Examination of Head
- Hair quality, quantity, dist, baldness, texture
- Nits, lice.
- Redness or scaling of scalp.
- Skull size and deformities, tenderness, lumps
- Facial expression, symmetry, deformities, tenderness, lumps.
- Skin color, texture, thickness, hair dist., lesions
Examination of Nose
- Inferior turbinate and inf. border of middle turbinate - color, swelling, polyps.
- Mucosa - color, swelling, bleeding
- Septum - deviation or perforation
Examination of Sinuses
- Palpate - pain or tenderness
- Percuss - pain or tenderness
- Transilluminate
Examination of Mouth - major parts
Lips, buccal mucosa, mucosa, gums/teeth, roof of mouth, tongue
Examination of Mouth - Lips
Lips - color, moisture, lumps, cracking, ulcers, lesions
Examination of Mouth - Buccal Mucosa
Buccal mucosa - color, pigmentation, ulcers, nodules, leukoplakia, candidiasis,
Examination of Mouth - Mucosa
Mucosa - color swelling, bleeding, Stenson’s (parotid) and Wharton’s (submandibular glands)
Examination of Mouth - Gums/teeth
Gums/teeth - inflammation, bleeding, retraction, missing teeth, caries, fillings, abnormal shape/position
Examination of Mouth - Roof of mouth
Roof of mouth - palpate hard and soft palate (torus)
Examination of Mouth - Tongue
Tongue - tongue symmetrical, inspect inferior and lateral tongue.
Examination of Pharynx
Depressor middle third of tongue.
Pt says Ahh at different pitches.
Inspect soft palate, pillars, tonsils, uvula, and pharynx for color, symmetry, swelling, exudates.
Examination of Lymph Nodes
- Inspect neck for swelling, tracheal deviation asymmetry
- Note size shape, mobility, consistency, tenderness of lymph nodes
- Palpate BL: Pre-auricular, post-auricular, occipital, tonsilar, submandibular, submental
- Palpate UL: Superficial cervical, posterior cervical, deep cervical, supraclavicular
Examination of Thyroid
- observe
- swallow water
- finger on crichoid, swallow to feel isthmus
- palpate isthmus and lobes
- note: enlargement, nodules
Examination of Ear - Outer
- Auricle or tragus pain tenderness
- Mastoid - redness swelling
- Canal - swelling redness pain d/c
Examination of Ear - TM
- Position - bulging neutral retracted
- Color - pearly gray, dull, cloudy, amber, red, blue hemorrhage, bullae
- Cone of light, umbo
- Bony landmarks - manubrium
- Insufflation
Examination of Ear - Whispered Voice Test
Pt repeats at least 3 of 6 numbers of letters correctly
Examination of Ear - Weber
Is there a difference in sensation or hearing in one of the ears.
- Conductive loss - sound lateralizes to bad ear
- Sensory loss - sound lateralizes to good ear
Examination of Ear - Rinne
When pt no longer hears tuning fork on mastoid, position tuning fork just over ear. Can they hear it?
- Normal AC >= BC
- Conductive loss BC>= AC
- SN loss decrease AC > decrease BC
Examination of Eyes - Major Parts
- Snellen and Rosenbaum charts
- Peripheral vision
- Position/alignment/outer eye exam
- Conjunctiva and Sclera
- Cornea, iris, ant chamber, lens
- PERRLA, hippus
- Extraoccular movements
Examination of Eyes - Position/alignment/outer eye exam
- Exophthalamos (proptosis) - bulging eyes
- Strabismus (cross-eye)
- Hirschberg corneal reflex (light reflect same spot both eyes
- Eyebrows - quanitity, loss outer third, scaling
- Eyelids - edema, redness, hordeolum, chalazions, blepharitis, eyelashes, dropping of eyelids
- Lacrimal apparatus - redness, swelling, excess or dry
Examination of Eyes - Conjunctiva and Sclera
- pull down lower lid - look up, to side
- lift upper lid - look down
- excessive injection, jaundice, chemosis, local redness, nodularity
Examination of Eyes - Cornea, Lens, Anterior Chamber, Iris
- Oblique lighting - opacities of cornea, lens
- oblique/tangential lighting - ant chamber blood, pus, or inflammatory cells (flare of iritis)
- tangential lighting - shadow of iris
Examination of Eyes - PERRLA
- Equal
- Round
- Reactive to Light (direct, consensual)
- Accommodation - constriction, convergence (tip of pen)
Examination of Eyes - Extraocular movements
- H or X
- Abnormalities in gaze, congruity of gaze, lateral movement (CN 6), inferior/medial movement (CN 4), any other movement (CN 3), strabismus, nystagmus
Ophthalmoscopic Exam - Retina
Optic disc - clarity of outline, color, cup/disc ratio
A/V crossings - nicking
Lesions on retina
Macula
Ophthalmoscopic Exam - Anterior Chamber
Slit aperture, green diopters
Flare of iritis, hyphema (blood), hypopyon (pus), opacity of lens
