Inspection

Question 1

Face, head and neck?

Answer 1

• Expression
• Symmetry
• Swellings (Pulsations)
• Hair (Distribution, loss)
• Shape of face and skull
• Scars
• Skin (Rashes, acne, blisters, vitiligo)
• Movements (Weakness)

Question 2

Eyes?

Answer 2

• Lid lag
• Proptosis
• Eye movements
• Sclera (Jaundice or anaemia)
• Features of thyroid disease

Question 3

Skull and face?

Answer 3

• Facial symmetry

- Features of Cushing’s, acromegaly, bony changes.

Question 4

Nose?

Answer 4

1) Look from front, side and from above, observe the nasal pyramid
- Notice any discharge.
- Look for skin changes or deformity

2) Using patients own thumb test air flow

3) Elevate the tip of the nose and inspect the nasal vestibules and nasal septum (deviation?) - Use a light source
- Nasal vestibule – skin changes (e.g. ulceration) / swelling / asymmetry
- Nasal septum – polyps / deviation / perforation / areas of cautery
- Inferior turbinates – asymmetry / inflammation / polyps

Question 5

Ears?

Answer 5

• Pinna (Outer ear) note any nodules or other lesions
• Pinna pushed forward? (A sign of mastoiditis)
• External auditory meatus (Any discharge)
• Behind the pinna (scars)
• Mastoid process (Bruising or Battle’s sign)

Question 6

Lips?

Answer 6

• Cyanosis
• Angular stomatitis
• other lesions

Question 7

Open mouth?

Answer 7

• Dentition (tooth decay, gingivitis and periodontal disease)
• Floor of the mouth, submandibular duct (ulceration, stones and swellings)
• Hard and soft palate (swelling, ulceration, papillomas)
• Inside of each cheek
• Parotid duct opening (Patients upper 2nd molar)
• Ask patient to say ahhh (Deviation of the uvula?)
• Tonsils and Tonsillar folds/pillars (enlargement, asymmetry, peritonsillar swelling, ulceration, inflammation and tonsillar stones)
• Tongue

Question 8

Tongue?

Answer 8

• Dorsal surface
• Lateral borders (Dryness/fasciculations/wasting?)
• Frenulum
• Submandibular duct and opening
• Looking for candida, glossitis, ulceration, swelling, rarer conditions (black hairy tongue, Kaposi’s sarcoma)

Question 9

Bite?

Answer 9

Ask patient to gently bite teeth together

Question 10

Neck?

Answer 10

Inspect from both front and side:

• Voice (Hoarse or weak)
• Any dyspnoea or stridor
• Scars
• Swelling
• Lumps (Observe site, size, skin changes)
• Movement with tongure protrusion, “please stick your tongue out” and swallowing, “please take a sip of water, hold in your mouth, and now swallow”