1

Introduce self, wash hands, stand on right

Vitals and Head/Neck
feel radial pulse for 15 sec
measure RR
measure BP (hold arm at heart level)
palpate and observe scalp
palpate LNs: (preauricular posterior auricular, occipital, tonsillar, submaxillary, submental, posterior
cervical, supraclavicular, anterior cervical)
ask patient to swallow and observe thyroid
[stand in back of patient:]
palpate laryngeal cartilage to locate thyroid
palpate thyroid when swallowing and without swallowing

Eye
look at lid, cornea, and conjunctiva (hold bottom lid and ask patient to look up; hold top lid and ask patient
to look down). inspect each separately
ask patient to hold out eye chart, read the best possible line
follow H
check convergence
force eyelids closed against pressure
[dim lights] consensual light reflex
visual fields by counting fingers
opthalmoscope

Ears
inspect external ears
otoscope
Weber test with 512
Rinne with 512
[stand in back of patient]
rub fingers 3-4 from ears -- ask patient to identify which ear

Nose:
ask patient to close one nostril while sniffing through another
use otoscope to look at each nasal passage
palpate for frontal sinus tenderness above each eye
palpate for maxillary sinus tenderness below each eye

Mouth and Throat
inspect lips, gums, tongue, teeth using tongue blade and light from otoscope
have patient breathe only through mouth
look at posterior pharynx
say ah
look for stensens duct and submandibular gland duct
stick out tongue and move it from side to side
put hands on masseter muscle and have patients bite down
smile for me


2
turn head against resistance
shrug shoulders against resistance

Lungs and thorax
look at back
percuss posterior lung fields
fist percuss for kidney tenderness
breathe through open mouth before auscultating
listen for posterior lung fields (LOOK AT BATES)
look at anterior chest
percuss anterior lung fields
auscultate anterior lung fields (LOOK AT BATES)

Heart
[raise bed to 30 degrees]
turn head to left, look for JVP
expose apical heart and look for observable apical impulse
place finger pads to feel for thrill on A, P, T, apex
stethoscope: auscultate with diaphragm and then bell

Pulses/Edema
ask patient to hold breath, then auscultate carotid using bell
palpate pulses: carotid, femoral, popliteal, dorsalis pedis (top of foot), posterior tibial pulses (behind medial
malleolus)
Check for pitting edema: press on lower tibia for 3-5 seconds

Abdomen
[adjust table to be flat]
look at abdomen
auscultate 4 quadrants
percuss 4 quadrants
palpate 4 quadrants with light and deep pressures (with right over left hand)
palpate spleen: ask patient to inhale, then exhale as deepen palpation
percuss liver
palpate liver: ask patient to inhale, then exhale as deepen palpation

MSK
assess hip flexion by moving thigh towards trunk
assess hip internal and hip external rotation
flex and extend each knee
inspect midfoot, toes, plantar surfaces of both feet
plantarflex and dorsiflex the ankles
inspect palms and backs of both hands
ask patient to spread fingers, palms down (finger extension)
ask patient to make fist with each hand (finger flexion)
supinate and pronate the forearms while inspecting fists and wrists
flex and extend each wrist
inspect, then flex and extend the elbow


3
shoulder flexion (zombie, arms overhead, return arms to lap)
shoulder external rotation: clasp hands behind neck and pull elbows back
shoulder internal rotation: place hands behind the back as high up on back as possible.
neck flexion and extension (chin on chest, look at ceiling)
neck rotation
neck bending -- ear towards shoulder
[ask patient to open back of gown, stand behind them]
torso -- bend to right and left
torso -- bend forwards and backwards

Neuro: motor
pronator drift
wrist extension, one arm at at a time
deltoid strength, one arm at at a time
biceps strength, one arm at at a time
triceps strength, one arm at at a time
sit down -- test hip flexor
test knee extensor and knee flexor

Neuro: sensation
[demonstrate sharp and dull by touching patients forearm]
ask patient to close eyes
test sensation for V1, V2, V3
test sensation on back
test sensation on upper and lower arms
test sensation on upper and lower legs
[demonstrate vibration with 128 Hz tuning fork]
test vibration on lateral malleolus
[demonstrate up and down motion of toes]
ask patient to close eyes
move toes up or down

Neuro: reflexes
biceps
brachioradialis
triceps
patellar
achilles
Babinski
finger-to-nose
alternately slap front and back of hands against thigh
heel to knee to shin
Romberg -- have patient stand up, close eyes, see if patient falls
walk across room
walk on tip toes
walk on heels
walk heel-to-toe
ask patient to return to exam table, tell have completed exam, shake hand and thank you for your time


4

http://informatics.med.nyu.edu/modules/pub/neurosurgery/motor.html