PRE-EXAM
cartilage. Swallow water feel for isthmus rise. Displace to one side,
Wash hands and stethoscope
DRAPE
VITAL SIGNS
Blood pressure
o Fit cuff around arm with finger space
o Radial pulse, pump till you dont feel pulse, release, pump +30
o Rest their arm on your shoulder, use bell side
Pulse
o Radial, measure bilaterally - Both equal, strong and regular
o Measure 1 side only, count pulse for 30 sec
Respiration
o Count resp while taking second half 30 sec of pulse
HEENT
Palpate scalp front to back, note lumps or tenderness
Inspect hair separate strands at roots texture fine, no signs of HEART
alopecia
Wrinkle forehead, show teeth, smile
Inspect conjunctive, sclera of both eyes together move eyelids
down/up no conjunctival pallor/discharge, no scleral icterus
Visual acuity pt holds 14 away, cover eye, read low line possible
Visual field by confrontation move fingers inwards diagonally (2)
and horizontally (1), switch eyes tell me when you see 0, 1, or 2
fingers.
Exraocular eye mvmts CN 3, 4, 6 - Draw H
Convergence finger towards nose pupils also constricted
Pupil 4 mm, symmetric and round
Pupillary light reflex Dim lights, direct and consensual, both eyes
Opthalmoscope exam At 15*, see red reflex, follow vessels to optic
disc, look at me, I see the macula
Palpate external ear and mastoid pull on auricle, push on tragus,
palpate mastoid process. Any tenderness at any of those?
Auditory acuity cover 1 ear at a time, both eyes, rub fingers tell
me when you hear something and what you hear
Weber test 512 hz place fork on mid skull hear sound better in
one ear or both ears equally?
Rine test 512 hz- place on mastoid process tell me when hearing
goes away. Place in front of ear tell if you still hear it
Otoscope exam - brace hand against head, pull auricle see
tympanic membrane, its not erythematous or bugling, no exudate
Palpate sinuses frontal and maxillary
Inspect lips, gums, tongue, teeth, buccal mucosa, floor of mouth- use
tongue blade and light no fissures or lesions
Uvula CN 10 say ahh, uvula was midline
CN 11 pt shrug shoulder against your resistance
Lymph nodes (6) - Preauricular in front of ears/on cheeks , post
auricular behind ears, occipital at behind mastoid process, tonsillar is
under jaw near the back, submandibular is under jaw near chin,
submental is right under chin, superficial cervical is down the neck
on the outside of thyroids, posterior cervical is behind scm muscle,
deep cervical is same as posterior cervical except that you pinch the
skin slightly instead of just palpating them. Ask pt to raise shoulders,
and supraclavicular is right behind clavicle.
Neck ROM flex/ext, r/l lat rot, r/l lat bending
Thyroid Exam stand behind, index fingers positioned at cricoid
swallow water feel right lobe. Displace to other side, swallow
water feel left lobe. No nodules or irregularities
LUNGS
Inspect and palpate trachea trachea above sternal notch, midline
Tactile fremitus patient cross arms, you place hands at upper, mid,
lower thorax back,bilateral, pt says 99 no inc/dec/absent fremitus
Percuss post lung fields 3 levels, bilat
Percuss lat lung fields 2 levels, bilat
Auscult lung fields 3 levels, bilat, post slow deep breaths viamouth
Auscult lung fields 3 levels, bilat, lat slow deep breaths via mouth
Whispered pectoriloquy auscult 3 levels, bilat, pt whisper 99
Egophony auscult 3 levels, bilat, pt says ee
Percuss ant lung fields 2 levels, bilat
Auscult ant lung fields 2 levels bilat
Raise bed to 30-45*
Inspect Neck veins(R side only) noticing neck for any jugular
venous distention
Auscult carotid (bell) pt deep breath in, hold it, note bruits
Palpate carotid (1 side at a time) pulse is strong/regular/2+
Inspect Precordium I dont notice any heaves
Palpate precordium Use palm of hands at upper L sternal border
feel for impulses, thrills, or lift
Palpate point of max intensity (PMI) 5th intercostal, midclavic line,
PMI is nickel coin sized, strong in quality
Auscult Aortic area (diaphragm)
Auscult Pulmonic area (diaphragm)
Auscult Tricuspid area (diaphragm) from bottom if female
Auscult Mitral area (diaphragm)
Auscult Mitral area (bell) no gallops, murmurs or rubs
Palpate femoral pulse one at a time, bilat
Palpate popliteal pulse one at a time, bilat, bent knee
Palpate dorsalid pedis pulse both at same time, bilat equal/strong
Pitting edema test press for 5 sec on ant/med tibia
ABDOMEN
Bed is flat, expose abdomen abd is flat, no veins, rashes, masses
Auscult 4 quads bowel sounds present, no bruits
Percuss 4 quads
Palpate 4 quads 1st superficially, then deeply watching the patients
face to see if in any pain
Percuss liver span - Start at or below umbil level and move upwards
until percussion note changes from tympany to dullness, note that
level. Start nipple line and move downwards until note changes from
resonance to dullness. Liver span Normal length is 6 to 12 cm
Palpate liver edge Hooking technique, inspire feel liver edge
Palpate spleen Pt in R lat decub, inspire, feel spleen
Peritoneal inflamm ask if pt is feeling any pain in abd, palpate
towards that area, check rebound tenderness
Appendicitis 2/3 way from umb to ASIS is McBurneys point, ask
pt if any pain or tenderness
Costo-vertebral angle tenderness palm on mid back, L and then R
pound on palm, any tenderness?
NEUROLOGIC/EXTREMITIES MEDICAL HISTORY

