PHYSICAL EXAMINATION CHECKLIST
GENERAL EXAMINATION
Hand Splinter Haemorrhage | Koilonychias | Capillary Refill Time Clubbing Fingers
Peripheral Cyanosis | Tar Stains | Osler’s Nodes Palms | Janeway Lesion
Face Conjuctiva pallor | Jaundice mouth | Central cyanosis
CARDIOVASCULAR EXAMINATION
General Radial pulse – bpm, rhythm, volume, character (collapsing pulse?)
Blood pressure – systole & diastole by using sphygymomanometer
Jugular venous pressure –
Bilateral pitting edema – in lower limb
Precordium Position: 45
Exposure: chest to waist
Inspection
Surgical scar | Visible Pulsation | Apex beat | Thrill | Left Parasternal Heave
Auscultation
A (2R) – P (2L) – T (4L) – M (5L)
Peripheral Radial pulse – radial-radial delay & radial-femoral delay
Vascular Other pulse: brachial, femoral, popliteal, posterior tibial, dorsalis pedis
RESPIRATORY EXAMINATION
General Breathing – rate, effort, sound, pattern, nasal flaring
Flapping tremor
Anterior Position: Sitting up
Exposure: chest to waist
Inspection
Shape of chest (barrel, pigeon, funnel) | Surgical scars | Intercostal recession
Palpation
Position of trachea | Chest expansion | Tactile vocal fremitus
Percussion – resonant / hyper resonant / dull / stony dull
Percuss at supraclavicle, clavicle, ICS (2nd, 3rd, 5th & 6th)
Auscultation – bronchial / crackles / rhonchi
ICS (2nd & 4th) – diaphragm | Apical region (neck) – bell | Vocal fremitus
Posterior Position: Sitting up + hug a pillow
Exposure: chest to waist
Inspection
Shape of chest (normal / scoliosis / kyphosis) | Surgical scars
Palpation
Chest expansion | Tactile vocal fremitus
Percussion – resonant / hyper resonant / dull / stony dull
ICS – compare bilaterally
Auscultation – bronchial / crackles / rhonchi
ICS (2nd & 4th) – diaphragm | Vocal fremitus - diaphragm
ABDOMINAL EXAMINATION
Position: Supine
Exposure: Nipple line to mid-tight (respect: nipple line to symphysis
pubis)
Inspection
1) At the end of bed: symmetry, distension
2) Crouching: breathing pattern, visible pulsation
3) At the right side: shape, umbilicus (central/deviated/inverted/everted)
4) Discoloration
5) Dilated surface veins: spider naevi, caput medusa
6) Surgical scars: laparotomy, laparoscopic puncture marks,
appendectomy scars
7) Visible peristalsis
8) Scratch marks
9) Striae
Palpation
1) Superficial: mass, tenderness, guarding, raise temperature
2) Deep
3) Hepatomegaly
4) Spleenomegaly
5) Ballotable kidneys
Percussion – dull / resonant
1) All 9 quadrants
2) Liver length (normal: 6-12 cm)
3) Traube’s space – splenomegaly
4) Ascites – fluid trill, shifting dullness
Auscultation
1) Bowel sound (at umbilicus, using diaphragm). Normal 1-3 sound/min
(hyperactive / high pitched tinkling or rushing / grumblings)
2) Renal bruit (above lateral 2” from umbilicus, using bell)
3) Aortic bruit (midway btwn umbilicus & xiphoid, using bell)
End with Inguinoscrotal examination
Per rectal examination
LYMPH NODES EXAMINATION
Method Use pulp of index & middle fingers, circular motion. Comment on:
Site
Size (normal: <0.5 cm)
Tenderness
Consistency: soft / rubbery / matted / craggy / stony hard
Fixity to skin
Cervical LN Patient position: Sitting up
Examiner position : Stand behind
Palpation
Submental | Submandibular | Periauricular | Postauricular | Occipital |
Superior/Deep/Posterior Cervical Chain | Supraclavicular
Axillary LN Patient position: Sitting up
Examiner position : Stand in front
Palpation
Medial wall | Anterior wall | Lateral wall | Posterior wall | Upwards for deep
lymph nodes
NERVOUS SYSTEM EXAMINATION
Sensory Dorsal column
Light touch
Proprioception
Vibration
Two-point discrimination
Spinothalamic
Pain – sharp or dull
Temperature – hand/foreram/arm & foot/leg/thigh
Parietal cortex
Stereognosis
Graphestesia
Motor Upper limb
Inspection: exposure, bulk, fasciculation, involuntary movement
Tone: at wrist, elbow & shoulder (hypotonia/hypertonia)
Power: at shoulder, elbow, wrist, fingers
Reflex: at biceps, triceps, brachoradialis
Coordination: finger-nose test & rapid alternating movement
Lower limb
Inspection: exposure, bulk, fasciculation, involuntary movement
Tone: at ankle, knee & hip (hypotonia/hypertonia) –any clonus on
dorsiflex foot?
Power: at hip, knee & ankle
Reflex: at knee, ankle & plantar
Coordination: heel-shin test
Gait: normal walk, heel-to-toe, on toes, on heels, romberg’s test
Cranial Olfactory – sensory (eyes closed)
nerves Optic – sensory (visual acuity, visual fields, pupillary examination,
fundoscopy)
Occulomotor / Trochlear / Abducen – motor (H shaped movement)
Trigeminal – sensory, motor, corneal reflex & jaw jerk
Facial – sensory + motor (facial expression: wrinkle forehead, shut eyes tight,
grin)
Vestibulocochlear – sensory (Rinne & weber test)
Accessory – motor (trapezius & SCM)
Glossopharyngeal / Vagus – sensory + motor (uvula & aahhh)
Hypoglossal – motor (tongue wasted or deviated)
