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Routine Adult Physical Examination

Checklist

Student__________________________________ Instructor_____________________________

____1. Examiner washes hands at beginning and end of exam.

____2. Examiner introduces self to patient.

Positioning – patient sitting facing examiner.

General/Vital signs

____3. Note general appearance.

____4. Check pulse in radial artery for 15 seconds. (x4 = HR/minute)

____5. Compare both radial pulses.

____6. Obtain blood pressure in one arm.

Head

____7. Inspect scalp and hair.

Eyes

____8. Inspect external eye (conjunctiva, eyelids, sclera).

____9. Check extraocular movements (6 positions).

____10. Check visual fields by confrontation.

____11. Determine pupil reaction to light (direct, consensual).

____12. Perform ophthalmoscopy exam (dim lights, positions patient correctly), holds ophthalmoscope with
correct hand (i.e. right for right eye) and index finger to switch lenses. Verbalizes structures examined.

Ears

____13. Perform hearing test using rubbed fingers or whispered number or tuning fork.

____14. Inspect external ear.

____15. Perform otoscope exam bilaterally.

Nose/Mouth/Sinuses

____16. Inspect nasal septum and turbinate with otoscope.

____17. Palpate frontal and maxillary sinuses.


____18. Have patients phonate and protrude tongue; observe palate and uvula with swallow.

____19. Inspect mouth with tongue blade: tongue, mucosa, duct openings, tonsillar fossa, pharynx.

Positioning – examiner moves behind patient.

Neck/Shoulder/Back

____20. Palpate lymph nodes in head and neck region (verbalize node groups).

____21. Palpate thyroid lobes and isthmus. Ask to swallow.

____22. Check neck range of motion, to sides, forward, back.

____23. Palpate spine.

____24. Percuss costovertebral angles with fist.

Chest

____25. Check symmetry of chest expansion with deep inspiration.

____26. Percuss posteriorly and laterally.

____27. Instruct patient to breathe through open mouth and auscultate posteriorly and laterally.

Positioning – examiner moves to front of sitting patient.

____28. Percuss anterior lung fields.

____29. Auscultate anterior lung fields.

Cardiovascular

____30. Instruct patient to exhale and lean forward, auscultate heart with diaphragm at left sternal border third
to fourth ICS) (maneuver to determine presence of aortic insufficiency).

Positioning – patient supine, examiner at patient’s right side.

____31. Inspect neck veins with patient at 30 degree angle.

____32. Palpate one carotid at a time.

____33. Auscultate carotids (ask patient to hold breath).

____34. Inspect and palpate precordium identifying PMI and palpating valve areas and left sternal border.

____35. Auscultate each valve area with diaphragm.

____36. Auscultate PMI/apex with bell.

____37. Instruct patient to roll in left lateral position; palpate apex and auscultate apex with bell.
Breasts (may be deferred)

Abdomen

____38. Inspect.

____39. Auscultate for bowel sounds.

____40. Auscultate for bruits.

____41. Percuss liver dullness (measure span in midclavicular line)

____42. Palpate four quadrants superficially.

____43. Palpate four quadrants deeply.

____44. Palpate liver edge in inspiration using proper hand position.

____45. Palpate spleen in deep inspiration using proper hand position.

____46. Palpate and estimate aortic pulsation.

Lower extremities

____47. Palpate femoral pulses and listen for femoral bruits.

____48. Inspect and palpate legs, checking for pretibial and ankle edema.

____49. Check dorsalis pedis and posterior tibial pulses.

Neurological/Musculoskeletal Exam

____50. Cranial nerve exam not done in HEENT: facial sensation, clench jaw and palpate temporal and
mandibular muscles, wrinkle forehead, show teeth, close eyes, shoulder shrug, head to side, close eyes.

____51. Check range of motion and strength of upper extremities.

____52. Check range of motion and strength of lower extremities.

____53. Test sensation to pinprick in lower extremities.

____54. Test vibration (128 cps) and position sense in lower extremities.

____55. Perform reflexes – biceps, triceps, brachioradialis, knee, ankle.

____56. Test plantar reflex bilaterally.

____57. Test finger-to-nose.


____58. Test heel-to-shin.

____59. Check gait.

____60. Observe toe-to-heel walking.

____61. Perform Romberg test.

____62. Perform pronator drift.