The following is a sample checklist for the physical examination.

These are
the types of skills you will tested on for the OSCE (Objective Structured
Clinical Examination) at the end of the CPD course.

ClinicalPerformanceDevelopment
HistoryandPhysicalExamAssessment
ProceduralChecklistbySystem
Initiatingtheinterview
1.Thestudentintroducedhis/herselfbyfirstandlastname.
2.Thestudentidentifiedtheprimaryandsecondaryreasonsforseekinghealthcare.
3.Thestudentsetagenda/contractswithpatientregardinghowinterviewwillproceed.
4.Comments:

Yes No
Yes No
Yes No

InformationGathering:Process
5.Thestudentusedconcise,easilyunderstoodquestionsandcomments;AVOIDEDJARGON.
6.Thestudentusedopenendedandclosedquestionsappropriately;movedfromOPENTOCLOSED.
7.ThestudentobtainedhistoryinaLOGICALSEQUENCE;progressedfrompasttopresent.
8.ThestudentmovedfromoneareatoanotherusingTRANSITIONALSTATEMENTStoexplainagenda.
9.ThestudentsoughtSPECIFICITYandVERIFICATIONofpatient'sresponses.
10.Comments:

Yes
Yes
Yes
Yes
Yes

No
No
No
No
No

InformationGathering:Content
11.ThestudentelicitHistoryofPresentIllness(HPI)

No
Yes

Notes: ThestudentmustelicitALLofthefollowing:1LOCATION;2QUALITY;3SEVERITY;4FIRST
OCCURANCE;5CONTEXT;6MODIFYINGFACTORS;7ASSOC.SYMPTOMS.
12.Thestudentaskedpatientquestionsrelatingtohis/herPASTMEDICALHISTORY.

Yes
13.Thestudentaskedpatientquestionsrelatingtohis/herFAMILYHISTORY.

Yes
14.ThestudentaskedifpatientwastakinganyMEDICATIONS(PRES/OTC).

Yes
15.ThestudentaskedifpatienthadundergoneanySURGERIESorhadeverbeenHOSPITALIZED.

Yes
16.ThestudentaskedpatientquestionsregardinglifestyleRISKFACTORS.

Yes
17.ThestudentdidtheReviewofSystems.

Yes
Notes: ThestudentquestionedpatientsonATLEAST10organsystems:general;head,eyes,ears,nose,
mouth,throat(HEENT);cardiovascular;respiratory;gastrointestinal;genitourinary;musculoskeletal;
integument;neurologic;psychiatric;endocrine;hematologic.
18.Thestudentaskedadditionalfocusedquestionsaboutthesystem(s)directlyrelatedtotheproblem(s)

No
No
No
No
No
No

No

identifiedintheHPI.
19.Comments:

Yes

ClinicalCourtesy(CC)
20.Thestudentwashedhis/herhandsinviewofthepatient.
21.ThestudentTOOKNOTES(ifdone)inamannerthatdidnotinterferewithdialogueorrapport.
Notes: Check"Yes"ifnonotesweretaken.
22.Thestudentappropriatelydrapedthepatientthroughoutthephysicalexamination.
23.Thestudentverballydemonstratedanawarenessandrespectforpatient'scomfortlevelthroughoutthe
physicalexamination.
24.Comments:

Yes No
Yes No

Yes No
Yes No

VitalSigns(VS)
25.BP:Exshouldslightlyflexpatientsarm,andsupportarm(table,hold A=Attempted B=Attempted
arm,etc.)
Satisfactory
Below
Satisfactory
26.BP:Exshouldcheckthesizeofthecuff,locatethebrachialarteryby A=Attempted B=Attempted
palpation,andplacethecuffsnuglyabouttheupperarm,centeringthe Satisfactory
Below
bladderoverthebrachialartery;armshouldbefreeofclothing.
Satisfactory

C=Did
Not
Attempt
C=Did
Not
Attempt

27.BP:Exshouldpalpatearadialpulse,andpumpupbloodpressurecuff A=Attempted B=Attempted

untilradialpulseisnolongerpalpable,notingthepressureatwhichthe Satisfactory
Below
pulsedisappears.Exshouldthenrapidlydeflatethecuff.Exshould
Satisfactory
wait30secondsbeforeproceeding.Exshouldplacestethoscopeover
thebrachialartery,andpumpupcuff20to30mmHgabovepalpable
systolicpressure,andthenreleasethecuffslowly,atrateof23mmHg
persecond,listeningforKorotkoffsounds.Exshouldrecordblood
pressure.

