Professional Documents
Culture Documents
Physical Exam Checklist
Physical Exam Checklist
Student Name__________________
General Skills
YES
NO
1._______
1._______
2._______
2._______
3._______
3._______
4._______
4._______
5._______
5._______
6._______
6._______
7._______
7._______
8._______
8._______
Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
Not
Done
1._______
1._______
1._______
2._______
2._______
2._______
3._______
3._______
3._______
4._______
4._______
4._______
5._______
5._______
5._______
6._______
6._______
6._______
7. Inspect nails and nail beds. Check clubbing and capillary refill.
7._______
7._______
7._______
8. Inspect and palpate both arms and forearms with clothing removed,
including temperature
8._______
8._______
8._______
9._______
9._______
9._______
10. Palpate axillary nodes (use proper technique to palpate axillary nodes).
10.______
10.______
10.______
11.______
11.______
11.______
12.______
12.______
12.______
13.______
13.______
13.______
14.______
14.______
14.______
15.______
15.______
15.______
EYES
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Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
Not
Done
16.______
16.______
16.______
17.______
17.______
17.______
18. Test visual fields in each eye separately in 4 (up, down, right, left)
directions.
18.______
18.______
18.______
19. Evaluate extraocular muscle function in 4 (up, down, right, left) directions. 19.______
19.______
19.______
20.______
20.______
20.______
21.______
21.______
21.______
22.______
22.______
22.______
23.______
23.______
23.______
24.______
24.______
24.______
25. Ophthalmoscope held properly and index finger used to switch lenses.
25.______
25.______
25.______
26. Hold ophthalmoscope with right hand to inspect patients right eye.
26.______
26.______
26.______
27.______
27.______
27.______
28.______
28.______
28.______
29.______
29.______
29.______
30.______
30.______
30.______
31.______
31.______
31.______
32. Hold ophthalmoscope with left hand to inspect patients left eye.
32.______
32.______
32.______
33.______
33.______
33.______
34.______
34.______
34.______
35.______
35.______
35.______
36.______
36.______
36.______
37.______
37.______
37.______
38.______
38.______
38.______
39.______
39.______
39.______
40.______
40.______
40.______
41.______
41.______
41.______
42.______
42.______
42.______
43.______
43.______
43.______
44.______
44.______
44.______
45.______
45.______
45.______
46.______
46.______
46.______
47.______
47.______
47.______
48.______
48.______
48.______
49.______
49.______
49.______
EARS
NOSE
(CN I asked here __________ )
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Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
Not
Done
50.______
50.______
50.______
51.______
51.______
51.______
52.______
52.______
52.______
53.______
53.______
53.______
54.______
54.______
54.______
55.______
55.______
56.______
56.______
56.______
56.______
57.______
57.______
57.______
58.______
58.______
58.______
59.______
59.______
59.______
60.______
60.______
60.______
61.______
61.______
61.______
62.______
62.______
62.______
63.______
63.______
63.______
64.______
64.______
64.______
65.______
65.______
65.______
66.______
66.______
66.______
67.______
67.______
67.______
68.______
68.______
68.______
69.______
69.______
69.______
70.______
70.______
70.______
71.______
71.______
71.______
72. Perform fist percussion of: thoracic, lumbar, and sacral vertebrae;
sacroiliac joints bilaterally; and costovertebral angles.
72.______
72.______
72.______
73.______
73.______
73.______
74.______
74.______
74.______
75. Ask patient to cross arms to move scapula and expose lung fields.
75.______
75.______
75.______
76.______
76.______
76.______
77.______
77.______
77.______
78.______
78.______
78.______
79.______
79.______
79.______
MOUTH
NECK
SECTION D. BACK
THORAX
SECTION E. LUNGS
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Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
Not
Done
80.______
80.______
80.______
81.______
81.______
81.______
82.______
82.______
82.______
83.______
83.______
83.______
84.______
84.______
84.______
85.______
85.______
85.______
86.______
86.______
86.______
87.______
87.______
87.______
88.______
88.______
88.______
SECTION F. BREASTS (Female) Note: This section is not tested as part of physical diagnosis
competency exam.
Inspect both breasts:
1. Patient sitting, arms at side
2. Patient sitting, arms above head
3. Patient leaning forward
4. Patient sitting, hands pressed to hips
5. Four quadrants
6. Nipple
7. Areola
Palpate breasts with patient in recumbent position:
8. Ask patient to put arm behind head to aid examination
9. Four quadrants and tail
10. Nipple
11. Areola
12. Attempt to express material from nipple
13. Examine all areas completely and symmetrically
BREASTS (Male)
