CS PHYSICAL EXAM CHECKLIST

Tips for the Exam

1. Always let the patient know what you are going to do before proceeding
2. Always drape the patient
3. Do not forget to wash your hands
a. Once you touch the patient’s feet you cannot go back to touch any part of them without
washing your hands first
b. Do not touch your face or clipboard once you have washed your hands and examination
has begun
4. Examination should be done on the skin and not through the gown or any clothing
5. Alert the patient if you are going to move the gown
6. Mentally organize the exam and have a roadmap before starting.

HEENT:

1. Head
a. Inspect
b. Palpate
c. Lymph nodes
d. Thyroid
2. Eyes
a. Inspect sclera and conjunctiva
b. Extra ocular muscles
i. H-test

1. LR6SO4
2. PPRF- paramedian pontine reticular formation
c. Ophthalmoscope to check fundus
i. Do it with patients with visual problems, diabetes, hypertension
ii. Start at arms length. Look for retinoblastoma red-orange flash
iii. Go in until 1 cm. do in 10seconds
iv.
d. Ocular reflex
i. Symmetry and reactivity
e. Visual acuity
 i. Ask patient to cover eye and cup without pressing on the eye. Please read the
lowest line
ii. If they miss one letter OD 20/40 -1

f. Visual fields
i. From behind the head til they can see
ii. How many fingers on what hand wiggle
iii.
3. Ear
a. Inspect
b. Ottoscope
i. Pull ear up and back
ii. Don’t stick ottoscope all the way in, just rest on edge lightly
iii. Hold like a pen and hold pinky out
iv. Throw speculum out
c. Whisper test
d. Perform Webber and Rinne tests
i. Use finger tip right on edge to flick the tuning fork
 ii. Never positive or negative “no lateralization on Weber’s test” “Rinne’s test
AC>BC bilaterally”
4. Nose
a. Inspect
b. Palpate nose and sinuses
c. Examine nasal turbinates with light source
5. Throat
a. Auscultate for bruit
b. Palpate thyroid
c. Inspect mouth with light source
d. Inspect tongue, uvula, tonsils
6. Thyroid
a. Palpate
b. Swallow to check for mobility
c. Check hair and skin for dryness
d. Check for tremors
e. Check pulses
f. Pretibial edema
g. Reflexes
h. Heart sounds for RRR

Cardiovascular

1. Inspect neck
2. Auscultate the carotid
3. Palpate the carotid pulse each side one at a time
4. Listen for bruits
a. With bell side
5. Check for JVD
a. Ask patient to look to the left and right
6. Inspect chest
7. Palpate for costochondritis
8. Auscultate heart
a. 4 places
b. 3 seconds for position
c. if patient wants to simulate a murmur, they will say “hush-hush”
d. put patient in 30 degree angle and pull out leg stand
9. Check PMI (point of maximal impulse)
a. With bell
10. Palpate heart for heaves and thrills
11. Check pulses
a. Always bilaterally
b. Radial, popliteal, pedal, posterior tibial
12. Check fingers for cyanosis, clubbing capillary refill
13. Check for edema
Pulmonary:

1. Inspect
a. Respiratory rate
b. Dyspnea
c. Use of accessory muscles
2. Palpate
a. Tactile Fremitus
b. Areas of tenderness
3. Percuss
4. Auscultate
a. Wait for full inspiration and expiration
5. Chest expansion
6. CVA tenderness*** (Abdominal Exam)
7. Fingers for clubbing or cyanosis

Abdomen:

1. Inspect
2. Auscultate
a. 3 seconds each quadrant
3. Percuss
a. 2 taps over each quadrant
4. Palpate
a. Light first then deep
b. Start away from the painful area
5. Percuss liver span
6. Rebound tenderness
7. Murphy’s sign
8. CVA tenderness
a. Pain  pyelonephritis
9. Rovsing’s sign
10. Psoas sign
11. Obturator

Neuro:

 Mini Mental Status Exam (less than a minute to complete)

o On write up  unable to recall 3 objects, impaired memory.
o Everything normal except attention  normal MMSE except impaired attention,
o Unable to repeat words normal MMSE except impaired language
o Mini mental status exam: OMALO; never mention “mental exam” to patient
o I’m going to ask you a few silly questions, please bare with me. I know you may know
the answer but I still have to ask them.
 O –Orientation A&O X 3
  M- memory ask them to memorize 3 OBJECTS of different type (pen, shoe,
moon)
 A- attention
 L- Language
 No ifs ands or buts  can you please recall the 3 objects from earlier.
(write close your eyes without looking down)
 O- obey commands
 Read “Close your eyes” from paper.
o Orientation
o Concentration
 Serial 7s
 Months of the year backwards
o Memory
 Cranial Nerves
o Intact CN 2-7, 9-12
o Upper extremity
 Motor
 ROM
 Passive and active
 Sensation
 Reflexes
o Bilaterally
 Lower extremities
o Motor
 General: arm flex, ext, abd/add. Squeeze fingers, leg ext/flex, gas pedal, kick up.
o ROM
o Sensation
o Reflexes
 Bilaterally
 Flick of wrist forward motion. Palpate for ligment, then strike.
 Antecubidal, relax arm on thigh, lift gown, use tip of hammer if on finger/blunt
on patient skin
 Brachioradialis reflex
 Tricep reflex (one strike)
 Knee
 Achilles
 Babinski- lateral to medial  positive  hyperextension and fanning out
o Cerebellum
 Gait
 Ask patient to stand, grab drape so it doesn’t fall, help them come
down, pull out stool  walk heel to toe (3 steps)  Rhomberg +
supination + feet together, make sure you’re standing beside them.
 Back pain  touch your toes and run fingers down spine to look for scoliosis,
did you feel any pain? If no back pain, skip.
  Rotate the trunk
 Finger to nose – dysmetria
 Move finger to 2 diff spots, do again with other hand. If they miss 
dysmetria
 Alternating rapid hand movements – dysdiadochokinesia
 Heel to shin
o Special tests
 Kernig – “knee” – you HAVE to bend the knee because they will not help you.
Bend knee and then straighten out. Bilateral kernig  meningitis
 Brudzinski – flex head  positive they flex the legs and scream in pain.
 Babinski
 Rhomberg
 Tinnel – “Tap” median nerve – retinaculum  carpal tunnel  hyperextend
wrist and tap a few times on wrist, do you feel any pain or pins and needles?
 Phalen – carpal tunnel  median nerve  bird with hands (back of hand
against back of hand  pins and needles)
 Webber
 Rinne

Musculoskeletal:

1. Inspect joints
2. Palpate proximal to distal
3. ROM -
4. Pulses
5. Strength
6. Reflexes
7. Sensation
a. This is sharp, this is soft (move side to side so the patient knows) test on middle finger
tip ask do you feel this, is it sharp or soft, then between thumb and index finger. If they
have feeling there, then you’re done.
b. Same for lower extremities.
c. If positive, then you need to keep checking more dermatome layers.
8. Spine
a. ROM
b. Straight leg test – disk herniation
c. Assess gait
9. Shoulder
a. Axillary nerve sensation – deltoid ; shoulder dislocation  test deltoid sensation 
axillary nerve
i. Snap back in place and then reduce shoulder back into place, no sensation
present  axillary nerve damaged; so make sure you check for nerve after
reducing a shoulder dislocation to ensure no nerve impingement
b. ROM
i. Across chest – perform in all shoulder pain
 1. If unable to  unable to perform hands across chest on left side.
ii. Like throwing baseball
iii. Big circular motion
iv. Put hands behind head
v. Put hands behind back
vi.
10. Knee exam
a. Ligaments
i. Drawer test (anterior and posterior)
ii. Valgus and varus test (Medial and lateral collateral ligaments) (positive- crackles
in joint)
iii. McMurray’s test (Meniscal injuries)
iv. Patellar movement test

Webers:
 Equal
 Webers has no lateralization to either rear
 Weber: louder on the side with the hearing loss
o BC>AC (on side decreased hearing)
 CONDUCTIVE LOSS.
 Sensorineural?
o Weber’s louder in the normal ear.
 AC>BC on side with decreased hearing.
 Rinne’s
o AC>BC
o BC>AC