C=Did
Not
Attempt

28.PULSE:Exshouldpalpatetheradialarteryforatleast15secondsand A=Attempted B=Attempted

recordfindingsasaperminuterate.
Satisfactory
Below
Satisfactory
29.RESPIRATION:ExshouldstandinfrontorbehindPtandobservePt's A=Attempted B=Attempted
breathingatrestforatleast30seconds(normalrateforanadultis
Satisfactory
Below
generally1220breathsperminute).
Satisfactory

C=Did
Not
Attempt
C=Did
Not
Attempt

30.Comments:

Head,Neck&Eyes(HNE)
31.LymphNODES:TheExshouldpalpatethepreauricular
nodes.
32.LYMPHNODES:TheExshouldpalpatetheposteriorauricularnodes.

33.LYMPHNODES:TheExshouldpalpatetheoccipitalnodes.

A=
Attempted
Satisfactory
A=
Attempted
Satisfactory
A=
Attempted

B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below

C=Did
Not
Attempt
C=Did
Not
Attempt
CDid
Not

34.LYMPHNODES:TheExshouldpalpatetheposteriorcervicalnodes.

35.LYMPHNODES:TheExshouldpalpatethecervical/tonsillarnodes.

36.LYMPHNODES:TheExshouldpalpatethesubmandibularnodes.

37.LYMPHNODES:TheExshouldpalpatethesubmentalnodes.

38.LYMPHNODES:TheExshouldpalpatethesupraclavicularnodes.

39.NECKTRACHEA:Exshouldpalpatethethyroidandcricoidcartilage
withthePt'sheadslightlyextended.Exshouldpalpatethetracheawith
oneorbothhands,notingtheconsistencyofthetissueaswellas
symmetry.

Satisfactory
A=
Attempted
Satisfactory
A=
Attempted
Satisfactory
A=
Attempted
Satisfactory
A=
Attempted
Satisfactory

Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory

Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt

A=
Attempted
Satisfactory
A=
Attempted
Satisfactory

B=Attempted
below
Satisfactory
B=Attempted
Below
Satisfactory

C=Did
Not
Attempt
C=Did
Not
Attempt

40.NECKTHYROID:ExshouldstandbehindseatedPtandaskPttobend A=
headtoaneutralpositionorslightlyforward.TheExshouldlocatethe
Attempted
isthmusofthethyroidbynotingachangeintissueconsistencyfromthat Satisfactory
ofthecartilage.TheExshouldfollowtheisthmusbilaterallytopalpate
thetwoLOBESofthegland.Twofingersofeachhandshouldbeplaced
oneithersideofthetrachea.ExshouldthenaskPttoswallow(ortotakea
sipofwater)whileExpalpatestheisthmus.Exshouldthendisplace
tracheatotheleftandaskPttoswallowwhilepalpatingtrachea.Repeat
ontheleftside.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

41.EYEINSPECTION:Exshouldinspecttheeyes(lids,sclera,conjunctiva, A=
irises).ExshouldaskPttolookupwardasExgentlymovesthelowerlidsof Attempted
eacheyedownward.Inthesameway,thePtshouldlookdownwardasEx Satisfactory
gentlymovestheupperlidsupward.CranialNerveII(visualacuity)is
examinedinspecialcircumstances.

B=
Attempted
Below
Satisfactory

CDid
Not
Attempt

42.VisualFieldsTestingbyConfrontation.ExasksPttolookathis/hereyes. A=
Exwillmovehis/herhandfromtheperipheryoneoffourvisualquadrants Attempted
withseveralfingersheldup(numbershouldvarywitheachpass).ThePt Satisfactory
willtelltheExthenumberoffingersdisplayedassoonastheycomeinto
peripheralvision.

B=
Attempted
Below
Satisfactory

C=Did
Not
Attempt

43.EYEPUPILSIZE:Exshouldinspectthesizeofbothpupils,noting
symmetry.Usingtheswingingflashlighttest,evaluateforconsensual
constriction.

A=
Attempted
Satisfactory

C=Did
Not
Attempt

44.EYEEXTRAOCULARMOVEMENT/ACCOMMODATION:Exshould
bepositionedinfrontofPtandrequestthatwithoutmovinghis/herhead,
Pt'seyesfollowEx'sfingerorapencilthroughsixcardinaldirectionsof
gaze(leadPtsgazeinawideHshape).Exshouldevaluateforconjugate
eyemovements,presenceofnystagmus,and/orlidlag.Checkfor
convergenceasPtsgazefollowstheobjecttowardthebridgeofthePts

A=
Attempted
Satisfactory

B=
Attempted
Below
Satisfactory
B=
Attempted
Below
Satisfactory

C=Did
Not
Attempt

nose.Exshouldalsonotepupillaryconstrictionwithaccommodation.
45.EYEOPHTHALMOSCOPY:WithlightsOFF,ExshouldinstructPttolook A=
atadistantpointdirectlyinfrontofhim/herandfocusonthatpoint.Ex
Attempted
shouldplacehis/herhandonPt'sheadtoorienthimself/herself.Exshould Satisfactory
holdophthalmoscopeinrighthandtoviewPt'srighteyeandlefthandto
viewPt'slefteye.Exshouldbeginfrom10"15"laterallyandmovein
slowly,changinglensstrengthifnecessaryintheprocess,Exshouldmove
to1"3"awayfromtheeyeuntilforeheadsalmosttouch.ExshouldaskPt
tobrieflylookdirectlyintothelightatsomepointduringtheexam.Examine
theretina.
46.Comments:

B=
Attempted
Below
Satisfactory

C=Did
Not
Attempt

Ears,NoseandThroat(ENT)
47.EARSOTOSCOPY:Exshouldgentlypulltheauricleupandback.While A=
holdingtheotoscope,theExshouldslowlyinsertthespeculumwitha
Attempted
downwardandforwardmovementintotheearcanal.TheExshould
Satisfactory
observetheexternalcanal,cerumen,tympanicmembrane,andtympanic
membranelandmarks.Repeatwithoppositeear.

B=Attemped C=Did
Below
Not
Satisfactory
Attempt

48.NASALPATENCY:ExshouldaskPttoinhalethrougheachnostril
A=
separatelywhiletheoppositenostrilisheldshut.CranialNerveI(senseof Attempted
smell)isexaminedinspecialcircumstances.
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

49.NARES:ExshouldbepositionedinfrontofPtwhilegentlyinsertingthe A=
shortwidetippedspeculumintoPt'snostril.Exshouldexaminethelower Attempted
portionsofthenoseandthenaskPttotiltheadslightlybackwards.
Satisfactory
Observethemucosaforcolorandpresenceoflesions.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

50.MOUTH&THROAT:Exshouldusealighttoinspectthemouth(lips, A=
tongue,mucosa,teeth,gums,parotidduct,uvula,pharynx,tonsils,soft& Attempted
hardpalates)forstructure,color,moisture,andlesions.Usingatongue Satisfactory
depressorExshoulddepressmorethanhalfwaybackonthetongueto
observetheposteriororopharynxandsurroundingstructures.Exmay
havePtphonatewhileinspectingthethroat.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

51.MOUTH&THROAT:ExshouldaskPttobitedown.Exwillprobably A=
inspecttheteethandgumsatthesametimeusingatonguedepressoror Attempted
glovedfingertomovethelipsandbuccalmucosaaside.
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

52.MOUTH&THROAT:ExshouldaskPttoextendTONGUEandmoveit A=
fromsidetoside.Inspectthefloorofmouth(underthetongue).
Attempted
Satisfactory
53.Comments:

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

Heart&BloodVessels(Heart)
54.INSPECTIONJUGULARVENOUSPULSE:WithPtreclinedto30
A=
degreesfromhorizontal,Exshouldshinehis/herpenlightoverrightside Attempted
ofthePt'sneck.Exshouldmeasurejugularvenousheightforrightatrial Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

pressureestimate(verticaldistanceabovesternalangle),changeinheight
withrespiratorycycle,andvenouswavecontour(aandvwaves).
55.PULSEPALPATIONCAROTID:Exshouldexertgentlepressurewith A=
thepadsoffingersonPt'scarotidarteryjustbelowtheangleofthejaw. Attempted
ThisprocedureshouldberepeatedontheoppositesideandshouldNOTbe Satisfactory
donesimultaneously.ExshouldaskPttoholdhis/herbreathwhileExuses
thebellofthestethoscopetoauscultatethecarotidartery.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

56.INSPECTIONPRECORDIAL:Exshouldinspecttheprecordium.
Observesymmetry,visualevidenceofthePMI

A=
Attempted
Satisfactory
57.PALPATIONPRECORDIUM:Exshouldusethepalmarsurfaceof
A=
his/herfingerstogentlypalpatetheleftsternalborderandthebasewhile Attempted
Ptislyingsupine.Exshouldassessforthrills,timingofS1orS2.
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt
B=Attempted C=Did
Below
Not
Satisfactory
Attempt

58.PALPATIONOFPOINTOFMAXIMALIMPULSE(PMI):Exshould
observelocationandintensity.ExmayaskPttorolltothelefttohelp
identifythePMI.IfthePtisfemale,breasttissuemayneedtobe
displaced.

