You are on page 1of 9

Physical Exam Competency Checklist

Student Name__________________

General Skills

YES

NO

1. Students appearance and manner are appropriate and professional;


Student introduces himself/herself.

1._______

1._______

2. Student establishes rapport; explains purpose of exam.

2._______

2._______

3. Student shows concern for patients comfort and assures


privacy/confidentiality during the examination.

3._______

3._______

4. Student explains procedures and prepares the patient for use of


instruments; instructions to the patient are clear.

4._______

4._______

5. Exam sequence is logical and progresses from one region to another


without undue repetition.

5._______

5._______

6. Sequence includes comparison of symmetrical parts of the body.

6._______

6._______

7. Student examines patient using serial exposure appropriate to the steps of


the examination.

7._______

7._______

8. Balances need for palpation/percussion/auscultation to elicit information


with gentle examination technique.

8._______

8._______

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

Not
Done

1. Wash hands before starting examination.

1._______

1._______

1._______

2. Measure blood pressure in one upper limb.


Place cuff snugly in correct anatomical position.

2._______

2._______

2._______

3. Measure respiratory rate for at least 60 seconds.

3._______

3._______

3._______

4. Palpate radial pulse for at least 15 seconds.

4._______

4._______

4._______

5. Palpate radial pulses simultaneously for symmetry.

5._______

5._______

5._______

6. Inspect and palpate both hands (dorsal and palmar).

6._______

6._______

6._______

7. Inspect nails and nail beds. Check clubbing and capillary refill.

7._______

7._______

7._______

8. Inspect and palpate both arms and forearms with clothing removed,
including temperature

8._______

8._______

8._______

9. Palpate epitrochlear nodes.

9._______

9._______

9._______

10. Palpate axillary nodes (use proper technique to palpate axillary nodes).

10.______

10.______

10.______

11. Wash hands after palpating axillary nodes.

11.______

11.______

11.______

12. Palpate scalp thoroughly.

12.______

12.______

12.______

13. Assess scalp and hair for texture and consistency.

13.______

13.______

13.______

14. Inspect external ocular structures (lids, cornea, conjunctiva).

14.______

14.______

14.______

15. Gently move eyelids up and down to obtain better view.

15.______

15.______

15.______

SECTION A. GENERAL INSPECTION/VITAL SIGNS

SECTION B. HANDS/ARMS INSPECT NAILS/SKIN

SECTION C. HEAD AND NECK

EYES

Page1of9

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

Not
Done

16. Estimate visual acuity (near or far) bilaterally.

16.______

16.______

16.______

17. Test visual fields by confrontation.

17.______

17.______

17.______

18. Test visual fields in each eye separately in 4 (up, down, right, left)
directions.

18.______

18.______

18.______

19. Evaluate extraocular muscle function in 4 (up, down, right, left) directions. 19.______

19.______

19.______

20. Check for convergence and accommodation.

20.______

20.______

20.______

21. Observe pupillary response to light (direct).

21.______

21.______

21.______

22. Observe pupillary response to light (consensual).

22.______

22.______

22.______

23. Patient positioned at height comfortable for examiner.

23.______

23.______

23.______

24. Lights dimmed before ophthalmoscopic examination.

24.______

24.______

24.______

25. Ophthalmoscope held properly and index finger used to switch lenses.

25.______

25.______

25.______

26. Hold ophthalmoscope with right hand to inspect patients right eye.

26.______

26.______

26.______

27. Inspect anterior structures with ophthalmoscope.

27.______

27.______

27.______

28. Inspect optic nerve.

28.______

28.______

28.______

29. Trace vessels in four quadrants.

29.______

29.______

29.______

30. Observe macula.

30.______

30.______

30.______

31. Ophthalmoscope held at proper distance to visualize posterior structures


in eye (i.e., within less than 1 inch from eye).

