• Inspect the Head o Normocephalic
Microcephalic abnormally small head
Macrocephaly abnormally large head o Temporal artery
Arteritis o Temporomandibular joint o Scalp
Inspect for lesions, scaling, tenderness, and masses o Inspect the face
Symmetry
• Central brain lesion (CVA)
• CN VII damage e.g. Bell’s palsy
Facial expression – anxiety, excessive smiling
Abnormal facial structure
• Exophthalmus, changes in skin color
• Edema – periorbital or across the cheeks
• Tics
• Excessive blinking
• Grinding of the jaw
Compare Eyebrows, nasolabial folds, sides of mouth
o Inspect the Neck
Symmetry – head position midline
Head tilt in muscular spasm
Trachea in midline
ROM
• Chin to chest
• Head to shoulder
• Turn head to R and L (say “no”). o Person turns shoulders instead of neck
• Note pain, ratchety movement, limited ROM due to arthritis or inflammation of neck muscles o Lymph nodes - Note:
Size and shape
Delimitation
Mobility
Consistency – hard or soft
Tenderness (with acute infection)
Lymph Nodes
• Preauricular:
• Posterior auricular
• Occipital: base of the skull
• Submental
• Submandibular: halfway between the angle and the tip of the mandible
• Jugulodigastric (tonsilar)
• Superficial cervical
• Deep cervical
• Posterior cervical
• Supraclavicular o Thyroid Gland
Goiter
• Inspect the Eyes o Inspect External Ocular Structures o Facial expression – squinting o Eyebrows
Move symmetrically
No scaling or lesions o Eyelids/eyelashes
Eyelids meet together
The palpebral fissure
Eyelashes should be evenly distributed
Ptosis – drooping of upper lid
Skin without redness, discharge or lesions o Eyeballs
Exophthalmos (protruding eyes)
Enophthalmos (sunken eyes) o Conjunctiva and sclera
Conjunctiva - normal color – pink over lower lids, white over sclera
Sclera – china white o Assess for drainage, swelling, redness, asymmetry & lesions
External & Internal hordeolum (stye)
Ectropion Conjuctivitis
Arcus Senilis Cataract o PERRLA
Contralateral Pupil Constriction
• Inspect the Ear o Inspection of the Ear o Ears should be equal size
Microtia – ears smaller than 4 cm vertically
Macrotia – ears larger than 10 cm vertically o Skin intact, same color as face, intact
Tenderness
Move pinna and push on tragus
Assess for lesions, swelling, drainage o Tympanic Membrane
Otoscope – just for fun
Note any redness, swelling, discharge, foreign bodies
The tympanic membrane, or eardrum translucent with a pearly gray color.
• Ear drum