Head and Neck Assessment
Checklist
Procedure
1. Identify the patient.
2. Explain the purpose of the head and neck examination and answer any questions.
3. Perform hand hygiene.
4. Inspect the head and then the face for color, symmetry, lesions, and distribution of facial hair. Note
facial expression. Palpate the skull.
5. Inspect the external eye structures (eyelids, eyelashes, eyeball, and eyebrows), cornea, conjunctiva, and
sclera. Note color, edema, symmetry, and alignment.
6. Examine the pupils for equality of size, shape, reaction to light by darkening the room and using a
penlight to shine the light on each pupil.
7. To test for pupillary accommodation and convergence, ask the patient to focus on an object as you brin
it closer to the nose.
8. Using an ophthalmoscope, check the red reflex.
9. Test the patient’s visual acuity with a Snellen chart. Ask the patient to read the smallest possible line of
letters, first with both eyes and then with one eye at a time.
10. With the patient about 2 feet away, ask the patient to focus on your finger and move the patient’s eyes
through the six cardinal positions of gaze.
11. Inspect the external ear bilaterally for shape, size, and lesions. Palpate the ear and mastoid process.
12. Perform an otoscopic examination. For an adult, pull the auricle up and back; for a child, pull the
auricle down and back. Note cerumen (wax), edema, discharge, or foreign bodies and condition of the
tympanic membrane.
13. Use a whispered voice to test hearing. Stand about 1 to 2 feet away from the patient, out of her line of
vision. Ask the patient to cover the ear not being tested. Perform test on each ear.
14. Use a tuning fork to perform Weber’s test and Rinne’s test if the patient reports diminished hearing in
either ear.
15. Inspect and palpate the external nose.
16. Palpate and lightly percuss over the frontal and maxillary sinuses. Transilluminate the sinuses if the
patient reports tenderness.
17. Occlude one nostril externally with a finger while patient breathes through the other; repeat for the
other side.
18. Inspect the internal nostrils using an otoscope with a nasal speculum attachment.
19. Palpate the temporomandibular joint by placing your index finger over the front of each ear as you ask
the patient to open and close the mouth.
20. Perform hand hygiene and don gloves. Inspect the lips, oral mucosa, hard and soft palates, gingivae,
teeth, and salivary gland openings by asking the patient to open the mouth wide using a tongue blade and
penlight.
21. Inspect the tongue. Ask the patient to stick out the tongue. Place a tongue blade at the side of the
tongue while patient pushes it to the left and right with the tongue. Inspect the uvula by asking the patient
to say “ahh” while sticking out the tongue. Palpate the tongue for muscle tone and tenderness. Remove
gloves.
22. Palpate from the forehead to the posterior triangle of the neck for the posterior cervical lymph nodes
using the fingerpads in a slow, circular motion.
23. Inspect and palpate in front of and behind the ears, under the chin, and in the anterior triangle for the
anterior cervical lymph nodes.
24. Inspect and palpate the left and then the right carotid arteries. Only palpate one carotid artery at a time
Use the bell of the stethoscope to auscultate the arteries.
25. Inspect and palpate the trachea.
26. Palpate the thyroid gland. Then, if enlarged, auscultate the thyroid gland using the bell of the
stethoscope.
27. Inspect and palpate the supraclavicular area.
28. Inspect the ability of the patient to move his neck. Ask the patient to touch his chin to chest and to eac
shoulder, each ear to the corresponding shoulder, and then tip head back as far as possible.
29. Perform hand hygiene.