31.______

31.______

31.______

32. Hold ophthalmoscope with left hand to inspect patients left eye.

32.______

32.______

32.______

33. Inspect anterior structures with ophthalmoscope.

33.______

33.______

33.______

34. Inspect optic nerve.

34.______

34.______

34.______

35. Trace vessels in four quadrants.

35.______

35.______

35.______

36. Observe macula.

36.______

36.______

36.______

37. Observe auricles and postauricular regions bilaterally.

37.______

37.______

37.______

38. Palpate auricles bilaterally.

38.______

38.______

38.______

39. Test auditory acuity.

39.______

39.______

39.______

40. Use proper technique to test each ear separately.

40.______

40.______

40.______

41. Examine ears bilaterally with otoscope.

41.______

41.______

41.______

42. Insert speculum without causing pain to the patient.

42.______

42.______

42.______

43. Stabilize otoscope upon insertion.

43.______

43.______

43.______

44. Test for patency of both nasal passages.

44.______

44.______

44.______

45. Palpate for frontal sinus tenderness.

45.______

45.______

45.______

46. Palpate for maxillary sinus tenderness.

46.______

46.______

46.______

47. Inspect nasal vaults with nasal speculum on otoscope.

47.______

47.______

47.______

48. Insert speculum without causing pain to the patient.

48.______

48.______

48.______

49. Use proper technique to visualize nasal vaults.

49.______

49.______

49.______

EARS

NOSE
(CN I asked here __________ )

Page2of9

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

Not
Done

50. Inspect lips, gums, tongue, teeth.

50.______

50.______

50.______

51. Inspect floor of mouth and base of tongue.

51.______

51.______

51.______

52. Inspect posterior pharynx.

52.______

52.______

52.______

53. Examine patient without causing discomfort.

53.______

53.______

53.______

54. Observe elevation of the palate by asking patient to say ah.

54.______

54.______

54.______

Palpate lymph nodes:


55. Preauricular nodes

55.______

55.______

56.______

56. Posterior auricular nodes

56.______

56.______

56.______

57. Occipital nodes

57.______

57.______

57.______

58. Tonsillar nodes

58.______

58.______

58.______

59. Submaxillary nodes

59.______

59.______

59.______

60. Submental nodes

60.______

60.______

60.______

61. Anterior cervical nodes (superficial and deep)

61.______

61.______

61.______

62. Posterior cervical nodes

62.______

62.______

62.______

63. Supraclavicular nodes

63.______

63.______

63.______

64. Infraclavicular nodes

64.______

64.______

64.______

65. Palpate thyroid with swallowing.

65.______

65.______

65.______

66. Palpate thyroid without swallowing.

66.______

66.______

66.______

67. Palpate thyroid from front and back of patient.

67.______

67.______

67.______

68. Palpate thyroid in correct anatomical location.

68.______

68.______

68.______

69. Palpate carotids bilaterally.

69.______

69.______

69.______

70. Auscultate carotids bilaterally.

70.______

70.______

70.______

71. Palpate spinous processes of thoracic and lumbar vertebrae.

71.______

71.______

71.______

72. Perform fist percussion of: thoracic, lumbar, and sacral vertebrae;
sacroiliac joints bilaterally; and costovertebral angles.

72.______

72.______

72.______

73. Inspect thoracic expansion.

73.______

73.______

73.______

74. Palpate chest expansion, symmetry.

74.______

74.______

74.______

75. Ask patient to cross arms to move scapula and expose lung fields.

75.______

75.______

75.______

76. Percuss posterior lung fields.

76.______

76.______

76.______

77. Percuss fields bilaterally and symmetrically, in all areas.

77.______

77.______

77.______

78. Measure maximum excursion of the diaphragm bilaterally.

78.______

78.______

78.______

79. Instruct patient to breathe through open mouth.

79.______

79.______

79.______

MOUTH

NECK

SECTION D. BACK

THORAX
SECTION E. LUNGS

Page3of9

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

Not
Done

80. Auscultate posterior lung fields.

80.______

80.______

80.______

81. Auscultate bilaterally and symmetrically, in all areas with patient


breathing through open mouth.

