Interactive Guide to Physical Examination
Examination of the head includes inspection of the face, skin, hair, scalp and skull. Begin by observing facial features, understanding that they may vary by sex and race. Inspect the eyebrows, eyelids, palpebral fissures, nasolabial folds and mouth, noting any asymmetry. Remember that certain disease states can affect these features (e.g. hypothyroidism, acromegaly). Many genetic disorders cause characteristic facies identified through careful inspection. When inspecting the facies, note if the patient appears his stated age, older or younger, if he appears in good or poor general health, and if there is any generalized swelling or periorbital edema.
Facial skin should also be carefully inspected, noting color, pigment changes, texture, hair distribution, rashes or lesions.
Inspect and palpate the hair, noting its texture, distribution, quantity and pattern of hair loss if any. Part the hair in several places, looking for scalp scaliness, lumps, lesions or nits.
Inspect the skull, noting the general size, shape and symmetry.
