Blabel Clinical Examination in points Internal Medicine & Surgery

 GENERAL (Don't forget: Rt Side o{_Patient) Colon  CARDIAC (Neck to Umbilicus)

Environment & Surrounding Urinary Bladder  INSPECTION & PALPATION
Intellectual Gall Bladder Precordial Bulge
(Consciousness, Alert, Cooperative, Mood, Abdominal Mass Pulsations (Epigastric, Apex, Pulmonary,
Intelligence, Orientation to Time & Place, Hernia (Impulse in Cough) Aortic, Rt & Lt Para- Sternal Suprasternal)
Memory, Speech) Check (Border, Surface, Fingers, Apex (Site, Extent, Rate, Rhythm, Character,
Body Built / Decubitus / Position Consistency, Pulsating, Tender) Rocking, Thrill)
Temperature Techniques (Ordinary, Bimanual Hooking, Thrill
Pulse Dipping, Fingers' Tips) Gynecomastia
Rate, Rhythm, Volume, Equality, Character,  PERCUSSION Palpable Sounds
Wall Peripherals, Deficit Tidal Percussion & Traub's Area Skin (Scars, Veins, Pigment)
Blood Pressure (Auscultatory I Palpatory) Knee Elbow (Puddle Sign) Back
Upper & Lower I Bilateral/,y Shifting Dullness  PERCUSSION
Respiratory Rate Transmitted Thrill Tidal Percussion (Liver)
Jaundice (Eye) Percuss (Liver, Spleen, Bladder) Bare Area (Heart)
Pallor (Lips, Palm & Eye)  AUSCULTATION Lower 1/3 Sternum (Direct)
Cyanosis (Tongue I Periphery) Intestinal sounds Aortic Area (Rt 2nd space)
Clubbing (Window test) Bruit = Murmurs Pulmonary Area (Lt 2nd Space)
Edema (Side, Site, Level, Pitting, Tenderness) Venous Hum Right Atrium (3rd &4th right space)
N eek veins (? Crn, Waves, Respiration, Systole) Scratch Test, Succession Splash, Friction Left Atrium/ Waist (3rd left space)
Carotid (Rate, Rhythm, Thrill, .. .. ) Rubs, Peritoneal Rub Outside Apex
Thyroid Shifting Dullness (Ejfasion)
Inspect I Palpate I Percuss /Auscultate  CHEST (Neck to Umbilicus)  AUSCULTATION
Trachea
 INSPECTION SJ, S2, S3, S4, Split, Click, Snap, Munnurs, Rub,
Neck Crepitations
Shape (5:7 & Symmetrical)
Lymph Nodes (Occipital Subrnental, Apex/Mitral (Lt 5th space MCL)
Expansion
Subrnandibular, Pre er Post auricular, General) Pulmonary (Lt 2nd Space)
Type of Movement
Skin (Rash, Pigment, Ulcers, Veins, Spider Tricuspid (Lower Lt Sternal)
Rate, Rhythm, Depth, Pattern
nevi, Injections, Scratch) 1st Aortic (Rt 2nd space)
Trachea (Mediastinum)
Upper & Lower limbs 2nd Aortic (Lt 3rd Space)
Pulsations (Epigastric, Apex, Pulmonary,
Tremors (Flapping I Fine)
Aortic)
Specific
Skull, Face, Eye, Nose, Ear, Cneeks, Teeth,
Respiratory Muscles  RHEUMATOLOGY
Litten' s Sign
Lips, Gum, Tongue, Parotid, Mucosa, Tonsils,  FOR ALL JOINTS
f oints, Breast Skin (Scars, Veins, Pigment) Hand, Wrist, Elbow, Shoulder, Ankle, Feet, Knee,
Back Hip, Spine, Sacroiliac, Sternoclavicular, TM]
Refill Time, Nails & Palm
Skin
 PALPATION Muscles
 ABDOMINAL (Nipple to Midthigh) Tenderness Swelling
 INSPECTION Expansion (Marnrnary!Scapular!Supra!Infra!) Movement
Contour Subcostal Angle Deformities
Breast (Gynecomastia I Atrophy) Pulsations (Epigastric, Apex, Pulmonary, Tenderness
Movement Aortic)  SPECIAL TESTS
Subcostal Angle Tactile Vocal Fremitus (TVF) Baby Steps for Examination of Hand
Epigastric Pulsations Palpable Sounds, Pleural Rub Prayer Sign & Reversed Prayer
Divarication of Recti Trachea (Shift, Tug) Phalen's Test (Hand er Wrist)
Umbilicus (Site, Shape, Hernia, Veins, Gynecomastia Tinel's Test (Hand e!rWrist)
