FACULTY

OF
MEDICINE
UITM

GENERAL PHYSICAL EXAMINATION

5 Important Things To Do Before You Start Examine Your Patient:
1. Introduce address the patient by using Encik/Puan, never use Abang/Kakak (some lecturers
might not like it)
2. Always ask for permission
3. Positioning flat for abdominal & CNS examination, 45O supine for chest examination
4. Exposure adequately
5. Ask whether the patient is comfortable
General Inspection

Start your inspection by standing at the end of the bed

Observe your patient thoroughly for 10 secs from head to toe as well as its surrounding
1. Position patient lying flat, at 45O, sitting
2. Comfortability is the patient comfortable or not?
3. Look does the patient look well or ill? Pale or jaundice
4. Consciousness & alertness ask about time, place & person; in any head injury, its
important to use Glasgow Come Scale (GCS) to assess the level of consciousness.

5. Pain does the patient in pain?

6. Features of respiratory distress
- Tachypnea ( >20 breath/min)
- Nasal flaring
- Pursed lips
- Use of accessory muscle
- Subcostal & intercostals muscle retraction
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Cyanosis (severe)
*in asthma, kena tahu the difference between severe and life-threatening asthma in
terms of features.
7. Hydrational status
- Dry mucous membrane
- Coated tongue
- Decrease in skin turgor
- Sunken eyeballs
- Depressed anterior fontanelle (in Paeds patient)
8. Nutritional status cachexic or obese, muscle wasting
9. Attachment IV canulla

Examples:
1. Madam X is lying comfortably in supine position propped up to 45 O. The patient looks well. She is
conscious and alert to time, place and person. She is not in pain or in respiratory distress. Her
hydrational and nutritional status are adequate. There is an IV line attached to her right dorsum,
connected to normal saline.

2. Madam X is lying comfortably supported by 1 pillow. The patient looks well but she appears to
be jaundice. She is conscious and alert to time, place and person. She is not in pain or in
respiratory distress. Her hydrational status is inadequate by evidence of dry mucous membrane
and coated tongue. She looks cachexic by evidence of muscle wasting. There is an IV line
attached to her right dorsum, connected to normal saline.

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CARDIOVASCULAR EXAMINATION
1. Remember to do those 5 things first.
2. General inspection at the end of the bed
3. Proceed with general examination of CVS at RIGHT side of the bed
General Examination of CVS

Always start with hands first

Palms
1. Moisture dry/moist
2. Temperature warm/cold
3. Colour pink/pale
Fingers & nails
1. Cyanosis peripheral cyanosis
2. Capillary refilling should be < 2 secs, otherwise its due to reduced perfusion
3. Finger clubbing due to infective endocarditis; there are 5 stages
Stage 1: loss of angle between nail & nail bed
Stage 2: increase in longitudinal & transverse curvature
Stages 3: positive fluctuating test
Stage 4: drumstick appearance
Stage 5: hypertrophic osteoarthropathy (HPOA)

4. Infective endocarditis stigmata splinter hemorrhage, Oslers nodes, Janeway lesion

Pulse check for rate, rhythm (regular/irregular), volume
1. If its irregularly irregular, consider Atrial Fibrillation
2. Radio-radial delay
3. Radio-femoral delay (coarctation of aorta)
4. Collapsing pulse (aortic regurgitation, patent ductus arteriosus)
5. Dont just check for radial pulse, check for brachial and carotid pulses on both sides
Blood pressure
Head
1. Eyes
- Conjunctiva (pink/pale)
- Sclera (jaundice)
- Xanthelasma
- Corneal arcus
2. Mouth & tongue
- Tongue (moist, dry/coated)
- Central cyanosis
- Dental hygiene (in IE)

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3. Face
- Malar flush (in Mitral Stenosis)
Neck assess Jugular Venous Pressure (JVP) on the right neck (JVP wave kena tahu)
1. Patient propped up to 45O, head is turned away to the left side to relax the
sternocleidomastoid muscle
2. Detect a pulsatile movement, differentiate it from carotid pulsation, measure it
3. If JVP is elevated, distinguish it from carotid pulsation:
- JVP is visible but not palpable
- JVP decreases on inspiration
- Filled from above in venous pulsation
- Hepatojugular reflex: JVP rises transiently
4. Causes of elevated JVP:
- Right ventricular failure
- Superior vena cava obstruction
- Tricuspid stenosis or regurgitation
- Pericardial effusion
- Constrictive pericarditis
Lower limbs (kalau Dr Zubin, he would prefer if we check the lower limbs last sekali after habis
specific chest examination)
1. Pitting edema while looking at the patients face, press on the tibial prominence on
both sides for 15 seconds, extend up to the knee joint if present
2. Peripheral pulses posterior tibialis & dorsalis pedis arteries (position of these arteries
kena tahu)

