PHYSICAL EXAMINATION CHECKLIST

Date : Time :
Name : _________________________________________ Age :
Sex : __ M __ F Marital Status: _____________ Occupation: _______________
Nationality: _______________ Religion: ___________ Date of Admission: __________
Address: _____________________________________________________________________________________

GENERAL SURVEY
1. State of Health
 Acutely ill  Frail
 Chronically ill  Robust
 Fit
2. Level of Consciousness
 Alert  Lethargic
 Awake  Obtunded
 Comatose  Stupor
3. Signs of Distress
Cardiac or Respiratory Distress
 Clutching of the chest  Labored breathing
 Coughing  Pallor
 Diaphoresis  Wheezing
Pain
 Facial grimacing
 Protectiveness of a painful area
 Sweating
 Unusual posture favoring one limb/body area
 Wincing
Anxiety or Depression
 Anxious facial expression  Flat affect
 Blank mind  Irritability
 Cold and moist palms  Keyed up
 Difficulty in concentrating  Muscle tension
 Difficulty of sleeping  Poor eye contact
 Fatigue  Psychomotor slowing
 Fidgety movements  Restless
4. Skin Color and Obvious Lesions
Skin Color Location Lesions Location
Changes in skin color Bruises
Cyanosis Nevi
Jaundice Plaques
Pallor Rashes
Scars

5. Dress, Grooming, and Personal Hygiene

 Appropriate clothing  Cosmetics
 Appropriate grooming for age, lifestyle,  Excess clothing
occupation  Run-down shoes
 Body piercings  Shoe holes
 Clean  Unusual jewelry
6. Facial Expression
Eye Contact
 Absent  Averted quickly
  Natural  Unblinking
 Sustained
7. Odors of the Body and Breath
 Alcoholic  Fruity
 Fishy  Yeasty
 Foul
8. Posture, Gait, and Motor Activity
Preferred Posture
 Leaning forward with arms braced
 Side lying
 Sitting upright
Patient is ___________
 Quiet
 Restless
Changes of position
 All the time
 Often
 Sometimes
 Seldom
 Never/avoiding movement
Patient walks __________
 Smoothly  Limp or discomfort
 With comfort  Fear of falling
 With self-confidence  Loss of balance
 With balance  Movement disorder
Gait
 Spastic Hemiparesis  Parkinsonian Gait
 Scissors Gait  Cerebellar Ataxia
 Steppage Gait  Sensory Ataxia
Involuntary Movement
 Oral-Facial Dyskinesias  Athetasis
 Tics  Chorea
 Dystonia
Tremors
 Resting (Static) Tremors  Intention Tremors
 Postural Tremors
9. Height and Weight
Height : _____ cm Weight : _____ kg
 Unusually short
 Unusually tall
Build
 Slender  Emaciated
 Muscular  Overweight
 Stocky  Obese
If the patient is obese, is the fat distributed ___?
 evenly
 concentrated over the upper torso
 around the hips
BMI: ______ kg/m2
 Underweight  Overweight
 Normal  Obese
If BMI is ≥35:
 Waist Circumference: _____cm

VITAL SIGNS
BP: _____ mm Hg

Category Systolic Diastolic

Normal <120 <80
Prehypertension 120–139 80–90
Stage 1 Hypertension 140–150 90–99
Stage 2 Hypertension ≥160 ≥100
If Diabetes or Renal Disease <130 <80

HR: _____ bpm

Rhythm:
 Regular  Irregular
 Fast (>100)  Sporadic
 Normal (60-100)  Regularly irregular
 Slow (<60)  Irregularly irregular

RR: _____ bpm

Rhythm:
 Normal  Tachypnea  Hyperpnea
 Bradypnea  Cheyne-Stokes Breathing  Hyperventilation
 Sighing respiration  Obstructive Breathing  Ataxic Breathing

Temperature
Oral: _____ ℃ Axillary: _____ ℃ Rectal: _____ ℃ Tympanic: _____ ℃

PAIN
 Acute Pain  Chronic Pain
Location: ________________________
Severity
Scale Category
0 No Hurt
2 Hurts Little Bit
4 Hurts Little More
6 Hurts Even More
8 Hurts Whole Lot
10 Hurts Worst

