1
Inspect NECK
GENERAL ORDER OF THE EXAM *
• Entire body → color, lesion, hair distribution Inspect
• Inspect → visually observe pt
• Finger/Toenails → pitting or clubbing • Obvious masses or pulsations
• Palpate → use hands to feel pt
• Describe lesions noting number, location,
• Percuss → light striking of body parts to Palpate
arrangement & type & document later
produce sounds • Lymph nodes of head & neck; identify chains
• Auscultate → listening to body w/stethoscope →
Palpate (Use the back of the hand)
o Bell = low-pitch sound o Preauricular, postauricular, occipital
• Moisture, temperature, texture, turgor
o Diaphragm = high-pitch sound o Tonsillar, submandibular, submental
*All systems except GI (pinch back of hand), checking for tenting
• Note areas of tenderness or induration o Anterior cervical, posterior cervical &
4 CLASSICAL ASSUMPTIONS deep cervical (lean R/L)
• A & O x 4 (person, place, time, situation) o Supraclavicular, infraclavicular
• Vital signs WNL “I will continue to inspect the rest of the body o Non-palpable or <1cm, mobile, & non-
• Visual acuity assessed via Snellen chart bilaterally throughout the remainder of my tender
(CN 2 – Optic) exam” • Carotids → pulses
• Patient is in NAD • Trachea → deviation
HEAD → NCAT • Thyroid → size, symmetry, tenderness,
PREPARATION
consistency, nodules (palpate from behind)
• Knock on entry Inspect
• Introduce yourself • Skull → general size & contour
Neuro Test
o “Hi, my name is Sumiyah, and I’m a • Scalp → lesions or inhabitants
• CN 11 – Spinal Accessory (motor) → shrug
nursing student. I will be performing • Hair → quantity, texture, distribution, balding
shoulders, turn head against resistance
a physical exam on you today.” • Face → symmetry (eyebrows, palpebral
• Hand hygiene fissures in line with helices of ears, nasolabial “CN 2 – 12 are intact”
folds)
GENERAL SURVEY
• Physical Appearance Palpate
o Age, sex, race/ethnicity • Skull → deformities or tenderness
• Body Structure • Temporal Artery → induration & intensity
o Tall/short (2+ = normal)
o Underweight/overweight/average weight • TMJ → pain, popping or crepitus
o Proportionality of weight to height (pt. open/close mouth)
• Mobility
o Ease in ambulation Neuro Test
o Ease in movement of limbs • CN 7 (Facial - motor) → pt. smile, frown,
• Behavior/Mood puff cheeks, resist eye opening
o Response to questions • CN 5 (Trigeminal - motor) → pt. clench jaw
o Grooming/hygiene – masseter muscle engaged
o Affect/speech/eye contact • CN 5 (Trigeminal - sensory) → light touch x6
Ex: “Pt is a (#) y/o (gender ident.) of avg. & (ask pt. close your eyes & say “now” when you
proportional height & weight, who moves easily feel it)
& responds to questions. They are well groomed “Pt is normocephalic – atraumatic”
& have appropriate affect to situation.”
SKIN
, 2
EYES → PERRLA & EOMI EARS
Inspect • Assess gross hearing
• External Inspection (CN 8 – Vestibular Cochlear)
o Eyelashes → point out & away o Normal conversation
o Conjunctiva/sclerae/cornea → clear & o Whisper test/finger rub
moist o Ask pt. to close their eyes & point
o Pupil → size & shape to the ear where they hear the
o (3-5mm b/l, round) finger rub
o If abnormal, continue to Weber
• 3 Finger Test (midline) & Rinne (AC>BC) test
o Visual fields on confrontation Inspect
(CN 2 – Optic) (Jazz hands) • Auricle → symmetry, lesions, nodules
▪ Start laterally → Ask pt. stare • Special attention to back & top of ears as it is
straight in front & let me know a common site for skin cancer
when you see my fingers
o 6 cardinal fields of gaze (CN 3, 4, & 6 – Palpate
Oculomotor, Trochlear & Abducens) • Tragus & mastoid → tenderness
(Cat Whiskers)
▪ Ask pt. follow my finger & not Otoscopic Exam
move your head • Maneuver Auricle
o Accommodation & Convergence o Adults Pinna → up & back
(CN 2 & 3) (Follow Finger) o Peds Pinna→ down & back
▪ Ask pt. to follow my finger as I • Inspect canals → cerumen (ear wax), foreign
bring it closer to pt. face & away bodies, inflammation, discharge
• Inspect TM & note presence of the
• 2 Light Test (Pen light) following/abnormalities
o Direct (CN 2) constrict & consensual o Not bulging or retracted
(CN 3) light reflexes, consensually o Pearly gray color
constricts o Bony prominences
o Corneal light reflex → strabismus o Cone of light (R ‘ 5; L ‘ 7)
(shine light & see that the light falls in the
same place in both eyes)
• 1 Ophthalmoscope Exam
(Right Eye to Right Eye)
o Catch red light reflex & move closer into
pt.
