MCU-FDTMF MEDICAL FOUNDATION

DEPARTMENT OF MEDICINE (PD I and PD II)

ACADEMIC YEAR 2013-2014
GUIDELINES ON THE PROPER RECORDING OF PHYSICAL
EXAMINATION FINDINGS
General Survey: 7S Female / Male DOG, Pretty Girl-My Girl
State of Health
Facial Expression
Posture
State of Consciousness
Mood
Gait
State of Development
Dressing
Motor
Activity
State of Nutrition
Odor
Gross
Deformities
Signs of Distress
Grooming
Skin Color & Obvious Lesions
Speech
Example:
1. Patient is a young, healthy looking male, alert, about 5 feet tall,
weighing 55 kg, BMI of 21 kg/m2, in quiet, regular breathing and
not in pain. He has dark complexion with no visible lesion, speaks
very well and fluently. He looks shy but maintained eye contact
when asked. He is clad in a clean T-shirt, maong pants and rubber
shoe with tied laces. No malodorous scent noted and hairs are
short and well-kempt. Patient is sitting with erect posture and can
maintain balanced gait when asked to walk.
He has no
involuntary movement nor gross deformity
2. Patient is a young, frail-looking male, appears drowsy about 57 in
height and 38 kg in weight, BMI is
17 kg/m2 and waist
circumference of 80 cm. His breathing is labored, rapid and deep
with use of accessory muscles of inspiration. He is diaphoretic
with generalized jaundice. He speaks in phrases, very anxious
and in active pain, assuming doubling up position. He wears
sando and shorts and different slippers. He has a fruity odor with
long unkempt hairs. Though patient preferred to sit on bed, at
times he will lie down in a knee chest position. No involuntary
movement noted but muscle wasting of lower and upper
extremities are present.
Vital Signs: Five Components
1. Blood Pressure
Palpatory Method
Auscultatory Method
2. Heart Rate & Rhythm
Pulse rate
Cardiac Auscultatory Rate
3. Respiratory Rate, Depth and Regularity
4. Temperature
5. Pain Scale
Examples:
1. Vital signs are as follows:
BP: 110 palpatory, 110/70 auscutatory

HR: 85/min and regular rhythm

RR: 14/min with quiet-breathing and regular
Temperature: 370C
Pain scale: zero
2. Vital signs revealed the following:
BP: 80 palpatory, 80/60 auscultatory
HR: 125/min with regular rhythm
RR: 32/min with rapid, deep breathing
Temperature: 390C
Pain scale: 10/10
Skin: Come My Treasured Toddler, Mark Those Little Hands Now
Color
Moisture
Temperature
Texture
Mobility
Turgor
Lesions (Life & Death, Patterns & Shape, Too Complicated)

Location
Distribution
Patterns
Shape
Type
Color

Hairs
Nails
Example:
1. The skin is fair in color, moist, warm to touch and smooth. It is
elastic with good skin turgor. A circular scar of about 2.5cm noted
between the left thumb and index finger on the dorsal aspect and a
tattoo on the right deltoid area. The hair are black and equally
distributed in the head while the nails are clean with pinkish beds
and capillary refill time of less than 2 sec. no clubbing noted
2. Generalized icteresia of the skin noted, dry, very warm and coarse.
It is elastic with decrease skin turgor. An erythematous ulcer with a
diameter of 3cm noted in the dorsal aspect of the left foot with foul
smelling discharge. The hairs are evenly distributed, thick and
black.
The nail beds are pale with capillary refill of 8 sec.
Shamroths test is present.
Head: High School Stint, Forever Special
Hair
Scalp
Skull
Face
Skin