Inspect Hands Nails, dorsum and palms Hx of Present illness

Check muscle tone tell patient to be relax, move shoulder, elbow o Chief complaint
and wrist joints. Move knee and ankle joints. Tone is not hypo or o Onset
hypertonic o Pall/prov
o Quality
Shoulder w/ R abd, add o Region
Forearm w/ R flex, ext o Severity
Wrists w/ R flex, ext o Time related change
Fingers w/ R flex, ext o Assoc symptoms
Hips w/ R flex and ext o Attrib by pt
o Ask pertienent negatives
Knee w/ R flex, ext
Past/Family Medical Hx
Ankle w/ R dorsiflex and planar flex
o Past/chronic illness
o Past hospitilizations/surgeries
Wash Hands
o Current meds/OTC/
o Allergies
Biceps reflex (sharp edge)
o Immunizations
Brachioradialis (sharp edge) ask pt to move thumb, use point o Family history related to CC
Triceps reflex (flat edge) pt move triceps, use point above elbow o Inherited familial DM, HTN, heart disease, cancer
Patellar reflex (flat edge) Social Hx
Achilles reflex (flat edge) o Pts living arrangement
Babinski/Plantar reflex slide tool on bottom of feet o Safe/comfortable at home? Exposure relation to CC?
o Work where?
Inspect feet and in b/w toes no atrophy, edema, no fungus, lesions o Safe/comfortable at work? Exposure relation to CC?
Vibration sense at toe (128 hz) hit fork, put your finger under big o Family married/kids
toe, put fork on top of toe tell me when vibration goes away o Smoke/alcohol/rec drugs
Position sense in toe Tell them whats up and down, close eyes, o Physical activity
move toes up or down o Diet
o Sexually active?
Wash Hands o Feel safe at home? At work?
Review of Systems 4 systems, 2 per
Light vs sharp touch 2 points on each side of face (4 total) , 1 point o General Fever, chills, weight loss
per limb o CV chest pain, dyspnea on exertion, orthopnea, paroxysmal
nocturnal dyspnea (PND shortness of breath while sleeping),
Cerebellar function pt touch your finger and then touch their nose. edema, syncope
Move your finger 3 spots for their left hand and then 3 spots w/ their o Endocrine goiter, heat-cold intolerance, polydipsia
right hand. o Central Nervous headache, vertigo, loss of vision, weakness in
any limbs
Spine curvature from back check scoliosis, from side check o Respiratory cough, sputum, dyspnea, wheezing
kyphosis and lordosis

Pronator drift pt standing, close eyes, feet apart, pt hand up in

pronated form for 15 sec

Romberg test pt standing, close eyes, feet together, arms side for
15 sec

Gait
o Normal
o On toes
o On heels
o Heel to toe