Specific Examination of CVS

Inspection (inspect carefully for 10 secs, adequate exposure is required)

1. Chest wall movement with each respiration
2. Move symmetrically or not
3. Chest wall deformity
4. Surgical scar (previous CABG)
5. Visible pulsation including visible apex beat
6. Pericardial bulge
Palpation
1. Apex beat (mitral area)
- You should be able to feel for apex beat at left 5th intercostal space at midclavicular
line, bleow the nipple (show the examiner how you count the intercostal space)
- If its not palpable, roll the patient over to the left side (left lateral)
- Causes of impalpable apex beat: obesity, dextrocardia
- Assess character if its abnormal:
Tapping (palpable 1st heart sound)- Mitral Stenosis
Heaving (forceful, sustained, undisplaced impulse) Aortic Stenosis

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Thrill (palpable murmur, more like vibration)

2. Left sternal edge
- Parasternal heave or thrill
3. Pulmonary area
- Tapping (palpable 2nd heart sound in Pulmonary Hypertension)
- Thrill
4. Aortic area
- Tapping (palpable 2nd heart sound in Systemic Hypertension)
Percussion not needed
Auscultation
1. Listen with bell at the apex, roll the patient to the left side and listen for Mitral Stenosis
murmur
2. Change to diaphragm, listen again at the apex, trace up to the left axilla to listen for
radiation of murmur in Mitral Regurgitation
3. Listen with diaphragm at the tricuspid (lower left sternal border), pulmonary (left 2nd
intercostal space), aortic (right 2nd intercostal space) areas, trace up to the right side of
the neck to listen for radiation of murmur in Aortic Stenosis
4. Sit the patient up and listen at these 3 areas again
5. Perform the dynamic maneuvers (respiration) if the murmur is present
- Right-sided valve (tricuspid & pulmonary): murmur increases on inspiration
- Left-sided valve (mitral & aortic): murmur increases on expiration
6. For every auscultation, listen for:
- 1st and 2nd heart sounds and their intensity (soft, normal, loud)
- Extra heart sound (3rd and 4th heart sounds)
- Murmur
- Timing: systolic or diastolic (check using carotid pulse; if the pulse coincides with the
murmur, the murmur is systolic)
- Area of greatest intensity
- Radiation of murmur
Mitral Regurgitation left axilla
Aortic Stenosis right side of neck
Aortic Regurgitation left sternal border
- Grading of murmur (Grade 1-6)
Grade 1: Heard by an expert in optimum conditions
Grade 2: Heard by a non-expert in optimum conditions
Grade 3: Easily heard, no thrill
Grade 4: Loud murmur, with thrill
Grade 5: Very loud, often heard over wide area, with thrill
Grade 6: Extremely loud, heard without stethoscope
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Changes with alteration in position (left lateral position or sitting forward)

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Dynamic maneuvers

Example:
There is a pansystolic murmur best heard over the mitral area with radiation to the
axilla. The grade of the murmur is 3/6 and is accentuated on left lateral position.

Basic yang kita kena tahu:

1. Causes of pansystolic murmur: Mitral Regurgitation, Tricuspid Regurgitation, VSD
2. Differences between Mitral Regurgitation and Aortic Stenosis
3. Causes of Atrial Fibrillation: Mitral Regurgitation, Mitral Stenosis, Cardiomyopathy, etc
4. How to know if the patient is having IE: look for IV antibiotic during inspection, it may
provide the clue
5. Signs of Heart Failure, differences between Left-sided & Right-sided HF
6. Types of pulses (Bounding pulse, Collapsing pulse, Pulsus alternans, Pulsus paradoxus)
Complete your examination by examining the abdomen for hepatomegaly and chest at the back
for pleural effusion and basal crepitations (if you suspect there are signs of heart failure during
examination, baru proceed buat these 2. Kalau takde, its not necessary to do it as it will be time
consuming). You can check for sacral edema at the back.

