Examine Head and Face:

I’m now going to inspect your head and your face. This is because I want to ensure you don’t
have any lumps, lesions or infestations. I’m also going to check your sinuses and assess for
tenderness. I’m also going to check that your ears are aligned with your eyes.
Wash hands and put on gloves. Inspect skull for contour and hair for color and distribution as
well as texture. Palpate/assess scalp for tenderness, lesions, masses, etc. Inspect facial features
and symmetry.
Your facial features are symmetrical and I don’t feel any masses or lesions. Now I’m going to
check your TMJ or your jaw joint. I need you to open/close/open/side to side. Check TMJ
(temperomandibular joint).

I’m going to feel your temporal pulses now and then we can move on to your neck.

Examine Neck and lymph nodes and skin turgor:

Now I’m going to observe your neck and your lymph nodes. I’m also going to make sure your
trachea is midline or in the right place. Can you please turn your head laterally or side to side?
And can you please flex your head forward- chin to chest? Now can you please extend your
backwards, now can you please touch each ear to the corresponding shoulder? I’m checking your
range of motion. Now I’m going to pinch your skin and see how fast it goes back down, this is
just to check your skins elasticity.

PERRLA, Cardinal Gazes, Look Inside Mouth, Nose, Ears, etc:

I’m now going to check on some various nerves, and inspect your mouth, nose and ears. First
I’m going to check your visual acquity. Can you please cover one eye and read the lowest line
possible and then cover the other eye and do the same?
Assess CN II-Have the patient stand 20 feet away from the Snellen eye chart, cover one eye and
read the lowest line that they can, cover the other eye and do the same.
Now, I’m checking to make sure that your pupils are equal and reactive. Please look straight
ahead while I check your PERRLA. PERRLA stands for pupils are equal round and reactive to
light. Now I need you to look straight ahead, cover one eye and uncover, then cover the other
eye and uncover.
Now please follow my finger with your eyes only.
Check the patient's cardinal gazes. Have them follow your finger with eyes only. Then have
them follow your finger as you gradually bring it closer to their nose. (testing for convergence) -
their eyes should become crosseyed.
Ok great, I don’t see any nystagmus, deviation, or lid lag present. Now one last thing for your
eyes, I’m going ensure that your conjunctiva and sclera are the proper color and clarity, this is
partially to make sure that you aren’t jaundiced.
Now I’m going to inspect your nose to ensure you don’t have a deviated or perforated septum.
Look up their nose (CN 1 - Olfactory) with pen light. Your nose looks good, nose hair is present,
this is good because nose hair helps filter things from just flying in your nose. Can you occlude
or cover one nostril and close your eyes and let me know if you smell anything and what it is?
Use alcohol pad under both nostrils. I’m just ensuring that your sense of smell is functional.
(CN 9, 10, 12)
Now I’m going to have you open your mouth so I can inspect your teeth and your tongue and the
back of your throat. I’m just ensuring that everything is intact and in the proper place.
Have them stick out their tongue and say “ahh”. Have them stick out their tongue and move it
from side to side.
Can you swallow for me please? “Great!”
Now I just need you to smile and show teeth, and no teeth. Great, now I need you to frown. Can
you puff out your cheeks? Perfect, now can you push your cheek against my hand? On both
sides.
Now I’m going to place my hands on your shoulders and I need you to shrug your shoulders. So
everything is looking good so far, no signs of ptosis or facial droop. Now I am about to test your
facial sensation, meaning that I’m ensuring that you can feel sharp and dull sensations. I’m
going to have you close your eyes and then tell me when you feel something touching your face
and let me know if it feels sharp or dull. Inspect
CN 5 (Trigeminal) - sensory/touch.
Now I’m going to conduct some hearing tests. But first I’d like to inspect your ears. I’m
ensuring there aren’t any lesions, drainage or any masses present. Ok great! Your ears look
good, now I’m going to use this item, called a tuning fork. I’m just checking your hearing in
both ears.
CN 8 (Vestibulocochlear)- Webber and Rhinne

HAVE PATIENT MOVE TO EDGE OF BED.

Range of Motion- Upper Extremities:

Can you please?
-Have them raise both hands above head, then back down.
-Then raise both hands out to the side and back down.
-Extend arms behind and then back, do same with the other arm.
-Have them put arms out in front of them (like they are going to put up their dukes), but then
move arm down and then back up again.
-Then have them put hands out. Spread fingers, then together. Make a fist. Hands up
toward ceiling, then down towards the ground. Then in a circle/rotate.
-Touch each finger to your thumb.

Examine Upper Extremities:

Now I’m just going to examine your upper extremities, I’m assessing your skin and your
temperature and ensuring that there isn’t any swelling. Remember if there is any pain during this
assessment, please let me know.
Inspect patient's arm for skin characteristics, symmetry, and deformities.
Palpate the arms, elbows and wrists and fingers for temperature, tenderness, pain. Inspect palm
of hands for calluses or rough spots. Check capillary refill.
I’m ensuring that your blood is flowing adequately by checking your nails and I’m also ensuring
that there isn’t any clubbing which could indicate hypoxia. Now I just need to check your pulses
and your reflexes.
Palpate the brachial and radial pulses for presence and amplitude.
Now can you please put up your arms like you’re getting ready to fight? I’m going to test your
muscle strength. I’m going to push your arms towards you and I want you to push towards me.
Ok, great. Now I’m going to pull towards me and I want you to resist my pulling. Now I need
you to squeeze my fingers as hard as you can.