Example:
1. The hairs are black, thick, evenly distributed, no scales or lumps
noted. The head is round with no depressions, no tenderness. The
face is symmetrical with no involuntary movements while the skin
is white with no obvious lesions
2. The hairs are thin with frontal baldness; seborrheic scales were also
present. The skull is symmetrical with moon-fascie appearance.
Fine hairs are also present in the face with facial plethora and acneform lesions.
The Eyes: Peaches & Almonds, Eat Everything Leisurely: Cakes &
Salad, Chicken & Lambs, Ice cream, Pizzas, Chocolates, Egg pies,
Lollipops, Candies, Fruits
Position & Alignment of the Eyes
Confrontation test
Eyebrows
Extra ocular movement
Eyelids
Lid Lag
Lacrimal apparatus
Convergence test
Conjunctiva & Sclera
Fundoscopy
Cornea & Lens
Iris
Pupils
Examples:
1. The eyebrows are symmetrical with equally distributed fine hairs.
The upper lids are symmetrical occupying the upper 1/3 of eyeballs.
The medial canthi are not swollen. The sclerae are white with
pinkish palpebral conjunctiva. The cornea and lens are clear with
well-defined borders of the iris. The pupils are equal about 2-3 mm
in size reactive to both direct and consensual reflex. No visual
defects noted on confrontation test; the EOMs are intact and
positive convergence test. The red orange reflex was noted on
Fundoscopy. The optic disc is yellowish orange in color with welldelineated physiologic cup located centrally with AV ratio of 2:3, no
hemorrhage, exudates noted in the surrounding fundi.
2. The eyebrows are symmetrical with lateral thinning of hairs,
drooping of upper eyelid noted in the left eye, swollen medial
canthus of the left eye with purulent fluid discharge. Icteric sclerae
with pale palpebral conjunctiva. Corneal opacities are present on
both eyes with ill-defined margin of the iris. The pupil are equal
about 2-3 mm both reactive to direct and consensual reflex. No
visual defects noted on confrontation test, intact EOMs, positive
convergence test with lid lag of the left eye. Red-orange reflex not
appreciated on Fundoscopy
The Ears: Animal: Elephants & Dogs, Alligators & Birds
Auricle
Ear canal & Drum
Air & Bone conduction
Example:
1. The ears are symmetrical, non tender auricle and negative tug test.
Otoscopy showed absence of redness and swelling of the ear canal.

pinkish-gray tympanic membranes with bright cone of light on both

ears. Snapping of fingers noted on both ears at a distance of about
1 foot. Webers test heard at the midline, air conduction is greater
than bone conduction on Rinnes test.
2. The ears are symmetrical with erythematous nodule at the right
post-auricular area. The right auricle is tender, tug test positive in
the right ear. Otoscopy showed swollen erythematous ear canal on
the right ear with sticky brown cerumen. Webers test best heard at
the left ear while bone conduction is longer than air conduction in
the right ear.
The Nose: Attack & Invade: 3 Nurses Leading Policy
Anterior & Inferior surfaces of the nose
Nasal obstruction
Nasal mucosa
Nasal septum
Lesions
Paranasal sinuses
Example:
1. Symmetrical with high-bridge nose, patent nasal passages, septum
at the midline, reddish nasal mucosa with no lesions. The frontal
and the maxillary sinuses are not tender
2. Symmetrical snub nose with flaring of ala nasi, patent nasal
passages, deviated septum to the right with large polyp on the left,
erythematous mucosa of the left with tender left maxillary sinus
and non tender frontal sinuses
The Throat: Love Our Gurus & Teachers, Respect Them Forever
Please
Lips
Oral mucosa
Gums & Teeth
Roof of the mouth
Tongue
Floor of the mouth
Pharynx
Example:
1. Moist, red lips without lesions, reddish oral mucosa, pinkish gum
and white teeth, high arch hard palate. Symmetrical tongue on
protrusion, uvula at the midline and tonsils are not enlarged,
reddish pharynx with no lesions
2. Dry lips with cracks white patches on the right buccal mucosa,
swollen gums with dental carries, tongue at the middle, uvula
deviated to the right, enlarged tonsils with exudates and
erythematous pharynx
The Neck: SLE Limited Time To Diagnose
Symmetry
Lesions
Enlargement of Parotid/Submandibular Glands