THE SKIN, HAIR, & NAILS

Skin
1. Color
 Increased brown pigmentation
 Loss of pigmentation
 Redness
 Pallor
 Cyanosis
 Jaundice
 Carotenemia
 Erythema
2. Moisture
 Dry
 Sweating
 Oily

3. Temperature
 Warm
 Cool
4. Texture
 Rough
 Smooth
5. Mobility and Turgor
 Decreased/increased mobility
 Decreased/increased turgor

6. Lesions
Distribution Color Pattern and
Type of Lesions Location
Shape
o Macule o Generalized o Exposed surfaces o Brown o Linear
o Patch o Localized o Skin-fold areas o Grey o Clustered
o Plaque o Extensor areas o Purple o Annular
o Papule o Flexor areas o Red o Arciform
o Nodule o Acral areas o Others ______ o Geographic
o Cyst o Others __________ o Serpiginous
o Wheal o dermatomal
o Vesicle
o Bulla
o Pustule
o Burrow
o Scale
o Crust
o Scars
o Lichenification
o Keloids
o Erosion
o Excoriation
o Fissure
o Ulcer
o Nevi

Hair
 Quantity
 Abundant Area : _________________
 Sparse Area : _________________
 Distribution
 Equally distributed
__________________________
 Unequally distributed
__________________________
 Texture
 Coarse
 Fine
 Rough
 Silky
 Smooth
Nails
 Color : _________________
 Shape : _________________
 Lesions : _________________
 Presence of:
 Paronychia
 Clubbing
 Onycholysis
 Terry’s Nail
 Leukonychia
 Mee’s Lines
 Beau’s Lines
 Pitting

THE HEAD & NECK

The Head
1. The Hair
Distribution
 Equally distributed
____________________________
 Unequally distributed
____________________________
Quantity
 Abundant area : _______________
 Sparse Area : _______________
Pattern of loss
 Diffuse  Patchy  Total
Texture
 Rough  Silky
 Smooth  Coarse
 Fine
2. The Scalp
 Lumps  Scaliness
 Nevi  Other lesions
 Redness
3. The Skull
 Deformities  Lumps
 Depressions  Tenderness
4. The Face
 Asymmetry  Involuntary movements
 Edema  Masses
 Facial expression
5. The Skin
 Changes in color  Pigmentation
 Hair distribution  Texture
 Lesions  Thickness

The Eyes
Visual Acuity
 Right Eye : _____________  Myopia
 Left Eye : _____________  Presbiopia
Visual Field
 Horizontal Defect
 Blind right Eye
 Bitemporal Hemianopsia
 Left Homonymous Hemianopsia
 Homonymous Left Superior Quandrantic Defect
 Left homonymous Hemianopsia
Position and Alignment of the Eyes
 Inward deviation  Outward deviation
Eyebrows
 Quantity : ___________________
 Distribution : ___________________
 Scaliness
Eyelids
 Width of palpebral fissures
 Edema of lids
 Color of lids
 Lesions
 Condition and direction of the eyelashes: _______________________
 Adequacy of eyelid closure : _______________________
Abnormalities of the Eyelids
 Ptosis  Lid retraction
 Entropion  Exophthalmos
 Ectropion
Lacrimal Apparatus: Lumps and Swelling
 Pinguecula  Chalazion
 Episcleritis  Xanthelasma
 Sty  Dacryoscystitis
Conjunctiva and Sclera
Cornea, Lens, Pupils
Corneal Opacities
 Corneal arcus  Kayser-Fleischer Ring
 Corneal scar  Pterygium
 Cataracts  Peripheral cataract
Iris
 With shadow
 No shadow
Pupil
 Size : ________________
 Shape : ________________
 Symmetry
 Miosis
 Midriasis
 Direct reaction
 Consensual reaction
Extraocular Movements
Cover-Uncover Test
 Nystagmus
 Lid lag
 Conjugate movements of the eye
 Exotropia
 Esotropia
Convergence: Follows object to within 5 – 8 cm
Fundi (Fundoscopy)
 With red reflex
 Without red reflex
Optic Disc Inspection
 Sharpness or clarity of the disc outline
 Blurred (normal)
 Clear
 Color
  Yellowish orange  White
 Pink  Red
 Size of the Central Physiologic Cup
 Less than half the horizontal diameter of the disc
 More than half the horizontal diameter of the disc
 Comparative symmetry
________________________________________________