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RESPIRATORY EXAMINATION
1. Remember to do those 5 things first.
2. General inspection at the end of the bed
3. Proceed with general examination of Respiratory System at RIGHT side of the bed
General Examination of Respiratory System

Always start with hands first

Palms
1. Moisture dry/moist
2. Temperature warm/cold
3. Colour pink/pale
Fingers & nails
1. Cyanosis peripheral cyanosis
2. Capillary refilling should be < 2 secs, otherwise its due to reduced perfusion
3. Finger clubbing causes
A: Lung Abscess
B: Bronchiectasis
C: Lung Carcinoma
D: Emphysema
E: Lung Fibrosis
4. Nicotine-stained fingers tobacco smoking
Pulse check for rate, rhythm (regular/irregular), volume
1. Bounding Pulse (carbon dioxide retention)
2. Pulsus Paradoxus (severe asthma)
Blood pressure
Flapping tremor carbon dioxide retention, liver failure, respiratory acidosis)
Head
1. Eyes
- Conjunctiva (pink/pale)
- Sclera (jaundice)
- Evidence of Horners syndrome (ipsilateral ptosis, ipsilateral miosis, ipsilateral
anhidrosis, enophthalmos)
2. Mouth & tongue
- Tongue (moist, dry/coated)
- Central cyanosis
Neck
1. Check for elevated JVP in cor pulmonale
2. Trachea deviation causes

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Towards the lesion: upper lobe collapse, upper lobe fibrosis

Away from the lesion: massive pleural effusion, tension pneumothorax

3. Tracheal tug
4. Feel the distance from the cricoid cartilage to the suprasternal notch and measure in the
number of finger breadths (normal: 3-4 of finger breadths). The distance reduces in
hyperinflation
Lower limbs pitting edema

Specific Examination of Respiratory System

(Perform inspection, palpation, percussion & auscultation on the FRONT of the chest first, then sit the
patient forward, repeat the examination on the BACK. Posterior aspect is preferable because the
findings are easier to be elicited so dont waste too much time examine the front of the chest. Examine
buat syarat je because in Short Case, you will be given only 7 minutes to perform.)

Inspection
1. Chest wall movement with each respiration
2. Move symmetrically or not
3. Chest wall deformity
- Barrel chest in chronic asthma
- Pigeon chest (pectus carinatum) in severe asthma
- Funnel chest (pectus excavatum)
- Harrisons sulcus in chronic childhood asthma
- Kyphosis
- Scolisosis
4. Surgical scar & chest drains
5. Visible pulsation
Palpation
1. Chest expansion
- Perform on upper, middle & lower parts
- The lung should expand symmetrically by at least 5 cm
- Reduced expansion on the affected side indicates a lesion on that side
Unilateral
Localized pulmonary fibrosis
Consolidation
Collapse
Pleural effusion
Pneumothorax

Bilateral
Chronic airflow limitation (severe COPD)
Diffuse pulmonary fibrosis

2. Apex beat
3. Vocal fremitus
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Ask the patient to repeat ninety-nine or nenek-nenek while palpating the chest
wall with the palm of the hand
Compare on both sides (right & left)
Perform on upper, middle, lower, lateral parts
Increase in vocal fremitus = increase in vibration
vocal fremitus
Pneumothorax
Consolidation

vocal fremitus
Pleural effusion
Collapse

Percussion
1. Start by percussing supraclavicular area on both sides and compare, then percuss ikut
rib spaces
2. Dont forget to percuss axillae
3. Equivalent sites on the 2 sides are percussed consecutively for comparative purposes
4. Listen & feel for the nature and symmetry of the percussion note:
Resonant: Normal lung
Hyperresonant: Pneumothorax
Dull: Consolidation, Collapse, Fibrosis
Stony dullness: Pleural Effusion
Auscultation
1. Ask the patient to breathe in & out and compare each side with the other
2. Use the diaphragm in all areas except supraclavicular area (use bell)
3. Breath sound
- Intensity (normal, reduced, absent)
- Nature (vesicular or bronchial breath sound)
Vesicular breath sounds
Normal breath sounds
Louder & longer on inspiration than
expiration
No gap between each phases

Bronchial breath sounds

Abnormal breath sounds
Inspiration & expiration of equal length
Expiratory sound has higher intensity
than inspiration
Gap in between 2 phases

4. Added sounds
- Time it in relation to the respiratory cycle, either inspiration, expiration or both
- 3 types (rhonchi, crackles, pleural rub)
Rhonchi (wheezing)
On expiratory
Monophonic or polyphonic
Asthma, airway obstruction, COPD

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Crackles
Fine (crepitations): pulmonary edema,
pulmonary fibrosis
Coarse: bronchiectasis