Lymph nodes
Trachea
Thyroid
Distension of neck veins
Example:
1. Neck is slender, supple, non-tender with no palpable mass or lymph
adenopathy. The trachea is in the midline while the thyroid gland is
diffusely enlarged, about 25 gm in weight, firm, non-tender and
moves with deglutition, no bruit noted.
2. The neck is short and broad, with visible horizontal surgical scar,
palpable lymph adenopathy on submandibular areas, firm, mobile
matted and non tender. The thyroid gland is not palpable
Chest and Lungs
Inspection: Start Showing Dedication Regarding Lessons Worth
Remembering
Shape
Symmetry
Deformities
Respiratory movements
Lagging
Widening of intercostals space
Retraction
Palpation: Cool Teachers Must Teach
Chest expansion
Tactile fremitus
Mass
Tenderness
Percussion: Resonance
Auscultation: Be Vigilant To Anyone
Breath sounds
Vocal fremitus
Transmitted voice sounds
Adventitious sound
Example:
1. The thorax is elliptical in shape, symmetrical in expansion with no
deformity, widening of intercostals space, retractions and skin
lesions. The breathing is quiet and regular with no use of accessory
muscles of respiration.
Equal chest expansion on palpation as well as the tactile fremitus
on both lung fields posteriorly and anteriorly.
There was no
palpable mass or area of tenderness.
On percussion, the lung fields are predominantly resonant except
the cardiac area anteriorly and the scapular areas posteriorly
The breath sounds are predominantly vesicular in both lung fields
anteriorly and posteriorly except the area of the trachea and the
manubrium which are tracheal and bronchial in nature. Vocal
fremitus are equal on both lung fields anteriorly and posteriorly with
no adventitious sounds noted, no bronchophony, egophony and
whispered pectoriloquey appreciated.

2. The thorax is barrel shape with unequal chest expansion. The

intercostals spaces are widened with retractions but with no
deformity or skin lesions. The breathing is shallow, and rapid at 26
cycles/min but regular with no period of apnea using accessory
muscles of respiration. There was lagging on the right side on
palpation, decreased tactile fremitus on the right lung fields
anteriorly and posteriorly.
There was crepitus noted on the right supraclavicular area, no mass
or tenderness noted.
The right lung fields are more resonant than the left anteriorly and
posteriorly.
The breath sounds are predominantly bronchial in the right lung
field anteriorly and posteriorly with wheezes, vocal fremitus is
decreased in the right lung fields anteriorly and posteriorly.
Bronchophony and whispered pectoriloquey are decreased in the
right lung fields while egophony not present in both lung fields

The Heart: Jesus Christ

Jugular venous pressure
Carotid pulse
Inspection: Dont Lock Before Leaving
Dynamicity of the precordium
Location of PMI (if present)
Bulging of precordium
Lesions
Palpation: Aging Heart: True Love, True Love
Apical Beat
Heaves
Thrill
Lift
Tenderness
Lesions
Percussion: (if apical impulse not appreciated)
Auscultation: 4H
Heart rate
Heart rhythm
Heart sounds
Heart murmurs
Example
1. JVP is 7cm above the right atrium, strong carotid pulses with brisk
upstroke.
Dynamic precordium, PMI at 2nd ICS (L) midclavicular line, no
precordial bulging, visible skin lesions, or mass noted.
The apex beat at 4th ICS (L) midclavicular line, no palpable mass or
area of tenderness noted as well as thrills, heaves or lift.
The heart rate is 72/min with regular rhythm. The intensity of S1 is
greater than S2 at the apex while S2>S1 in the base, no murmur
appreciated.