Variations of the Optic Disc

 Physiologic cupping, central cup
 Physiologic cupping, temporal cup
 Rings
 Crescents
 Medullated nerve fibers
Abnormalities of the Optic Disc
 Papilledema
 Glaucomatous cupping
 Optic atrophy
The Retina (Arteries, Veins, Fossa, Macula)
 Normal  Copper wiring
 Focal narrowing  Silver wiring
 Narrowed light reflex
Arteriovenous Crossing
 Concealment or AV nicking  Banking
 Tapering
Fundi
 Normal  Macular distortion
 Cotton-wool patches  Hard exudates
 Maclar star  Drusen
 Red dots  Scar
 White spots

The Ear
Auricle (Inspection)
 Keloid  Basal Cell Carcinoma
 Chondrodermatitis Helicis  Cutaneous Cyst
 Tophi  Rheumatoid Nodules
Auricle (Tug Test)
 With pain
 Without pain
Ear Canal and Drum (Otoscope)
 Discharge  Cerumen
Color : ____________ Color : ____________
Odor : ____________ Odor : ____________
Quality : ____________ Quality : ____________
Quantity : ____________ Quantity : ____________
  Foreign bodies  Perforation
 Redness  White spots
 Swelling
Auditory Acuity-Whispered Voice Test (reported hearing loss)
 Patient repeats initial sequence correctly
 Patient repeats at least three out of the possible six numbers and letters correctly
 Four of the six possible numbers and letters are incorrect
Weber Test
 Right ear  Left ear  Both ears
Rinne Test
 Air conduction > bone conduction  Air conduction > bone conduction
The Nose and Sinuses
Inspection
 Tenderness  Obstruction
 Swelling  Asymmetry
 Discharge  Deformity
 Redness
Nasal Mucosa
 Color  Bleeding
 Swelling
 Exudates:
 Clear  Mucopurulent  Purulent
Nasal Septum
 Deviation  Ulcers
 Inflammation  Polyps
 Perforation
Sinus (Palpation)
 With tenderness
 Without tenderness
The Mouth and Pharynx
Lips
 Color : _________________  Scaliness
 Moist  Lesions
 Lumps  Tenderness
 Ulcers  Swelling
 Cracking  Spots
Oral Mucosa
 Color : _________________  Tenderness
 Moist  Swelling
 Lumps  White patches
 Ulcers  Nodules
 Cracking  Spots
 Lesions
Gums
 Color : _____________  Lesions
 Moist  Tenderness
 Lumps  Swelling
 Ulcers  Spots
Teeth
Hard Palate
 Color : ___________
 Architecture

Tongue and Undersurface

 Symmetric protrusion  Ulcers
 Asymmetric protrusion  Lesions
 Color: ____________________  Tenderness
 Moist  Swelling
 Lumps  Spots
Pharynx
 Uvula deviates to the right  No deviation
 Uvula deviates to the left

Tonsils
 Symmetric  Redness
 Asymmetric  Ulcers
 Color: ____________________  Lesions
 Moist  Tenderness
 Exudate  Swelling
 Spots
 Lumps

The Neck
Lymph Nodes
Node Size Shape Delimitation Mobility Consistency Tenderness
Preauricular
Posterior
Auricular
Occipital
Tonsillar
Submandibular
Submental
Superficial cervical
Posterior cervical
Deep cervical chain
Supraclavicular

Trachea
 Right deviation  Symmetric
 Left deviation  Asymmetric
 No deviation  Mass
  Lesions
Thyroid Inspection
 Symmetry  Contour
Thyroid Palpation
 Size : ______________  Nodules
 Shape : ______________  Tenderness
 Consistency  Bruit

