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for general appearance and reaction. Look at the patient’s eyes and note the appearance of the corneas, sclera, conjunctiva, and iris. Check the pupils for accommodation, reflexes, and any irregularities. Then, check their visual field, visual acuity, extraocular movements, and corneal reflex.  Have your patient read the letters on a Snellen chart to check their visual acuity and asses the function of their second cranial nerve. Ask the patient to cover up 1 eye and read the chart with the uncovered eye and then repeat for the other eye.  You may also ask the patient if they are having any issues with their vision. You may also want to check for symptoms of common eye issues. For example, you could check for conjunctivitis by looking for signs of swelling, discharge, and redness around the eyelids. Check the patient’s pinnae and periauricular tissue, which are the parts of the ear outside of the patient’s head. Then, use the otoscope to look into the patient’s ear. The tissues should appear pink and healthy inside and outside of the patient’s ears with no signs of fluid or excess earwax buildup.  You may also ask the patient if they have noticed any hearing loss. If the patient has asked you to repeat yourself multiple times or if they are turning their head or leaning in to hear you better, then this may indicate hearing problems. The Weber test uses a tuning fork to check for unilateral hearing. To perform the Weber test, strike the tuning fork and then place the handle against the patient’s head just above their forehead. Ask them which ear they hear the sound in the loudest. If the patient has normal hearing, they should report that they hear the sound equally in both ears. If they have hearing loss in 1 ear, they will report not hearing it as loudly in the affected ear. The Rinne test uses a tuning fork to check for hearing loss in 1 ear. To perform the Rinne test, strike the fork and  place the handle against the patient’s mastoid bone. Then, take the fork away from the mastoid bone and bring it up and over the ear. Ask the patient to let you know when they no longer hear the tuning fork.  If the patient has hearing loss in that ear, they will report no longer hearing the tuning fork after you take it away from their mastoid bone. Repeat the test on the other ear after you finish checking the first ear. Dim the lights in the exam room, and then use the otoscope to look in the patient’s eyes through their pupils. Pay special attention to the retina, optic disc, arteries, vessels, media, cornea, lens, and macula lutea. Ask the patient to follow a pen with their eyes to check for any issues with cranial nerves III, IV, and VI. Attach the nasal speculum to the otoscope and look into the patient’s nostrils. Check for the present of pink, healthy looking mucous membranes.  You might also ask the patient if they have any issues with their sense of smell, which may indicate a problem with cranial nerve I.  You may also ask the patient if they suffer from allergies or other related problems as you inspect their nasal passages. Note any dental issues, such as decay, dental work, or noticeable issues with their bite. Then, check the pharynx and ask the patient to say “ah” to assess cranial nerves IX, X, and XII. The pharynx should elevate symmetrically when the patient does this. You might also ask the patient if they see a dentist regularly. Ask the patient to smile, frown, and open their mouth to see if their face is symmetrical when they do so. This will allow you to assess the function of cranial nerve VII. You may also touch the patient’s face lightly around their temples, middle of their face, and jaw to check for symmetry and to assess the function of cranial nerve V. Gently palpate the lymph nodes and salivary glands by pressing on them. Push down on the skin by about 1⁄2 in (1.3 cm). The lymph nodes and salivary glands are located along the sternocleidomastoid muscle in the front and back, in front and back of the ears, and on the underside of the jaw.  Signs of problems with the salivary glands or lymph nodes may include pain when you palpate them, hard spots on the glands, or swelling.  Also, check for an enlarged lymph node above the left mid cervical bone. This is a potential sign of gastric cancer and it requires further evaluation. The gland is shaped like a butterfly with its wings outspread, and it is located at the front, center of the neck, just above the collar bone. Note any irregularities in its size or shape. For example, if the patient’s thyroid gland is oversized or has a palpable nodule on it, then this would require further investigation.
Examine the patient’s eyes Look at the external and internal parts of the patient's ears. Perform the Weber test if the patient has hearing problems. Perform the Rinne test to check for hearing loss in 1 ear. Check the patient’s eyes using the otoscope. Inspect the patient’s nasal passages. Examine the mouth, tongue, teeth, and oral mucosa. Look at the patient’s face to check for symmetry. Check the lymph nodes and salivary glands. Locate and palpate the patient’s thyroid gland.