A=
Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

A=
59.CARDIACAUSCULTATION:ExshouldlistentoPt'sheartusingthe
Attempted
diaphragmofthestethoscope.Whenusingthediaphragm,itshouldbe
Satisfactory
pressedfirmlyontochest.Ptshouldbesupine.Evaluateforcardiac
murmursandnotelocation,loudness(1/66/6),quality(harshsoft,high
orlowpitch),radiationpattern,andinwhichportionofthecardiaccycle
themurmuroccurs(DiastolicvsSystolic).Usingthebellofthe
stethoscopeoverthePMIExshouldlistenforpresenceofcardiac
gallopsincludingS3and/orS4.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

60.AUSCULTATIONAORTICAREA:Exshouldlistentotheheartinthe A=
right2ndintercostalspace.
Attempted
Satisfactory
61.AUSCULTATIONPULMONICAREA:Exshouldlistentotheheartin A=
theareatheleft2ndintercostalspace.
Attempted
Satisfactory
62.AUSCULTATIONTRICUSPIDAREA:Exshouldlistentotheheartin A=
theleftparasternal5thintercostalspace.
Attempted
Satisfactory
63.AUSCULTATIONMITRALAREA:Exshouldlistentotheheartatthe A=
intersectionoftheleftmidclavicularlineandthe5thintercostalspace.
Attempted
Satisfactory
64.PULSEPALPATIONBRACHIAL:Exshouldlocateandpalpatethe
A=
pulseofthebrachialarterybilaterally.
Attempted
Satisfactory
65.PULSEPALPATIONRADIAL:Exshouldlocateandpalpatethepulseof A=
theradialarterybilaterally.Exshouldassessrate,rhythm,volume,
Attempted
compressibility,contour,symmetry,andvolumevariationwithrespiration. Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt
B=Attempted C=Did
Below
Not
Satisfactory
Attempt
B=Attempted C=Did
Below
Not
Satisfactory
Attempt
B=Attempted C=Did
Below
Not
Satisfactory
Attempt
B=Attempted C=Did
Below
Not
Satisfactory
Attempt
B=Attempted C=Did
Below
Not
Satisfactory
Attempt

66.PULSEPALPATIONULNAR:Exshouldlocateandpalpatethepulseof A=
theulnararterybilaterally.
Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

67.PULSEPALPATIONPOPLITEAL:Exshouldlocateandpalpatethe
pulseofthepoplitealarterybilaterally.

A=
Attempted
Satisfactory
68.PULSEPALPATIONDORSALISPEDIS:Exshouldlocateandpalpate A=
thepulseofthedorsalispedisarterybilaterally.
Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt
B=Attempted C=Did
Below
Not
Satisfactory
Attempt

69.PULSEPALPATIONPOSTERIORTIBIAL:Exshouldlocateand
palpatethepulseofthePosteriortibialarterybilaterally.

A=
Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

71.INSPECTIONofCHEST:ExshouldvisuallyinspectPt'schestinasitting A=
positionforshapeandsymmetry,symmetryofrespiratoryexcursion,
Attempted
pulsations,heavingandrespiratoryeffort.
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

72.THORACICEXPANSION:WhilestandingbehindPt,Exshouldplace A=
thumbsparallelandseveralincheslateraltohis/hermidtolowerspine.Pt Attempted
shouldthenbeaskedtoinhaledeeplythenexhalewhileExassessesthe Satisfactory
rangeandsymmetryofPt'srespirations.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

73.TACTILEFREMITUS:WhilestandingbehindPt,Exshouldplacehis/her A=
palmarorulnarsurfaceofbothhandsonPt'supper,middleandlower
Attempted
back.ExshouldaskPttoreciteafewwordsornumbers(ex."99")while Satisfactory
he/shenotesthetransmittedvibrationsbilaterallybothposteriorlyand
interiorly.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

74.PERCUSSION:Expercussesoverposteriorandanteriorchest.Explaces A=
middlefinger,whichishyperextended,againstPt'sskin,liftingtherestof Attempted
thestationaryhandup.Usingthemiddlefingerofthedominanthand,Ex Satisfactory
shouldtapitagainstthestationaryone.Exshouldmovehorizontallyfrom
onelungtotheotherthenrepeatonthreetofourdifferentlevels.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

75.DIAPHRAGMATICEXCURSION:ExshouldaskPtto"takeadeep
A=
breathandholdit"whileExpercussesdownthemidscapularline.The Attempted
lowestlevelofexcursionshouldbedeterminedbypercussion.Exshould Satisfactory
thenaskPtto"exhaleandholdit"aslongaspossiblewhilehe/shere
percussesthebacktodeterminethehighestlevel.Thedifferencebetween
theselinesshouldbedeterminedbilaterally.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

76.AUSCULTATIONOFPOSTERIORBREATHSOUNDS:Exshould
A=
listentothePt'schestusingthediaphragmofthestethoscope,which
Attempted
shouldbepressedfirmlyontochest.ExshouldaskPttobreathedeeply Satisfactory
throughmouthwhileExlistenstoatleastonefullbreathbilaterallyover
threetofourlevelsofthelungfields.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

77.ANTERIORBREATHSOUNDS:Exshouldusestethoscopetolistento A=
bothsidesofthefrontofPt'schest.Exshouldatleastauscultateoverright Attempted
middleloberegionandleftlingua.
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

78.VOCALRESONANCE:Whileauscultatingwiththestethoscopeoverthe A=

B=Attempted C=Did

70.Comments:

Chest/Lung(Chest)

back,ExasksthePttosay"eee".Theexaminershouldmovethe
Attempted
stethoscopefromonesidetotheotherwhilelisteningforegophonyateach Satisfactory
location.EgophonyisnotedbyanEtoAchange.