THE THORAX & LUNGS

Initial Survey of Respiration and the Thorax
Breathing
 Rate : _________________
 Rhythm : _________________
 Depth : _________________
 Effort of breathing : _________________
 Cyanosis : _________________
 Audible wheezing : _________________
Neck
 Accessory muscle contraction during inspiration:
 Sternomastoid
 Scalene muscles
 Supraclavicular retraction
 Is the trachea midline? ________________
Chest
 Shape
 Normal  Pigeon
 Funnel  Traumatic Flat
 Barrel  Thoracic Kyphoscoliosis
 Posterior Chest
Inspection
 Deformities in chest expansion : ____________________
 Asymmetry in chest expansion : ____________________
 Abnormal retraction of the interspaces during inspiration : ____________________
 Impaired respiratory movement:
 One side
 Both side
 Unilateral lag in movement
Palpation
 Tender areas : ___________________
 Visible abnormalities:
 Mass  Sinus tracts
 Chest expansion : ___________________
 Tactile Fremitus:
  Increased  Decreased
Percussion
 Flat  Resonant  Tympanitic
 Dull  Hyperresonant

o Specific Area
 1  4  7
 2  5
 3  6
Auscultation
 Breath Sounds
 Vesicular  Bronchial
 Bronchovesicular  Tracheal

 Adventitious Sounds
 Crackles (Rales)
 Discontinuous  Like dots in time
 Intermittent, nonmusical  Fine crackles
and brief  Coarse crackles
 Wheezes
 Continuous  Like dashes in time
 ≥250 ms, musical,  Wheezes
prolonged  Rhonchi
 Stridor
 Pleural Rub
 Transmitted Voice Sounds: ______________________

 Anterior Chest
Inspection
Shape and movement of chest : ______________________________
Deformities and asymmetry : ______________________________
Abnormal retractions : ______________________________
Local lags/impairment in respiratory movement : ______________________
Palpation
Tender area : __________________________
Abnormal area : __________________________
Assessment of chest expansion : __________________________
Tactile Fremitus : __________________________
Percussion
 Flat  Resonant  Tympanitic
 Dull  Hyperresonant
Auscultation
 Breath Sounds
 Vesicular  Bronchial
 Bronchovesicular  Tracheal

 Adventitious Sounds
 Crackles (Rales)
 Discontinuous
  Intermittent, nonmusical  Fine crackles
and brief  Coarse crackles
 Like dots in time
 Wheezes
 Continuous  Like dashes in time
 ≥250 ms, musical,  Wheezes
prolonged  Rhonchi
 Stridor
 Pleural Rub
 Transmitted Voice Sounds: ______________________

CARDIOVASCULAR SYSTEM
Blood pressure: _________ mm Hg Heart Rate: _________ bps
Jugular Venous Pressure and Pulsation
Jugular Venous Pressure : ___________________
Jugular Venous Pulsation : ___________________
 Amplitude : ___________________
 Timing : ___________________
Carotid Pulse
 Amplitude : ___________________
 Contour : ___________________
 Variation in amplitude : ___________________
 Timing of carotid upstroke in relation to S1 and S2 : ___________________
 Pulsus Alternans
 Paradoxical Pulse
 Thrills
 Bruits
Brachial Artery

The Heart
Inspection and Palpation
 Point of Maximal Impulse
 Location : ______________  Lifts
 Diameter : ______________  Thrills
 Amplitude : ______________  S1 and S2
 Duration : ______________  Right Ventricle
 Heaves
 Left Ventricular Area – The Apical Impulse
Point of Maximal Impulse
 Location : ______________  S3 and S4 : ______________
 Diameter : ______________  Right ventricular Area
 Amplitude : ______________  Pulmonic Area
 Duration : ______________  Aortic Area
Auscultation
 S1
 S2
 Split S2
 Systole Extra Sounds : ______________
 Diastole Extra Sounds : ______________
 Murmurs:
Timing
 Midsystolic  Early diastolic  Continuous
 Pansystolic  Middiastolic murmur
 Late systolic  Late diastolic
Shape
 Crescendo  Crescendo-decrescendo
 Decrescendo  Plateau
Location of Maximal Intensity : _________________________
Radiation : _________________________
Intensity
 Grade 1  Grade 3  Grade 5
 Grade 2  Grade 4  Grade 6
Pitch
 High  Medium  Low

