Source: ________________________________________ _____________________________________________________________________________

Reliability: ________ %
_____________________________________________________________________________
General Data _____________________________________________________________________________
Name _________________________________________________
_____________________________________________________________________________
Birthdate ________________ Age _______ M F Single Married
WidowedFilipino Others __________Religion_____________Occupation _____________ _____________________________________________________________________________
Current address ______________________________________________________ _____________________________________________________________________________
Date of admission _________________1st timeNo _______ time ___________
Chief complaint(s)_____________________________________________________ ____________________________________________________________________________
___________________________________________________________________
Past Medical History
measles mumps chicken pox Others _________________________________ Socioeconomic History:
BCG MMR OPV Others ____________________________________________ I. Living circumstances
DM HPN AsthmaOthers ___________________________________________ a. Place and nature of dwelling
Previous hospitalizations (medical, surgical, psychiatric): b. Number of persons living in the house
When Hospital Doctor Diagnosis Discharge Condition c. Relationships among household members

II. Economic circumstances

a. Members of the family who work
b. Sources of funds
Past illnesses When Interventions
Environmental History
 Exposure to pollutants
 Health condition in the neighborhood
Food and drug allergies _________________________________________________
 Garbage disposal
___________________________________________________________________
 Proper ventilation
Obstetric History
 Water source
G ____P ______ LMP _______________ PMP ________________
Menstruation: Age _____ Duration _______ # of Pads/day ________
regular interval(28-32 days)normal flow heavy scanty dysmenorrhea amenorrhea
unusual discharges Others _____________________
General Survey
currently pregnant AOG ____________
alert drowsy confused stuporous coma coherent responsive cooperative dyspneic
Previous pregnancies: GDM HPN Others ________________________________
in pain febrile tachypneic dyspneic respiratory distress
Prenatal history (check-up, vitamins, tetanus shots) __________________________
Attachments (e.g. IV line,O2, others) _______________________________
___________________________________________________________________
Personal and Social History
Vital signs
Stressors ______________________________________________
BP__________ mmHgPR_____bpmRR_____cpm T__________ OC/axilla
Source of support _______________________________________
Height___________ Weight ____________ BMI __________
Coping style eating drinking others ______________________
ADLs (usual routine, include sleep and rest):
Skin & Nails
Time Activity Time Activity
Color__________ jaundiced lesions masses lumps bruises moist dry rough smooth
scaly others _________________
hair well distributed fine coarse good skin turgor mobile
cyanotic nails finger clubbing
Daily water intake _____________________polydipsia
Water source for drinking __________ cooking & others _________ Head
Voiding: ____ /day ____ /night color __________ regular frequency polyuria oliguria normocephalicdeformed
anuria incontinence nocturia hematuria othersdysuria urgency Hair black brown gray/white others ____________
Defecation: ____ /day week regularconstipation diarrhea bloody stool well distributed fine coarsemoist dry hair lossdandruff lice infestation
other problems ___________________________________________________ lumpslesions __________________tenderness on palpation
Exercise ________________________________ hrs/day_____times/wk_______ CN V: intact facial sensation (pain, temperature) clench teeth
Food and drink preferences pork beef fish vegetables softdrinks sweets CN VII: face symmetric Facial expressions intact – able to smile, wrinkle forehead, puff cheek
others __________________________________________________________
Food source ______________________preparation _______________________ Eyes
Supplements, vitamins _______________________________________________ Symmetric
Routine check-up BSA Eyebrows
Smoking: age ________# of sticks per day ________pack-years ________ Eyelashes
Alcohol: age ____ amt & freq ___________ rhum beer others___________ Eyelids and palpebral fissures (coverage, redness, swelling)
Illegal drug use: age of onset ______ forms _____________________________ Sclera white icteric
Educational attainment ___________________________________ Cornea transparent arcus/annulus senilis/juvinalis
Rank of px in the family ___________________________________ Lens transparent opaque
# of siblings ____ all well comorbidities ____________________ equally round pupils
# of children____people px is living with _____________________ CN II and III: direct & consensual reaction to light and accommodation(TEST EACH EYE)
all well comorbidities __________________________________ CN II:
# of rooms _____ well-ventilated congested# of CR _________ visual acuity – can read newsprint at ___ ft away each eye
sexually-activeage of 1st contact _______ # of partners_________dyspareunia other visual field – intact/defect on ___ field ___ eye by confrontation test
problems _________________________________________ CN III, IV, VI: full range of motion by FFT
condom OCP’s diaphragm IUDOthers ___________ Hx of STD’s CN V & VII: corneal reflex (positive/delayed)
Travel history ___________________________________________ Conjunctiva
Lacrimals
Family History Intraocular pressure – soft/hard/very soft and equal by digital palpation test
HFD’s (paternal, maternal, both) DM_____ HPN_____ Stroke_____ Asthma_____
CA_______________ Others ____________________________________________ Ears
Grandparents alive age & cause of death ___________________ Symmetric discharges inflammation
Parents alive age & cause of death ________________________ Shape/deformities
Siblings alive age & cause of death ________________________ tenderness (Tug-test)
Otoscope: Ear Canal (discharge color and consistency, odor)
History of present illness (Problems) Tympanic membrane (intact, grayish pearly white, good cone of light, perforations, slightly
_____________________________________________________________________________ concave)
_____________________________________________________________________________ Tenderness, recoils
CN VIII: hearing acuity – both ears able to hear whispered voice at ___ ft
_____________________________________________________________________________
_____________________________________________________________________________ Nose
Nasal septum (intact, midline, perforations, deviations, inflammation)
_____________________________________________________________________________ Nasal mucosa (color, moisture, lesions & polyps, discharges, swelling)
_____________________________________________________________________________ Turbinates (congestion)
Paranasal sinuses (transillumination, congestion, tenderness)
CN I: sense of smell intact Muscles atrophy fasciculations wasting tenderness
Joints crepitation pain swelling
Mouth and Pharynx Capillary refill time (n<2secs) Peripheral pulses ____________
Lips (color, moisture, lesions, cracks, scales) Nail clubbing cyanosisReflexes
Oral mucosa (color, ulcers, patches) Muscle strength: L ___ /5 R ___ /5intact pain and temperature sensation
Gums (color, bleeding, swelling)
Teeth (complete, number, dentures, caries) Lower Extremities
Tongue (color, moisture, lesions) Symmetric deformities non-pitting edemapitting edema
Uvula (position, mobility) 1+ Mild pitting, slight indentation, no perceptible swelling of leg, 0-15 secs, ≤2mm
Tonsils (enlargement, color) 2+ Moderate pitting, indentation subsides rapidly, 16-30secs, 2–4mm
Palate (color, soft/hard) 3+ Deep pitting, indented for a short time, leg looks swollen, 31–80secs, 4–8mm
Pharyngeal mucosa (color, exudates, swelling) 4+ Very deep pitting,indented lasts a long time, leg is very swollen, >60secs, 6-8mm
CN V: jaw @ midline on protrusion Muscles atrophy fasciculations wasting tenderness
CN VII:sweet salty sour Joints crepitation pain swelling
CN IX & X:rise on saying “ahh”, gag reflex +/- Capillary refill time (n<2secs) Peripheral pulses ____________
CN XII: tongue midline on protrusion Nail clubbing cyanosisPsoas signObturator sign Reflexes
Muscle strength: L ___ /5 R ___ /5intact pain and temperature sensation
Neck
lesions masses bruising symmetric trachea midline
supple (flexion, extension, sideways)
tenderness on palpation palpable masses lymphadenopathies Neurologic Exam
Thyroid glandmobiletender on palpation not palpable CEREBRAL:
Blood vessels (pulsations, palpability, equality, bounding, bruits) General behavior and mood ______________________________
CN XI: rise shoulders rotate head to the left &right orientated to time and place long-term memory short-term memory
able to swallowJVP ____ cm above sternal angle w/ HOB @ ____O agnosia (objects) aphasia (language) apraxia (movement)
able to calculate abstract reasoning GCS E(4)__ M(6)__ V(5)__
Anterior Chest and lungs
Shape__________ lesions/masses bruising retractions use of accessory muscles bony CRANIAL NERVES:
deformities I Sense of smell intact
Chest expansion: equal delayed L / R II,III Visual acuity good, both pupils reactive to light - direct and consensual,
Tactile fremitus: equal increased L / R diminished L / R visual field intact by confrontation test
Percussion: resonant others _________________ tenderness III,IV,VI Extraocular muscles intact by Finger Following Test
Ausculatation: vesicular others __________________________ V (+) corneal reflex, facial sensations intact, muscles of mastication strong, smooth jaw
movements
Posterior Chest and lungs VII Face symmetrical, taste in anterior 2/3 of tongue intact, facial movements good
Shape__________ lesions/masses bruising retractions use of accessory muscles bony VIII Able to hear whispered, spoken, loud voice at ___ ft
deformities IX,X (+) gag reflex, uvula and soft palate at midline, well-modulated voice, posterior
Chest expansion: equal delayed L / R pharynx constricts upon prolonged “ahh”
Tactile fremitus: equal increased L / R diminished L / R XI Can shrug shoulders and rotate head against resistance
Percussion: resonant others _________________ tenderness XII Tongue at midline on protrusion
Ausculatation: vesicular others __________________________
CEREBELLAR:
Breast Finger-to-nose testRapid rhythmic alternating movements
Inspection: shape _________ symmetric breastssymmetric nipples lesions bruises Heel-to-shin testFigures of 8 test Tandem walking
dimpling nipple retraction dischargesmasses others _______________________
Palpation: palpable masses ____________________ tenderness palpable lymph nodes MOTOR:
nipple discharges upon pinching Tandem walkwalk on toes walk on heels Romberg’s Test
Muscle tone Full ROM Limited ROM
Heart Muscle strength:
PMI clearly visible barely visiblenot visiblepalpable at: 0 No muscle contract
R / L 3rd4th5th ICS ____ cm from MSLbrisk 1 Barely detectable, flicker or trace
Diameter_____ cm (≤ 2.5cm) 2 Gross movements but not against gravity – severe weakness
CAD: 3rd ICS = ____ cm from MSL (4-5cm) 3 Gross movements against gravity – moderate weakness
4th ICS = ____ cm from MSL (6-7cm) 4 Gross movements against slight resistance – mild weakness
5th ICS = ____ cm from MSL (8-10cm) 5 Gross movements against full resistance – full strength
distinct S1 & S2 regular gallops HR _____ bpm
SENSORY:
Murmurs: timing, location of max intensity, radiation or transmission, intensity, pitch, quality)
eg. medium-pitched, grade 2/6, blowing decrescendo diastolic murmur, heard best in the 4th pain temperature light touch vibration proprioception
left interspace, with radiation to the apex stereognosis graphesthesia 2-point disccrimination
Grade 1 Very faint, heard only after listener has “tuned in”; may not be heard in all positions
Grade 2 Quiet, but heard immediately after placing the stethoscope on the chest REFLEXES:
Grade 3 Moderately loud 4-very brisk; 3-brisker than average; 2-normal; 1-decreased; 0-no response
Grade 4 Loud, with palpable thrill _____Biceps (C5,C6) _____Triceps C6,7
Grade 5 Very loud, with thrill. May be heard when the stethoscope is partly off the chest _____Supinator/Brachioradialis (C5,6) _____Knee (L2,3,4)
Grade 6 Very loud, with thrill. May be heard with stethoscope entirely off the chest
_____Abdominal (above:T8-10, below:T10-12) _____Ankle (S1)
_____Plantar (L5,S1) _____Cremasteric (T12)
Back _____(Anal S2,3,4)
no bony deformitieskyphosis lordosis scoliosis lesions bruises palpable lymph node
costovertebral angle tenderness (Kidney Punch Test)
Physical Examination Checklist
Abdomen
Inspection: shape, skin, umbilicus (location, shape) flat/concave, movement brought about by
respiration, midline pulsations, peristalsis General
Auscultation: ________ clicks/min 1) Wash hands before beginning examination—in the CLASS
Percussion: tympanitic except over liver and bladder areas, pain, liver span @ ___ cm R MCL (6-
12cm), ___ cm MSL (4-8cm) center, you MUST use the hand wipes that are located in or
Palpation: reflexes; abdomen (relaxed, tenderness, masses, pain); liver edge (smooth and near the sinks (remember that they are not plumbed)
palpable, ___ cm below R costal margin); spleen; kidneys 2) Display a professional demeanor towards the patient during
Abdominal reflexes
Ascites: Shifting-dullness test Fluid wave test the exam
Cholecystitis: Murphy’s Sign a) Introduce yourself as a medical student
Appendicitis: Rebound Tenderness Rovsing’s Sign b) Use the patient’s last name
Upper Extremities
c) Dress professionally in white coat
Symmetric deformitiesnon-pitting edemapitting edema 3) Appropriate interaction with the patient—sensitivity to
1+ Mild pitting, slight indentation, no perceptible swelling of leg, 0-15 secs, ≤2mm privacy, comfort and dignity
2+ Moderate pitting, indentation subsides rapidly, 16-30secs, 2–4mm
3+ Deep pitting, indentedfor a short time, leg looks swollen, 31–80secs, 4–8mm
4) Drape the patient appropriately during each segment of the
4+ Very deep pitting,indented lasts a long time, leg is very swollen, >60secs, 6-8mm exam
5) Use proper sequencing of the examination and proper pacing
6) All palpation and auscultation must be done on bare skin
Vital Signs
1) Take the BP in one arm (NOTE THAT YOU NEED NOT
TAKE THE BP IN BOTH ARMS UNLESS SPECIFICALLY
INSTRUCTED TO DO SO)
a) Choose a cuff of appropriate size for the patient
b) Center the bladder of the cuff over the brachial artery
i) Identify location of the brachial artery by palpation
ii) Lower border of the cuff should be about 2.5 cm
above the antecubital crease
iii) Secure the cuff snugly
c) Position the patient’s arm so that it is slightly flexed at the
elbow and at raised to heart level
d) Estimate the systolic pressure by palpation of the radial
artery (Bates, pp 76)
i) Wait 15 seconds after deflating the cuff before
auscultating the BP
e) Take the BP, using auscultation
i) Listen with the stethoscope over the brachial artery
ii) Inflate cuff rapidly to at least 150 mm Hg
iii) Deflate at rate of 2-3 mm Hg per second
iv) Note systolic and diastolic pressures
2) Take the radial pulse for 15 secs if the rhythm is regular (60
secs if rate is slow or fast)
a) Use the pads of index and middle fingers
b) Compress the radial artery until a maximal pulsation is
detected
3) Count the respiratory rate for 1 minute
a) Watch movement of the chest wall
Head
1) Inspect the skull, scalp, hair, by parting the hair in at least
three places
2) Inspect the face
Ears
1) Inspect the external ear—auricle or pinna
2) Palpate the tragus for tenderness
3) Use the otoscope to inspect the internal auditory canal and the
eardrum and middle ear
a) Select the largest available speculum for the otoscope
b) Position the patient’s head to allow best insertion of the
otoscope
c) Pull the auricle gently upwards and backwards to
straighten the canal
d) Hold the otoscope between thumb and fingers (see Bates,
p 156)
e) Insert the speculum gently into the ear canal
i) Identify the eardrum
ii) Identify the cone of light
iii) Identify the malleus
4) Assess hearing
a) Ask the patient to occlude one ear with a finger and then
the examiner whispers softly from 1 to 2 feet away toward
the unoccluded ear
i) Choose short words (see Bates p 157)
b) Check air and bone conduction
i) Weber test
(1) place the base of the lightly vibrating tuning fork
firmly on top of the patient’s head
(2) Ask where the patient hears it
ii) Rinne test
(1) Place the base of the lightly vibrating tuning fork
on the mastoid bone
(2) When the patient can no longer hear the sound,
quickly place the fork close to the ear canal and
ask whether sound can still be heard
Eyes
1) Check for visual acuity using a Snellen eye card or eye chart
in the exam room
2) Assess visual fields (Bates, p 145-146)
a) Ask the patient to look with both eyes into your eyes
b) While you return the patient’s gaze, place your hands
about 2 feet apart, lateral to the patient’s ears.
c) Instruct the patient to point to your fingers as soon as they
are seen
d) Then slowly move the wiggling fingers of both your
hands along the imaginary bowl and towards the line of
gaze until the patient identifies them
e) Repeat this pattern in the upper and lower temporal
quadrants
3) Inspect external eye
a) Stand in front of the patient and survey the eyes for
position and alignment with each other
b) Inspect the eyebrows—quantity and distribution
c) Inspect the eyelids
d) Inspect the region of the lacrimal glands
e) Inspect the conjunctiva and sclera
i) Ask the patient to look up as you depress both lower
lids with your thumbs (Bates p 147), exposing sclera
and conjunctiva
f) Inspect the cornea and lens, using a penlight shined
oblique across the eye
g) Inspect each iris
h) Inspect the pupils for size, shape and symmetry
4) Assess pupillary reflexes
a) To light—ask the patient to look into the distance and
shine a bright light obliquely into each pupil in turn (turn
off the room light if necessary)
i) Note direct reaction—pupillary constriction in the
same eye
ii) Note indirect reaction—pupillary constriction in the
opposite eye
b) Assess accomodation – ask the patient to look alternately
at a pencil held 10 cm from his eye and into the distance
directly behind it. Observe for pupillary constriction with
near effort
5) Assess Extraocular movements
a) From 2 feet in front of the patient, shine a light into the
patient’s eyes and ask the patient to look at it. Inspect the
reflections in the corneas, which should be visible slightly
nasal to the center of the pupils
b) Ask the patient to follow your finger or pencil as you
sweep through the six cardinal directions of gaze
i) To the patient’s extreme right
ii) To the right and upward
iii) To the right and downwards
iv) Without pausing in the middle to the extreme left
v) To the left and upwards
vi) To the left and downwards
6) Ophthalmoscopic exam (See “Steps for using the
ophthalmoscope” and “Steps for examining the optic disc and
the retina” in Bates pp 152 and 153
Nose
1) Inspect the anterior and inferior surfaces of the nose
a) Push gently on the tip of the nose to widen the nostrils
b) Use a penlight to view the nasal vestibule
2) Inspect the inside of the nose using an otoscope with the 6) Abducens (CN VI) – you have already tested for lateral
largest available speculum deviation of the eye with your extra-ocular movement
a) Tilt the patient’s head back slightly and insert the maneuvers
speculum (Bates p 159) 7) Facial (CN VII)
b) Inspect the inf and mid turbinates and nasal septum a) Ask the patient to raise both eyebrows
3) Palpate the frontal and maxillary sinuses for tenderness (Bates b) Frown
p 160 c) Close both eyes tightly
d) Show both upper and lower teeth
e) Smile
Mouth and Pharynx
f) Puff out both cheeks
1) Inspect the lips
8) Acoustic (CN VIII) – you have already assessed hearing and
2) Inspect the oral mucosa using a good light and a tongue blade
performed Weber and Rinne maneuvers
3) Inspect the gums and teeth
9) Glossopharyngeal (CN IX) – tested together with CN X
4) Inspect the hard palate
10) Vagus (CN X)
5) Inspect the tongue and floor of the mouth
a) Ask the patient to say “ah” and watch the movements of
a) Ask the patient to put out his tongue
the soft palate and pharynx
b) Ask the patient to put his tongue on the roof of his mouth
b) Check gag reflex with a tongue blade
6) Inspect the pharynx
11) Spinal Accessory (CN XI)
a) Tongue in normal position, ask the patient to say “ah;” but
a) Ask the patient to shrug both shoulders against your hands
if pharynx not well visualized use a tongue blade
b) Ask the patient to turn her head to each side against your
b) Inspect the soft palate, tonsils and pharynx
hand
12) Hypoglossal (CN XII)
Neck a) Ask the patient to protrude her tongue
1) Assess neck ROM (Bates p 504) by asking the patient to b) Ask the patient to push the tongue against the inside of
perform the following maneuvers: each cheek
a) Flexion: touch the chin to the chest
b) Extension: look up at the ceiling
Posterior thorax
c) Rotation: turn the head to each side, looking directly over
1) The patient should be sitting with the posterior thorax
the shoulder
exposed.
d) Lateral bending: tilt the head, touching each ear to the
2) The doctor assumes a midline position behind the patient
corresponding shoulder
3) Inspect the cervical, thoracic and upper lumbar spine (you will
2) Palpate the lymph nodes (See Bates p 163-164 for specific
check for ROM of the thoracic and lumbar spine towards the
technique)
end of the complete physical when the patient is standing up)
3) Inspect trachea and feel for any deviation by placing a finger
4) Palpate the spinous processes of each vertebra for tenderness
along one side of the trachea, noting the space, and compare
with your thumb or by thumping with the ulnar surface of your
with the opposite side.
fist (Bates p 503)
4) Inspect the thyroid gland
5) Assess for costovertebral tenderness
a) Tip the patient’s head back
a) Place the ball of one hand in the costovertebral angle and
b) Locate the cricoid cartilage and inspect the region below
strike it with the ulnar surface of your fist (Bates p 344)
for the thyroid
6) Inspect the shape and movement of the chest wall
5) Palpate the thyroid gland (See Bates p 167) – may be done
a) Place your thumbs at the level of the 10th ribs with your
either from an anterior or posterior approach
fingers loosely grasping the rib cage and gently slide them
a) Flex the neck slightly forward
medially.
b) Place finger of both hands on the patient’s neck with
b) Ask the patient to inhale deeply and observe whether your
index fingers just below the cricoid cartilage
thumbs move apart symmetrically
c) Feel for the thyroid isthmus
d) Displace the trachea to the right with the fingers of your
left hand; palpate with R fingers for the right lobe of the Posterior thorax – lung exam
thyroid 1) Examination techniques MUST be performed on bare skin
e) Reverse the use of the fingers to feel the left lobe of the 2) Palpate for tactile fremitus
thyroid a) Use either the ball of your palm or the ulnar surface of
your hand for palpation
b) Ask the patient to repeat the words “ninety-nine”
Cranial Nerves (Bates, pp 567-571)
c) You may palpate one side at a time or use both hands
1) Olfactory (CN I) – usually not tested
simultaneously to compare sides
2) Optic (CN II) – you have already tested for visual fields.
d) Palpate in four locations on both sides of the chest and
Visual acuity can be tested with an eye chart
compare (Bates p 223)
3) Oculomotor (CN III) – you have already tested pupillary
3) Percuss
constriction and the EOM controlled by this nerve
a) Ask the patient to keep both arms crossed in front of the
4) Trochlear (CN IV) – you have already tested for downward,
chest
inward movement of the eye
b) Press the DIP joint of the left middle finger firmly against
5) Trigeminal (CN V)
the chest wall, avoiding contact with other fingers (Bates
a) While palpating the temporal and masseter muscles in
p 223)
turn, ask the patient to clench her teeth
c) Strike this DIP joint with the tip of the right middle
b) Check the forehead, cheeks and jaw on each side for pain
finger, swinging from the wrist
and light touch
d) Percuss in seven areas on each side (Bates p 225)
c) Check the corneal reflex with a wisp of cotton
4) Auscultate for breath sounds
 a) Instruct the patient to breathe deeply through an open
mouth
b) Listen with the diaphragm of the stethoscope in the same
seven areas in which you percussed
Anterior thorax—lung exam
1) Examination techniques MUST be performed on bare skin
2) The patient may be either sitting or supine. The drape should
be adjusted to allow exposure of the area being examined
3) Inspect the shape of the patient’s chest and movement of the
chest wall (NB when moving from the post chest when you
have completed auscultating, it is acceptable to auscultate the
ant chest before inspection or palpation)
4) Palpate for tactile fremitus
a) Use the ball of the palm or ulnar surface of the hand to
palpate in 3 areas on each side of the anterior chest (Bates
p 231)
5) Percuss the anterior and lateral chest, comparing sides, in 6
areas on each side (Bates p 231)
a) Displace a woman breast with your left hand or ask her to
move her breast for you
6) Auscultate the anterior chest, comparing sides in the 6 areas
on each side where you percussed.
EXTENDED EXAM TECHNIQUES FOR THE THORAX AND
LUNGS
1) Percussion for diaphragmatic excursion (Bates, p 226)
a) Determine the level of diaphragmatic dullness during
quiet respiration
b) Have the patient take in a deep breath and hold it and
again determine the level of dullness
c) Have the patient exhale completely and hold it and
determine the level of dullness
d) Measure the distance between the levels of dullness at
maximal exhalation and maximal inhalation
2) Egophony
a) Ask the patient to say “ee” while auscultating over the
lung
3) Whispered pectoriloquy
a) Ask the patient to whisper “one-two-three” or “ninety-
nine” while listening over the lung
Axillae – examination of the axillae can be performed at the
present juncture. It is sometimes performed at the end of the exam,
or as part of a breast exam in a female
1) Inspect the skin of each axilla (Bates, pp 310-311)
2) Palpation L axilla
a) Ask the patient to relax with the L arm down
b) Support the L wrist or hand with your left hand
c) Cup together the fingers of your right hand and reach as
high as you can toward the apex of the axilla
d) Press your fingers toward the chest wall and slide down to
feel potential LN
e) To palpate for lateral group of LN, feel along the upper
humerus
3) Palpation R axilla – reverse your hands and follow the steps
above
Cardiovascular
1) The patient should be supine with the upper body raised by
elevated the table to about 30°. The drape should be arranged
to expose the precordium. EXAM TECHNIQUES MUST BE
PERFORMED ON BARE SKIN.
2) The examiner should stand tat the patient’s right side
3) Inspect the precordium
a) look for apical impulse
b) look for any other movements
4) Palpate for precordium
a) Use the palmar surfaces of several fingers to locate the
PMI—can switch to one fingertip when located
i) Displace a woman’s breast upward or laterally, or ask
her to do this for you
ii) Note location of PMI, amplitude and duration
b) Palpate for the RV impulse along the lower left sternal
border
5) Auscultation of the heart
a) Listen to the heart with the diaphragm of your stethoscope
in the R 2nd ICS, L 2nd ICS, L 3rd or 4th ICS, and the lower
left sternal border (5th ICS) and at the apex (may also start
at the apex and proceed to the base of the heart)
b) Listen to the heart with the bell of your stethoscope in the
same five listening areas
6) Inspect the neck for jugular venous pulsations
a) Turn the patient’s head slightly away from the side you
are inspecting (Bates p 267)
b) Raise or lower the bed until you identify the pulsations
c) Identify the highest point of pulsation
i) Measure the vertical distance of this point above the
sternal angle
7) Inspect the neck for carotid pulsations
8) Palpate the carotid pulsation
a) Place your left index and middle fingers (or thumb) on the
right carotid artery
i) Note amplitude and contour of the pulse wave
ii) Never palpate both carotids simultaneously
b) Use your right fingers or thumb to palpate the left carotid
artery
9) Auscultate the carotid arteries for bruits with the bell of the
stethoscope
a) Ask the patient to take a deep breath and hold it to
eliminate breath sounds
EXTENDED EXAM TECHNIQUES FOR THE
CARDIOVASCULAR EXAM
1) Steps for assessing the JVP (Bates, p 267)
2) Use of left lateral decubitus position to enhance apical sounds
(Bates, p 271)
3) Use of sitting position to enhance the murmur of AI
4) Timing of S3 and S4 (Bates, p 280)
5) Attributes of classical heart murmurs of SEM, AS, AI, MR,
MS (Bates, p 281 and Tables)
Abdomen
1) The patient should be in a supine position with arms at side or
folded across the chest
2) The drapes should be arranged to expose the abdomen from
above the xyphoid process to the symphysis pubis.
3) Approach the patient from his right side
4) Inspect the abdomen
5) Auscultate the abdomen as the next step in the exam after
inspection
a) Place the diaphragm of the stethoscope gently on the
abdomen
b) Listen for bowel sounds
i) Listening in one spot is sufficient
c) Listen for an aortic bruit on the midline just above the
naval
6) Percuss the abdomen lightly in four quadrants and in the
suprapubic and epigastric areas
7) Percuss for liver dullness
 a) Define the lower edge of liver dullness in the mid-
clavicular line, starting at a level below the umbilicus
b) Define the upper edge of liver dullness in MCL, starting
in the area of lung resonance
i) Gently displace a woman’s breast as necessary
c) Measure in centimeters with a ruler the vertical span of
liver dullness in the MCL
8) Percuss for splenic dullness
a) Percuss along the L lower chest wall between the lung
resonance above and the costal margin moving laterally
(Bates p 341)
i) Ask the patient to take a deep breath and percuss
again in this area
9) Palpate the abdomen lightly in four quadrants
a) Use a gentle, light dipping motion (Bates p 335)
10) Palpate the abdomen deeply in all four quadrants
a) Use a firmer dipping motion
11) Palpate for the liver edge
a) Place your R hand on the right abdomen lateral to the
rectus muscle, beginning more than 3 fingerbreadths
below the costal margin
b) Ask the patient to take in a deep breath
c) Palpate upwards trying to feel the descending liver edge,
using a rocking motion
i) May also use the “hooking technique” described in
Bates p 340
12) Palpate for a spleen tip
a) Reach over and around the patient with your left hand to
support and press forward the lower left rib cage
b) Press inward towards the spleen with your right hand,
beginning at least 3 finger breadths below the L costal
margin
c) Ask the patient to take in deep breaths, trying to feel the
spleen tip as it comes down to meet your fingertips.
13) Palpates for aorta by pressing deeply with one hand on each
side of the aorta (Bates, p 344)
14) Palpate for the superficial inguinal lymph nodes (Bates, p 452)
15) Palpate for both femoral artery pulses
a) Press deeply below the inguinal ligament (Bates, p 452)
EXTENDED EXAMINATION TECHNIQUES FOR THE
ABDOMEN
1) Palpation for the kidneys
a) Left Kidney (Bates, p 343)
i) Move to the patient’s left side
ii) Place your R hand behind the patient, just below and
parallel to the 12th rib with your fingertips reaching
the costovertebral angle, and lift, trying to displace
the kidney anteriorly
iii) Place your L hand in the LUQ, lateral and parallel to
the rectus muscle
iv) Ask the patient to take a deep breath
v) At the peak of inspiration, press your left hand firmly
and deeply into the LUQ just below the costal margin
and try to capture the kidney between your two hands
vi) Ask the patient to breathe out and then hold it, while
you release the pressure of your L hand, allowing the
kidney to slide back into its expiratory position
b) Right kidney
i) Move to the patient’s right side
ii) Switch the positions of your hands and proceed as
above
2) Assess for possible ascites (Bates, p 345-347)
a) Test for shifting dullness
i) With the patient supine, map the borders of tympany
and dullness, by percussing outward from the central
area of tympany
ii) Ask the patient to turn onto one side and percuss and
mark the borders of dullness one more
b) Test for a fluid wave
i) Ask the patient or an assistant to press the edges of
both hands firmly down the midline of the belly
ii) Tap one flank sharply with your fingertips and feel on
the opposite flank for an impulse transmitted through
the fluid
c) Balottement of organs in ascitic fluid
i) Make a brief jabbing movement with the fingers of
one hand into the protuberant abdomen towards the
anticipated organ
3) Psoas sign (Bates, p 348)
a) Place your hand just above the patient’s right knee and
ask the patient to raise that thigh against your hand
4) Obturator sign (Bates, p 348)
a) Flex the patient’s right thigh at the hip, with the knee
bent, and rotate the leg internally at the hip
Upper extremity—MSK and Partial Neurological (these
maneuvers must be repeated on both upper extremities
1) Inspect the hands, including each finger, its skin and joints,
and nails
a) Palpate any abnormal joints
2) Inspect the wrist
3) Palpate the distal radius and snuff box; palpate the distal ulna
4) Palpate the radial pulse on the flexor surface of the wrist,
laterally
a) Compare the pulses in both arms
5) Check ROM of the fingers
a) Ask the patient to make a tight fist with each hand
b) Extend and spread the fingers
c) Ask the patient to spread the fingers apart and back
together
d) Ask the patient to move the thumb across the palm and
touch the base of the 5th finger, and then back across the
palm and away from the fingers
e) Have the patient touch the thumb to each of the other
fingertips
6) Check ROM of the wrist (Bates p 499)
a) Flexion
b) Extension
c) Ulnar and radial deviation
7) Check ROM of the elbow (Bates p 497)
a) Flexion and extension: ask the patient to bend and
straighten the elbow
b) Pronation and supination: with arms at his side, and
elbows flexed, ask the patient to turn the palms up and
then down
8) Palpate for epitrochlear lymph nodes (Bates p 451)
a) Flex the elbow to 90°
b) Palpate in the groove between the biceps and triceps
9) Inspect the shoulder (Bates, p 492)
10) Palpate the shoulder (Bates, p 493)
a) Locate the acromion process and the acromioclavicular
joint
b) Locate the greater tubercle of the humerus
c) Locate the coracoid process of the scapula
11) Check ROM of the shoulder (Bates, p 493)
a) Watch for smooth, fluid movement as you stand in front
of the patient and ask:
i) Raise the arms to shoulder level (abduct) with palms
facing down
ii) Raise the arms to a vertical position above the head
with the palms facing each other
 iii) Place both hands behind the neck with elbows out to b) Felon
the side (external rotation and abduction) c) Paronychia
iv) Place both hends behind the small of the back d) Flexor tendon sheath
(internal rotation and adduction) e) Ganglion
12) Test Muscle strength in the upper extremity (Bates pp 574-
575). You must compare sides
Lower extremity—MSK and Partial Neurological (these
a) Test grip—ask the patient to squeeze two of your fingers
maneuvers must be repeated on both lower extremities
as hard as possible and not let them go
b) Test finger abduction—position the patient’s hand with 1) The patient may be sitting or lying down and draped so that
palms down and fingers spread. Try to force the fingers the external genitalia are covered with the legs fully exposed
together during the exam
c) Test opposition of the thumb—the patient should try to 2) Inspect both feet and ankle—compare sides
touch the little finger with the thumb against your 3) Palpate the feet and ankles (Bates, p 517)
resistance a) Assess for pedal edema—press firmly with your thumb
d) Test extension of the wrist by asking the patient to make a over the dorsum of the foot, behind each medial malleolus
fist and resist you pulling it down and over the shins (Bates, p 455)
e) Test flexion and extension of the elbow by having the b) Palpate the anterior aspect of each ankle joint
patient pull and push against your hand c) Palpate the heel, especially the post and inf calcaneus
d) Palpate the MTP joints
e) Palpate the heads of the five metatarsals
EXTENDED EXAM OF JOINTS OF THE UPPER EXTREMITY
4) Palpate for the peripheral pulses of the legs
1) Shoulder (Bates, Table 15-4, page 526-527)
a) Dorsalis pedis—feel the dorsum of the foot just lateral to
a) Acromioclavicular joint (Bates, p 494)
the extensor tendon of the great toe
i) Palpate and compare both joints for swelling or
b) Posterior tibial—feel below the medial malleolus of the
tenderness
ankle
ii) Adduct the patient’s arm across the chest
5) Check ROM of the ankle (Bates, p 518)
b) Rotator cuff (Bates, p 494)
a) Dorsiflex and plantar flex the foot at the ankle
i) With the patient’s arm at the side, palpate the three
b) Invert and evert the foot
“SITS” muscles that insert of the greater tuberosity of
c) Flex the toes
the humerus
6) Inspect the knee for alignment and contours
ii) Passively extend the shoulder by lifting the elbow
7) Palpate the knee with the knee in flexion (Bates, p 511-513)
posteriorly
a) Identify the medial femoral condyle and the medial tibial
iii) Once again palpate the SITS muscle insertions
plateau
iv) Check the “drop arm” sign by asking the patient to
b) Identify the tibial tubercle
fully abduct the arm to shoulder level and lower it
c) Identify the lateral femoral condyle and lateral tibial
slowly
plateau
c) Bicipital tendonitis (Bates, p 495)
d) Identify the patellar tendon and ask the patient to extend
i) Rotate the arm and forearm externally and locate the
the leg
biceps muscle distally near the elbow
e) Palpate the medial collateral and lateral collateral
ii) Track the muscle and its tendon proximally into the
ligaments and menisci
bicipital groove along the anterior aspect of the
f) Feel for swelling above and to the sides of the patella
humerus
g) Check the prepatellar, anserine and popliteal bursae
iii) Check for tendon tenderness
(Bates p 513)
d) Glenohumeral joint
8) Check ROM of the knee (Bates p 515)
i) Inspect the shoulder from above
a) Ask the patient to flex and extend the knee while sitting
ii) Palpate the capsule and synovial membrane beneath
(or by asking the patient from a standing position to squat
the ant and post acromion
and then stand up again
2) Elbow (Bates, p 496 and Table 15-5, p 528)
b) Check internal and external rotation by asking the patient
a) Lateral epicondylitis (tennis elbow)
to rotate the foot medially and laterally
i) Pain and tenderness at the lat epicondyle and possibly
9) Inspect the hip by observing the patient’s gait at some time
in the extensor muscles close to it
during the exam (Bates p 506)
ii) Pain increases when the patient tries to extend the
10) Palpate the surface landmarks of the hip
wrist against resistance
a) Anterior surface: locate the iliac crest, iliac tubercle and
b) Medial epicondylitis (pitcher’s, golfer’s or Little League
anterior superior iliac spine
elbow)
b) Posterior surface: locate the posterior superior iliac spine,
i) Tenderness at the medial epicondyle
the greater trochanter and the ischial tuberosity
ii) Wrist flexion against resistance increases the pain
11) Check ROM of the hip (Bates, p 509-510)
c) Ulnar neuropathy at elbow
a) Flexion—with the patient supine, ask him to bend each
3) Wrist (Bates, p 497)
knee in turn up to the chest and pull it firmly against the
a) Carpal tunnel syndrome
abdomen
i) Pain and numbness on the ventral surface of the first
b) Abduction—grasp the ankle and abduct the extended leg
three digits, especially at night, due to median nerve
until you feel the iliac spine move
compression in the carpal tunnel
c) Adduction—hold one ankle and move the leg medially
ii) Weakness of abduction of the thumb
across the body and over the opposite extremity
iii) Tinel’s sign – percuss lightly over the course of the
median nerve in the carpal tunnel d) Rotation—flex the leg to 90 at hip and knee; stabilize the
4) Fingers (Bates, Table 15-6, p 530-531) thigh with one hand, grasp the ankle with the other and
a) Trigger finger swing the lower leg, medially and laterally
12) Check muscle strength in the LE (Bates, p 576-578)
a) Test flexion at the hip—place your hand on the patient’s
thigh and asking the patient to raise the leg against your
hand
b) Test adduction at the hips—place your hands firmly on
the bed between the patient’s knees. Ask the patient to
bring both legs together
c) Test abduction at the hips—place your hands firmly on
the bed outside the patient’s knees. Ask the patient to
spread both legs against your hands
d) Test extension at the hips—have the patient push the
posterior thigh down against your hand
e) Test extension at the knee—support the knee in flexion
and ask the patient to straighten the leg against your hand
f) Test flexion at the knee—place the patient’s leg so that
the knee is flexed with the foot resting on the bed. Tell
the patient to keep the foot down as you try to straighten
the leg
g) Test dorsiflexion and plantar flexion at the ankle—ask the
patient to pull down and push down against your hand
EXTENDED EXAM OF JOINTS OF THE LOWER
EXTREMITY
1) Knee
a) Prepatellar bursitis (housemaid’s knee) – swelling over
the patella is suggestive
b) Patellar tendonitis – tenderness over the patellar tendon
c) Chondormalacia – pain with patellar movement during
quadriceps contraction is suggestive
d) Pes anserine bursitis – swelling postero-medial to the
tibial tubercle (usually from running)
e) Abduction Stress Test for the MCL (Bates, p 515)
f) Adduction Stress Test for the LCL (Bates, p 515)
g) Anterior Drawer Sign for the ACL (Bates, p 515)
h) Lachman Test (Bates, p 516)
i) Posterior Drawer sign (Bates, p 516)
Neurological – some parts of the neurological exam have been
woven into exam of the head and neck and extremities (i.e. Cranial
Nerve exam and motor testing). The remaining components of the
neurological exam are covered here
1) Mental Status Exam
a) Level of alertness
b) Language function (fluency, comprehension, repetition
and naming)
c) Memory (short-term and long-term
d) Calculation
e) Visuospatial processing
f) Abstract reasoning
2) Motor function
a) Gait – see below
b) Coordination
i) Fine finger movements
ii) Rapid alternating movements and point-to-point –
described below under cerebellar/coordination
c) Involuntary movements
d) Pronator drift (Bates, p 582)
e) Tone – resistance to passive manipulation
f) Bulk
g) Strength – incorporated into regional exams of LE and UE
3) Reflexes (Bates, p 588-591)
a) Biceps reflex (C5, C6) — with patient’s arm partially
flexed at the elbow and palm down, place your thumb or
finger firmly on the biceps tendon and strike with reflex
hammer
b) Triceps reflex (C6, C7) – flex the patient’s arm at the
elbow with palm towards the body and pull it across the
chest. Strike the triceps tendon above the elbow
c) Brachioradialis (C5, C6) –The patient’s hand should rest
on the abdomen or the lap with the forearm partly
pronated. Strike the radius about 1-2 inches above the
wrist
d) Knee (Patellar) reflex (L2, L3, L4) – patient may be either
sitting or supine with knee flexed. Tap the patellar tendon
just below the patella
e) Ankle (Achilles) reflex (S1) – dorsiflex the foot at the
ankle and strike the Achilles tendon
f) Plantar (Babinski) response (L5, S1) – with a key or the
tip of the shaft of a reflex hammer, stroke the lateral
aspect of the sole from the heel to the ball of the foot,
curving medially across the ball
4) Sensory (Bates, p 583-584)
a) Pain – Create a sharp from a broken tongue blade
i) Compare symmetrical areas on the two sides of the
body, including arms, legs and trunk
ii) Compare the distal with the proximal areas of the
extremities
iii) Vary the pace of your testing and occasionally
substitute the blunt end for the point, while asking “Is
this sharp or dull?” or “Does this feel the same as
this?”
b) Light touch – using a fine wisp of cotton, touch the skin
lightly, avoiding pressure
i) Ask the patient to respond whenever a touch is felt.
ii) Compare one area with another
c) Vibration – Use a low-pitched tuning fork (128 Hz)
i) Set the fork vibrating and place it firmly over a DIP
of a finger and of the great toe
ii) Ask what the patient feels
iii) If vibration sense is impaired, move to more proximal
bony prominences
d) Joint position sense
i) Grasp the patient’s big toe, holding it by its sides and
pull it away from the other toes so as to avoid
friction.
ii) Demonstrate “up” and “down”
iii) With patient’s eyes closed ask him to identify up and
down movements
iv) Compare sides
v) Move more proximally if joint position is impaired
vi) Test JPS in the UE by moving a finger joint
e) Proprioception (Bates, p 585)
5) Cerebellar/Coordination (Bates, p 578-580)
a) Rapid alternating movements
i) UE – Show patient how to strike one hand on the
thigh, first with the palm, then with the back of the
hand. Have the patient repeat these alternating
movements as rapidly as possible. Repeat with
opposite hand
(1) OR Show the patient how to tap the distal joint
of the thumb with the tip of the index finger as
rapidly as possible. Have the patient perform the
action. Check the opposite hand
ii) LE – ask the patient to tap your hand as quickly as
possible with the ball of each foot in turn
b) Point-to-point movements
i) UE – ask the patient to touch your index finger and
then his nose alternately several times. Move your
finger about.
ii) LE – Ask the patient to place one heel on the opposite
knee and then run it down the shin to the big toe.
Repeat on the other side
6) Gait
a) Ask the patient to walk across the room, then turn and
come back
b) Walk heel-to-toe in a straight line
c) Walk on toes then on heels
7) Romberg Test
a) The patient should first stand with feet together and eyes
open and then close both eyes for 20-30 secs without
support

Back
1) ROM (Bates, p 505)
a) Flexion – with patient standing, ask him to bend forward
to touch the toes
b) Extension – place your hand on the posterior superior iliac
spine and with your fingers pointing towards the midline,
ask the patient to bend backward as far as possible
c) Lateral bending – ask the patient to lean to both sides as
far as possible

NOTE THAT BREAST, GENITAL AND RECTAL EXAMS

HAVE NOT BEEN INCLUDED IN THIS CHECKLIST