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5. Vocal resonance
- Same as vocal fremitus, but using stethoscope
Ask the patient to sit up, repeat the examination on the back of the chest. Move the elbows
forward across the front of the chest to move the scapulae away from the lung field. The same
procedure goes from inspection until auscultation.
Palpate for cervical lymph nodes while the patient is sitting. (Its important)
Group of cervical lymph nodes: Submantel, Submandibular, Preauricular, Postauricular,
Occipital, Deep Cervical Chain, Posterior triangular, Supraclavicular, Scalene (in lung carcinoma)

Example:
There is pleural effusion over the left lower zone evidenced by reduced chest expansion,
decreased vocal resonance and fremitus, stony dullness and reduced breath sounds with no
added sounds over the left lower zone.

Basic yang kita kena tahu:

1. Pancoasts syndrome and Horners syndrome
2. Types of chest retraction or recession: suprasternal, intercostal, subcostal
3. Differences between wheezing and stridor (remember dua2 adalah symptoms, not
findings)
4. Group of lymph nodes yang kita kena tahu: cervical, axillary, inguinal

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GASTROINTESTINAL EXAMINATION
1. Remember to do those 5 things first.
2. General inspection at the end of the bed.
3. Proceed with general examination of Gastrointestinal System at RIGHT side of the bed.
General Examination of Gastrointestinal System

Always start with hands first

Palms
1. Moisture dry/moist
2. Temperature warm/cold
3. Colour pink/pale
4. Palmar erythema- causes
Physiological causes
Pregnancy
Puberty
Familial

Pathological causes
Chronic liver disease
Rheumatoid arthritis
Thyrotoxicosis
OCP
Polycythemia

Fingers & nails

1. Finger clubbing causes (Cirrhosis, Inflammatory Bowel Disease, Coeliac Disease, GIT
Lymphoma)
2. Leuconychia
- Whitish nail due to hypoalbuminemia
- Causes: Reduced intake (malnutrition), Reduced absorption (malabsorption),
Reduced synthesis (liver disease), Increased loss (nephrotic syndrome, malignancy)
3. Koilonychia
- Spoon-shaped nail in iron deficiency anemia
Pulse check for rate, rhythm (regular/irregular), volume
Blood pressure
Forearms & Arms
- Scratch marks due to pruritus in obstructive jaundice
- Bruising due to clotting abnormalities in liver failure & obstructive jaundice
- Sign of needle thread
- Tattoo
Flapping tremor in hepatic encephalopathy
Head
1. Eyes
- Conjunctiva (pink/pale)
- Sclera (jaundice)

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2. Mouth & tongue

- Tongue (moist, dry/coated)
- Glossitis in Iron deficiency & Megaloblastic anemia
- Angular stomatitis in Vit. B6, B12, folate & Iron deficiency anemia
3. Breath fetor hepaticus in severe hepatocellular disease
Chest wall & axillae
1. Spider naevi
- A central arteriole with leg-like branches, blanch on pressure
- Arise in the distribution of superior vena cava (arm, neck, upper chest & back)
- More than 3 suggest underlying chronic liver disease, pregnancy or hyperthyroidism
2. Gynaecomastia
- For male only
- Due to increase in estrogen/androgen ration
- Causes: liver disease, testicular tumour, hyperthyroidism, estrogen, digoxin,
spironolactone, cimetidine
3. Axillary hair loss in chronic liver disease
Lower limbs pitting edema due to hypoalbuminemia

Specific Examination of the Abdomen

(For proper exposure, the patient should be exposed from the nipples down to the mid-thigh, but it is
more appropriate to expose from the nipples down to the symphysis pubis due to patients modesty)

Inspection
1. Shape of the abdomen (distended or flat)
- Causes of abdominal distension (5F- fat, fetus, flatus, fluid, feces)
2. Symmetrical or asymmetrical
3. Movement with respiration
- If its sluggish, it could be due to diffuse peritonitis
4. Position of umbilicus centrally located & inverted/everted
5. Surgical scar laparotomy
6. Prominent or dilated veins in Portal Hypertension or Vena Caval Obstruction
7. Skin discolouration (jarang nampak)
- Bluish hue in Cullens & Grey Turners sign in acute pancreatitis
- Purple coloured striae in Cushings syndrome, ascites, pregnancy
8. Visible peristalsis in Pyloric Stenosis & Bowel Obstruction
9. Visible pulsation in Abdominal Aortic Aneurysm
10. Cough impulse
- Expose the inguinal region and ask the patient to cough
- Look for presence of cough impulse (mcm ada bulging sikit)
- If present, proceed to hernia examination

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Example:
The abdomen is not distended and it moves symmetrically with respiration. The umbilicus is
centrally located and inverted. Theres no surgical scar, dilated vein, and visible peristalsis. The
hernia orifice are not intact.

