Head (6 steps)

1. Inspects the head (size, shape, symmetry, and position)

2. Inspects the face (symmetry, features, movement, and expression)

3. Palpates skull

4. Separates hair to inspect scalp

5. Palpates the temporomandibular joint

6. Palpates the temporal artery, bilaterally

1.  Inspects position and alignment

2.  Inspects eyebrows, eyelids, and lashes

3.  Inspect the conjunctivae and sclera

4.  Inspect for ptosis and lidlag

5.  Uses oblique lighting to inspect cornea, irides, and lens

6.  Gauges pupil size in millimeters

7.  Tests for Pupillary Light Reflex: darken the room and ask patient to gaze into the distance

8.  Advances light from the side and note the response

9.  Inspects for Direct Light Reflex and Consenual Light Reflex

10.  Palpates lacrimal apparatus by pressing the index finger against the gland, sac, and duct

11.  Asks patient to look down with eyes closed, and indent lid gently to check tension

1.  Inspects external ear (auricle, tragus, and lobule).  Assesses for size, symmetry, swelling, or thickening.

2.  Inspects external auditory canal; note any swelling, redness, or discharge.

3.  Palpates for tenderness by moving the pinna and by pressing on the tragus and mastoid process.

1.  Inspects external nose (symmetry and position).

2.  Uses penlight to inspect nasal cavities, septum, turbinates, nasal mucosa and for drainage.

3.  Tests for patency.

Paranasal Sinues (2 steps)

1.  Palpates by pressing thumbs upon frontal and maxillary sinuses.

2.  Avoids pressure on the eyes.

1.  Inspects the lips (color, moisture, cracking, or lesions).

2.  Using gloves and a penlight, inspects teeth & gums.  Asks the patient to bite as if chewing-note alignment.

3.  Inspects the tongue by asking the patient to open mouth & stick out tongue (color, surface characteristics, and moisture).

4.  Inspect the buccal mucosa using a tongue blade (color, moisture, nodules, or lesions).

5.  Inspects the palate (color, rugae).

6.  Inspects the throat.

1.  Presses free end of tongue blade firmly down upon the midpoint of arched tongue.

2.  Inspects the uvula (midline).

3.  Asks patient to say "ah."

4.  Inspects all structures of pharynx.

5.  Inspects the tonsils if present (color, size).

1.  Inspects the neck:  Head position is centered in midline, accessory neck muscles and symmetrical.  Assess that head is erect and still.

2.  Palpates the lymph nodes of the neck, using a gentle circular motion; naming them (submental, submandibular, tonsillar, preauricular, postauricular, occipital, superficial cervical, deep cervical, supraclavicular, and posterior cervical.

3.  Asks patient to flex neck slightly forward.  Uses pads of index & middle fingers to move skin over underlying tissues in each area.

4.  Places finger on the trachea in area of the sternal notch, slips it off the trachea to each side.

5.  Palpation of the thyroid using the anterior or posterior approach (enlargement, consistency, symmetry, and nodules).

6.  Assesses neck for range of motion.

• Symmentrical.
• Eyebrows full and symmetrical, eye lashes evenly distributed without inflammation, no ptosis or lidlag.
• Conjunctivae clear, sclera white, no lesions or redness. Lacrimal apparatus without inflammation or discharge.
• Pupils equal, round, and reactive to light; R 3/1=3/1L.
• Direct and consensual light reflex noted bilaterally.
• Irides flat, round regular shape, with even coloration.
• No eyelid tension palpated.

• Pinna without masses, lesions, nodules, inflammation, or tenderness.
• No apparent swelling, redness or discharge of external auditory canal.

• No deformities,
• septum midline,
• no lesions,
• masses,
• bleeding,
• swelling,
• nares patent,
• no sinus tenderness.

• Mucous membranes pink, gums healthy, teeth in good repair. Tongue symmetric and midline.
• Hard and soft palates intact; tonsils absent.
• Pharynx pink without lesions or exudate, uvula midline and rises with phonation.

• Symmetrical , supple, without masses or tenderness, no lymphadenopathy. 
• Trachea midline.
• Thyroid non palpable, non tender.
• Full range of motion noted.