81.______

81.______

81.______

82. Percuss lateral lung fields bilaterally.

82.______

82.______

82.______

83. Auscultate lateral lung fields bilaterally.

83.______

83.______

83.______

84. Percuss anterior lung fields.

84.______

84.______

84.______

85. Percuss fields bilaterally and symmetrically.

85.______

85.______

85.______

86. Auscultate apices in supraclavicular fossae.

86.______

86.______

86.______

87. Auscultate anterior lung fields.

87.______

87.______

87.______

88. Auscultate fields bilaterally and symmetrically.

88.______

88.______

88.______

LATERAL LUNG FIELDS

ANTERIOR LUNG FIELDS

SECTION F. BREASTS (Female) Note: This section is not tested as part of physical diagnosis
competency exam.
Inspect both breasts:
1. Patient sitting, arms at side
2. Patient sitting, arms above head
3. Patient leaning forward
4. Patient sitting, hands pressed to hips
5. Four quadrants
6. Nipple
7. Areola
Palpate breasts with patient in recumbent position:
8. Ask patient to put arm behind head to aid examination
9. Four quadrants and tail
10. Nipple
11. Areola
12. Attempt to express material from nipple
13. Examine all areas completely and symmetrically
BREASTS (Male)
1. Palpate all four quadrants of each breast
2. Palpate nipples bilaterally
3. Palpate areolae

SECTION G. HEART
89. Observe precordium.

89.______

89.______

89.______

90.______

90.______

90.______

91.______

91.______

91.______

92.______

92.______

92.______

93.______

93.______

93.______

Auscultate with patient sitting:


Use diaphragm of stethoscope:
94. Aortic area

94.______

94.______

94.______

95. Pulmonic area

95.______

95.______

95.______

96. Tricuspid area

96.______

96.______

96.______

97. Mitral (apical) area

97.______

97.______

97.______

Palpate with patient sitting:


90. Aortic area (2nd ICS - right)
nd

91. Pulmonic area (2

rd

-3

ICS left)

92. Right ventricular area (4th 5th ICS, LLSB)


th

93. Mitral (apical) area (5

ICS left MCL)

Page4of9

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

Use bell of stethoscope (patient still sitting):


98. Aortic area

98.______

98.______

98.______

99. Pulmonic area

99.______

99.______

99.______

100. Tricuspid area

100._____

100._____

100._____

101. Mitral (apical) area

101._____

101._____

101._____

102. Observe neck veins (with patient lying at 30-45 angle).

102._____

102._____

102._____

Palpate with patient recumbent:


103. Aortic area (2nd ICS right)

103._____

103._____

103._____

104._____

104._____

104._____

105. Right ventricular area (4th 5th ICS, LLSB)

105._____

105._____

105._____

106. Mitral (apical) area (5th ICS left MCL)

106._____

106._____

106._____

107. Right ventricular heave and left ventricular lift

107._____

107._____

107._____

Auscultate with patient recumbent:


Use diaphragm of stethoscope:
108. Aortic area

108._____

108._____

108._____

109. Pulmonic area

109._____

109._____

109._____

110. Tricuspid area

110._____

110._____

110._____

111. Mitral (apical) area

111._____

111._____

111._____

Use bell of stethoscope:


112. Aortic area

112._____

112._____

112._____

113. Pulmonic area

113._____

113._____

113._____

114. Tricuspid area

114._____

114._____

114._____

115. Mitral (apical) area

115._____

115._____

115._____

116. Ask patient to roll to left lateral position.

116._____

116._____

116._____

117. Relocate apex.

117._____

117._____

117._____

118. Auscultate apex with bell.

118._____

118._____

118._____

119. Auscultate apex with diaphragm.

119._____

119._____

119._____

120. Inspect abdomen and teach patient to relax abdomen.

120._____

120._____

120._____

121. Watch patients face while examining abdomen.

121._____

121._____

121._____

122. Auscultate before manipulation or palpation.

122._____

122._____

122._____

Auscultate for bruits:


