It is very important to examine the face as it gives information about different diseases. The most
common signs are:
• General Appearance
• Colour of conjunctiva
• Colour of sclera
• Colour of skin
• Parotid glands
What is the General Appearance of the face?
The appearance of the face may change in certain diseases. For example, moon-like face is found in Cushing’s syndrome, while an expressionless (mask-like)face is seen in Parkinson’s disease.
Is there any Puffiness on the face?
The puffiness may be due to oedema around the eyes, seen in renal failure, nephrotic syndrome and acute glomerulonephritis. Puffiness of the face is also observed in angioedema and myxedema.
Check if Exophthalmos is present
Protrusion of the eyeball is known as exophthalmos, also called proptosis. Their eyes look unusually prominent. In graves disease, exophthalmos is present on both sides. The orbital tumour causes exophthalmos of one side only.
Check the Colour of the conjunctiva
The pallor of conjunctiva manifests anaemia. To look at the colour is f the conjunctiva, ask the patient to look upwards and pull the lower eyelid downwards to expose the conjunctiva.
Check the Colour of the sclera
The yellow colour of the sclera is a manifestation of jaundice. To look at the sclera, ask the patient to look downwards and pull the upper eyelid upwards.
Is there any rash on the face?
The rash may be present over the cheeks and bridge of the nose, making it a butterfly. It occurs in systemic lupus erythematosus .
Check the colour of the skin on the face
Checking the colour of the skin of the face is also important. In cyanosis, bluish discolouration of the tip of the nose and ear lobules. Likewise, in mitral stenosis, there is redness on the cheeks called a malar flush. It may also be present in normal individuals.
If the patient is female, look for excessive hit growth in the face; if present, it is called
Look for any swelling of the parotid gland. If the parotid gland on only one side is swollen, it may be due to a tumour. In case of bilateral swelling, it may be due to mumps.
Examination of lips
The inner surface of the lips becomes bluish due to cyanosis.
Examination of tongue
Various songs must be looked for while examining the tongue. Look for dryness of tongue which occurs in case of dehydration. Also, look for cyanosis and pallor at the dorsum or upper surface of
the tongue. There may be baldness of the dorsum of the tongue due to atrophy of the villi and redness due to inflammation.
For jaundice, look at the undersurface of the tongue. Also, look at the size of the tongue. It’s enlarged in acromegaly.
General physical examination of the Neck
While doing a general physical examination of the neck, check for the following:
• Thyroid gland
• Neck veins
• Lymph nodes
The thyroid gland is a bilobed structure. Each lobe is on either side of the trachea, connected by an isthmus. Thyroid land enlargement is called goitre. The thyroid gland is examined in these steps:
Extend the neck of the patient. Look for any swelling on either side of the trachea. In the next step, ask the patient to swallow; if the swelling moves while swallowing, it is the thyroid gland. Check if it is bilateral or unilateral, diffuser nodular. Also, check its size.
2)Palpation of thyroid the gland
You can palate the thyroid gland both from the front and back. Put both your hands on the swelling and ask the patient to swallow. Note the following traits of the swelling moving under your fingers
1)What is the size of the swelling?
2)What is the consistency of the swelling?
3)Check for tenderness.
4)Is there a single nodule which is diffused in multiple nodules?
3)Auscultation of the thyroid gland
If the thyroid gland is hyperfunctioning, a sound resembling the murmur is here, which is called a bruit. Ask the patient to hold his breath while auscultating the thyroid gland. The sound of the thyroid should not be much d from the murmur radiating from the heart.
Examination of neck veins
By examining the pulsations in the jugular vein, one can estimate the pressure in the right atrium.
Examination of the lymph nodes of the neck
The following features of the lymph nodes are noted while doing a clinical examination of the lymph nodes:
a) Location of lymph nodes
b) Size of the lymph nodes
c) What is the number of lymph nodes?
d) Is there any tenderness?
e) Is there any discharge from lymph nodes?
f) What is their consistency?
Lymph nodes of the neck
The following groups of lymph nodes are present in the neck:
• Lymph nodes of the anterior triangle of the neck
• Lymph nodes of the posterior triangle of the neck
What is method of palpation of the lymph nodes of the neck?
Stand behind the patient.
Ask the patient to flex his neck.
Push your middle and ring fingers under his chin. Palate the submandibular and submental lymph nodes.
Then palpate preauricular and postauricular lymph nodes in front and back of the article. Then palpate the occipital group with the thumbs. Move your fingers behind the sternocleidomastoid to the palate nodes of the posterior triangle of the neck. Finally, palpate the lymph node of the anterior triangle of the neck between the trachea and sternocleidomastoid.
Note: Lymph nodes of both sides are palpated simultaneously except those of the anterior triangle to prevent blood flow blockade in the internal carotid arteries.
Here, the neck examination (including the thyroid gland, veins and lymph nodes) ends.