General and Vitals

Introduce yourself
please let me know if anything makes you uncomfortable
Wash hands
General inspection / overall appearance
Inspect hands for cyanosis or clubbing
Radial pulse (compare bilaterally briefly the measure unilaterally for 15 s)
Respiratory rate
Blood pressure
does that sound normal for you?
HEENT
Inspection (ptosis, sclera color, scars, etc.)
Visual acuity (near card) (II)
cover one eye, read the lowest line possible, cover o/ eye, read lowest line possible
backward
Fields of vision (cover your eye directly opposite the patients eye, check all 4 quadrants) (II)
Extraocular eye movements (H trace plus accommodation) (III, IV, VI)
Pupillary light reflex (direct, consensual, swinging flashlight test) (III)
Inspect bilaterally w/ light inside ears and nose
Inspect mouth w/ light:
say ah and inspect pharynx, equivalent palate elevation bilaterally (IX, X)
inspect underneath tongue
stick out tongue left/right (XII)
Touch forehead, cheeks, jaw bilaterally for sensation (V)
Furrow brow, squeeze eyes closed tightly, show your teeth, puff cheeks (VII)
Rub fingers and move hand away from ear to test range of hearing (VIII)
Weber (midline) and Rinne (air conductance>bone conductance) tests
Otoscopic exam
Shoulder shrug and head turn head against resistance (XI)
Palpate TMJ while patient opens mouth and moves jaw side to side
Coming from behind patient: palpate tracheal midline and find thyroid, ask patient to
swallow
Pulmonary
Inspect back and spine (scoliosis, etc.)
Tap down spine and along either side (CVA tenderness)
Respiratory excursion (check for symmetry bilaterally)
Fremitus check (have patient say 99, rest fingertips over all lung fields)
Percuss lung fields (3+axilla) through patients back, always comparing bilaterally
Percuss for diaphragmatic excursion (find diaphragm, deep breath in and hold, normal 4-5
cm)
Auscultate lungs during normal tidal breaths and forced expiration, always comparing
bilaterally
Egophony test (E) and/or whispered pectoriloquy (blue moon)
Cardiac
Auscultate for aortic/pulmonic regurgitation or pericardial rubs (w/ diaphragm)
Patient exhales, stops breathing, leans over, listen over R 2nd IC space. Repeat on L.
Have the patient lay down to 45

Inspect jugular pulse (have patient turn head away from you)
Measure jugular venous pressure (pulse distance above sternal angle of Louis + 5 cm)
Inspect precordium

Palpate precordium for heaves and thrills (all 4 quadrants)

Palpate carotids for pulse one at a time
Auscultate carotids for bruits (have patient hold breath)
Auscultate all 4 quadrants w/ both diaphragm and bell
Tip the patient into left lateral decubitus position: palpate PMI, auscultate mitral valve (bell)
Abdominal
Inspect
Auscultate all 4 quadrants
Auscultate renal arteries (R/L epigastrium) and abdominal aorta (midepigastrium) for bruits
Palpate then auscultate? femoral arteries for pulse
Percuss all 4 quadrants, liver (at midclavicular line, note span in cm), and try w/ spleen
Lightly (1 hand) and then deeply (2 hands) palpate all 4 quadrants
Palpate bottom edge of liver and try to palpate spleen
MSK
Passive ROM: hip flexion keeping other leg straight, hip ab/adduction. knee flexion/extension
Slide heel to shin
Anterior and posterior drawer tests
McMurrays test (gentle varus and valgus pressure on knee to test for meniscal injury)
Have the patient sit back up
Neer and Hawkins test
Strength: deltoids, elbow flexion, wrist flexion, finger ab/adduction, hip flexion, knee flexion,
ankle
dorsiflexion/plantarflexion
Neuro
Sensation (sharp/dull/vibration)
Graphesthesia (draw a number of palm)
Reflexes: biceps, triceps, brachioradialis, patellar, Achilles
Babinskis sign
Cerebellar function tests (finger/nose, finger touches, hand flips)
Have the patient stand up
Observe hip flexion while patient bends forward, inspect back for symmetry
Patient side-bends to the right and then left
Test hip rotational ROM while stabilizing pelvis
Observe gait, walk backward, walk on tip toes, walk on heels, walk heel to toe
Trendelenburg sign (stand on one foot, look for contralateral hip drop)
Test for pronator drift and Romberg sign (standing w/ arms extended and eyes closed)