Phys Exam Check List

Routine Adult Physical Examination --Check List--
provided by Dr. GH Stein.

At beginning and end 1. Examiner washes hands at beginning and end of exam.

General Inspection/
Upper Extremities 2. Inspect both hands (nails, dorsum, palms).
3. Inspect and palpate arms.
4. Palpate epitrochear nodes.
5. Test muscle strength in hand grip, and flex joints (wrists and elbows).

Vital Signs 6. Pulse in radial artery for 10 seconds.
7. Compare both radial pulses.
8. Blood pressure in right arm.

Head 9. Inspect scalp and hair.

Eyes 10. Measure visual acuity (each eye separately and together).
11. Inspect external eye (conjunctive, eyelids, sclera).
12. Extraocular movements (6 positions).
13. Pupil reaction to light (direct, consensual).
14. Visual fields by confrontation (each eye separately).
15. Ophthalmoscopy exam (dims lights, positions patient appropriately).
16. Holds ophthalmoscope with correct hand (i.e. right for right eye) and index finger to switch lenses.
17. Verbalize structure examined.

Ears 18. Hearing test using wrist watch or whispered number (if abnormal, tuning fork).
19. Inspect external ear.
20. Pulls on pinna (auricle), push on tragus.
21. Otoscope exam bilaterally.

Nose/Mouth 22. Inspects nasal septum and turbinates with otoscope or speculum.
23. Palpate frontal and maxillary sinuses.
24. Inspect mouth with blade: tongue, mucosa, ducts, tonsillar fossa, pharynx.
25. Phonate and protrude tongue; observe palate and uvula.

Neck/Shoulder/Back 26. Palpate lymph nodes (verbalize node groups).
27. Palpate thyroid.
28. Palpate trachea.
29. Neck range of motion, to sides, forward, back.
30. Shoulder shrug - test strength.
31. Palpate spine.
32. Fist percussion of costovertebral angles.

Chest 33. Inspect skin.
34. Check symmetry with deep breath.
35. Percuss posteriorly and laterally.
36. Measure diaphragm excursion.
37. Instruct patient to breathe throuth open mouth.
38. Auscult posterior and laterally.
39. Palpate axillary lymph nodes.
40. Inspect breast.
41. Percuss anterior lung fields.
42. Auscult anterior lung fields.
43. Auscult heart with diaphragm at left sternal border (3-4th ICS).

Breasts 44. Inspect and palpate.

Cardiovascular 45. Inspect neck veins.
46. Auscult carotids at upper and lower extents.
47. Palpate one carotid at a time.
48. Inspect and palpate precordium.
49. Auscult each valve area with diaphragm.
50. Auscult each valve area with bell.
51. Ask patient to roll in left lateral position; palpates apex.
52. Auscult with bell at apex.

Abdomen 53. Inspect.
54. Auscult epigastrium, 4 quadrants.
55. Palpate 4 quadrants (superficial and deep).
56. Palpate liver edge in deep inspiration.
57. Percuss liver dullness (measure span in midclavicular line).
58. Palpate spleen in deep inspiration.
59. Percuss for splenic dullness.
60. Palpate and measure aortic pulsation.
61. Palpate inguinal nodes.
62. Palpate and auscult femoral pulses.

Lower Extremities 63. Inspect and palpate legs.
64. Check range of motion, hips, knees.
65. Test for ankle edema.
66. Check dorsalis pedes and posterior tibial pulses.
67. Wrinkle forehead, show teeth, protrude tongue, eye closure (may be done during head exam).
68. Extend arms for drift.
69. Check muscle strength in upper and lower extremities (proximal and distal).
70. Reflexes - biceps, ankle, knee.
71. Plantar reflex bilaterally.
72. Test sensation to pinprick.
73. Test vibration (128 cps) and position sense in lower extremities.
74. Test finger to nose.
75. Test heel to shin.
76. Check gait.
77. Toe to heel walking.
78. Romberg test.

Male Genitalia
(may be deferred) 79. Inspect and palpate penis.
80. Palpate testes and scrotum.
81. Performs hernia exam.

Rectal Exam 82. Rectal exam.

Physical Exam Check List
originated and provided by Dr. GH Stein.

