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physical exam & interview checklist

physical exam & interview checklist

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Published by jmosser

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Published by: jmosser on Jan 19, 2010
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02/01/2013

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The Interview
Chief concern: "What brings you in today"?
HPI:Seven characteristics of a symptom
Onset - how and when did it start? Have you ever felt something like this before? Are there

other symptoms associated with it?
Provocative &Palliative- what makes it better or worse?
Quality - what's it like? Is it sharp, dull, piercing, throbbing?
Radiation - where is it? Does it move to other parts of the body?
Severity - how bad is it (on a scale of 1 to 10)?
Timing - does it usually start at a certain time of day? How long does it last? Is it constant

throughout, or does it change over time? Does it recur or did it only happen once?
Remember to establish a goodtimeline
Other things to ask:
Is there anything in particular that you're concerned that it might be?
PMH:I'd like to ask some questions about your health in the past, in order to get a complete

picture.
How was your health as achild? Any major childhood illnesses?
How has your health been as anadult? Any major adult illnesses? Hospitalizations?

Surgeries?
Whatmedications are you currently taking?
Do you have anyallergies to foods, medicines, or anything else?

Family History:Before we move on, I'd like to ask some background questions about your
family's health history.
How has yourparents' health been? Any major illnesses, hospitalizations, or surgeries? Are
they still living?
Tell me about yourbrothers andsisters' health. Any major illnesses, hospitalizations, or
surgeries?
And yourgrandparents? Any major illnesses, hospitalizations, or surgeries?
Social history:I'd like to know a little more about you before we get started with the exam.

Tell me about what you do for a living.
How far did you go in school?
Do you live with anyone? Are you married, or have you ever been? Do you have children?

Tell me about them.
Have you ever used tobacco? How about alcohol? Have you ever used illegal drugs?
If yes: when, for how long, how many packs / drinks / etc. per day (max use).
1
Introduction
Introduce self, say hi
Wash hands before starting exam
HEENT
(tools: Snellen card, opthalmascope, otoscope, tongue depressor)
(Patient sitting upright)
Scalp/Face (1)
Inspect & palpate
Eyes (3)

Inspect sclera / conjunctiva
Snellen card eye test (cover one eye)
Opthalmoscope -lower lights first; find fundus; switch hands with opthalmoscope

Ears (2)
Inspect external ear (x2)
Otoscope - find tympanic membrane
Nose (1)
Otoscope (new speculum) to inspect nares
Oro-pharynx (2)
Uvula / pallate (inspect, stick out tongue & say "ah", usetongue depressor, raise/lower
tongue)
Inspect dentition / gums
Neck (4)
• Inspect

Palpate sternal notch - trachea midline?
Palpate lymph nodes
Palpate thyroid gland (tilt head & swallow, then palpate)

Neuro
(tools: penlight, tuning fork, cotton swab, reflex hammer)
Mental Status(8)
Preface with "routine questions"
Awake/alert?
Orientation: name, day, date, time, place
Attention: days of week forwards, backwards

Aphasia (3):
Name 3 objects
Repeat "The sky is blue in Baltimore"
Point to ceiling, point way out of room

Dysarthria (observe)
2
Mood: "How have you been feeling lately?"
Cranial Nerves (11)
CN II / III: check pupils (darken room,penlight, oblique, both sides)
CN II / III (2): visual fields
Four visual quadrants
◦ Upper/lower fields

CN III / IV / IV: Extra-ocular movements (cross)
CN V: touch face
CN VII (2)

Close eyes tightly / open widely
◦ Show teeth

CN VIII: hearing (rub fingers, same on both sides?)
CN IX: elevation of palatte (penlight, open mouth, say "ah")
CN XI: shoulder shrug (bilateral)
CN XII: stick out tongue

Motor (5)
Remember: have the patient resist a force (passive); isolate the joint
Proximal arm: chicken wing (one at a time)
Distal arm: finger extensor strength
(Patient sitting on table)

Proximal leg: hip flexor (instruct patient to brace with hands first)
Distal leg: dorsiflex foot
Pronator drift:eyes closed, hold hands out like tray for 10 seconds

Sensory (4)
(Patient sitting on table with arms out, palms up, on knees)
Light touch x 8 (eyes closed, usecotton swab on upper arm x 2, distal index finger x 2,
thigh x 2, distal big toe x 2)
Sharp touch x 8 (eyes open, usebroken cotton swab upper arm x 2, distal index finger x

2, thigh x 2, distal big toe x 2)
Vibration (tuning fork on PIP of great toe x 2 - hit tuing fork hard)
Proprioception (shield vision, move great toe up x 5 and down x 5 for each great toe)

Wash hands after feet
Reflexes (3)- usingreflex hammer

Biceps x 2 (palpate first)
Patella x 2 (palpate, then slightly lateral to midline)
Babinski x 2 (warn of discomfort)

Wash hands after feet
Coordination / Gait ()

Finger - nose x 2 (full reach)
Hand tapping (or flipping)
Walk across room (full length)
Romberg (stand with eyes closed, feet together: against wall, provide contact guard)
Tandem walk (drunk walk)
Stand on heels, then toes

3

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