Below
Satisfactory

Not
Attempt

80.INSPECTION:ExshouldinspectTHEabdomenforcontour,symmetry, A=
movement,scars.(Exshouldstatewhathe/sheisinspectingfor.)
Attempted
Satisfactory
81.AUSCULTATION:Exshouldlistentoallfourquadrantsofthe
A=
abdomen:RUQ,LUQ,RLQ,andLLQ.
Attempted
Satisfactory
82.VASCULARAUSCULTATION:ExshouldlistentotheAORTICartery A=
(locatedinthemiddleoftheabdomenabovetheumbilicus),therenal
Attempted
arteries(locatedbilaterallyabovetheumbilicus),theiliacarteries(located Satisfactory
bilaterallybelowtheumbilicus).

B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory

C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt

83.LIVERPERCUSSION:Exshouldbeginpercussingtheliverattheright A=
midclavicularlineovertherightabdomenattheleveloftheumbilicusand Attempted
proceedsuperiorly.Then,Exshouldbeginintherightmidclavicularline Satisfactory
overthelungandproceedinferiorly.Theareaofdullnessbetweenthese
twoareasrepresentstheliverspan.Exshouldnoteitssizeincentimeters.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

84.LIVERPALPATION:Usingdeeppalpationpressfirmlyatthecostal
A=
marginandattempttofeeltheliversedge.Thehookingtechnique,
Attempted
pressingthefingersaroundthecoastalmarginwhilehandsoverlytheribs, Satisfactory
isalsoacceptable.

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

85.SPLEENPERCUSSION:ExshouldpercussatCastell'sSpot(the
junctionanterioraxillaryline&costalmargin)andthenrepeatwhilePt
holdsadeepbreath.

A=
Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

86.SPLEENPALPATION:WhilestandingonthePtsRtheExshould
reacharoundthePtsLribcageandapplypressureusingtherighthand
whiletheusingtheotherhandtopalpatefirmlyatthelateralcostal
margin.

A=
Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

87.PALPATIONLIGHT:Exshouldfirstpalpateallfourquadrantsandthe A=
epigastriumLIGHTLYwhileusingthepalmarsurfaceofthefingersto Attempted
identifyanymasses,areasoftenderness,andresistancetopressure.
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

88.PALPATIONDEEP:Exshouldpalpateallfourquadrantsandthe
A=
epigastriummoreDEEPLYwhileusingthepalmarsurfaceofthefingers. Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

89.PALPATIONAORTICPULSE:Exshoulduseanopposingthumband A=
fingerorpalmarsurfaceoffingersandpalpatetheaorticpulsationlocated Attempted
intheupperabdomenslightlytotheleftofmidline.
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

79.Comments:

Abdominal(Abd)

90.PALPATIONCVATENDERNESS:Exshouldusehis/herfistand
percussthekidneysbilaterallyjustunderthelowestribposteriorly.
91.Comments:

A=
Attempted
Satisfactory

B=Attempted C=Did
Below
Not
Satisfactory
Attempt

Neurological(NEURO)
92.MENTALSTATUS:ExshouldaskPtquestionspertainingto A=Attempted
his/herorientation(person,place,time,and/orsituation).Ex Satisfactory
shouldaskaminimumof3questions.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

CRANIALNERVES:
PleasenotethatCNsII,III,IV,VIarealsolistedintheHNE
sectioncanalsobedoneinsteadduringtheneurologicexam.
TheseneedtobeperformedonlyONCEinwhicheverorderthe
studentprefers.
93.CranialNerveI(olfactory)Testingofthisnerveisnot
A=Attempted
required,butsubstancessuchascoffeegroundsmaybeutilized Satisfactory
ifindicatedincertainclinicalcircumstances.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

94.CranialNerveII(visualacuity)Testingofthisnerveisnot
required,butmaybedoneifindicatedincertainclinical
circumstances.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

A=Attempted
Satisfactory

A=Attempted
95.CNIII,IV,VI:EYEEXTRAOCULARMOVEMENT:Ex
Satisfactory
shouldbepositionedinfrontofPtandrequestthatwithout
movinghis/herhead,Pt'seyesfollowEx'sfingerorapencil
throughsixcardinaldirectionsofgaze(leadPtsgazeinawide
Hshape).
96.CRANIALNERVES:VTrigeminal.
A=Attempted
ExshouldaskPTtoconfirmsensationoffacialtouchineach Satisfactory
ofthethreenervedivisionsbilaterally.