This check list has been used to study the quantitative physical exam skills of entering first year residents
at Kameda Medical Center, Kamogawa City.

Part of the results were presented by Dr. GH Stein
under the title of "Physical Examination Skills of First Year Residents"
at the 29th Annual Meeting of Japanese Association for Medical Education
held on July 18, 1997 at Kanazawa City, Japan.

Vital Signs
[Point Maximum(PM)=3] 1. Pulse
2. Blood pressure
3. Resp rate
4. Others

General Appearance
[PM=5] 1. General appearance

Eyes
[PM=2] 1. Visual acuity
2. Inspect external eye (conjunctivae, sclera, other)
3. Extraocular movements
4. Visual fields
5. Pupil reaction to light direct, consensual, accomodation
6. Ophthalmoscopy

Ears
[PM=4] 1. Inspection
2. Hearing
3. Otoscope

Nose and Mouth
[PM=4] 1. Inspect nose
2. Palpate frontal and maxillary sinuses
3. Oral tongue blade exam
4. Gag reflex
5. Tongue motion
6. Palate and uvula motion

Neck
[PM=4] 1. Inspect veins
2. Palpate lymph nodes
3. Palpate throid
4. Palpate trachea
5. Range of motion

Chest
[PM=4] 1. Percuss
2. Diaphragm motion
3. Auscult posterior and anterior
4. Palpate axillary lymph nodes
5. Other

Breasts
[PM=2] 1. Palpate 4 quadrants
2. Squeeze nipple

Cardiovascular
[PM=5] 1. Palpate carotids
2. Auscult carotids
3. Palpate precordium, PMI

Abdomen
[PM=6] 1. Inspect
2. Auscult bowel sounds
3. Auscult aorta
4. Percuss and measure liver
5. Percuss spleen
6. Palpate liver and spleen
7. Palpate 4 quadrants
8. Palpate aorta
9. Palpate inguinal nodes, femoral pulses

Joints
[PM=3] 1. Range of motion
2. Back ROM
3. CVA tenderness

Lower Extremities
PM=3 1. Pedal edema
2. Pulses DP

Neurologic Exam
[PM=6] 1. Mental status
2. Cranial nerves
3. Muscle strength, muscle tone
4. Sensory (light, pin, position, vibration)
5. Reflexes (arms, legs, Babinski)
6. Coordination (arms, legs)
7. Gait, Romberg

