HEAD EXAMINATION

Done
Head Inspection Done Not Done
Properly
1. Set at the same level or slightly higher than the patient.
2. Observe the position of patient's head; note head
movements.
3. Note characteristic facies.
4. Note facial movements
5. Inspect the skull.
6. Inspect the hair.

Done
Head Palpation Done Not Done
Properly
1. Palpate the skull through the scalp by gentle rotary
movement starting from the frontal area towards the occipital
area.
2. Palpate for the patient's hair and note its texture, color and
distribution.
3. With the elderly, palpate any tenderness, hardness or
thickening in the temporal artery.

Done
Head Auscultation Done Not Done
Properly
1. Auscultate over the temporal region, over the eyes and
below the occiput using the bell to detect bruit.

EAR EXAMINATION

INSPECTION OF THE EXTERNAL EAR

Done
Inspection and Palpation of the External Ear Done Not Done
Properly
1. Sit at the same level or slightly higher than the patient.
2. Inspect symmetry, size and shape of pinna.
3. Check normal ear position.
4. Palpate the auricle between the thumb and forefinger.
5. Palpate the mastoid process using the index and middle
fingers.
6. Press the tragus inward toward the ear canal using the index
and middle fingers.

OTOSCOPIC EXAMINATION

Done
Inspection of the External Auditory Canal Using Otoscope Done Not Done
Properly
1. Inspect the unaffected ear first.
2. Patient to tip the head slightly toward the opposite shoulder
away from the side being examined.
3. Choose the largest speculum the patient's ear will
comfortably accommodate.
4. With the other hand, straighten the ear canal by pulling the
auricle gently upward and backward.
5. Turn on the otoscope light.
6. Grasp the otoscope with the dominant hand and hold it
either upright or against the patient's head.
7. Insert the otoscope into the external auditory canal carefully
until the tympanic membrane is visualized. Inspect the external
auditory canal as you go inside.

Inspection of the Tympanic Membrane Noting for Major Done

Done Not Done
Landmarks and Color Properly
1. Note color of the tympanic membrane.
2. Note whether the tympanic membrane is intact, flat or
concave, and bulging.
3. Note cone of light (white light reflex). Is it complete, diffused,
dull or absent?
4. Identify the parts of tympanic membrane.
5. Observe response to Valsalva maneuver and Tonybee
maneuvers.
6. Examine the other ear.

HEARING TEST

Done
Calibrated Finger Rub Auditory Screening Test (CALFRAST) Done Not Done
Properly
1. Stand about 6-10 inches in front of a seated patient.
2. Patient to close both eyes.
3. Extend both arms laterally so that your fingers are
equidistant from your ears and the patient's ears, a distance of
approximately 70 cm.
4. Instruct patient to listen carefully to the sound that you will
produce.
5. Patient to report hearing the sound by raising the hand on
the side of the perceived signal.
6. Produce strong sound by rubbing the thumb across your
distal fingers to each ear separately and repeat at least three
times (CALFRAST-Strong 70)
7. If the patient reports it accurately, subject the patient to the
next test - the faint finger rub (CALFRAST-Faint 70)
8. Produce sound by rubbing the thumb across your distal
fingers softer than before with your arms fully extended.
9. If the patient can hear CALFRAST-Faint 70 bilaterally, the
testing is complete.
10. If the patient does not hear CALFRAST-Strong 70 with either
ear, produce a louder stimuli.
11. Flex your elbow to 90 degrees while rubbing your fingers 35
cm from the tested ear (CALFRAST-Strong 10)
12. If patient cannot hear, place your fingers 10 cm from the
tested ear (CALFRAST-Strong1 10)
13. If the patient cannot hear, present the 2 cm distance
stimulation as close to the tragus as possible, without touching
the earlobe (CALFRAST-Strong 2)
 Done
Voice/Whisper Test Done Not Done
Properly
1. Stand closely behind a seated patient (at most 2 feet
distance) on the side of the ear to be tested.
2. Patient to cover the other ear with his/her hand.
3. Whisper a few words then ask patient to repeat what was
whispered.
4. Perform the same procedure to the other ear.

