Ldm Physical Exam

Front 1

Introduction

Back 1

(3)

1. State name/purpose

2. Wash Hands

3. Clean stethoscope

Front 2

General Appearance

Back 2

(4)

1. Habitus/posture

2. Level of comfort

3. Sign of distress and affect

4. Voice Quality

Front 3

Vital Signs

Back 3

(7)

1. Take/verify Temp

2. Palpate radial pulses bilaterally

3. Count radial pulses

4. Count respirations

5. Check oxygen saturation

6. Take BP on R arm

7. Check weight

Front 4

Upper Extremities

Back 4

(5) Inspect:

1. Palms - erythema, moistness, tremors, thenar atrophy

2. Nails - clubbing/cyanosis

3. Skin - color/lesions

4. Musculature - symmetry, atrophy, involuntary movements, swelling, deformity, tenderness, etc.

5. Joints - swellings, symmetry,

(4) ROM

1. Fingers

2. Wrists

3. Elbows

4. Shoulders

Front 5

Head

Back 5

(2)

1. Inspection (face/scalp) - shape, size, nits, rashes, lesions

2. - Palpate scalp - deformities, lumps, tenderness

Front 6

Eyes

Back 6

(6)

1. Vision test w/ Snellen Chart

2. Inspect conjunctivae - color/lesions

3. Inspect sclera - color/lesions

4. Inspects & test pupils w/ light - size, shape, equality, reaction

5. Test extraocular movement "H"

6. Funduscopy

Front 7

Ears

Back 7

(4)

1. Inspect auricle (anterior/posterior) - deformities, lumps, lesions

2. Inspect canal w/ otoscope - cerumen, discharge, foreign bodies

3. Inspect TM w/ otoscope - color, landmarks, bulging, retraction, perfroation

4. Test hearing

Front 8

Nose

Back 8

(a)

Inspect with otoscope - patency, septal deviation, lesions, discharge, blood

Front 9

Mouth/Throat

Back 9

(9)

Inspect:

1. Lips

2. Buccal mucosa

3. Teeth

4. Gingiva

5. Tongue (including underside and sides)

6. Palate

7. Tonsil

8. Pharynx

9. Uvula

Front 10

Neck

Back 10

(3) ROM

1. Flexion

2. Extension

3. Rotation

(3) Palpate lymph nodes

1. Anterior

2. Posterior

3. Supraclavicular

(1) Inspect thyroid as patient swallows - goiter, nodules

(2) Palpate thyroid with patient swallowing

1. Isthmus

2. Lateral lobes

Front 11

Chest

Back 11

(1) Inspection - posterior view - Rate, rhythm, depth, effort

(1) Inspection of skin on back - skin lesions, scars, rashes

(2) Auscultate posterior lungs

1. 3 areas lateral to vertebral bodies

2. 1 lateral to the posterior axillary line

(2) Auscultate anterior lungs

1. 3 areas lateral to the sternum

2. 1 lateral to the anterior axillary line

Front 12

Chest Wall

Back 12

(4) Palpate axillary nodes - 4 groups

1. Central

2. Subscapular

3. Lateral

4. Pectoral

Front 13

Cardiovascular

Back 13

(6) Auscultate with diaphragm

1. Apex

2. LSB

3. Pulmonic Area

4. Aortic Area

5. Carotids (palpitate and auscultate)

6. Auscultate mid-epigastrium

Front 14

Abdomen

Back 14

(1) Inspection - contour, symmetry, masses, scars, striae, veins, pulsation

(4) Superficial palpation (KNEES FLEXED)

1. RUQ

2. LUQ

3. RLQ

4. LLQ

(4) Deep palpitation (KNEES FLEXED)

1. RUQ

2. LUQ

3. RLQ

4. LLQ

(1) Palpate liver edge (bimanual technique)

(1) Palpate for spleen (bimanual technique)

Front 15

Lower Extremities

Back 15

(4) Inspect:

1. Skin - color, lesions

2. Musculature - symmetry

3. Joints - swelling, deformity

4. Vessel - varicosities

(3) ROM

1. Ankle

2. Knee

3. Hip

(1) Palpate pretibial area - edema

(1) Palpate dorsalis pedis pulse

(1) States or check if dorsalis pedis pulse is absent, check for posterios tibialis pulse

Front 16

Neurologic

Back 16

(8)

1. Fundoscopy (if not already checked)

2. Test extraocular movements (if not checked)

3. Wrinkle forehead

4. Show teeth

5. Stick out tongue

6. Shoulder shrug against resistance

7. Deep reflexes (bicep, knee, ankles)

8. Observe patient's gait

Front 17

Gentalia

Back 17

STATE

(2/3)

1. Either sex - "I would preform a rectal exam as indicated"

2. Female patient - "I would do a breast and pelvic exam"

3. Male patient - "I would do a penis/scrotum and hernia check"