1. Palpate all four quadrants of each breast
2. Palpate nipples bilaterally
3. Palpate areolae
SECTION G. HEART
89. Observe precordium.
89.______
89.______
89.______
90.______
90.______
90.______
91.______
91.______
91.______
92.______
92.______
92.______
93.______
93.______
93.______
94.______
94.______
94.______
95.______
95.______
95.______
96.______
96.______
96.______
97.______
97.______
97.______
rd
-3
ICS left)
Page4of9
Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
98.______
98.______
98.______
99.______
99.______
99.______
100._____
100._____
100._____
101._____
101._____
101._____
102._____
102._____
102._____
103._____
103._____
103._____
104._____
104._____
104._____
105._____
105._____
105._____
106._____
106._____
106._____
107._____
107._____
107._____
108._____
108._____
108._____
109._____
109._____
109._____
110._____
110._____
110._____
111._____
111._____
111._____
112._____
112._____
112._____
113._____
113._____
113._____
114._____
114._____
114._____
115._____
115._____
115._____
116._____
116._____
116._____
117._____
117._____
117._____
118._____
118._____
118._____
119._____
119._____
119._____
120._____
120._____
120._____
121._____
121._____
121._____
122._____
122._____
122._____
123._____
123._____
123._____
124._____
124._____
124._____
125._____
125._____
125._____
126._____
126._____
126._____
127. Aorta
127._____
127._____
127._____
128._____
128._____
128._____
nd
rd
-3
ICS left)
Not
Done
SECTION H. ABDOMEN
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Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
Not
Done
Palpate (superficially):
129. Left upper quadrant
129._____
129._____
129._____
130. Epigastrium
130._____
130._____
130._____
131._____
131._____
131._____
132._____
132._____
132._____
133._____
133.__ ___
133._____
Palpate deeply:
134. Left upper quadrant
134._____
134._____
134._____
135._____
135._____
135._____
136._____
136._____
136._____
137._____
137._____
137._____
138._____
138._____
138._____
139._____
139._____
139._____
140._____
140._____
140._____
141._____
141._____
141._____
142._____
142._____
142._____
143._____
143._____
143._____
144._____
144._____
144._____
145._____
145._____
145._____
146. Popliteal
146._____
146._____
146._____
147._____
147._____
147._____
148._____
148._____
148._____
149._____
149._____
149._____
150._____
150._____
150._____
151._____
151._____
151._____
152._____
152._____
152._____
153._____
153._____
153._____
154. Serial 7s
154._____
154._____
154._____
155._____
155._____
155._____
156. Information
156._____
156._____
156._____
157._____
157._____
157._____
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Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
158._____
158._____
158._____
159._____
159._____
159._____
160._____
160._____
160._____
161._____
161._____
161._____
162._____
162._____
162._____
163._____
163._____
163._____
164._____
164._____
164._____
165._____
165._____
165._____
166._____
166._____
166._____
167._____
167._____
167._____
168._____
168._____
168._____
169._____
169._____
169._____
170._____
170._____
170._____
171._____
171._____
171._____
172._____
172._____
172._____
173._____
173._____
173._____
174._____
174._____
174._____
175._____
175._____
175._____
176. Test CN-VII (Motor): Show teeth, puff out cheeks, or smile
176._____
176._____
176._____
177._____
177._____
177._____
178._____
178._____
178._____
179. Test CN-XII: Observe midline protrusion of tongue (do with EENT exam) 179._____
179._____
179._____
PATIENT STANDING
Not
Done
SPINE
CRANIAL NERVES
171. Test CN-I: (Sense of smell not usually done); Adequate to ask patient
if he/she has experienced a change in smell and/or taste
Test CN-II (Done during EENT exam)
a. Visual acuity
b. Visual fields
c. Ophthalmoscopic (disc, blood vessels, retina)
Test CN-III, IV, VI (Done during EENT exam)
a. Pupillary reaction to light
b. Extraocular movements
Page7of9
Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
Not
Done
180._____
180._____
180_____
181. Test for drift of outstretched arms with eyes closed (can combine with
Romberg test).
181._____
181._____
181._____
182._____
182._____
182._____
183._____
183._____
183._____
184._____
184._____
184._____
185._____
185._____
185._____
186._____
186._____
186._____
187._____
187._____
187._____
188._____
188._____
188._____
189._____
189._____
189._____
190._____
190._____
190._____
191._____
191._____
191._____
192._____
192._____
192._____
Cutaneous reflexes:
193. Test plantar reflex
193._____
193._____
193._____
194._____
194._____
194._____
195._____
195._____
195._____
196._____
196._____
196._____
197._____
197._____
197._____
198. Test alternating light touch and pin prick on four limbs.
198._____
198._____
198._____
199._____
199._____
199._____
200._____
200._____
200._____
UPPER LIMB
patient
patient
patient
patient
walk on toes
walk on heels
hop on each foot
do deep knee bend
REFLEXES
CEREBELLAR FUNCTION
SENSORY STATUS
Page8of9
competency exam.
Inspect:
1. Penis (lift to examine under surface)
2. Retract foreskin (or have patient retract)
3. Meatus
4. Scrotum
5. Inguinal canal
Palpate:
6. Penis
7. Scrotum (include testes, epididymis, and spermatic cord)
8. Hernia examination (including inguinal canal)
Perform rectal examination:
9. Inspect anus
10. Exert pressure on external sphincter anteriorly and pause to allow sphincter to relax.
11. Palpate prostate.
12. Rotate examining finger through an arc of 360 degrees
13. Perform stool guaiac test
POINT SCORE_________________________________
TECHNIQUE___________________________________
PROCTOR:
Page9of9