Physical examination maneuver

Physical Exam

Head and Face Inspection

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How to Perform

Inspect the head and face for size, shape, and symmetry. Note the contour of the skull and any swellings or depressions, the symmetry of the facial features at rest and with movement, the distribution and texture of the scalp and facial hair, and the color, texture, and any lesions of the facial skin. Observe the overall facial expression and look for any characteristic facies.

How to Interpret

Showing 5 of 11 findings

Acromegaly

Coarse acromegalic facies
Rule in
HelpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate

Cushing Syndrome

Cushingoid facies
Rule in
Somewhat helpfulDerived CI
Rule out
Somewhat helpfulDerived CI
Evidence:Moderate

Hypothyroidism

Myxedematous facies
Rule in
Not helpful
Rule out
InconclusiveWide CI
Evidence:Moderate

Stroke

Acute facial droop as part of the FAST / Cincinnati stroke triad
Rule in
Helpful
Rule out
Somewhat helpful
Evidence:ModerateResearch in progress
Isolated facial droop (without arm-drift or speech testing)
Rule in
Somewhat helpfulDerived CI
Rule out
Minimally helpfulDerived CI
Evidence:Moderate

Related Bedside Tests

Extraocular MovementsMembers
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Extraocular Movements
Rule in:VHStroke, SHHyperthyroidism, SHMyasthenia Gravis +9 more
Rule out:HMyasthenia Gravis, SHHyperthyroidism, NHOrbital Fracture +9 more
🎬Video coming soon
Gait Assessment
Rule in:VHStroke, HFalls, HVascular Parkinsonism +24 more
Rule out:SHDementia, SHVascular Parkinsonism, MHFalls +24 more
Heart RateMembers
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Heart Rate
Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more
Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more
🎬Video coming soon
Achilles Deep Tendon Reflex
aka Ankle jerk
Rule in:VHPeripheral Neuropathy, SHHypothyroidism, NHLumbosacral Radiculopathy +5 more
Rule out:VHPeripheral Neuropathy, MHHypothyroidism, NHLumbosacral Radiculopathy +5 more
🎬Video coming soon
Patellar Deep Tendon Reflex
aka Knee jerk
Rule in:VHLumbosacral Radiculopathy, VHPeripheral Neuropathy, IECerebellar Disease +5 more
Rule out:SHPeripheral Neuropathy, ICLumbosacral Radiculopathy, IECerebellar Disease +5 more
🎬Video coming soon
Babinski Reflex
aka Plantar reflex
Rule in:VHUpper Motor Neuron Lesion, VHVascular Parkinsonism, HMultiple System Atrophy +4 more
Rule out:SHUpper Motor Neuron Lesion, MHMultiple System Atrophy, NHVascular Parkinsonism +4 more

Related Systems / Regions

Head, Eyes, Ears, Nose, Throat

Related Diagnoses

AcromegalyCushing SyndromeHyperthyroidismHypothyroidismLow Cardiac OutputMitral StenosisParkinson DiseaseStrokeSystemic Lupus Erythematosus

Related Chief Complaints

AcneBalance ProblemsBulging EyesCarpal Tunnel SymptomsCentral Weight GainCoarse Facial FeaturesCold IntoleranceConfusionConstipationDeepening VoiceDepressionDifficulty SpeakingDifficulty WalkingDizzinessDouble VisionDroolingDry SkinEasy BruisingEnlarged NoseEnlarging FeetEnlarging HandsErectile DysfunctionExcess Facial HairEyelid RetractionFacial DroopFacial FlushingFacial FullnessFacial RashFacial SwellingFat Pad on the Back of the NeckFatigueFlushed CheeksFrequent FallsHair LossHeadacheHeat IntoleranceHeavy PeriodsHigh Blood PressureHoarse VoiceIncidental FindingIncreased SweatingIncreased Thirst and UrinationIrregular PeriodsJaw ProtrusionJoint PainLoss of SmellMemory ProblemsMood ChangesMoon FaceMuscle AchesMuscle WeaknessNumbness on One SideObstructive Sleep ApneaOily SkinPalpitationsPhotosensitive RashProminent JawProtruding EyesPuffy FacePurple Stretch MarksRash Across the NoseRash on the CheeksResting TremorRing No Longer FitsRound FaceShoe Size IncreaseShuffling GaitSkin TagsSlow Heart RateSlowness of MovementSlurred SpeechSmall HandwritingSnoringSoft VoiceSpaced TeethStaring AppearanceStiffnessSudden Vision LossThickened LipsThin SkinTremorVision ChangesVisual Field LossWeakness on One SideWeight GainWeight Loss

References

Research in progress on one or more findings above; ratings may change.

  • Vouzouneraki K, Ylipaa E, Olsson T, Berinder K, Hoybye C, Petersson M, Bensing S, Akerman AK, Borg H, Ekman B, Robert J, Engstrom BE, Ragnarsson O, Burman P, Dahlqvist P. Detection of acromegaly from facial images using machine learning: a comparison with clinical experts. J Endocr Soc. 2026;10(2):bvaf203. doi:10.1210/jendso/bvaf203. PMID: 41608201. PMCID: PMC12838525.
  • Parasiliti-Caprino M, Bioletto F, Frigerio T, D'Angelo V, Ceccato F, Ferraù F, et al. A New Clinical Model to Estimate the Pre-Test Probability of Cushing's Syndrome: The Cushing Score. Front Endocrinol (Lausanne). 2021;12:747549. PMID: 34675882; PMCID: PMC8524092.
  • Indra R, Patil SS, Joshi R, Pai M, Kalantri SP. Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study. J Postgrad Med. 2004;50(1):7-11. PMID 15047991.
  • Indra R, Patil SS, Joshi R, Pai M, Kalantri SP. Accuracy of physical examination in the diagnosis of hypothyroidism: a cross-sectional, double-blind study. J Postgrad Med. 2004;50(1):7-11. PMID: 15047991.
  • Kim T, Jeong HY, Suh GJ. Clinical Differences Between Stroke and Stroke Mimics in Code Stroke Patients. J Korean Med Sci. 2022;37(7):e54. doi:10.3346/jkms.2022.37.e54. PMID: 35191231. PMCID: PMC8860772.
  • Goldstein LB, Simel DL. Is this patient having a stroke? JAMA. 2005;293(19):2391-2402. PMID: 15900010.
  • Gaddipati RV, Meyer DR. Eyelid retraction, lid lag, lagophthalmos, and von Graefe's sign quantifying the eyelid features of Graves' ophthalmopathy. Ophthalmology. 2008;115(6):1083-1088. PMID: 17900690.
  • Wood P. An appreciation of mitral stenosis: I. Clinical features. Br Med J. 1954;1(4870):1051-1063. PMID: 13149899.
  • Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ, Rothfield NF, Schaller JG, Talal N, Winchester RJ. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1982;25(11):1271-1277. doi:10.1002/art.1780251101. PMID: 7138600.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.