|At beginning and end||1. Examiner washes hands at beginning and end of exam.|
|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.
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.
(may be deferred)
|79. Inspect and palpate penis.|
80. Palpate testes and scrotum.
81. Performs hernia exam.
|Rectal Exam||82. Rectal exam.|
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.
2. Blood pressure
3. Resp rate
|1. General appearance|
|1. Visual acuity|
2. Inspect external eye (conjunctivae, sclera, other)
3. Extraocular movements
4. Visual fields
5. Pupil reaction to light direct, consensual, accomodation
|Nose and Mouth
|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
|1. Inspect veins|
2. Palpate lymph nodes
3. Palpate throid
4. Palpate trachea
5. Range of motion
2. Diaphragm motion
3. Auscult posterior and anterior
4. Palpate axillary lymph nodes
|1. Palpate 4 quadrants|
2. Squeeze nipple
|1. Palpate carotids|
2. Auscult carotids
3. Palpate precordium, PMI
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
|1. Range of motion|
2. Back ROM
3. CVA tenderness
|1. Pedal edema|
2. Pulses DP
|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|