o Optic disc → clear, well defined, creamy
yellow
o 4 sets of retinal vessels
o Macula → 2 optic discs away
“Pt is PERRLA & EOMI - Pupils are equal,
round, reactive to light & accommodation ;
Extra ocular movements intact”
Inspect NECK
GENERAL ORDER OF THE EXAM *
• Entire body → color, lesion, hair distribution Inspect
• Inspect → visually observe pt
• Finger/Toenails → pitting or clubbing • Obvious masses or pulsations
• Palpate → use hands to feel pt
• Describe lesions noting number, location,
• Percuss → light striking of body parts to Palpate
arrangement & type & document later
produce sounds • Lymph nodes of head & neck; identify chains
• Auscultate → listening to body w/stethoscope →
Palpate (Use the back of the hand)
o Bell = low-pitch sound o Preauricular, postauricular, occipital
• Moisture, temperature, texture, turgor
o Diaphragm = high-pitch sound o Tonsillar, submandibular, submental
*All systems except GI (pinch back of hand), checking for tenting
• Note areas of tenderness or induration o Anterior cervical, posterior cervical &
4 CLASSICAL ASSUMPTIONS deep cervical (lean R/L)
• A & O x 4 (person, place, time, situation) o Supraclavicular, infraclavicular
• Vital signs WNL “I will continue to inspect the rest of the body o Non-palpable or <1cm, mobile, & non-
• Visual acuity assessed via Snellen chart bilaterally throughout the remainder of my tender
(CN 2 – Optic) exam” • Carotids → pulses
• Patient is in NAD • Trachea → deviation
HEAD → NCAT • Thyroid → size, symmetry, tenderness,
PREPARATION
consistency, nodules (palpate from behind)
• Knock on entry Inspect
• Introduce yourself • Skull → general size & contour
Neuro Test
o “Hi, my name is Sumiyah, and I’m a • Scalp → lesions or inhabitants
• CN 11 – Spinal Accessory (motor) → shrug
nursing student. I will be performing • Hair → quantity, texture, distribution, balding
shoulders, turn head against resistance
a physical exam on you today.” • Face → symmetry (eyebrows, palpebral
• Hand hygiene fissures in line with helices of ears, nasolabial “CN 2 – 12 are intact”
folds)
GENERAL SURVEY
• Physical Appearance Palpate
o Age, sex, race/ethnicity • Skull → deformities or tenderness
• Body Structure • Temporal Artery → induration & intensity
o Tall/short (2+ = normal)
o Underweight/overweight/average weight • TMJ → pain, popping or crepitus
o Proportionality of weight to height (pt. open/close mouth)
• Mobility
o Ease in ambulation Neuro Test
o Ease in movement of limbs • CN 7 (Facial - motor) → pt. smile, frown,
• Behavior/Mood puff cheeks, resist eye opening
o Response to questions • CN 5 (Trigeminal - motor) → pt. clench jaw
o Grooming/hygiene – masseter muscle engaged
o Affect/speech/eye contact • CN 5 (Trigeminal - sensory) → light touch x6
Ex: “Pt is a (#) y/o (gender ident.) of avg. & (ask pt. close your eyes & say “now” when you
proportional height & weight, who moves easily feel it)
& responds to questions. They are well groomed “Pt is normocephalic – atraumatic”
& have appropriate affect to situation.”
SKIN
, 2
EYES → PERRLA & EOMI EARS
Inspect • Assess gross hearing
• External Inspection (CN 8 – Vestibular Cochlear)
o Eyelashes → point out & away o Normal conversation
o Conjunctiva/sclerae/cornea → clear & o Whisper test/finger rub
moist o Ask pt. to close their eyes & point
o Pupil → size & shape to the ear where they hear the
o (3-5mm b/l, round) finger rub
o If abnormal, continue to Weber
• 3 Finger Test (midline) & Rinne (AC>BC) test
o Visual fields on confrontation Inspect
(CN 2 – Optic) (Jazz hands) • Auricle → symmetry, lesions, nodules
▪ Start laterally → Ask pt. stare • Special attention to back & top of ears as it is
straight in front & let me know a common site for skin cancer
when you see my fingers
o 6 cardinal fields of gaze (CN 3, 4, & 6 – Palpate
Oculomotor, Trochlear & Abducens) • Tragus & mastoid → tenderness
(Cat Whiskers)
▪ Ask pt. follow my finger & not Otoscopic Exam
move your head • Maneuver Auricle
o Accommodation & Convergence o Adults Pinna → up & back
(CN 2 & 3) (Follow Finger) o Peds Pinna→ down & back
▪ Ask pt. to follow my finger as I • Inspect canals → cerumen (ear wax), foreign
bring it closer to pt. face & away bodies, inflammation, discharge
• Inspect TM & note presence of the
• 2 Light Test (Pen light) following/abnormalities
o Direct (CN 2) constrict & consensual o Not bulging or retracted
(CN 3) light reflexes, consensually o Pearly gray color
constricts o Bony prominences
o Corneal light reflex → strabismus o Cone of light (R ‘ 5; L ‘ 7)
(shine light & see that the light falls in the
same place in both eyes)
• 1 Ophthalmoscope Exam
(Right Eye to Right Eye)
o Catch red light reflex & move closer into
pt.
o Optic disc → clear, well defined, creamy
yellow
o 4 sets of retinal vessels
o Macula → 2 optic discs away
“Pt is PERRLA & EOMI - Pupils are equal,
round, reactive to light & accommodation ;
Extra ocular movements intact”