Nodules, Color, Discharge, Skin) Bulge Test (Knee)
Suprapubic Hair
 PERCUSSION Patellar Tap (Knee)
Hernial Orifices Fluctuation Test (Knee)
All spaces M CL & MAL
External Genitalia Medial & Lateral Stress Test (Knee)
Kronig's isthmus (Apex ofLung)
Visible Peristalsis Schober Test (Spine)
Clavicular (Direct)
Skin (Veins, Scars, Swellings, Pigrnentation, Modified Schober (Spine)
Infra-Clavicular
Scratch Marking) Modified-modified Schober (Spine)
Tidal Percussion (Liver)
Back (Scar, Deformity, Tuft ofhair, Cafe' au Springing of the Pelvis (Sacroiliac)
Traub's Area (Spleen)
lait, Renal angle)
Bare Area (Heart) Faber Test (Sacroiliac)
 PALPATION (With flexed Knee) Pressure Test (Sacroiliac)
Shifting Dullness (Effusion)
Superficial (S-Shape) - (Tenderness, Swelling, Gaenslen' s Test (Sacroiliac)
Suprascapular, Interscapular, Subscapular
Rigidity, Guarding)
Breast
 AUSCULTATION Sciatic Nerve Examination
Vesicular, Bronchial Kernig's Sign
Subcostal Angle
Wheezes, Crepitations, Pleural Rub Brudzinski' s Sign
Epigastric Pulsations
Vocal Resonance (Bronchophony, Lassegue Test
Liver
Aegophony, Whispering, Pectoriloquy)
Spleen (Notch)
 BACK (IN ALL SYSTEMS)
Kidney (±Punch Tenderness Test) My regards To Leo memo ⎯ Inspection, Palpation, Percussion, Auscultation
I I
1
 Blabel Clinical Examination in points Internal Medicine & Surgery
NEUROLOGY (2Sides) 5. Deep Reflexes: (Ey_e on Muscle2 • Sensory (Taste ant. 213 Tongue,
 MENTALITY Biceps (12{}')- (C5,6) Lacrimation)
Intellectual (Consciousness, Alert, Cooperative, Brachioradialis (Semi supinated) - (C5,6) • Motor (Blow, Whistle, Close Eye, Elevate
Mood, Intelligence, Orientation to Time cr Triceps (9{}')- (C6,7) Eye Brow)
Place, Memory, Speech) Knee (Carry by forearm, heel just touch bed) • Reflexes (Corneal Conjunctiva£
Glasgow Coma Scale - (L2,3,4) Glabellar)
Mini Mental State Examination Ankle (9{}')- (SJ,2) 8. Vestibulocochlear
 SPEECH 6. Pathological Reflexes: • Whisper & Ask to Repeat
Development Supraspinatus (C3,4) • Watch, Rinne & Weber Tests
Deltoid
Formulation Disorders • Caloric & Rotating Chair Tests
Articulation Disorders Pectoralis
9. Glossopharyngeal
Palmo-mental
• Sensory (Post. 1/3 of Tongue)
 SENSORY (2Sides) Hoffman
• Reflexes (Palatal, Pharyngeal)
Phantom
1. Superficial:
Pain (Pin) Wartenberg's Sign
• m Ah & Inspect Uvula
II. Spinal root ofAccessory
Touch (Cotton) Finger Jerk
Sternomastoid, Trapezius
Temperature Wrist Clonus
12. Hypoglossal (Protrude Tongue)
2. Deep: Adductor Reflex (L4)
Vibrations Patellar Reflex
Pinching Muscles Patellar Clonus  HEMATOLOGY
Moving Joints (Proprioception) Ankle Clonus General + Decubitus / Position
Nerve Sense (Ulnar) 7. Coordination: Hemolytic (Pallor, Hyperdynamic Circulation,
Finger to Nose Failure to thrive, Spooning Nail, Mild jaundice,
3. Cortical:
Dark Stool. .... .)
Tactile (Pin) Finger to Finger
Head & N eek (Atrophic glossitis, Bleeding Gurns,
2 Points Discrimination Finger to Doctor's Finger
Beefy Tongue, Wet Purpura, Congested neck veins,)
Stereognosis Heel to Knee
Thalassemia (Mongoloid Face, Splenomegaly! ectomy)
Graphesthesia Heel to Shin
Petechia / Ecchymosis / Purpura
Heel to Doctor's Finger
Perceptual Rivalry
Buttoning & Unbuttoning
 RENAL FAILURE
General (BP, Muscles, Breathing, ... .)