B=AttemptedBelow CDid
Satisfactory
Not
Attempt

97.CRANIALNERVES:VIIFacial.Exshouldassesspt'sfacial A=Attempted
musclesatrestandthenassesssymmetryduringactivationby Satisfactory
askinghim/hertoraiseeyebrows,puffoutcheeks,andsmile.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

98.CRANIALNERVES:VIIIAcoustic.ExshouldaskPtto
A=Attempted
identifywhenhe/shebeginstoheartherubbingoffingers.Ex Satisfactory
willbeginwithfingersapprox.3feetfromthesideofPt'shead
andwillmoveincloseruntilidentified.ExmayaskPtto
distinguishwhisperineachear.Eithertechniqueisacceptable.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

99.CRANIALNERVES:IXandXGlossopharyngeal.TheEx. A=Attempted
Shouldaskthepatienttoopenhis/hermouthandsayAHto Satisfactory
assessforpalatesymmetry,elevation,and/oruvuladeviation.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

100.CRANIALNERVES:XISpinalAccessory.TheExshould A=Attempted
askPtto turn his/her head to the side and resist while the Ex Satisfactory
attempts to push it back to the midline.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

ORExshouldaskPttoshrugshouldersupagainstEx's
hands.
101.CRANIALNERVES:XIIHypoglossal.ExshouldaskPtto A=Attempted
stickhis/hertongueoutofthemouthandmoveitfromside Satisfactory
toside.
MOTORFUNCTION:
102.UPPEREXTREMITYSTRENGTHTESTINGAssessC5,6 A=Attempted
byhavingPtflexbilateralbicepsmuscles.
Satisfactory
103.UPPEREXTREMITYSTRENGTHTESTINGAssessC5, A=Attempted
6,7byhavingPtextendbilateraltricepsmuscles.
Satisfactory
104.UPPEREXTREMITYSTRENGTHTESTINGAssessC6, A=Attempted
7,8,radialnervebyhavingPtextendbilateralwrists.
Satisfactory

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

105.UPPEREXTREMITYSTRENGTHTESTINGAssessC7, A=Attempted
8,&T1byhavingPttightlygripExsfingersbilaterally.
Satisfactory

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

106.UPPEREXTREMITYSTRENGTHTESTINGAssessC8, A=Attempted
T1byhavingPtabductallfingers/thumbwhileExattempts Satisfactory
toforcedigitstogether.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

107.LOWEREXTREMITYSTRENGTHTESTINGAssessL2, A=Attempted
3,4byhavingPtflexbilateralhips.
Satisfactory

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

108.LOWEREXTREMITYSTRENGTHTESTINGAssessS1 A=Attempted
byhavingPtextendbilateralhips.
Satisfactory
109.LOWEREXTREMITYSTRENGTHTESTINGAssessL2, A=Attempted
3,4byhavingPtextendatthekneebilaterally.
Satisfactory
110.LOWEREXTREMITYSTRENGTHTESTINGAssessL4, A=Attempted
5,S1,S2byhavingPtflexatthekneebilaterally.
Satisfactory
111.LOWEREXTREMITYSTRENGTHTESTINGAssessL4, A=Attempted
5,S1byhavingPtbothdorsiflexandplantarflexatbilateral Satisfactory
ankles.

SENSORYFUNCTION:
112.SENSATIONLIGHTTOUCH.Usingawispfromacotton A=Attempted
Satisfactory
swaborlightlytouchingthepatientwithExsfingertips,
assessforbilateralperceptioninallfourextremitiesboth
proximallyanddistallyinanattempttotestalldermatomes.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

113.SENSATIONPINPRICKORTEMPERATURE.Usinga

B=AttemptedBelow C=Did

A=Attempted

sharpsafetypinorbrokenendofaswabstick,assessfor
Satisfactory
bilateralperceptioninallfourextremitiesbothproximallyand
distallyinanattempttotestalldermatomes.Testtubeswith
hotandcoldwatercanalternativelybeused

Satisfactory

Not
Attempt

114.SENSATIONPROPRIOCEPTION.ExshouldholdPtstoes A=Attempted
(oneatatime)oneachside.Demonstrateupversus
Satisfactory
downtoPt.Ptshouldclosehis/hereyes&Exshouldtest
randomdigits.Thisassessmentshouldbeonbothtoes&
fingers.Ifintact,Exmaystop.Ifdeficitsexist,Exshould
evaluatenextmoremostdistaljoint;ie,ankleorwrist.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

115.SENSATIONVIBRATION:Exshouldplaceavibrating
A=Attempted
tuningforkagainstthebonyprominenceofPt'sFINGER
Satisfactory
ANDTOEandaskPttostatewhenthevibrationstops.If
vibrationsenseisdecreaseddistally,thestudentshouldcheck
vibrationsenseattheankleorwrist.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

REFLEXES:
116.REFLEXTECHNIQUE:Themovementofthehammer
shouldbearapiddownwardsnapofthewrist.Thehammer
shouldnotbeheldtoofirmly.

