• Signs of distress or disease • Relationship with others in room • Degree of interest in what is happening in room • Manner with which you are met • Moistness of palm when you shake hands • Eyes—luster and expression of emotion • Speech pattern, disorders, foreign language • Difficulty hearing, assistive devices • Vision problems, assistive devices • Orientation, mental alertness Stand in front of patient seated on examining table. • Inspect skin characteristics. • Inspect symmetry and external characteristics of eyes and ears. • Inspect configuration of skull. • Inspect and palpate scalp and hair for texture, distribution, and quantity of hair. • Palpate temporomandibular joint while patient opens and closes mouth. • Palpate sinus regions; if tender, transilluminate them (may be helpful, but sensitivity and specificity are uncertain when considered separate from other findings). • Inspect ability to clench teeth, squeeze eyes tightly shut, wrinkle forehead, smile, stick out tongue, and puff out cheeks (CN V, VII). • Test sensation using light touch on forehead, cheeks, chin (CN V). • Inspect eyelids, eyelashes, palpebral folds. • Determine alignment of eyebrows. • Inspect sclerae, conjunctivae, irides. • Test pupillary response to light and accommodation. • Perform cover-uncover test and corneal light reflex. • Test extraocular eye movements (CN III, IV, VI). • Assess visual fields (CN II). • Ophthalmoscopic examination: • Inspect lips, buccal mucosa, gums, hard and soft palates, floor of mouth for color and surface characteristics. • Inspect oropharynx: note anteroposterior pillars, uvula, tonsils, posterior pharynx, mouth odor. • Inspect teeth for color, number, surface characteristics. • Inspect tongue for color, characteristics, symmetry, movement (CN XII). • Test gag reflex and “ah” reflex (CN IX, X). • Assess sense of taste test when clinically indicated (CN VII, IX). • Inspect for symmetry and smoothness of neck and thyroid. • Inspect for jugular venous distention (also when patient is supine). • Perform active and passive range of motion; test resistance against examiner’s hand. • Test strength of shoulder shrug (CN IX). • Palpate carotid pulses. Be sure to palpate one side at a time (also when patient is supine). • Palpate lymph nodes—preauricular and postauricular, occipital, tonsillar, submental, submandibular, superficial cervical chain, posterior cervical, deep cervical, supraclavicular.
Head-to-Toe Examination
Adult
Components of the Examination
General Inspection
Patient Seated, Wearing Gown
Head and Face
Eyes
Mouth and Pharynx
Neck
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree