NU 650 HEENT UPDATED ACTUAL Questions and CORRECT Answers
Inspect and palpate the skull
Note size, contour, deformities, depressions, lumps, tenderness
Assessment of Head
Inspect facial symmetry, color, expressions, involuntary movements, edema, or
masses
Normal head assessment normocephalic and atraumatic
History of headaches - include 7 characteristics
Pattern of headaches
Subjective assessment of head Associated headache sx - dizziness, nausea, photophobia
History of head trauma or facial trauma
Any medications patient takes / coping with headaches
Microcephaly or Macrocephaly - measure circumference
Fontanel closure - Posterior by 2 mos. Anterior by 18 mos
Note facial expression
Pediatric considerations for Head
Assess for trauma/birth marks on face
assessment
Mother's health during pregnancy - i.e., ETOH and FAS
Assess for Caput Succedaneum - normal process during birth leavs
swelling/ecchymosis on presenting part
Cornea anterior portion of the outer covering of the eye
Posterior part of the eye seen with ophthalmoloscope
Fundus
Made up of retina, macula, fovea, optic disc, and vessels
Location: laterally and slightly infetior to the optic disk. Dark and circular area within
the macula
Fovea
Seen on ophthalmoscopic exam
, round darker area of the ocular fundus that mediates vision only from the central
visual field
Macula
surrounds fovea, with non-discernable/fuzzy margins
Appears on ophthalmoscope exam as round, yellowish-orange to creamy pink disc
with sharp margins and vessels converging here.
Optic Disc
arteries- lighter and thinner
veins - darker and thicker
swelling of the optic disc
Papilledema
Appears pink, more visible with more numerous vessels and blurred margins
normal palpebral fissures symmetrical with distance of 8-12 cm
the structures that produce, store, and remove tears
consists of the lacrimal gland (above eye)
lacrimal apparatus lacrimal sac (inner canthus of eye)
and lacrimal duct (runs along nose)
should be free from swelling or nodules
normal conjunctiva translucent, flat, sclera visible beneath
normal cornea transparent, smooth, moist, shiny
normal iris visible through cornea, well-defined border, note color on exam
Direct Pupillary Reflex pupillary constriction in same eye exposed to light
Reflex in which shining light into an eye, the OTHER eye (not receiving light) also
Consenual Pupillary Reflex
constricts
Like the pupillary reflex, the pupil constricts or dilates based on the distance of the
pupil accomodation image requiring focus - i.e., move an object closer to patient, pupils constrict as
object gets closer
Face patient and imagine glass bowl encircling patient head on
Ask patient to look directly at you with both eyes
Place hands 2 ft apart, lateral to pt's ears
How to complete finger wiggle test slowly move wiggling fingers along border of "glass bowl"
Ask pt to tell you when they can see your fingers
Map our lateral extent of L/R visual fields
Test 1 eye at a time if you suspect visual defect
Stand in front of patient and ask them to follow finger with eyes
Sweep through 6 cardinal directions of gaze by making an "H" in the air.
How to assess for extraocular movements
Order: Patient's extreme Right, up, then down, straight across to patient's exteme
Left, up, then down.
Nystagmus repetitive rhythmic/jerking movements of one or both eyes
also known as the Hirschberg test, assesses parallel alignment; have pt look straight
Corneal light reflex ahead, shine light from 12" and look for reflection on corneas in exactly the same
position in both eyes appearing as a white light
Stand approximately 15 inches away
examine R eye with R hand (vice versa)
positioning for ophthamoscope exam Angle ophthalmoscope 20 degree angle
after locating red reflex, move closed until almost touching thumb steadying
patient's eyebrow
Inspect and palpate the skull
Note size, contour, deformities, depressions, lumps, tenderness
Assessment of Head
Inspect facial symmetry, color, expressions, involuntary movements, edema, or
masses
Normal head assessment normocephalic and atraumatic
History of headaches - include 7 characteristics
Pattern of headaches
Subjective assessment of head Associated headache sx - dizziness, nausea, photophobia
History of head trauma or facial trauma
Any medications patient takes / coping with headaches
Microcephaly or Macrocephaly - measure circumference
Fontanel closure - Posterior by 2 mos. Anterior by 18 mos
Note facial expression
Pediatric considerations for Head
Assess for trauma/birth marks on face
assessment
Mother's health during pregnancy - i.e., ETOH and FAS
Assess for Caput Succedaneum - normal process during birth leavs
swelling/ecchymosis on presenting part
Cornea anterior portion of the outer covering of the eye
Posterior part of the eye seen with ophthalmoloscope
Fundus
Made up of retina, macula, fovea, optic disc, and vessels
Location: laterally and slightly infetior to the optic disk. Dark and circular area within
the macula
Fovea
Seen on ophthalmoscopic exam
, round darker area of the ocular fundus that mediates vision only from the central
visual field
Macula
surrounds fovea, with non-discernable/fuzzy margins
Appears on ophthalmoscope exam as round, yellowish-orange to creamy pink disc
with sharp margins and vessels converging here.
Optic Disc
arteries- lighter and thinner
veins - darker and thicker
swelling of the optic disc
Papilledema
Appears pink, more visible with more numerous vessels and blurred margins
normal palpebral fissures symmetrical with distance of 8-12 cm
the structures that produce, store, and remove tears
consists of the lacrimal gland (above eye)
lacrimal apparatus lacrimal sac (inner canthus of eye)
and lacrimal duct (runs along nose)
should be free from swelling or nodules
normal conjunctiva translucent, flat, sclera visible beneath
normal cornea transparent, smooth, moist, shiny
normal iris visible through cornea, well-defined border, note color on exam
Direct Pupillary Reflex pupillary constriction in same eye exposed to light
Reflex in which shining light into an eye, the OTHER eye (not receiving light) also
Consenual Pupillary Reflex
constricts
Like the pupillary reflex, the pupil constricts or dilates based on the distance of the
pupil accomodation image requiring focus - i.e., move an object closer to patient, pupils constrict as
object gets closer
Face patient and imagine glass bowl encircling patient head on
Ask patient to look directly at you with both eyes
Place hands 2 ft apart, lateral to pt's ears
How to complete finger wiggle test slowly move wiggling fingers along border of "glass bowl"
Ask pt to tell you when they can see your fingers
Map our lateral extent of L/R visual fields
Test 1 eye at a time if you suspect visual defect
Stand in front of patient and ask them to follow finger with eyes
Sweep through 6 cardinal directions of gaze by making an "H" in the air.
How to assess for extraocular movements
Order: Patient's extreme Right, up, then down, straight across to patient's exteme
Left, up, then down.
Nystagmus repetitive rhythmic/jerking movements of one or both eyes
also known as the Hirschberg test, assesses parallel alignment; have pt look straight
Corneal light reflex ahead, shine light from 12" and look for reflection on corneas in exactly the same
position in both eyes appearing as a white light
Stand approximately 15 inches away
examine R eye with R hand (vice versa)
positioning for ophthamoscope exam Angle ophthalmoscope 20 degree angle
after locating red reflex, move closed until almost touching thumb steadying
patient's eyebrow
