Physical Examine

Front 1

Introduction

Back 1

Introduction

Front 2

Wash Hands

Back 2

Wash Hands

Front 3

Mental status examination questions

Back 3

1) Person: Can you tell me your name
2) Place: Where are you?
3) Time: What is today's date?
4) Situation: Why are you here?

Front 4

Blood Pressure- one arm sitting

Back 4

o Make sure correct size cuff
o Must localize the brachial artery at elbow
o Note that the examiner is holding arm at level of heart
o Palpate pulse and inflate until radial pulse is lost
o Reinflate until 20 mm of Hg above value where radial pulse is lost
o Arm should be free of clothing

Front 5

Radial Pulse-rate / 15 seconds

Back 5

o Localize radial pulse
o Palpate pulse for 15 second and multiply by 4

Front 6

Inspect nails and capillary refill

Back 6

o Ask patient to extend fingers while examining nails

Front 7

Examine Scalp

Back 7

o Ask patient to flex head forward
o (Good point to ask for active range of motion for neck)

Front 8

Cranial Nerve V exam

Back 8

o Ask patient to close his/her eyes
o Tell me when you can feel my fingers?
o Do they feel the same on both sides?
o Test all 3 branches- V1, V2, V3 sensation
o Ask motor- for masseter and temporalis

Front 9

Cranial Nerve VII exam

Back 9

Forehead, frown/smile, puff out cheeks
o Ask patient to raise eyebrows
o Don’t let me open your eyes
o Ask pateitn to frown/smile
o Ask patient to puff out cheeks

Front 10

Cranial Nerve XI exam

Back 10

Examining the sternocleidomastoid muscle and trapezius muscle

Shrug shoulders and turn head to both sides

Front 11

Visual Fields (CN II)

Back 11

Tell me when you can see my fingers

Front 12

Extraocular movements (CN II, IV, VI)

Back 12

o Ask patient to following fingers with eyes
o Use H pattern, stopping at each apex
o Ask patient to look at the tip of his/her nose

Front 13

Inspect conjunctiva, sclera

Back 13

o Ask patient to look upward while exmaining conjunctiva of the lower lids
o Ask patient to look downward while examining conjunctiva of the upper lids

Front 14

Pupillary Reflexes (CN II, III)

Back 14

o Turn lights off
o Instruct patient to look straight ahead
o Shine light on each pupil separately

Front 15

Red Reflex/Fundoscopic Exam

Back 15

Examine disc, vasculature, macula

o Instruct patient to look at a distant point and focus on that point
o Place hand on patient’s shoulder to orient
o Hold ophthalmoscope in right hand to view right eye
o Hold opthalmoscope in left hand to view left eye
o Begin from 10-15 degrees laterally and move in slowly
o Ask patient to look directly into the light at some point of the exam to check red reflex (used to look for cataracts)
o Note that you are looking at the optic disc, the vessels of the eye, and macula

Front 16

Inspect pinnae

Back 16

Inspect pinnae

Front 17

Otoscopic ear exam

Back 17

o Gently pull auricle up and back
o While holding otoscope, slowly insert speculum with donward and forward movement into the ear canal
o Repeat with the opposite ear

Front 18

Hearing acuity (CN VIII)

Back 18

o Ask patient to block one ear with finger
o Check auditory acuity in opposite ear
o Rub fingers togeter 3 ft away

Front 19

Rinne Test

Back 19

The Rinne test is performed by placing a vibrating tuning fork (512 or 256 Hz) initially on the mastoid process until sound is no longer heard, the fork is then immediately placed just outside the ear. Normally, the sound is audible at the ear.

Front 20

Webber Test

Back 20

n the Weber test a vibrating tuning fork (either 256 or 512 Hz) is placed in the middle of the forehead equidistant from the patient's ears. The patient is asked to report in which ear the sound is heard louder.

Front 21

Examination of nasal passages

Back 21

Ask patient to tip head back while insert speculum

Front 22

Percussion of sinuses

Back 22

Percussion of sinuses

Front 23

Inspect oral cavity

Back 23

o Use light to inspect buccal muscosa and back of the mouth and throat; use a tongue depressor to depress halfway to the back of the tongue; GOOD PLACE FOR CN IX, X, XII EXAM (phonation)
o Ask patient to bite down; inspect teeth and gums using tongue depressor

Front 24

Palpate oral cavity

Back 24

o Ask patient to extend tongue and move it from side to side (CN XII exam)
o Use cotton gauze or gloved finger when touching the tongue

