Head-to-Toe Examination

Relationship with others in room

Degree of interest in what is happening in room

Alacrity with which you are met

Moistness of palm when you shake hands

Eyes—luster and expression of emotion

Skin color

Facial expression

Use of assistive devices


Sitting, rising from chair

Taking off coat

Dress and posture

Speech pattern, disorders, foreign language

Difficulty hearing, assistive devices

Stature and build

Musculoskeletal deformities

Vision problems, assistive devices

Eye contact with you

Orientation, mental alertness

Nutritional state

Respiratory problems

Significant others accompanying patient


Empty bladder.

Remove as much clothing as is necessary (always respecting modesty).

Put on a gown.


Measure weight and calculate the body mass index (BMI).

Measure height.

Assess distance vision—Snellen chart.

Document vital signs—temperature, pulse, respiration, blood pressure in both arms.


Stand in front of patient seated on examining table.


Head and face

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, quantity of hair.

Palpate facial bones.

Palpate temporomandibular joint while patient opens and closes mouth.

Palpate sinus regions; if tender, transilluminate (although often helpful, the sensitivity and specificity of transillumination are uncertain when considered separate from other findings.).

Inspect ability to clench teeth, squeeze eyes tightly shut, wrinkle forehead, smile, stick out tongue, puff out cheeks (CN V, VII).

Test light touch sensation of forehead, cheeks, chin (CN V).


External examination:
Inspect eyelids, eyelashes, palpebral folds.

Determine alignment of eyebrows.

Inspect sclerae, conjunctivae, irides.

Palpate lacrimal apparatus.

Near-vision screening—Rosenbaum chart (CN II).

Eye function:
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).

Test corneal reflexes (CN V).

Ophthalmoscopic examination:
Test red reflex.

Inspect lens.

Inspect disc, cup margins, vessels, retinal surface.


Inspect alignment and placement.

Inspect surface characteristics.

Palpate auricle.

Assess hearing with whisper test or ticking watch (CN VIII).

Perform otoscopic examination:
Inspect canals

Inspect tympanic membranes for landmarks, deformities, inflammation.

Perform Rinne and Weber tests.


Note structure, position of septum.

Determine patency of each nostril.

Inspect mucosa, septum, turbinates with nasal speculum.

Assess olfactory function when indicated: test sense of smell (CN I).

Mouth and pharynx

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).

Perform sense of taste test (CN VII, IX) when indicated.


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 tracheal position.

Palpate thyroid.

Palpate lymph nodes—preauricular and postauricular, occipital, tonsillar, submental, submandibular, superficial cervical chain, posterior cervical, deep cervical, supraclavicular.

Auscultate carotid arteries and thyroid.

Upper extremities

Observe and palpate hands, arms, shoulders.

Skin and nail characteristics

Muscle mass

Muscular strength

Musculoskeletal deformities

Joint range of motion and muscle strength—fingers, wrists, elbows, shoulders

Assess pulses—radial, brachial

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Mar 25, 2017 | Posted by in PHYSIOLOGY | Comments Off on Head-to-Toe Examination

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