Other 1. Rectal exam

Back to PhysicalExaminationSkills

At beginning and end	1. Examiner washes hands at beginning and end of exam.
General Inspection/ Upper Extremities	2. Inspect both hands (nails, dorsum, palms). 3. Inspect and palpate arms. 4. Palpate epitrochear nodes. 5. Test muscle strength in hand grip, and flex joints (wrists and elbows).
Vital Signs	6. Pulse in radial artery for 10 seconds. 7. Compare both radial pulses. 8. Blood pressure in right arm.
Head	9. Inspect scalp and hair.
Eyes	10. Measure visual acuity (each eye separately and together). 11. Inspect external eye (conjunctive, eyelids, sclera). 12. Extraocular movements (6 positions). 13. Pupil reaction to light (direct, consensual). 14. Visual fields by confrontation (each eye separately). 15. Ophthalmoscopy exam (dims lights, positions patient appropriately). 16. Holds ophthalmoscope with correct hand (i.e. right for right eye) and index finger to switch lenses. 17. Verbalize structure examined.
Ears	18. Hearing test using wrist watch or whispered number (if abnormal, tuning fork). 19. Inspect external ear. 20. Pulls on pinna (auricle), push on tragus. 21. Otoscope exam bilaterally.
Nose/Mouth	22. Inspects nasal septum and turbinates with otoscope or speculum. 23. Palpate frontal and maxillary sinuses. 24. Inspect mouth with blade: tongue, mucosa, ducts, tonsillar fossa, pharynx. 25. Phonate and protrude tongue; observe palate and uvula.
Neck/Shoulder/Back	26. Palpate lymph nodes (verbalize node groups). 27. Palpate thyroid. 28. Palpate trachea. 29. Neck range of motion, to sides, forward, back. 30. Shoulder shrug - test strength. 31. Palpate spine. 32. Fist percussion of costovertebral angles.
Chest	33. Inspect skin. 34. Check symmetry with deep breath. 35. Percuss posteriorly and laterally. 36. Measure diaphragm excursion. 37. Instruct patient to breathe throuth open mouth. 38. Auscult posterior and laterally. 39. Palpate axillary lymph nodes. 40. Inspect breast. 41. Percuss anterior lung fields. 42. Auscult anterior lung fields. 43. Auscult heart with diaphragm at left sternal border (3-4th ICS).
Breasts	44. Inspect and palpate.
Cardiovascular	45. Inspect neck veins. 46. Auscult carotids at upper and lower extents. 47. Palpate one carotid at a time. 48. Inspect and palpate precordium. 49. Auscult each valve area with diaphragm. 50. Auscult each valve area with bell. 51. Ask patient to roll in left lateral position; palpates apex. 52. Auscult with bell at apex.
Abdomen	53. Inspect. 54. Auscult epigastrium, 4 quadrants. 55. Palpate 4 quadrants (superficial and deep). 56. Palpate liver edge in deep inspiration. 57. Percuss liver dullness (measure span in midclavicular line). 58. Palpate spleen in deep inspiration. 59. Percuss for splenic dullness. 60. Palpate and measure aortic pulsation. 61. Palpate inguinal nodes. 62. Palpate and auscult femoral pulses.
Lower Extremities	63. Inspect and palpate legs. 64. Check range of motion, hips, knees. 65. Test for ankle edema. 66. Check dorsalis pedes and posterior tibial pulses. 67. Wrinkle forehead, show teeth, protrude tongue, eye closure (may be done during head exam). 68. Extend arms for drift. 69. Check muscle strength in upper and lower extremities (proximal and distal). 70. Reflexes - biceps, ankle, knee. 71. Plantar reflex bilaterally. 72. Test sensation to pinprick. 73. Test vibration (128 cps) and position sense in lower extremities. 74. Test finger to nose. 75. Test heel to shin. 76. Check gait. 77. Toe to heel walking. 78. Romberg test.
Male Genitalia (may be deferred)	79. Inspect and palpate penis. 80. Palpate testes and scrotum. 81. Performs hernia exam.
Rectal Exam	82. Rectal exam.

Vital Signs [Point Maximum(PM)=3]	1. Pulse 2. Blood pressure 3. Resp rate 4. Others
General Appearance [PM=5]	1. General appearance
Eyes [PM=2]	1. Visual acuity 2. Inspect external eye (conjunctivae, sclera, other) 3. Extraocular movements 4. Visual fields 5. Pupil reaction to light direct, consensual, accomodation 6. Ophthalmoscopy
Ears [PM=4]	1. Inspection 2. Hearing 3. Otoscope
Nose and Mouth [PM=4]	1. Inspect nose 2. Palpate frontal and maxillary sinuses 3. Oral tongue blade exam 4. Gag reflex 5. Tongue motion 6. Palate and uvula motion
Neck [PM=4]	1. Inspect veins 2. Palpate lymph nodes 3. Palpate throid 4. Palpate trachea 5. Range of motion
Chest [PM=4]	1. Percuss 2. Diaphragm motion 3. Auscult posterior and anterior 4. Palpate axillary lymph nodes 5. Other
Breasts [PM=2]	1. Palpate 4 quadrants 2. Squeeze nipple
Cardiovascular [PM=5]	1. Palpate carotids 2. Auscult carotids 3. Palpate precordium, PMI
Abdomen [PM=6]	1. Inspect 2. Auscult bowel sounds 3. Auscult aorta 4. Percuss and measure liver 5. Percuss spleen 6. Palpate liver and spleen 7. Palpate 4 quadrants 8. Palpate aorta 9. Palpate inguinal nodes, femoral pulses
Joints [PM=3]	1. Range of motion 2. Back ROM 3. CVA tenderness
Lower Extremities PM=3	1. Pedal edema 2. Pulses DP
Neurologic Exam [PM=6]	1. Mental status 2. Cranial nerves 3. Muscle strength, muscle tone 4. Sensory (light, pin, position, vibration) 5. Reflexes (arms, legs, Babinski) 6. Coordination (arms, legs) 7. Gait, Romberg
Other	1. Rectal exam