Palpation and Percussion

1. Its preferable to put your knees down beside the bed or you can just sit on a chair so
that your eye level is parallel to the abdomen, making sure your hands are warm
2. Ask first if there is any pain and start palpating away from that area
3. Palpate gently in each of the 9 quadrants (some lecturers prefer 4 main quadrants), look
at the patients face while palpating to assess any tenderness
4. Superficial palpation
- Consistency (soft or tense)
- Tenderness (guarding, rigidity & rebound tenderness)
5. Deep palpation
- Deep tenderness
- Palpate for masses
- Palpate for solid viscera (liver, spleen, kidney)
6. Palpate for masses descriptive features
- Site
- Shape
- Size
- Surface (smooth, regular, irregular)
- Consistency (soft, cystic, firm, hard)
- Edge (regular, irregular)
- Tenderness
- Pulsatile or not
- Mobility
- Whether one can get above the mass
- Percussion notes
- Fluctuation test if the mass is cystic
7. Palpate for liver
- Start palpating in right iliac fossa, use the radial border of the index finger & move
towards the right costal margin as the patient breathes in & out
- Confirm the lower border & define the upper border by percussion (normally the
upper limit is 6th intercostal space)
- If liver is palpable, measure the liver span (normal: 9-12cm)
- If hepatomegaly is present, comment on:
Size (using finger breadth), Consistency (soft, cystic, firm, hard), Surface (smooth,
nodular, regular, irregular), Margin (well-defined, ill-defined), Tenderness

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8. Palpate for spleen

- Start palpating in right iliac fossa, by using fingertips of the right hand & move
towards the upper quadrant with each respiration (spleen moves inferiomedially)
- As the right hand reaches the left costal margin, the left hand compress firmly over
the rib cage
- If the spleen is not palpable, roll the patient on the right side & repeat the palpation
- Percuss on 9th, 10th & 11th intercostals space at mid-axillary line (Traubes space)
9. Palpate for kidneys ballotable or not
Spleen
No palpable upper border
Not ballotable
Notch on medial border
Moves inferiomedially on inspiration
Dull to percussion

Kidney
Palpable upper border
Ballotable
No notch
Moves inferiorly on inspiration
Resonant on percussion (overlying bowel)

10. Murphys sign elicit only IF cholecystitis is suspected

11. Shifting dullness & fluid thrill
Auscultation
1. Bowel sound
- Place the stethoscope on the lower right umbilicus
- If present, comment on its intensity (normal, increased or decreased)
- Comment absent only after listening for 2 minutes with NO bowel sound heard (in
Paralytic Ileus, Peritonitis)
2. Renal bruits
Example:
The abdomen is soft & non tender. There was no mass palpable on deep palpation. The liver was
palpable 2 finger breadths below the costal margin, it was firm in consistency, smooth in surface,
well defined margin, non tender & non pulsatile. The spleen & kidneys were not palpable.
Shifting dullness was negative. The bowel sounds were present with normal intensity.

Cervical lymph nodes examination (when the patient is sitting up) Virchows node
Complete your examination by examine external genitalia & per rectal examination (mention je
kat examiner, no need to perform)
Basic things that we need to know:
1. 5 important signs when performing abdominal examination
- Flapping tremor
- Fetor hepaticus
- Cough impulse
- Supraclavicular lymph nodes

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2.

3.
4.
5.

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- External genitalia & per rectal examination

Peripheral stigmata in chronic liver disease
- Palmar erythema
- Spider naevi
- Gynaecomastia
- Caput medusa
Causes of Hepatomegaly
Causes of Splenomegaly, especially Massive Splenomegaly (3M- malaria, myelofibrosis,
CML)
The 9 quadrants and organs that lie in that site

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NERVOUS SYSTEM EXAMINATION

1. Remember to do those 5 things first.
2. General inspection at the end of the bed.
3. There are about 10 components in neurological examination. Listen carefully to what your
examiner wants because you might not get to do all of them in a short period of time. The ones
yang korang kena master are Cranial Nerve Examination, Upper & Lower Limbs Examination
(motor & sensory).
4. Common case yang korang selalu dapat for Neuro is Stroke, especially those with paresis/plegia.
Mental state examination (MSE)

Higher center assessment

Assess the following briefly:
1. Level of consciousness
2. Orientation to time, place & person
3. Short & long term memory
4. General knowledge
5. Posture
6. Abnormal movement (eg. Tremor)
7. Handedness
8. Speech

Cranial Nerve Examination

Its best to perform when the patient is sitting. Sit in front of the patient in the same level
Examination tools that you need to prepare: Penlight, Cotton, Hand-held Eye Chart, Red &
White Pin, Tongue Depressor, Tuning Fork (pinjam kat ward), Tendon Hammer, Orange Stick,
Fundoscope
1. CN I (Olfactory nerve)
- Sensory only, not routinely tested
- Ask if the patient has noticed anything abnormal about their sense of smell
2. CN II (Optic)
- Sensory only
- 5 components that need to be tested:
Visual acuity
Visual field (Confrontation test)
Pupils & pupillary light reflex
Colour vision not necessary
Fundoscopy should be able to start using the fundoscope

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3. CN III, IV, VI (Occulomotor, Trochlear, Abducent)

- These 3 nerves are tested together, they provide motor supply for ocular movement
- CN III supply all orbital muscles except superior oblique & lateral rectus, also supply
elevator palpabrae superior and parasympathetic tone to pupillary reflex
- CN IV supply superior oblique muscle
- CN VI supply lateral rectus muscle
4. CN V (Trigeminal)
- Sensation to the face (branches: ophthalmic, maxillary, mandibular) and motor
supply to the muscles of mastication (temporalis, masseter & pterygoid muscles)
- 4 components that need to be tested:
Facial sensation (using pin prick for pain & cotton wool for light touch)
Corneal reflex
Motor supply to the muscles of mastication (asking patient to clench teeth
& palpate for contraction of masseter & temporalis)
Jaw jerk
5. CN VII (Facial)
- One of the common nerves being tested in exam
- Motor supply to the muscles of facial expression (frontalis, orbicularis oris,
orbicularis oculi, buccinator)
Frontalis ask the patient to wrinkle his forehead by looking upwards
Orbicularis oculi close both eyes while you attempt to open them
Buccinator blow the cheeks out while you press the cheeks
Orbicularis oris show the teeth
- Bells palsy & Bells phenomenon
- Lower motor neuron lesion: All muscles are affected
Upper motor neuron lesion: Upper half of the face & emotional expression are
spared (normal eye closure & wrinkling of the forehead)
6. CN VIII (Vestibulocochlear)
- Ask if the patient has noticed any difficulty in hearing
- Rinnes test
- Webers test
7. CN IX & CN X (Glossopharyngeal & Vagus)
- By using penlight & tongue depressor, ask the patient to open the mouth & say
aaaahhh. Note any asymmetry of palatal movement. (no palatal elevation on the
affected side, with the uvula pulled towards the normal side)
- Ask the patient to speak & cough to assess the hoarseness or bovine cough
8. CN XI (Accessory)
- Ask patient to shrug the shoulders & test against resistance
- Ask patient to turn his head to each side & test against resistance while feeling the
bulk (Sternocleidomastoid)

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9. CN XII (Hypoglossal)
- Provides motor supply to the tongue
- Ask patient to protrude the tongue
- If there is unilateral lesion, the tongue will deviate towards the side of lesion
Upper Limb Examination

Motor system
1. Inspection look for any deformity, muscle wasting
2. Tone
3. Power
4. Reflexes biceps, triceps, supinator
5. Coordination finger nose test, rapidly alternating movement
Sensory system
1. Pain
2. Light touch
3. Joint position sense
4. Vibration
5. Temperature

Lower Limb Examination

Motor system
1. Inspection
2. Tone & clonus
3. Power
4. Reflexes knee & ankle jerk, Babinskis reflex
5. Coordination heel-shin test
Sensory system
1. Pain
2. Light touch
3. Joint position sense
4. Vibration
5. Temperature

Basic things that you need to know:

1.
2.
3.
4.
5.
6.
7.

Mini mental state test & its components

Each cranial nerve distributions
Bells palsy
Differences between lower motor neuron & upper motor neuron lesions
Pseudobulbar & bulbar palsy
Relevance for each test performed
Dermatome (very important for sensory distribution)

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8.
9.
10.
11.

Sensory distribution and tracts involved

Meningeal signs (there are 2 signs commonly elicited)
Muscle power grading
Brachial plexus

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