Upper extremities reflexes:

I’m going to be checking your arm reflexes now.
Biceps:
-support forearm on yours
-place your thumb over biceps tendon and strike your thumb nail
-you should feel and see a contraction of the bicep and flexion of the forearm

Triceps:
-suspend arm holding on upper arm
-strike triceps tendon just above elbow
-normal response is extension of forearm

Brachioradialis:
-hold thumb to suspend forearm in relaxation
-strike forearm directly
While I have you in this position, I’m going to check your lower extremities reflexes and muscle
strength and your pulses as well.

Lower extremities reflexes:

Patellar:
-let legs dangle freely
-strike tendon just below patella
-lower leg should extend

Achilles:
-dorsiflex foot
-strike achilles directly
-foot plantar should flex against hand

Pulses:
-popliteal
-posterior tibial
Dorsalis pedis

Muscle strength:
Now I’m going to test the muscle strength of your legs and knees.
Have patient move forward on the table a little, so their thighs are more accessible
Put your hands on patient's thighs and push down and ask them to lift leg (push against
hands/resist).
-Then put hands under patient's thigh and push up and have patient resist.
-Then push legs at outside of calf area to the inside and have patient resist.
-Then push inside of calf area outward and have patient resist.
-Then push on the top of the patient's foot and have them resist.
-Then push on the bottom of patient's foot and have them resist.
Ok great! Now I’m going to assess your chest and your back.

Assess Chest and back:

I’m checking for color, intactness, lesions, and scars. Your breathing is symmetric and appears
easy. Can you cough and take a deep breath?
Auscultate anterior chest for lung/breath sounds - there are 6 spots. Listening for resonance.
Ok great, there were no adventitious or concerning sounds. Your lungs sound clear bilaterally.
Now I’m just going to percuss or tap over the same spots I just listened at. I’m ensuring that
there aren’t any masses or other concerning issues.
Percuss.
Now I’m going to check your thoracic expansion and making sure that the vibrations in your
chest are bilateral or equal on both sides.
Place hands on either side and ask patient to breath deep. Then assess tactile fremitus by asking
patient to say “99”. 2 spots on front, (4 spots on back).
Now I’m going to listen to your heart sounds in 5 different spots. They are called the Aortic,
Pulmonic, Erb’s, Tricupsid, and Mitral.
Then auscultate heart sounds. While listening to apical, check radial. Have patient lean forward
some during apical.
Ok great, there were no rubs, clicks or murmurs.
Now I’m just going to go around you here and check your lung sounds and percuss or tap again
on your back. I’m also going to be checking your spine for alignment. When you feel the
stethoscope, please breath deep. Ok, great, now I’m going to check for thoracic expansion again,
as well as checking for the vibrations again. Please breathe deep, now say 99 each time I move
my hands. (4 spots on back)

Assess Abdomen:
I’m now going to assess your abdomen. I’m just checking to make sure that there aren’t any
bulges and that your umbilicus or belly button is midline. I’m also checking the contour of your
abdomen.
GET DOWN AT EYE LEVEL AND INSPECT.
I’m also looking to see if I see any movement or peristalsis or pulsations.
Auscultate abdomen (all four quadrants) for bowel sounds starting in the lower right quadrant.
Should hear tympany. Now I’m just going to percuss or tap to ensure that your organs are all in
place. Then lightly palpate using full hand, completely flat in all quadrants for tenderness,
guarding, and masses. Your abdomen should be soft, palpable, and without tenderness.
Now I’m going to examine your lower extremities.

Examine Lower Extremities:

I will now be checking for any swelling or edema. I will also check your pulses, posterior
tibialis and dorsalis pedis. This is to ensure that your blood is being perfused to your lower
extremities. Inspect their legs, ankles, and feet for skin characteristics, hair distribution, and
deformities.
-Palpate lower legs for masses, pain, edema etc.
-Palpate lower legs for temperature, pulses (posterior tibialis and dorsalis pedis) and tenderness
as well as edema (check for edema on the inner aspect of the lower leg).
(If comfortable, have patient take off socks so you can inspect their feet. Looking for
calluses, looking between each toe, as well as checking capillary refill)

Now, can you please stand up? I’m going to conclude this exam with some more range of motion
exercises.

-Have them twist side to side at the waist.

-Have them bend to one side and then to the other (like they are touching their hand to the side of
their knee).
-Have them bend over and touch their toes while you inspect their spine with forefinger and
middle finger spread apart to trace the spine. Make sure you stand at their side when they do this
and not behind them.
Ok great, your spine has normal curvature and I don’t see any signs of kyphosis or lordosis or
crepitus. Now I need you to stand up and close your eyes. This is called the Romberg test. I’ll
be right here in case you feel dizzy or fall.
Have them close their eyes with hands extended out in front of them for 30 seconds.
-Then have them lift one knee, then the other.
-Then extend one leg out, then the other.
-Then extend one leg behind and then back, then the other.
-Then abduct and adduct both legs at the side.
-Have patient rotate their knee toward the outside and then toward the inside. Do with the other
leg.
-Then have the patient bring the heel of one foot up toward the shin of the other foot and slide
foot down. Do the same with the other side.
-Then have them do foot exercises - stick one foot out, flex, dorsiflex, rotation, then repeat with
other foot.
-Then invert and evert your feet.

Conclusion:
Thank you so much for your time. The exam is now finished. Is there anything else you’d like
to discuss or need me to further explain? I’m now going to tidy your room back up and give you
your call light in case you need anything