Nose and

Sinuses
Examination Technique: Inspection, Palpation and
Percussion

Anatomical
External Nose

Normal
Located in
midline of face

Abnormal
Broken,
misshapen,
swollen nose

No swelling,
bleeding,
lesions, or
masses

Occluded
nasal
passages

Both nostrils
patent

Septum is
deviated

Septum
midline

Nasal mucosa
is red and
swollen

Nasal mucosa
is pink or dull
red

Purulent
drainage

Assess
Inspect and
palpate the
external nose.
Note nasal color,
shape,
consistency and
tenderness
Check patency of
airflow through
the nostrils.
Inspect the
internal nose

NORMAL

ABNORMAL

INSTRUMENTS:

Anatomical
Sinuses

Normal
Frontal and
Maxillary sinuses
are non-tender to
palpation, and no
crepitus is
evident.
The sinuses are
not tender on
percussion.
A red glow trans
illuminates the
frontal and
maxillary sinuses.

Abnormal

Assess

Frontal and
Maxillary sinuses
are tender to
palpation.

Palpate the
sinuses

The Frontal and

Maxillary sinuses
are tender upon
percussion.
Absence of a red
glow

Percuss the
sinuses

Transilluminate
the sinuses

NORMAL

ABNORMAL

INSTRUMENTS:

Mouth
Examination Technique: Inspection and Palpation

Anatomical
Mouth

Normal
Lips are smooth
and moist without
swelling and
lesions.
Pink lips
32 pearly whitish
teeth with smooth
edges
Upper molars
should rest
directly on the
lower molars
Front upper
incisors should
slightly override
the lower incisors.
No repaired or
decayed areas
No missing teeth
or appliances.

Abnormal
Pallor around the
lips
Bluish lips
Reddish lips
Swelling lips
Yellowish or
brownish teeth

Tooth decays
Missing teeth

Assess
Inspect the lips.
Observe lip
consistency and
color
Inspect the teeth
and gums. Note
the number, color,
condition, and
alignment of
teeth.

Anatomical

Normal

Abnormal

Mouth

Gums are pink,

moist and firm

Receding gums
Red swollen gums
that bleed easily

Buccal Mucosa

Should appear
pink
Tissue is smooth
and moist without
lesions

Leukoplakia

Tongue

Tongue should be
pink, moist, a
moderate size
with papillae
present

The tongues
ventral surface is

Assess

Inspect the buccal

mucosa

Black tongue
Inspect and
Hairy tongue
palpate the
Fissures
tongue. Inspect
Enlarged tongue
for color,
Small tongue
moisture, size and
Antrophied tongue
texture. Observe
for fasciculations
Leukoplakia
and check for
Persistent lesions
midline
Ulcers
portrusions.
Nodules
Assess the ventral
surface of the
tongue, frenulum

Anatomical

Normal
Frenulum is
midline
Whartons ducts
No swelling,
redness or pain
No lesions, ulcers
or nodules are
apparent
The tongue offers
strong resistance

Abnormal
Lesions
Nodules
Hypertrophied
duct

Leukoplakia
Persistent lesions
Nodules
Decreased tongue
strength

Loss of taste
Hard and soft palate

The client can

distinguish
between salt and
sweet.
The hard palate is
pale or whitish
with firm,
transverse rugae

Deep purple,
raised or flat
lesions

Assess
Inspect foe
Whartons Ducts

Observe the sides

of the tongue
Check the
strength of the
tongue
Check the anterior
tongues ability
taste
Inspect the hard
(anterior) and soft
(posterior) palates
and uvula

Anatomical

Normal
No unusual odor
or foul odor

Uvula
Tonsils

Throat

Abnormal

Assess

Fruity or acetone
Note odor
breath
Ammonia odor
Foul odor
Fecal breath odors
Sulfur odor

Fleshy, solid
Bifid uvula
Assess the uvula
structure that
hangs freely in the
midline
Tonsils are red and Inspect the tonsils
Normally pink and
enlarged
for color, size, and
symmetric
presence of
exudate or
Bright red throat
lesions.
Normally pink
Inspect the
without exudate
posterior
or lesions
pharyngeal wall

INSTRUMENTS:

Neck
Examination Technique: Inspection, Palpation and
Auscultation

Anatomical
Neck

Normal

Abnormal

Assess

Symmetric with
Swelling, enlarged Inspect the neck
head centered and
masses or nodules
for position,
without bulging
symmetry and
masses
lumps or masses
Asymmetric
Thyroid cartilage,
movement or
Inspect movement
cricoid cartilage
generalized
of the neck
and thyroid gland
enlargement of
structures
move upward
the thyroid gland
symmetrically
when swallows
Prominence or
swelling
C7 is usually
Inspect the
palpable and
Muscle spasms
cervical vertebrae
Limited mobility
visible
Inspect range of
Neck movement
motion
should be smooth
and controlled

Anatomical
Neck

Normal

Abnormal

Trachea is midline

Trachea may be
pulled to one side
in cases of tumor
Thyroid gland
enlargement
Landmarks
deviate from
midline

Palpate the
trachea

A soft blowing,
swishing sound
over the thyroid
gland

Auscultate the
thyroid gland only
if you find an
enlarged thyroid
gland during
inspection or
palpation
Palpate the lymph
nodes

Landmarks are
positioned midline
No bruits are
auscultated

Lymph Nodes

There is no
swelling or
enlarged or
tenderness

Enlarged nodes

Assess

Palpate the
thyroid gland

NORMAL

ABNORMAL

Palpating the neck and lymph nodes: