Physical Exam

Head and Face Inspection

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Video coming September 2026

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

Acromegaly

Coarse acromegalic facies

Rule in

HelpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:Limited

Hypothyroidism

Myxedematous facies

Rule in

Not helpful

Rule out

Somewhat helpful

Evidence:Limited

Stroke

Acute facial droop as part of the FAST / Cincinnati stroke triad

Rule in

HelpfulDerived CI

Rule out

Somewhat helpfulDerived CI

Evidence:Limited

References

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.
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.