Front 25

Neck Range of Motion

Back 25

Neck Range of Motion

Front 26

Palpate Neck Nodes

Back 26

o Preauricular: in front of ears
o Postauricular: behind ears
o Occipital: base of the back of the neck
o Posterior Cervical: back of the SCM
o Cervical/tonsilar: angle of the jaw
o Submandibular: halfway between angle of jaw and chin
o Submental: center of body under chin
o Cervical chain: along sternomastoid muscle
o Supraclavicular: in angle formed by collarbone and SCM muscle

Front 27

Thyroid Exam

Back 27

o Stand behind patient while seated
o Ask patient to bend head to neutral position or slightly forward
o Two fingers of each hand should be placed on either side of the trachea
o Examiner should ask patient to take a sip of water while feeling isthmus
o Examiner should displace trachea to left and ask patient to swallow while palpating trachea- repeat on opposite side

Front 28

Back exam

Back 28

o Palpate or percuss spine
o Percuss costo-vertebral angles
o Back mobility in 6 directions

Front 29

Cardiovascular Exam

Back 29

• Auscultate heart sitting: ausculate in 2 areas sitting
• Ask patient to lie down
o Palpate precordium for PMI
o Auscultate 4 areas-supine, with diaphragm
• Aortic Area
• Pumonic Area
• Tricuspid Area
• Mitral Area
o Auscultate 2 areas-supine, with bell
o Auscultate at apex, LLD, with bell

Front 30

Shoulder Exam

Back 30

o INSPECT: Inspect shoulder and assess for symmetry, deformity and discoloration (STATE).
o PALPATION: Examine scapular spine, acromion process, acromioclavicular joint
o ROM: Flex, extend, abduct (full arc), internally rotate (elbow flexed, thumb at opposite scapula) and externally rotate (elbow flexed, hands out at side or behind head) both shoulders
o STRENGTH- Resist patient while patient shrugs shoulders, flexes shoulder forward and abducts shoulder

Front 31

Elbow exam

Back 31

o INSPECTION: Assess symmetry, deformity and discoloration (STATE)
o PALPATION: Palpate lateral epicondyle, medial epicondyle and olecranon process
o ROM: Flex, extend, pronate and supinate both elbows
o STRENGTH: Examiner resists patient while patient flexes and extends elbow
o REFLEXES: Biceps and Triceps

Front 32

Hand exam

Back 32

o INSPECT: Assess symmetry, deformity and discoloration
o PALPATE: Palpate wrist, CMC, MCP and PIP joints
o ROM: Flex and extend patient’s wrists. Move hand to ulnar and radial sides. Flex and extend fingers at MCP joint with fingers straight- make a fist
o STRENGTH: Examiner resists patient while patient flexes and extends wrist, assesses grip strength, resists finger abduction and resists opposition of thumb and small finger

Front 33

Hip Exam

Back 33

o INSPECT
o PALPATE: palpate iliac crest and greater trochanter
o ROM: With patient supine, flex the patient’s hip with the knee bent. Subsequently extend hip. Then adduct and abduct patient’s hip. With patient supine and knee flexed to 90 degrees, internally and externally rotate patien’t hip.

Front 34

Knee Exam

Back 34

o INSPECT: Inspect for symmetry, deformity and discoloration
o PALPATE: palpate patella
o ROM: Flex and extend knee
o STRENGTH: Ask patient to try to flex and extend knee against resistance
o REFLEX: Knee Reflex
o ADDITIONAL: Pain

Front 35

Ankle/Foot Exam

Back 35

o INSPECT: Inspect for symmetry, deformity and discoloration
o PALPATE: Palpate achilles tendon, lateral and medial malleoli and forefoot
o ROM: Dorsiflection, plantar flexion, eversion and inversion of the ankle
o STRENGTH: Resist patient while patient dorsiflexes and plantar flexes ankle
o REFLEX: Ankle reflex, Babinski Reflex
o ADDITIONAL
• Vibration- toes
• Proprioception of big toe

Front 36

Cerebellar Exam- FTN or RAM

Back 36

o Ask patient to touch my index finger and nose
o Make sure to change location of finger several time
o Repeat with patient’s other hand

Front 37

Cerebellar Exam- Heel to Shin

Back 37

o Ask patient to run the heel of one foot up and down the shin of the opposite leg
o Repeat with the opposite leg

Front 38

Gait exam

Back 38

Normal gate

Tandem gate

Walk on heels/toes

Front 39

Romberg Exam (Proprioception)

Back 39

o Observe patient stand with his/her arms stretched out in front or beside him/her with eyes close

Tests dorsal column of the spinal cord

Front 40

Pronator Drift

Back 40

Ask patient to hold out arms 90 degrees to body and close eyes. If move, can indicate an upper motor lesion