Quality
 Blowing  Rumbling
 Harsh  Musical
Special Techniques
 Standing and Squatting
 Valsalva Maneuver
 Isometric Handgrip
 Transient Arterial Occlusion
THE BREASTS AND AXILLAE
The Female Breast
Inspection
 Arms at Sides
 Color
 Thickening of the skin
 Prominent pores
 Size and symmetry
o Areolae
 Contour of the Breasts
o Masses o Flattening
o Dimpling
 Characteristic of the Nipples
o Size o Rashes
o Shape o Ulceration
o Direction o Discharge
 Arms Over Head; Hands Pressed Against Hips; Leaning Forward

Palpation
 Lateral Portion of the Breast  Consistency
 Medial Portion of the Breast  Tenderness
 Nodules
 Location : ________________
 Size : ______ cm
 Number
o Single o Multiple
 Shape
o Round/cystic o Irregular/stellate
o Disclike o Lobular
 Consistency
o Soft o Firm o Hard
 Delimitation
o Well circumscribed o Not well circumscribed
 Tenderness
 o Usually nontender o Often tender
 Mobility
o Fixed to skin/tissues o Very mobile
o Mobile
 Retraction Signs
o Absent o Present
 The Nipple
 Elasticity

The Male Breast

Inspection
 Nipple and Areola
 Nodules  Swelling  Ulceration
The Axillae
Inspection of the Skin
 Rash  Infection  Unusual pigmentation
Palpation
 Pectoral Nodes  Lateral Nodes  Subscapular Nodes

THE ABDOMEN
Inspection
 The Skin
 Scars
Location : _____________
 Striae
o Old silver
o Pink-purple
 Dilated Veins
 Rashes
 Ecchymoses
 The Umbilicus
 Contour  Inflammation
 Location  Bulges
 The Contour of the Abdomen
 Flat
 Rounded
 Protuberant
o Fat o Pregnancy
o Gas o Ascitic Fluid
o Tumor
 Scaphoid
 Bulge
o Umbilical Hernia o Epigastric Hernia
o Diastasis Recti o Lipoma
o Incisional Hernia
 Symmetric  Enlarged liver
 Asymmetric  Enlarged spleen
 Visible organ  Peristalsis
 Masses  Pulsation
Auscultation
 Bowel sounds  Bruits  Friction rubs
Percussion
 Mass  Tympany  Dullness
Palpation

THE LIVER & THE SPLEEN

 Percuss span of liver dullness  Palpate the liver edge
 Percuss span of spleen  Palpate the spleen

THE KIDNEYS
Palpation
 Flank: ___ Right Kidney ___ Left Kidney
Percussion
 Tenderness

THE AORTA
 Palpate upper abdomen for aortic pulsations  Check for fluid wave
 Palpate for shifting dullness
Special Techniques
 McBurney’s Point  Psoas sign  Murphy’s sign
 Rovsing’s sign  Obturator sign
THE PERIPHERAL VASCULAR SYSTEM
1. Arms
Size :
Symmetry :
Swelling :
Venous pattern:
Skin :
Color :
Texture :
Nail Bed
Color :

A. Pulses
3+ : Bounding Right Arm Left Arm
2+ : Brick; expected (normal Radial pulse
1+ : Diminished, weaker than expected Brachial pulse
0 : Absent, unable to palpate
B. Epitrochlear Nodes
If a node is present, note:
Size :
Consistency :
Tenderness :
C. Allen’s Test ( )

