Prep sheet for comprehensive physical exam (Vital signs through

HEENT)

Beth Choby, MD
Includes VS, HEENT
Peripheral vascular, cardiac, lung and abdominal exams will be incorporated once that material is
presented in class

Transitioning from the history:

Be patient centered: Ive asked you a lot of questions- is there anything that you think is
important that we have not talked about before we start the physical exam?
Compare this to the less patient-centered I have all the information that I need for my
presentation and Im now going to do the physical exam. please avoid
Fine the words that work best for you

Points to remember:
Look for the white sheet of paper that has the patients height and weight
Look for the BMI card (on the counter) that is sitting by the paper with the height and
weight
Dont forget to get the patients DOB and full name (patients can have look alike/sound
alike names, so you want to be sure you have the right patient)
By protocol, examine from the RIGHT side of the table. This allows for a better exam of
jugular venous distention and the liver (once you get there). While you may need to cross
to the patients left (left side of table) for an ear exam or listening to/finding the PMI
during the cardiac exam (once you get there), conduct your exam from the right side of
the table.

Vital signs
Pulse: Checks bilateral radial pulse for at least 15-30 seconds
Respiratory rate: unobtrusively obtains respiratory rate
Blood pressure: Obtains blood pressure (supports arm at heart level)
BMI: determine BMI using card with height and weight provided by SP
Temperature: will be provided on the door notes (write it down with the vital signs in the
physical exam section of your notes)

HEENT
Head
Palpates skull
Examines hair
Palpates frontal and maxillary sinuses bilaterally
Palpates lymph nodes (occipital, pre- and post-auricular, tonsillar, submandibular, submental,
superficial cervical)
Eye
Examines eyelids and brows
Examines bilateral conjunctiva/sclera
Test extraocular muscles/range of motion/nystagmus
Checks pupillary reflexes (direct and consensual) and alignment (pupillary light reflection)
Checks vision with Snellen card
Checks optic discs bilaterally using ophthalmoscope

Ear
Inspects and palpates external ears (pinna, tragus, helix)
Conducts finger rub OR whisper test for hearing
Performs Webber test (places tuning fork on forehead or top of head to check if lateralization
occurs)
Performs Rinne test (assessing air vs. bone conduction)
Visualizes tympanic membrane and EAC using otoscope

Nose
Assesses nasal patency
Looks in bilateral nares using otoscope and speculum

Mouth/pharynx
Has patient open mouth and examines with light
Inspects buccal mucosa and under tongue
Inspects teeth and salivary glands
Visualizes oropharynx (using otoscope light with tongue blade [if needed])

Neck
Checks lymph nodes (if not done before: supraclavicular, superficial cervical and posterior
cervical)
Listens for carotid bruits bilaterally*
Palpates carotid pulse (one at a time; below carotid bulb)*
Palpates trachea to assess if midline/mobile
Palpates thyroid from anterior side
Checks thyroid from posterior approach
Inspects jugular venous distention (patient at 30 degree recumbency; may measure using ruler)*

*We will go over these PE maneuvers during peripheral vascular and cardiac exam segments