Done
Stopwatch/Tick Test Done Not Done
Properly
1. Stand close behind a seated patient (at most 2 feet distance)
on the side of the ear to be tested.
2. Patient to cover the other ear with his/her hand.
3. Hold a ticking watch/stopwatch near the ear being tested.
Patient is to say "yes" when the ticking is heard and "no" when
the ticking becomes inaudible as you move the watch slowly.
4. Perform the same procedure to the other ear.

TUNING FORK TESTS

Done
Weber Test Done Not Done
Properly
1. Sit at the same level or slightly higher than the patient.
2. Strike the tuning fork and place it firmly against the middle of
the patient's forehead or top of the head at the midline.
3. Patient to locate where the sound is heard.
4. Interpret findings.

Done
Rinne Test Done Not Done
Properly
1. Sit at the same level or slightly higher than the patient.
2. Strike the tuning fork and place it firmly against the patient's
mastoid process.
3. Patient to tell when the buzzing sound stops and note the
duration.
4. Immediately move the still vibrating tuning fork, though
vibrating weakly, near the external auditory meatus of the
patient.
5. Patient to tell when the buzzing sound stops and note the
duration.
6. Compare the duration of the bone conduction versus the air
conduction.
7. Interpret findings.
 Done
Swabach's Test Done Not Done
Properly
1. Sit at the same level or slightly higher than the patient.
2. Strike the tuning fork and place it firmly against the patient's
mastoid process.
3. Patient to tell when the buzzing sound stops and note the
duration.
4. Strike the tuning fork and place them firmly against your
mastoid process and note the duration of your own bone
conduction.
5. Compare your own bone conduction duration to that of the
patient's.
6. Interpret findings.

NOSE EXAMINATION

Done
Examination of the Nose Done Not Done
Properly
1. Inspect and palpate the nose.
2. Evaluate the patency of each nostril one at a time.
3. Inspect the internal nose by tipping the head back placing
the thumb against the tip of the nose OR by using a nasal
speculum and looking through the nares with the use of a
penlight in the other hand or otoscope.

4. Note any septal deviation, swelling or perforation.

5. Inspect nasal mucosa
6. Inspect inferior and middle turbinates for swelling, tumor or
mucoid discharges.

Done
Palpation of Paranasal Sinuses Done Not Done
Properly
1. Palpate the frontal sinuses for any tenderness by applying
digital pressure with the thumb and index finger over the bony
brow sides of the nasal bone without pressing against the eye
orbits.

2. Palpate the maxillary sinuses for any tenderness by applying

digital pressure with the thumb and index finger over the
maxillary bones.

Done
Transillumination of the Sinuses Done Not Done
Properly
1. If sinus tenderness is elicited, trans illuminate sinuses.
2. Completely darken the examining room.
3. With the use of an otoscope or light source, trans illuminate
the frontal sinuses by pressing the light source firmly against the
medial supraorbital rim and observe for a glow above the eye.

4. Then press on the skin just below the medial aspect of the
eye then have the patient tilt the head back and open the
mouth to observe for a glow in the area of the hard palate.
 MOUTH EXAMINATION

Inspection and Palpation of the Outer Structures of the Oral Done

Done Not Done
Cavity Properly
1. Locate the temporomandibular joints.
2. Patient to open and shut the jaw and expose the teeth.
3. Patient to move upper and lower jaws side to side.
4. Inspect and palpate salivary glands.
5. Inspect and palpate the upper and lower lips.

Done
Examination of the Lip and Cheek (Buccal) Oral Mucosa Done Not Done
Properly
1. Wear face mask.
2. Examine the underside of the lip and anterior surface of the
gums by displacing the lips with gloved fingers or gauze.
3. Examine the inner cheek using a tongue blade/depressor or
gloved finger to displace the cheek laterally and prevent
exposure .