2. JVP is 12cm above the right atrium, weak carotid pulses and the
upstroke undetected.
Hyperdynamic precordium, PMI at 6th ICS midaxillary line, no
precordial bulging, visible skin lesion, or mass noted.
The apical beat noted at the 6th ICS (L) mid axillary line with
palpable thrills noted at the aortic area.
The heart rate is 72/min with irregularly irregular rhythm. Faint
heart sound in the apex while S1 is greater than S2 in the base
noted.
A grade 4/6 harsh murmur noted at the 2 nd ICS (R)
parasternal line which is systolic in timing
Abdomen:
Inspection: Social Security System Are Paying People Unsatisfactorily
Shape
Symmetry
Skin and obvious Lesions
Abdominal breathing
Pulsations
Peristalsis
Umbilicus
Auscultation: Beer-Belly Boy Friend
Bowel sound
Borborygmi
Bruits
Friction Rub
Percussion: Apple Likes To Cha-cha
Abdominal tympani and dullness
Liver span
Traubes space
Costovertebral angle
Palpation:
Light palpation: Cottony And Soft
Consistency
Area of tenderness
Superficial masses or organs
Deep palpation Leave Room, Dine Out
Liver edge
Rebound tenderness
Deep masses
Organomegaly (liver, spleen, kidneys, bladder and aorta)
Special Techniques
Ascites (if abdomen is protuberant with bulging flanks) Fluid
Sinks
Fluid wave test
Shifting dullness
Appendicitis: DR Roland Please Order Chicken
Direct tenderness
Rebound tenderness
Ravings sign

Psoas sign
Obturator sign
Cutaneous hyperesthesia
Acute Cholecystitis: Mine
Murphys sign
Example
1. The abdomen is flat, symmetrical with an abdominal girth of 79cm,
no bulging flanks nor visible skin lesions noted. It moves with
respirations with no visible pulsation or peristaltic movement.
Umbilicus at the midline, inverted with no bulging.
The bowel sounds are 16/mm with no borborygmus. No bruit noted
to the areas corresponding to the aorta, renal and iliac artery. No
friction rubs in the hepatic or splenic area.
It is tympanitic in all quadrants, liver span of 8cm midclavicular line
right, Traubes space not obliterated and negative kidney punch
test.
On light palpation, the abdomen is soft in all quadrants with no area
of tenderness nor superficial masses and organs appreciated. The
liver edge is smooth with regular borders, no rebound tenderness
nor deep masses on all quadrants. The spleen, kidney, bladder and
aorta are not palpable.
Special tests are absent.
2. The abdomen is globular and protuberant with bulging flanks. The
abdominal girth is 38 inches. It moves with respiration with visible
pulsations and peristaltic movements. The umbilicus is everted and
midline. The bowel sounds are hyperactive at 40 sounds/min with
borborygmi. Abdominal bruit noted at the midline of epigastric
area. No friction rib in the area of the liver and spleen, both lower
quadrants are dull while the rest are tympanitic, liver span at 5 cm
right perasternal line, Traubes space is tympanitic with no
costovertebral angle tenderness. All quadrants are soft but with
direct tenderness on right upper quadrant. No superficial mass or
organ palpated. Fluid wave test and shifting dullness on both lower
quadrants are noted. Murphys sign is also present. Special
techniques for acute appendicitis were not appreciated.

DRE (if indicated): Please Add Sincerity To Inspire Patriotic Filipinos

Perinanal lesions
Anal lesions
Sphincteric tone
Tenderness
Induration/irregularities
Prostrate
Fecal matter
Examp le:
1. Perianal skin is dark-colored with no lesions. The anal orifice is
coarse with no swelling or visible lesions. Tight sphincter tone, no
tenderness, nodules, induration on the anal surfaces. The prostate

