PT SEATED, FACING EXAMINER
DOCTOR-PT INTERACTIONS
Introduce yourself to pt.
Throughout exam, communicate w/ clear, easy-to-understand instructions.
Throughout exam, place your hands on examinee respectfully & reassuringly.
Each time you reposition pt, adjust drape to preserve privacy & comfort.
GENERAL APPEARANCE - VS
Wash hands before shaking hands or starting examination.
Inspect & describe general appearance (development, comfort, look ill or well, etc.).
Count radial pulse & RR
Measure BP (by palpation & auscultation)
SKIN
Inspect skin (color/moisture/temperature/texture/mobility) during all portions of exam
EYES
Inspect lids (edema/color), lashes (condition/direction), sclera & conjunctivae (nodules/swelling/color)
Test pupil (direct/consensual) response to light (CN II, III) & visual fields (CN II)
Test EOMs (CN III, IV, VI) (nl conjugate movements/nystagmus/lid lag)
Visualize retina [optic disc (color/margin sharpness), cup (size), vessels, macula]
EARS, NOSE, MOUTH
Examine external ear (deformities/lumps/skin lesions)
Assess hearing w/ fingers rubbing - perform Rinne and Weber tests, if any abnormalities
Examine ear canal (cerumen/d/c/foreign bodies/redness/swelling) & TM (color/contour w/ cone of light)
Inspect nose (asymmetry/deformity), septum (deviation/inflammation/perforation), turbinates (color/swelling)
Inspect lips (color/moisture/lumps/ulcers/cracking/scaliness), gums (color/swelling/ulceration), teeth
(missing/discolored/misshapen), tongue/mouth floor (white or reddened areas/nodules/ulcerations), posterior pharynx
(color/exudate/tonsils presence & size)
Inspect soft palate symmetry & uvula midline while pt says ah (CN X)
Ask pt to protrude tongue (CN XII) (symmetry/color/texture)
NECK
Inspect & palpate for tracheal deviation (from midline position)
Palpate neck LNs: pre- & posterior auricular, occipital, submandibular, submental, anterior cervical,
posterior cervical, supraclavicular (size/shape/delimitation/mobility/consistency/tenderness)
Inspect thyroid gland while pt swallows (contour/symmetry)
Palpate thyroid while pt swallows (size/shape/consistency/nodules/tenderness)
UPPER EXTREMITIES
Inspect shoulders (contour), arms (size/symmetry/venous pattern), hands (contour), nails (color/shape)
Assess muscle bulk (size/contours) & tone (resistance to passive stretch), shoulder ROM
(flexion/extension/abduction/adduction/internal & external rotation)
Perform empty can (supraspinatus strength) & drop arm tests if shoulder discomfort
Perform pronator drift test if brain lesion suspected (upper limb weakness)
Palpate for axillary (central nodes) LAN
EXAMINER MOVES BEHIND SEATED PT
CHEST
Inspect back for curvature (upright spinal column), asymmetry (heights of shoulders/iliac crests), masses
Palpate spinous processes & check for tenderness
Check for CVA tenderness
Percuss posterior lung fields
Auscultate posterior, lateral, anterior lung fields (BS/adventitious sounds)
EXAMINER ON RIGHT SIDE OF SUPINE PT, HEAD ELEVATED 30-45
HEART/CV
Inspect neck veins (estimate JVP), anterior chest, precordium
Palpate carotid upstrokes (amplitude/contour)
Palpate heaves/lifts, thrills, PMI (location/diameter/amplitude)
Palpate radial & brachial pulses
Auscultate carotid arteries (bruits) w/ diaphragm
Auscultate precordium in anterior axilla & at apex, LLSB, 2ICS-LSB, 2ICS-RSB w/ diaphragm
Auscultate at apex & LLSB w/ bell
PT SUPINE (W/ PILLOW FOR NECK COMFORT)
ABDOMEN (pts legs bent)
Inspect (skin/umbilicus/contour/peristalsis/pulsations)
Auscultate (bowel sounds/bruits)
Percuss 4 quadrants, liver span, spleen
Palpate 4 quadrants lightly (guarding/rebound), then deeply (masses)
Palpate liver edge & spleen tip
Palpate aorta (pulsations/width)
Palpate femoral pulses
LOWER EXTREMITIES
Inspect knees, lower extremities, feet for swelling; feet for skin breaks, ulcers, sores
Palpate for pretibial pitting edema
Palpate joint line, MCL & LCL
Check knee ROM & perform Lachman test
Palpate DP & PT pulses (popliteal if DP or PT diminished)
NEUROLOGIC EXAM (if not integrated into regional exam)
Mental status: orientation, name 3 objects, repeat phrase, do 3 things, remember 3 objects
CNs: II through XII
Motor: tone, pronator drift, finger & foot taps, finger extension & ankle dorsiflexion strength
Reflexes: biceps, knee, ankle
Sensory: light touch, vibration/position, temperature/pain on distal extremities, Romberg
Coordination: finger-to-nose (FN)
Gait: walk across room, heel-to-toe (tandem), on toes, on heels