2. Legs
Inspection
Size :
Symmetry :
Swelling ( )
Venous pattern/enlargement ( )
Pigmentation ( )
Rashes ( )
Scars ( )
 Ulcers ( )
Skin
Color :
Texture :
Nail Bed
Color :
Hair distribution
Lower legs:
Feet/toes :
A. Inguinal Nodes
If a node is present, note:
Size :
Consistency :
Tenderness :
B. Pulses
3+ : Bounding Dorsalis Posterior
2+ : Brick; expected (normal Femoral Popliteal
Pedis Tibial
1+ : Diminished, weaker than R L R L R L R L
expected Radial pulse
0 : Absent, unable to palpate Brachial pulse

C. Peripheral Veins
Edema/Pitting ( )
If yes, note for: Swelling ( ) unilateral/bilateral?
Veins prominent ( )
D. Varicose veins, present ( )

THE MUSCULOSKELETAL SYSTEM

A. Temporomandibular Joint (TMJ)
Inspection
Face symmetric? ( )
Swelling/Redness ( )
B. Shoulder
Inspection
Scapula
Abnormal Positioning ( )
Atrophy ( )
Deformity ( )
Fasciculation ( ) *fine tremors
Swelling ( )
Joint Capsule
Swelling ( )
Upper extremities
Color change ( )
Skin alteration ( )
Unusual bony contours ( )

Palpation (any area of pain?)

Sternoclavicular joints
A: Acromion ( )
 B: Coracoid process ( )
C: Greater tubercle ( )

Biceps Tendon ( )

SITS muscles ( )
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

Range of Motions:
 Flexion Raise your arms in front of you and overhead
Extension Raise your arms behind you
Abduction Raise your arms out to the side and overhead
Adduction Cross your arm in front of your body
Internal Rotation Place one hand behind your back and touch your shoulder blade
External Rotation Place one hand behind your neck or head as if you are brushing your hair
Maneuvers:

Overall shoulder rotation Scratch test

Neer’s impingement

Rotator cuff

Hawkin’s impingement

Supraspinatus strength
“empty can test”

Infraspinatus strength

Forearm supination

Drop arm sign

C. Elbow
Inspection
Nodules ( )
Swelling ( )

Palpation
Olecranon displacement ( )

Range of motion and maneuvers

Flexion “Bend your elbow.”
Extension “Straighten your elbow.”
Supination “Turn your palms up, as if carrying a bowl of soup.”
Pronation “Turn your palms down.”

D. Wrist and Hands

Inspection
Movements smooth and natural ( )
Fingernail edges parallel ( )
Swelling joints ( )
Deformities/angulation ( )
Flexor tendon thickening ( )
Palpation
Wrist
Swelling ( )
Tenderness ( )
Anatomical snuffbox
Tenderness ( )
Carpal and metacarpals
Painful when pressed ( )
Swelling/Tenderness ( )
Fingers and thumb
Swelling ( )
Bony enlargement ( )
Tenderness ( )
Range of motion

Flexion “With palms down, pointyour fingers towardthe floor.”

Extension “With palms down, pointyour fingerstoward the ceiling.”
Adduction (radial deviation) “With palms down, bringyour fingers towardthe midline.”
Abduction (ulnar deviation) “With palms down, bringyour fingers awayfrom the midline.”

Manuevers

Test for sensation

Median nerve ( )
Ulnar nerve ( )
Radial nerve ( )

Hand grip test ( )

Finkelstein’s test( )
 Tinel’s sign
Median nerve Pain/numbness ( )
Phalen’s test (60 secs)
Numbness/tingling ( )

E. Spine
Inspection
Head and midline at same line? ( )
Shoulders and pelvis at same level? ( )
Palpation

Presence of tenderness/pain?
Spinous process of vertebra
Sacroiliac joints
Paravertebral muscles
Sciatic nerver

Range of motion (NECK)

Flexion “Bring your chin to your chest.”
Extension “Look up at the ceiling.”
Rotation “Look over one shoulder, and then the other.”
Lateral bending “Bring your ear to your shoulder.”