Examination of the Dorsal Surface of the Tongue, Hard and Soft Done
Done Not Done
Palate Properly
1. Inspect the dorsal tongue. Patient to extend the tongue and
say "ah"
2. Note symmetry of the tongue and uvula when the tongue is
protruded.
3. Inspect rise of soft palate as the patient says "ah"
4. Patient to tilt the head back with mouth open and examine
the palate with a light or dental mirror.

Done
Inspection of the Lateral and Ventral Tongue Done Not Done
Properly
1. Inspect the mucosa by displacing the tongue laterally.
2. Patient to touch the hard palate with tip of the tongue.
Examine the ventral surface.
3. Palpate the oral mucosa of the mouth with a gloved finger.

Examination of the Oral Cavity, Oropharynx, Posterior Tongue Done

Done Not Done
and Uvula and Nasopharynx Properly
1. Inspect the gingiva, palate, tongue, cheeks, posterior
pharynx and uvula.
2. Gently depress the anterior two thirds of the tongue with a
tongue blade.
3. Note the appearance of the oral mucosa of the tonsils.
4. Inspect the nasopharynx using nasopharyngeal mirror.
Always warm the mirror first.
5. Elicit a gag reflex by touching the posterior wall of the
pharynx with the tongue blade or dental mirror.
 NECK EXAMINATION

Done
Inspection of the Anterior Neck Area Done Not Done
Properly
1. Sit facing patient at the same level or slightly higher.
2. Inspect neck while the patient holds his/her head and neck in
a normal relaxed position.
3. Inspect the neck from the side.
4. Patient to extend the neck slightly and swallow saliva.

THYROID EXAMINATION

Done
Palpation of the Thyroid Gland (Anterior Approach) Done Not Done
Properly
1. Stand in front of the patient and allow his/her neck to be
relaxed and held in slight extension to make the thyroid gland
prominent.
2. Locate the thyroid isthmus directly below the cricoid cartilage
using the pads of the thumb and index fingers.
3. Patient to swallow that will cause the isthmus to rise (due to
the movement of the larynx) and note its rubbery texture on
palpation.
4. Place your fingers laterally anterior to the
sternocleidomastoid muscle of the neck and ask the patient to
swallow.
5. Focus on palpating first the left thyroid gland lobe by asking
the patient to tilt his/her head slightly forward and to the right.
6. Use left thumb in displacing the thyroid gland in a left lateral
position while palpating the left lobe with your right thumb and
index finger, then ask the patient to swallow.
7. Repeat procedure on the right lobe.

Done
Palpation of the Thyroid Gland (Posterior Approach) Done Not Done
Properly
1. Stand behind the patient who is seated with neck slightly
flexed to relax the neck muscles.
2. Put both thumbs on the back of the patient's neck as you
place your other fingers below the cricoid cartilage, palpating the
thyroid isthmus above it as you ask patient to swallow.
3. Patient to turn his/her head slightly to the side and palpate
the lobes. Use the fingers of the opposite side to displace the
gland in a lateral direction so that the fingers over the side being
palpated can be readily felt as the patient is asked to swallow.

4. Repeat the procedure on the right lobe.

Done
Auscultation of the Thyroid Done Not Done
Properly
1. Using the bell of the stethoscope, auscultate for bruit over each
lobe that may be accompanied by a thrill.
 Done
Examination of Lymphatics of the Head and Neck Done Not Done
Properly
1. Place the patient's head in a slightly flexed position and turned
away from the area being examined.
2. Simultaneously palpate the left and right side of the lymphatic
areas of the head and neck systematically following the sequence:
a. Preauricular in front of the tragus of the ear.
b. Post auricular or mastoid-overlying mastoid process.
c. Occipital or suboccipital at the base of the skull.
d. Tonsillar at the angle of the lower jaw.
e. Submaxillary midway between the angle of the lower jaw and
chin
f. Submental midline behind the tip of the chin
g. Superficial cervical chain over the sternocleidomastoid muscle
h. Posterior cervical chain anterior to the trapezius muscle.
i. Deep cervical chain embedded in the sternocleidomastoid
muscle by hooking thumb and fingers around the muscle
j. Supraclavicular that is within the angle formed by the clavicle
and the sternocleidomastoid muscle.