A=Attempted
Satisfactory

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

117.REFLEX:BICEPS,bilaterally

AAttempted
Satisfactory

118.REFLEX:TRICEPS,bilaterally

AAttempted
Satisfactory

119.REFLEX:BRACHIORADIALIS,bilaterally

A=Attempted
Satisfactory

120.REFLEX:PATELLAR,bilaterally

A=Attempted
Satisfactory

121.REFLEX:ACHILLESTENDON,bilaterally

A=Attempted
Satisfactory

122.REFLEX:PLANTAR(Babinski),bilaterally

A=Attempted
Satisfactory

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt
B=AttemptedBelow CDid
Satisfactory
Not
Attempt
B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

COORDINATION/CerebellarFunction:
123.PointtoPointMovements.FortheupperextremityEx
A=Attempted
shouldholdouthis/herindexfingerandaskPttotouchitwith Satisfactory
his/herindexfinger.Exsfingershouldbemoved
periodicallytoforcePttoalterdirection.RepeatwithPts
otherhand.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

124.PointtoPointMovements.ForthelowerextremityEx
A=Attempted
shouldplaceoneheelontheoppositekneeandrunitdownto Satisfactory
theankle.RepeatwithPtsotherfoot.

B=AttemptedBelow C=Did
Satisfactory
Not
Attempt

GAITandSTATION:

125.ROMBERGSIGN:ExshouldobservePtstandwithhis/her A=
armsstretchedoutinfrontofhim/herwitheyesclosed.
Attempted
Satisfactory

B=Attempted
Below
Satisfactory

C=DidNot
Attempt

126.GAIT:ExobservePtwalk,turn,andreturn.Alsoobserve
patientstandemgait.

B=Attempted
Below
Satisfactory

C=DidNot
Attempt

A=
Attempted
Satisfactory

Back(BACK)
127.Exshouldassessspineandhipsforalignmentbyinspectingand
palpatinganteriorsuperioriliacspine(ASIS)orposteriorsuperior
iliacspine(PSIS).

A=Attempted B=
Satisfactory
Attempted
Below
Satisfactory
128.SPINEPALPATION:Exshouldpalpatethespinousprocesses,the A=Attempted B=
paraspinalmusclesandthesacroiliacjoints.
Satisfactory
Attempted
Below
Satisfactory
129.SPINERANGEOFMOTION:Exshouldassessspinalflexion,
A=Attempted B=
extension,sidebending,andlateralrotation.
Satisfactory
Attempted
Below
Satisfactory
130.SPECIALTESTS:Exshouldperformastraightlegraisebilaterally A=Attempted B=
withPtsupine,passivelyraisinglegwithkneeextendedifEx
Satisfactory
Attempted
concernedaboutthepossibilityofradiculopathy.
Below
Satisfactory
131.SPECIALTESTS:ExshouldperformthePatrick/FABEREtest
A=Attempted B=
bilaterallywithPtinsupineposition.Whileplacingonelegin
Satisfactory
Attempted
flexion,abduction,externalrotationandextensionwithfootresting
Below
abovetheoppositeknee,theoppositelegshouldbefullyextended
Satisfactory
("figurefourposition").Exshouldthenpushdownontheflexed
kneewhileapplyingpressuretotheoppositeASIS.
132.Comments:

C=DidNot
Attempt

C=DidNot
Attempt

C=DidNot
Attempt

C=DidNot
Attempt

C=DidNot
Attempt

UpperExtremity(UE)
133.SHOULDERINSPECTION:Exshouldassesssymmetry,deformity A=Attempted B=Attempted
anddiscoloration.(Exshouldstatewhattheyareinspecting.)
Satisfactory
Below
Satisfactory

C=Did
Not
Attempt

134.SHOULDERPALPATION:Exshouldpalpateskeletalanatomyof
theshoulder:scapularspine,acromionprocess,acromioclavicular
jointandbicipitalgroove.Exshouldpalpatethemuscularsurface
anatomyoftheshoulder:trapezius,supraspinatus,infraspinatus,and
deltoid.(OnesideOK).

A=Attempted B=Attempted
Satisfactory
Below
Satisfactory

C=Did
Not
Attempt

135.SHOULDERRANGEOFMOTION:ExshouldaskPt.toflex,
extend,abduct(fullarc),internallyrotate(elbowflexed,thumbat
oppositescapula)andexternallyrotate(elbowflexed,handsoutat
sidesorbehindhead)bothshoulders.

