions.
 For the inside the of mouth, instruct the patient to open their mouth, use
penlight and tongue depressor. The normal result would be the buccal
mucosa and gums are pinkish, moist, with no lesions. Teeth are yellowish
with a complete set, (with no/some caries).
 Next, instruct the patient to move the tongue up and down and then left
and right. Normal result is tongue pinkish in color, midline in position, no
tremors, no coating, and no lesions. The hard and soft palate are pinkish,
no masses, no lesions, no bony protuberance.
 Next, instruct the patient to say “Ah”. Normal result, uvula is midline.
Tonsils and pharynx are adequate in size and pinkish, no enlargement, no
inflammation, no exudates.
“Sa neck examination naman po tayo”
Hawakan yung shoulder ni patient to test the range of motion.
“Ma’am/Sir tungo po kayo, tingala, tingin po sa kaliwa, kanan, bend po sa
kaliwa, at sa kanan.”
 No deviation of movement. Intact range of motion without any difficulties.
“Hawakan ko lang po yung sa bandang leeg niyo po, sabihin niyo lang po if
may masakit po ha?”
Palpate using index and middle finger on both sides using two hands (except
for submental, one hand lang gamit). Palpate and mention them.
“Start tayo dito sa preauricular, then posterior auricular, jugulodigastric,
submandibular, submental, superficial cervical, deep cervical chain,
posterior cervical, occipital, and supraclavicular.”
“May masakit po sa mga hinawakan ko po?”
 Negative for lymphadenopathies
“Tingala naman po kayo ma’am/sir tapos lunok po kayo”
Palpate for tenderness and enlargement.
 Thyroid gland moves with deglutition. It is soft, palpable, no tenderness,
no enlargement.
Place the finger sa sides ng trachea, compare both sides.
 Trachea is in the midline.