 MOTOR (2Sides) Rebound
CVS (Pericardia! Rub, .... )
1. Inspection Dysdiadochokinesia
Chest (Wheeze, Pleural Rub, Kussmaul Br.)
Size, Shape, Position, Deformity Romberg's Test
GIT (Halitosis, White coated Tongue, .. .)
Fasciculation 8. Percussion:
CNS (Apathy, Neural Affection, Hypothesis)
Trophic (Nail, Hair, Ulcer) I Percuss Muscles (Fasciculations) I I Skin (Scratching marks, Earthy look, .. .)
2. Palpation (Tone): Hematology (Anemia, Bleeding Tendency)
Gower's (Axilla)  GAIT Edema (Ascites, Lower Limb, Eyelid)
Circumduction (Shoulder, Hip) I Ask Patient to Walk I I  AD RENAL DI SEASE
Shaking (Wrist, Ankle)
Rolling (Thigh)
 CRANIAL (2Sides) General
1. Olfactory Androgen Effect (Acne, Hirsutism, ...)
Passive Flexion & Extension
2. Optic Epigastric Tenderness
Passive Abduction & Adduction
Pituitary Cause (Confrontation Test)
3. Palpation (Power): • Sensory (Acuity, Field, Color Vision)
ACTH (Pigment)
With Gravity - Against Gravity - Against
• Reflexes (Light, Accommodation) Signs (DM, Moon Face, Plethoric Face,
Resistance (Pre-joint is Fixed)
Trunkal Obesity, Buffalo Hump, Thin limbs,
Shoulder (C4,5) 3. Oculomotor Thin Skin, Ulcers, Stria Alba, Stria rubra,
Elbow • Motor Ptosis, Movement, Pupils, Squint, Hirsutism, Acne, Purpura, Supraclavicular
Wrist Nystagmus Pad offat, Libido, Impotence, Amenorrhea
Fingers (CS, Tl)
• Reflexes (Light, Accommodation & Muscle Waste, Stunted Growth, LL Edema)
Hip Cilio-Spinal)  ACROMEGALY
Knee
4. Trochlear & Abducent General (BB, DM, .. .)
Ankle
Movement of Eye CNS (glove crstock hypothesia, Thick ulnar)
Toes
5. Trigeminal Signs (Tall Suture, Husky Voice, Big skull,
4. Superficial Reflexes
• Motor (Temporalis, Masseter cr Kyphosis, Spade like and, Big Feet, Muscle Power,
Babinski (Key) Heart Enlargement, impotence, Hernia
Pterygoid) + Inspect.
Chaddock / Barrada Organornegaly, Gynecornastia, Galactorrhea)
• Sensory Compare 2 halves offace &
Shiaffer (Squeeze gastrocnemius tendon) Pituitary Cause (Confi"ontation Test, 3'd I 4Th 6'")
Compare each halfLower & Upper
Gordon (Squeeze cough muscles)
Quarter. In each Quarter Compare
 MYXEDEMA
Stransky (Little toe) General
Medial part to Lateral
Oppenheim (Squeeze & downward chin of tibia)
• Reflexes (Jaw, Corneal Palatal, CNS (Apathy, Slurred Speech, Slow
Gonda (Passive flexion of3d & 4 th toes then Movement, Hyporeflexia, Peripheral Neuritis)
Conjunctiva!).