123. Left upper quadrant to include LEFT renal artery

123._____

123._____

123._____

124. Right upper quadrant to include RIGHT renal artery

124._____

124._____

124._____

125. Right lower quadrant to include RIGHT iliac artery

125._____

125._____

125._____

126. Left lower quadrant to include LEFT iliac artery

126._____

126._____

126._____

127. Aorta

127._____

127._____

127._____

128. Auscultate for bowel sounds in four quadrants and epigastrium.

128._____

128._____

128._____

nd

104. Pulmonic area (2

rd

-3

ICS left)

Not
Done

SECTION H. ABDOMEN

Page5of9

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

Not
Done

Palpate (superficially):
129. Left upper quadrant

129._____

129._____

129._____

130. Epigastrium

130._____

130._____

130._____

131. Right upper quadrant

131._____

131._____

131._____

132. Right lower quadrant

132._____

132._____

132._____

133. Left lower quadrant

133._____

133.__ ___

133._____

Palpate deeply:
134. Left upper quadrant

134._____

134._____

134._____

135. Epigastrium to include aorta

135._____

135._____

135._____

136. Right upper quadrant

136._____

136._____

136._____

137. Right lower quadrant

137._____

137._____

137._____

138. Left lower quadrant

138._____

138._____

138._____

139. Percuss liver span

139._____

139._____

139._____

140. Use proper technique to palpate liver edge

140._____

140._____

140._____

141. Use proper technique to palpate tip of spleen

141._____

141._____

141._____

142. Use proper technique to palpate flanks

142._____

142._____

142._____

143. Inspect and palpate bilaterally with outer clothes removed.

143._____

143._____

143._____

144. Inspect feet including toes and heels.

144._____

144._____

144._____

Palpate pulses bilaterally:


145. Femoral

145._____

145._____

145._____

146. Popliteal

146._____

146._____

146._____

147. Posterior tibial

147._____

147._____

147._____

148. Dorsalis pedis

148._____

148._____

148._____

149. Palpate inguinal lymph nodes.

149._____

149._____

149._____

150. Auscultate for femoral bruit.

150._____

150._____

150._____

151. Check for peripheral pitting edema.

151._____

151._____

151._____

152. Use proper technique to check for pitting edema.

152._____

152._____

152._____

SECTION I. LOWER LIMBS

SECTION J NEUROLOGICAL/MUSCULOSKELETAL SCREENING EXAM


MENTAL STATUS (Can be done at any point in examination)
153. Orientation: Time, place, person