Range of motion (SPINE) Note: Support the back and pelvis of patient
Flexion “Bend forward and try to touch your toes.”
Extension “Bend back as far as possible.”
Rotation “Rotate from side to side.”
Lateral bending “Bend to the side from the waist.”
Anterior surface of the hip
 iliac crest at the level of L4
F. 
Hips iliac tubercle
 anterior superior iliac spine Inspection
 greater trochanter Stance and Gait
 pubic tubercle Smooth/Continuous rhythm ( )
Posterior surface of the hip, Knee flexed during stance ( )
 posterior superior iliac spine Atrophy ( )
Bruising ( )
 greater trochanter
 ischial tuberosity Palpation
 Sacroiliac joint
Inguinal structures (N-A-V-E-L)
 Nerve
 Artery
 Vein
 Empty space
 Lymph node
Bursae
 Range of motion/manuevers
Flexion “Bend your knee to your chest and pull it against your abdomen.”
Extension “Lying flat, move your lower leg away from the midline and down over the side of the table.”
Adduction “Lying flat, bend your knee and move your lower leg toward the midline.”
Abduction “Lying flat, move your lower leg away from the midline.”
External rotation “Lying flat, bend your knee and turn your lower leg and foot across the midline.”
Internal rotation Lying flat, bend your knee and turn your lower leg and foot away from the midline.

G. Knees
Inspection
Knees aligned? ( )
Atrophy of quadriceps muscle ( )
Swelling in patella ( )
Palpation
Pain and tenderness?
Tibiofemoral joint—with knees flexed
Joint line—place thumbs on either side of the patellar tendon.
Medial and lateral meniscus
Medial and lateral collateral ligaments
Patellofemoral compartment
Patella
Patellar tendon - ask patient to extend the leg.
Suprapatellar Pouch, Prepatellar Bursa, and Anserine Bursa
Medial tibial condyle
Popliteal surface

Effusions?

Bulge Sign
Balloon Sign
Ballote the patella

Gastrocnemius and soleus muscle: Tenderness ( )

Flexion “Bend or flex your knee.”

Achilles tendon: Tenderness
( Extension
) “Straighten your leg.”
External rotation “While sitting, swing your lower leg toward the midline.”
Internal rotation “While sitting, swing your lower leg away from the midline.”
 Range of motion
Maneuvers

McMurray test

Abduction (or Valgus) Stress

Test

Adduction (or Varus) Stress

Test

Anterior Drawer Sign

Lachman Test

Posterior Drawer Sign

H. Ankle and Foot

Inspection
Deformities ( ) Swelling ( )
Nodules ( ) Calluses ( )

Palpation
Ankle joint
Swelling/Tenderness ( )
Achilles Tendon
 Nodules ( )
Tenderness ( )
Heel
Tenderness ( )
Malleolus
Tenderness ( )
Metarsophalangeal joint
Tenderness ( )
Metatarsals
Tenderness ( )
Range of motion
Ankle flexion “Point your foot toward the floor.”
Ankle extension “Point your foot toward the ceiling.”
Inversion “Bend your heel inward.”
Eversion “Bend your heel outward.”

Manuevers
Ankle (tibiotalar) joint

Subtalar (Talocalcaneal)
joint

Transverse Tarsal joint

Metatarsophalangeal Move the proximal phalanx of each toe up and down.

Measure the length of legs (distance from anterior superior iliac spine and medial malleolus, tape should cross the knee on
the medial side)

THE NERVOUS SYSTEM

A. The Cranial Nerves

Compress one side of the nose
Ask the patient to sniff through the other
I Olfactory
Patient should then close both eye
Occlude one nostril and test smell in the other
 a. Visual acuity
II Optic b. Visual field (Confrontation)
c. Optic Fundi
a. Size of pupils
Right: ______mm
Left: ______mm
b. Shape of pupils
II/III Optic and Oculomotor
c. Pupillary reactions to light
d. Near response
e. Convergence
f. Accommodation of lens
a. Extraocular movements (six cardinal directions of gaze)
b. Diplopia? ( )
If present, do COVER-UNCOVER test:
Monocular ( )
Oculomtor
Binocular ( )
III/IV/VI Trochlear
c. Nystagmus? ( )
Abducens
If present, plane?
Horizontal ( ) Vertical ( )
Rotary ( ) Mixed ( )
d. Ptosis? ( )
MOTOR:
Palpate temporal and masseter muscle
Strength of muscle contraction:____________________
SENSORY
a. Pain sensation (eyes closed)
Right Left
Forehead
Cheeks
Jaw
*If any abnormality, check TEMP SENSATION:
Right Left
Forehead
V Trigerminal Cheeks
Jaw

