Skull: size, contour and asymmetry
Scalp: scaliness, lumps, nevi, lesions
Hair: quantity, distribution, texture, any pattern of loss
Face:expression, contours, asymmetry, involuntary movements, edema, masses
Temporomandibular joint - edema or erythema
1. General position and alignment o o o
a. Stand in front of the patient and ask the patient to stare directly at you.
b. Observe the eyes for any asymmetry or protrusions.
2. Eye lids & eyebrows: discoloration, edema, lesions
a. Inspect the eyebrows for sparseness or scaliness
b. Inspect the eyelids for adequate closure, ptosis, entropion, ectropion, retraction, discoloration, lesions, swelling, masses, or discharge.
3. Check for dryness or excessive tearing o o o
a. Examine the lacrimal gland and sac for swelling or tenderness.
4. Conjunctiva & sclera: color, edema, discharge o o o
a. Have the patient look upward while gently pulling downward on the lower lids with your thumbs.
b. Note color (pallor, icterus), vascular dilations, nodules, swelling, or discharge.
5. Cornea and lens: opacities o o o
a. Shine a penlight obliquely across the cornea, noting any surface irregularities or opacities.
b. Inspect the iris for rings, shadows, or ciliary injection, and inspect the lens for opacities.
6. Pupil size, shape & symmetry of BOTH eyes o o o
a) Note if small, large or unequal.
7. Note the position of the corneal reflections o o o
a. Have the patients stare at a penlight held about 20 cm away.
b. The reflection should be symmetrically located.
1. Inspect exterior nose: asymmetry, tenderness, deformity) o o o
2. Palpate for nares patency or obstruction bilaterally o o o
3. Inspect the internal nose using otoscope bilaterally o o o
a) nasal mucosa, nasal septum, inferior and middle turbinates', corresponding meatuses (for deviation, marked asymmetry, polyps, ulcers).
4. Check mucosa, septum, turbinates o o o
5. Palpate maxillary sinuses for tenderness, pressure, fullness o o o
6. Palpate frontal sinuses for tenderness, pressure, fullness o o o
7.Transilluminate sinuses: frontal and maxillary
1. Uses good light source to look in mouth o o o
2. Inspects outer and inner lip surfaces o o o
a) for color, moisture, lumps, ulcers, cracking, or scaliness
3. Inspect oral mucosa o o o
a) for discoloration, ulcers, white patches, nodules
4. Mention you would palpate the oral mucosa o o o
5.Inspect upper & lower gingiva
a) for erythema, discoloration, ulceration, swelling
6. Check upper and lower teeth o o o
a) for missing, discolored, misshapen, or abnormally positioned
7. Mention you would look for Stenson's duct o o o
8. Inspect the soft palate o o o
a) Anterior and posterior pillars, uvula, tonsils, and pharynx
b) For color, symmetry, exudate, swelling, ulceration, or tonsillar enlargement
9. Inspect the hard palate o o o
a) For erythema, discoloration, nodules, ulcerations, or deformities.
10. Test the hypoglossal nerve (CN XII)
a) Ask the patient to protrude their tongue and look for symmetry
11. Inspect tongue o o o
a) For color, texture, lesions
12. Mention palpation of the tongue o o o
13. Inspect floor of mouth o o o
a) For erythema, discoloration, nodules, ulcerations, or deformities
14. Mention palpation of the floor of mouth o o o
15. Test the vagus nerve (CN X) o o o
a) Ask the patient to say 'Ahh' and observe for symmetry of uvula.
16. Mention testing gag reflex