Physical Exam

Question 1

order of exam

Answer 1

1. hands
2. vitals
3. HEENT
4. Pulm
5. Cardia, axillary, lymph nodes
6. GI
7. Neuro/MSK
8. MSE
9. Gait
10. spine
11. Labs (chem-7, CBC)

Question 2

vitals

Answer 2

BP
HR
RR
Temp
O2 Sat

Question 3

HEENT

Answer 3

head
eyes
mouth, throat
Ears, eyes, nose
sinuses, lymph, thyroid, CN

Question 4

head

Answer 4

examine head, skin (normocephalic, atraumatic)

Question 5

eyes

Answer 5

snellen chart (CN II)
visual fields
EOM (CN III, IV, VI)
sclera, fundi
light, accommodation reaction (CN II, III)

Question 6

mouth/throat

Answer 6

oral cavity (int/ext) (CN IX, X)
stick out tongue (CN XII)

Question 7

eyes, ears, nose

Answer 7

opthalmoscopy
nasal examination (int/ext)
otoscopy (external inspection, w/ear pull and tragus compression)
ear finger rub test (CN VIII)
if indicated, Weber's midline? Rinne R/L

Question 8

sinuses, lymph thyroid, CN

Answer 8

facial sensation (pain/temp, light touch) (CN V)
temporalis, masseter clench (CN V3)
facial grimaces (CNVII)
neck turn, shoulder shrug against resistance (CN XI)
palpate sinuses
lymph nodes
thyroid exam (transition to back)

Question 9

pulm

Answer 9

inspect back (scars, skin lesions)
chest symmetry
percuss back (percuss diaphragm on inhalation/exhal)
pulm auscultation (fremitus, egophany if indicated)

Question 10

cardiac, axillary lymph nodes

Answer 10

cardiac auscultation (asses w/ pules)
carotid pulses (auscultate for bruits if necessary)
asses JVP (30 degress)
PMI
(edema)
axillary lymph nodes

Question 11

GI

Answer 11

1. inspect abdomen (scaphoid/protuberant/distended, hernias, scars, masses, asymetry, pulsations)
2. Bowel Sounds (Ao, renal bruits)
3. Percuss (hepato/spleno megaly)
4. Palpate (light then deep, 4 quads)
5. Liver edge on expiration?
6. Inguinal lymph nodes, femoral pulses

• upright
  7. CVA tendernes

Question 12

Neuro/MSK

Answer 12

1. hands (clubbing, cyanosis, nails)
2. Median/ulnar/radial
3. muscle bulk, tone
4. Active ROM (Passive if indicated)
5. strength of muscle groups
6. sensation (light touch, pain/temp, vibration, proprioception)
7. coordination (finger-nose, heel shin, rapid finger tap)
8. reflexes (bi, tri, brachiorad, knee, ank, babinski)
9. pedal pulse
10. feet: edema, toe webspaces, ulcers

Question 13

MSE

Answer 13

consciousness
orientation x3
attention: WORLD

language (rate, volume, prosody)
memory (ocean, red, honesty)
spatial LvR

calculations (3 qtrs, nickel, dime=90 cents)
affect/mood
thought content: suicidal/homicidal

Question 14

gait, spine

Answer 14

normal? (if indicated: tandem, heel-toe)
romberg
pronator drift

spine alignment (scoliosis, kyphosis)