A=Attempted B=Attempted
Satisfactory
Below
Satisfactory

C=Did
Not
Attempt

136.ELBOWINSPECTION:Exshouldassesssymmetry,deformityand A=Attempted B=Attempted

discoloration.(Exshouldstatewhattheyareinspecting.)
Satisfactory
Below
Satisfactory

C=Did
Not
Attempt

137.ELBOWPALPATION:Exshouldpalpatelateralepicondyle,medial A=Attempted B=Attempted

epicondyleandolecranonprocess(OnesideOK).
Satisfactory
Below
Satisfactory

C=Did
Not
Attempt

138.ELBOWRANGEOFMOTION:ExshouldaskPt.toflex,extend, A=Attempted B=Attempted

pronate,(elbowat90degree,palmdown)andsupinates(elbowat90 Satisfactory
Below
degree,palmup)bothelbows.
Satisfactory

C=Did
Not
Attempt

139.WRISTandHANDINSPECTION:Exshouldassesssymmetry,
A=Attempted B=Attempted
deformityanddiscolorationofthehands,aswellasthethenarand
Satisfactory
Below
hypothenareminences.(Exshouldstatewhattheyareinspectingfor.)
Satisfactory
A

C=Did
Not
Attempt

140.WRISTandHANDPALPATION:Exshouldpalpatewrist,CMC,
MCPandPIPjoints.

A=Attempted B=Attempted
Satisfactory
Below
Satisfactory

C=Did
Not
Attempt

141.WRISTandHANDRANGEOFMOTION:ExshouldaskPttoflex A=Attempted B=Attempted

andextendwrists,tomovehandtoulnarandradialsides,toextend Satisfactory
Below
fingersatMCPjointwithfingersstraight,andtomakefist,bilaterally.
Satisfactory

C=Did
Not
Attempt

142.Comments:

LowerExtremity(LE)
143.INSPECTION:Exshouldassessthestrengthofproximalhipmusclesby A=
askingPttorisefromchair.
Attempted
Satisfactory
144.INSPECTION:Exshouldassesships,knees,anklesandfeetfor
A=
symmetry,deformityanddiscolorationwhilePtisstanding.
Attempted
Satisfactory
145.HIPPALPATION:Exshouldpalpateiliaccrestandgreatertrochanter A=
ofthefemur.
Attempted
Satisfactory
146.HIPRANGEOFMOTION(PassiveFlexion):WithPtsupine,Ex
A=
shouldflexthepatient'shipwithkneebent.
Attempted
Satisfactory
147.HIPRANGEOFMOTION(PassiveRotation):WITHPTSUPINE
A=
ANDKNEEFLEXEDTO~90degrees,Exshouldinternallyand
Attempted
externallyrotatePt'ship.
Satisfactory
148.HIPRANGEOFMOTION(PassiveAbductionandAdduction):With A=
thePtsupine,ExshouldadductandabductPt'ship.
Attempted
Satisfactory
149.HIPRANGEOFMOTION(PassiveExtension):WithPtproneor
A=
standing,ExshouldextendPt'ship.
Attempted
Satisfactory
150.KNEEINSPECTION:ExshouldinspectkneewithPtsupinefor
A=
swellinganddiscoloration.
Attempted
Satisfactory

B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory

C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt

151.KNEEPALPATION:Exshouldpalpatethepoplitealspace,the
tibiofemoraljointspacelaterallyandmedially,andthepatella.

A=
Attempted
Satisfactory
152.KNEERANGEOFMOTION:ExshouldaskPttoflexandextendknee, A=
bilaterally.
Attempted
Satisfactory
153.KNEESPECIALMANEUVERSMediolateralInstability:Exshould A=
flexkneeto30degrees,applyvarusandvalgusstresstoknee,assessing Attempted
formedialandlaterallaxity.
Satisfactory

B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Atempted
Below
Satisfactory

C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt

154.KNEESPECIALMANEUVERSCruciateLigament,LachmanTest:Ex A=
shouldflexkneeto20to30degreesandgraspthedistalthighwithone Attempted
hand(thumbshouldwrapoverthighjustabovepatella).Exshould
Satisfactory
grasptheproximaltibiawithotherhandandpullstibiaanteriorly.OR
CruciateLigament,Drawertest:Exshouldflexkneeto90degrees,
stabilizefootbylightlysittingonit,andpulltibiaanteriorlyandalso
pushposteriorly.

B=Atempted C=Did
Below
Not
Satisfactory
Attempt

155.ANKLEandFOOTINSPECTION:Exshouldinspectforswellingand A=
discoloration.
Attempted
Satisfactory
156.ANKLEandFOOTPALPATION:Exshouldpalpateachillestendon, A=
lateralandmedialmalleoliandforefoot.
Attempted
Satisfactory
157.ANKLEandFOOTRANGEOFMOTION:ExshouldaskPtto
A=
dorsiflex,plantarflex,evertandinverttheankle.
Attempted
Satisfactory
158.Comments:

B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory
B=Attempted
Below
Satisfactory

C=Did
Not
Attempt
C=Did
Not
Attempt
C=Did
Not
Attempt