153._____

153._____

153._____

154. Serial 7s

154._____

154._____

154._____

155. Memory: immediate, recent and past

155._____

155._____

155._____

156. Information

156._____

156._____

156._____

157. Abstract reasoning

157._____

157._____

157._____

Page6of9

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

158. Observe gait.

158._____

158._____

158._____

159. Have patient walk on toes.

159._____

159._____

159._____

160. Have patient walk on heels.

160._____

160._____

160._____

161. Have patient hop on each foot.

161._____

161._____

161._____

162. Have patient do a deep knee bend.

162._____

162._____

162._____

163. Observe tandem gait (heel-to-toe).

163._____

163._____

163._____

164. Perform Romberg test.

164._____

164._____

164._____

165. Test flexion by having patient bend at waist to touch toes.

165._____

165._____

165._____

166. Test extension by having patient bend backwards.

166._____

166._____

166._____

167. Have patient bend sideways and rotate at hips.

167._____

167._____

167._____

168. Observe posture and curvature.

168._____

168._____

168._____

169. Perform screening test for scoliosis.

169._____

169._____

169._____

170. Test flexion, extension, and rotation of neck.

170._____

170._____

170._____

171._____

171._____

171._____

172. Test CN-V (Sensory): Light touch on cornea (offer to test)

172._____

172._____

172._____

173. Test CN-V (Sensory): Light touch on face

173._____

173._____

173._____

174. Test CN-V (Motor): Test contraction of masseter muscles, or forced


opening of mouth against resistance

174._____

174._____

174._____

175. Test CN-VII (Motor): Raise eyebrows, or forced eyelid closing

175._____

175._____

175._____

176. Test CN-VII (Motor): Show teeth, puff out cheeks, or smile

176._____

176._____

176._____

177. Test CN-XI: Rotation of patients head against resistance

177._____

177._____

177._____

178. Test CN-XI: Shoulder shrug against resistance

178._____

178._____

178._____

179. Test CN-XII: Observe midline protrusion of tongue (do with EENT exam) 179._____

179._____

179._____

PATIENT STANDING

Not
Done

SPINE

CRANIAL NERVES
171. Test CN-I: (Sense of smell not usually done); Adequate to ask patient
if he/she has experienced a change in smell and/or taste
Test CN-II (Done during EENT exam)
a. Visual acuity
b. Visual fields
c. Ophthalmoscopic (disc, blood vessels, retina)
Test CN-III, IV, VI (Done during EENT exam)
a. Pupillary reaction to light
b. Extraocular movements

Test CN-VIII (Hearing done with EENT exam)


Test CN-IX and X: Observe elevation of palate vocalizing ah (EENT exam)

Page7of9

Clinical Skill/Competency

Done
Correctly

Done
Incorrectly

Not
Done

180. Test for upper limb strength.

180._____

180._____

180_____

181. Test for drift of outstretched arms with eyes closed (can combine with
Romberg test).

181._____

181._____

181._____

182. Test distal strength on dorsiflexed wrist.

182._____

182._____

182._____

183. Test patients grip bilaterally.

183._____

183._____

183._____

184. Test strength of finger adduction and abduction.

184._____

184._____

184._____

185. Test thenar and hypothenar strength.

185._____

185._____

185._____

186. Test fine rapid movements fingers.

186._____

186._____

186._____

187._____

187._____

187._____

Deep tendon reflexes (test symmetrically):


188. Test biceps reflex

188._____

188._____

188._____

189. Test brachioradialis reflex

189._____

189._____

189._____

190. Test triceps reflex

190._____

190._____

190._____

191. Test patellar reflex

191._____

191._____

191._____

192. Test achilles reflex

192._____

192._____

192._____

Cutaneous reflexes:
193. Test plantar reflex

193._____

193._____

193._____

194. Test rapid alternating movements hands.

194._____

194._____

194._____

195. Test finger-to-nose bilaterally.

195._____

195._____

195._____

196. Test heel-to-shin bilaterally.

196._____

196._____

196._____

197. Test light touch or pin prick on both sides of trunk.

197._____

197._____

197._____

198. Test alternating light touch and pin prick on four limbs.

198._____

198._____

198._____

199. Test position sense at least in feet.

199._____

199._____

199._____

200. Test vibration sense in at least both ankles

200._____

200._____

200._____

MOTOR STATUS Examine functional groups of muscles for bulk,


tone, consistency, and strength

UPPER LIMB

LOWER LIMB (Mainly done with patient standing)


Have
Have
Have
Have

patient
patient
patient
patient

walk on toes
walk on heels
hop on each foot
do deep knee bend

187. Test fine rapid movements feet.

REFLEXES

CEREBELLAR FUNCTION

Observe tandem gait (done with patient standing)

SENSORY STATUS

(Romberg done with patient standing)

Page8of9

SECTION K. MALE GENITALIA AND RECTUM

Note: This section not tested as part of physical diagnosis

competency exam.

Inspect:
1. Penis (lift to examine under surface)
2. Retract foreskin (or have patient retract)
3. Meatus
4. Scrotum
5. Inguinal canal
Palpate:
6. Penis
7. Scrotum (include testes, epididymis, and spermatic cord)
8. Hernia examination (including inguinal canal)
Perform rectal examination:
9. Inspect anus
10. Exert pressure on external sphincter anteriorly and pause to allow sphincter to relax.
11. Palpate prostate.
12. Rotate examining finger through an arc of 360 degrees
13. Perform stool guaiac test

POINT SCORE_________________________________

TECHNIQUE___________________________________

SEQUENCE AND EFFICIENCY_____________________

DATE AND TIME:

PROCTOR:

Page9of9