Sudden release) Signs (Bujfj Face, Malar Rash, Dry Hair, Alopecia,
7. Facial
Abdominal Reflexes (Key) Cataract, Loss ofouter 113 Eyebrow, No Sweat
• Inspection (Nasolabial Fold, Deviation Xanthelasma, Thick Lips, Pallor, Husky Voice,
Cremasteric Reflex (Upper Medial Thigh)
ofMouth, Drippling Saliva, No Constipation, enlarged liver, Dry Cold Skin)
Anal & Gluteal Reflexes
Corrugations)

2
 Blabel Clinical Examination in points Internal Medicine & Surgery
 GENAREL SURGERY (MostlyinAll)  LYMPHENDOPATHY  VARICOSE VEINS
s n· n·
we 1ngs, Ul cers, LLSwe 1ng, Lyrnp h As General Surgery  INSPECTION & PALPATION
General (Page 1) + Axillary L.N Cervical L. N Etiology
Inspection (SS) Supraclavicular Inguinal L. N Pattern
:i_ite S.ize Number Metastasis Extent
S.hape :i_urface Edema Organomegaly Cough
Edge Discharge Despine Sign (Auscultation) (T4 Level) Complications
:i_urroundings S.kin  SPECIAL TESTS
Other :i_wellings :ipecial Characters ❖ Milking Test I I❖ Fegan Sign
 NERVES (Should Know N. Supply to Muscles}
Palpation
 INSPECTION & PALPATION
⎯ Schwartz Test I I⎯ Percussion Test
Tenderness Temperature ▪ Morrisey's Test
Site Size Etiology
▪ Trendelenburg's Test
Shape Surface Deformity
▪ Multiple T orniquet Test
Consistency Associations (Bone, Artery, Vein)
▪ Finger Compression Test
Fluctuation Test Wasting Muscles
➢ Perthes' Test
Modified Fluctuation test Parital Claw Hand (Ulnar Nerve)
➢ Modified Perthes' Test
Cross Fluctuation test Ulnar Paradox (Ulnar Nerve)
Paget Test Ape Hand (Median Nerve)
Bipolar Test Benediction Attitude (Median Nerve)  HERNIA (Lower Chest → Midthigh)
Edge Surrounding Pistol Hand (Median Nerve)  INSPECTION (As General Surg_ezy)
Pulsations (Expansile I Transmitted) Wrist drop (Radial Nerve) Swelling
Mobility Compressibility Foot drop (Sciatic Nerve) Scrotum
Reducibility Thrill Talipes Equino Varus (Lat. PoplitealN) Penis
Impulse on Cough Lymph Nodes Talipes CalcineoValgus (Med. Popliteal N) Perineum
Percussion  PERCUSSION Other Swellings
Auscultation (Murmur, Hum, Bruit) Tine! Test Surrounding
T ransillumination  TESTS  PALPATION
Test Motor(± Gravity/ Resistance) Swelling
Special Tests of Ulnar Nerve Scrotum (Testis. Tunica)
 BREAST (2 Sides) ➢ Bipolar Fluctuation Test
• Froment Test (Add. Policies)
(2 Breasts, Axil/a, Head, Neck, Face, Abdomen)
• Card Test (interossei) ➢ Pinching Test
 INSPECTION
• Ask to Abd. Little Finger (Abd Digti minimi) Spermatic Cord
Breast (Skin, Level, Symmetry, Contour)
Special Tests
Nipple (Retracted, Discharge, .. .) • Hold Middle Phalanx & Ask to flex
➢ Internal Ring Test
Areola Distal (Flexor Digitorum Profamdus)
➢ External Ring Test
Mass Special Tests of Median Nerve
➢ Three Fingers Test
Lymph Nodes • Oschner Clasping test ➢ Scrotal N eek Test
Contralateral Side • Pen touching Test (Abd. Policies brevis) ➢ Pubic Tubercle Test
• Opposition thumb Against other Fingers ➢ Bow Sign (IF Varicocele)
 PALPATION (4 Compartments) • Wartenberg's oriental prayer's position  PERCUSSION
(By Iip,. & Finger Surface) (Better in Semi Sitting)
Dull Omentocele
As General Surgery
Mass (Surface, Edge)  ISCHEMIA Resonant Enterocele

Surroundings:  INSPECTION & PALPATION  AUSCULTATION

Intestinal Sounds
Serratus Anterior → Press Against your Shoulders As General Surgery
Pectoralis Major → Press Against her Waist Etiology  TRANSILLUMINATION
Nipple & Areola Manifestation of Ischemia
Lymph nodes Pain Paralysis  THYROID (Head, Neck, Upper Chest)
Paresthesia Pulseless As General Surgery
Pallor Possible Gangrene
 PAROTID (2 Sides) Coldness Trophic changes
Inspection (Move with Swallow, Pulsations)
Palpation (Crile's, Lahey's or Classic Method)
 INSPECTION Venous Filling Superficial As General Surgery+
As General Surgery Time Thrombophlebitis Carotid (Berry's Sign) I I Thrill
Skin Impotence Capillary circulation
Pulsation Test
Skin Pinch I I Pamberton Sign
Percussion (Direct on Manubrium)
Ear Lobule Dependency Test
Auscultation (Bruit)
Other Swellings Buerger' s Test
Eye Signs Stellwag
Oral Cavity Adson's Deep Breathing Test
Dalrymple's Rosenbach's
Surrounding Allen's Test
Von Graft's Exophthalmos
Masseter & Sternomastoid Muscle I Facial N Lymph Nodes
Mobius Joffroy
 PALPATION  AUSCULTATION Topolansky 's sign Jellinek 's sign
Skin Bruit Tests Naffziger
Surrounding
Masseter & Sternomastoid Muscle I Facial N
Murmur (A-V Fistula) I I Frazer's Ruler
Compressibility KasrAh1iny 2015-2021 Best Wishes for All