gland is rubbery, non-tender and not enlarged and a yellow-brown

fecal material noted on tactating finger
2. The perianal skin is dark with excoriations. The anus is swollen and
thickened with tight sphincter tone. Partially filled rectal vault.
Pararectal tenderness noted with no induration or nodules noted.
The prostate gland is enlarged, firm and tender. Tarry stools noted
on tactating finger.
Musculoskeletal: I Pray Rosary, Mama
Inspection
Palpation of bony landmarks and soft tissues
Range of motion
Manuevers
Temporomandibular
Shoulder
Elbow
Wrist and hand
Neck
Spine
Hip
Knee
Ankle and foot
Example
Musculoskeletal
Temporomandibular joint: symmetrical face with no swelling or
redness of the joint; non-tender joint with smooth range of motion
with choking sounds heard when asked to open his mouth
Shoulder: symmetrical with intact bony structures.
No swelling,
redness or deformity noted. No tenderness noted. He can do
shoulder movement as to flexion and extension, abduction and
adduction and internal and external rotation without difficulty.
Elbow: intact medial and lateral epicondyle and olecranon processes,
non-tender not swollen; equal brachial pulses, can do flexion and
extension and supination and pronation without difficulty
Wrist and hands: hand movements are smooth and natural, no
swelling nor deformities noted. The radius and ulna are intact. The
anatomical snuffbox is not swollen or tender. Equal radial pulses.
The carpal, metacarpals, proximal, middle and distal phalanges are
all intact with no swelling or tenderness. He can do flexion,
extension, adduction and abduction and finger apposition without
difficulties. The Finkelsteins, Tinels and Phalens sign are all
negative.
Spine: looking at the side, there is cervical and lumbar concavities and
thoracic convexity. At the back, there is equal shoulder heights and
iliac crest heights. No skin lesion or swelling noted. No tenderness
or spasm noted. The neck and spinal column can do flexion and
extension, rotation and lateral bending without difficulty.
Hip: his gait is smooth with maintained balance with symmetrical leg
length. No tenderness, swelling or body prominence abnormalities
noted. He can do flexion and extension, abduction and adduction,

external and internal rotation without difficulty. The leg raising test
and Patricks test are negative.
Knee: symmetrical with no swelling or redness noted. No area of
tenderness or crepitus appreciated. Can do flexion, extension,
internal and external rotation without difficulty.
Ankle and foot: the surfaces are smooth with not obvious lesions. The
dorsalis pedis and posterior tibial pulses are equal. No swelling or
tenderness noted; can do flexion and extension, inversion and
eversion without difficulty.
Neuro: Men Can Make Scenarios Doing Challenging Moments
Mental Status: A Monkey On Pillow Talking To Iguana,
Joyfully And Merrily
Laughing Haha
Attention
Memory
Orientation
Perception
Thought processes
Thought content
Insight
Judgment
Affect
Mood
Language
Higher cognitive function
Cranial nerves assessment
Motor functions
Sensory functions
Deep tendon reflexes evaluation
Cerebellar functions
Meningeal signs

Example:
MSE
Patient is alert, very attentive and can maintained eye contact
when asked. Remote and recent memories are very sharp, oriented
to time, place and person. No illusion or hallucinations. He is
coherent and very anxious on what will happen to him, citing that
this the main reason why he sought consultation. His responses to
family or personal situation are appropriate. He is very cooperative
but at times seems worried and sad.
He is very talkative, his speech is fast, loud and clear and fluent.
Patient calculate mathematical problem easily. Could interpret
proverbs relevantly with intact construction ability when ask to
draw a clock face.

Cranial Nerves:
I
can smell coffee on both nostrils
II
no visual defects on confrontation test
the optic discs on fundoscopy are yellow with welldelineated borders
and centrally located physiologic cup
III
pupils reactive to light
III, IV, VI intact EOMs
V
can clench his teeth with positive corneal reflex on both
eyes
VII
symmetrical face can raise both eyebrows, can smile
and frown and
puff out both cheeks
VIII
can hear snapping of fingers at a distance of 1 foot on
both ears
IX, X
can swallow with difficulty
gag reflex present
XI
can snug both shoulders
XII
can to tongue protrusion
100%
5/5
5/5

5/5
5/5

100%

100%

100%

100%

100%

++
++

++
++

Intact
position, vibration & temperature sense; no Babinski reflex or ankle
clonus

Cerebellar
Can do tandem walking, fingers to nose test with good coordination
Rombergs test is negative
Menigeal
No nuchal rigidity
(-) Kernergs sign, (-) Brudzinskis sign