HEENT

Skin
- Color: erythema, ecchymosis, white, black
- Trophic changes (altered hair growth, sweat production)
- Scars
Swelling
Muscle tone: atrophy, hypertrophy
Deformity: asymmetry, rotation, amputation
- Face should be symmetric

General
- External eye (conjunctiva, sclera, pupil, iris, eyelids, lacrimal ducts, etc)
- Inspect for symmetry of pupils, eyelids
- Extraocular Movements/Near Response
- Pupillary response
Consider testing
- Visual Acuity
- Visual Fields
- Fundoscopy (Ophthalmoscopy
- Manometry (testing pressure)
- Fluorescein stain with woods lamp
- Slit lamp
- Ultrasound of the Eye

CN I (Olfactory)
- Smell (not routinely tested)
- Can test with strong smells such as lemon, peppermint
CN II (Optic)
- Pupil size, shape and symmetry
- Visual fields by assessing 4 quadrants in each eye
- Visual acuity using Snellen chart
- Direct pupillary reflex (shine light in eye, look for ipsilateral restriction)
- Consensual pupillary reflex (shine light in eye, look for contralateral restriction)
- Accommodation reflex (switch from near object to close object)
- Assess color using Ishihara plates
CN III, IV, VI (Oculomotor, Trochlear, Abducens)
- Eyelids: look for normal, symmetric movement
- Pupillary light reflex
- Accommodation
- Extraocular movement tested in all planes (classically with movement in an H pattern)
CN V (Trigeminal)
- V1: forehead
- V2: cheek
- V3: lower mandible
- Muscles of mastication (open and close mouth against resistance)
CN VII (Facial)
- Symmetry
- Rise eyebrows
- Close eyes tight
- Blow out cheeks
- Smile
CN VIII (Vestibulocochlear)
- Sound in each ear (can rub fingers together)
- Rinnes Test
- Webers Test
- Balance testing (needs to be updated)
CN IX, X (Glossopharyngeal, Vagus)
- Cough or swallow
- Open and say “ahhh”
CN XI (Accessory)
- Turn head (Sternocleidomastoid)
- Shrug shoulders (Trapezius)
CN XII (Hypoglossal)
- Open mouth
- Stick tongue out and move side to side

Other text or information.