b. Light touch
Right Left
Forehead
Cheeks
Jaw
Corneal Reflex (blinking of eye)
Right eye ( )
Left eye ( )
VII Facial Inspect the face both rest and during conversation.
Symmetric ( )
Tics ( )
Abnormal movements ( )
Can the patient?
 Raise both eyebrows ( )
Frown ( )
Close both eyes tightly ( )
Show both upper and lower teeth ( )
Smile ( )
Puff out both cheeks ( )
Whispered voice test ( )
If there is hearing loss:
VIII Acoustic
Rinne’s test ( )
Webers test ( )
Voice is hoarse ( )
Voice have a nasal quality ( )
Difficulty in swallowing ( )
Glossopharyngeal/ Ask the patient to say ‘AH’ or yawn
IX/X
Vagus Palate rises symmetrically? ( )
Uvula in midline ( )
Posterior pharynx moves medially ( )
Gag reflex ( )
Trapezius muscle
Atrophy ( )
Fasciculations ( )
XI Spinal accessory Strength ( )
Sternomastoid muscle (turn head against your hand)
Force of movement ( )

Tongue
On floor of mouth
Atrophy ( )
Fasciculations ( )
Symmetry( )
Protruded
XII Hypoglossal
Atrophy ( )
Fasciculations ( )
Symmetry ( )
Moved side to side
Symmetry ( )
Strength: __________

B. Motor System
Body position:
Involuntary movements (Tremors, tic, fasciculations): ( )
If present, note its:
Location :
Quality :
Rate :
Rhythm :
Amplitude :
Relation to
Posture :
Activity :
Fatigue :
Emotion :
Others :
Muscle bulk
Atrophy ( )
If present:
Unilateral / Bilateral?
Proximal / Distal?
Muscle tone
Resistance: Normal / Increased/ Decreased
Muscle strength *persons’ dominant side is slightly stronger than the nondominant side

Hands and wrist:

Flexion Biceps
Triceps
Extension Wrist
Grip
Abduction Ulnar nerve
Opposition of thumb Median nerve

Spine
Flexion
Extension
Lateral bending

Thorax
Expansion
Excursion

Hips
Flexion Iliopsoas Rapid Alternating Movement
Adduction Adductors
Gluteus medius
Abduction
Gluteus minimus
Extension at hips Gluteus maximus
Extension at knee Quadriceps
Flexion of the knee Hamstrings
Dorsiflexion
Plantar flexion
Speed Rhythmic? Smooth?
Arms
Distal joint of
thumb-index
finger
 Legs
Finger-nose
Heel to shin

Gait
Walk across the room ( ) Hop in place ( )
Walk heel to toe ( ) Shallow knee bend ( )
Walk on toes ( ) Rising form sitting position ( )
Stance
Romberg test ( )
Pronator drift ( )

C. Sensory System
Shoulders Forearms Thumbs Little fingers thighs Calves Buttock
Pain
Temperature
Light touch
Vibration
Proprioception
Discriminative Sensations

Right Left
Stereognosis
No. Identification
2 point discrimination
Point localization
Extinction
Deep Tendon Reflexes

Cutaneous

Right Left
Biceps
Triceps
Brachioradialis
Knee
Ankle
Clonus
Stimulation reflex

Abdominal
Plantar
Special techniques
Meningeal signs
Neck mobility/Nuchal rigidity ( )
Brudzinski’s sign ( )
Kernig’s sign ( )
Lumbosacral Radiculopathy:
Straight leg test ( )
Asterixis ( )
Scapula winging
Right ( ) Left ( )