Vital Signs & Measurements Checklist

UNIVERSITY OF SANTO TOMAS
Faculty of Medicine & Surgery

Department of Medicine
Medicine 1 SY 2016-2017
General Survey, Vital Signs, Anthropometric Measurements Checklist
PREPARATION
Asks permission
Explains what exactly is to be done to the patient
Ensures privacy and patient’s comfort
Ensures adequate lighting and exposure.
GENERAL SURVEY
Makes an accurate general survey and report according to the following parameters:
A. General appearance. Describe the general state of health ( well, acutely ill or chronically ill )
B. Skin color/Obvious skin lesions. Note for presence of jaundice, being sallow or pallor, cyanosis
C. Facies. Note for characteristic facies such moon facies of Cushing’s syndrome, stare of hyperthyroidism, etc.
D. Level of comfort. State whether patient is comfortable or in distress based on manner of speech (speaks in phrases);
position ( assumes tripod , 2-3 pillow orthopnea; squatting)
E. Level of consciousness. Report whether conscious, confused, lethargic, somnolent, obtunded, stuporous, or comatose;
Use also Glasgow coma scale
F. Ambulatory status. Observe if patient is ambulatory, ambulate with assistance, wheelchair borne, stretcher-borne,
bedridden.
G. Posture, gait distubances, and general motor activity. State if patient is relax, rigid, tense, restless, pacing, dragging one
foot, limping, shuffling gait, involuntary movements, immobile part
H. Body habitus. Classify patient whether hyposthenic (ectomorphic); sthenic (mesomorphic); hypersthenic (endomorphic)
I. Body Symmetry. Symmetrical, discrepancies in the size of parts, atrophy, hypertrophy. Abnormal distribution of normal
tissues (fat, muscles, subcutaneous tissue, bone)
J. Personal Hygiene and Grooming. Appropriate, well groomed, meticulous, unkempt
K. Odors of the body and breath. No characteristic odor, scent of alcohol, acetone breath in DKA, ammoniacal fish breath
of kidney failure
L. Mood and affect
- Attitude towards the examiner. Cooperative, guarded, suspicious, evasive, hostile, seductive
- Predominant mood. Neutral, anxious, fearful, elated , euphoric, angry, depressed, irritable
- Affect. Broad, restricted, labile. Intensity ( blunted, flat, animated
- Appropriateness
M. Psychomotor activity and speech
- Manner of Speech. Normal, slurred, appropriateness of words, hoarseness, pitch (high or low)
- Presence of abnormal movements. Grimacing, mannerism, stereotyping
N. Thought process and content. How the patient responds to questions; Stream of though is appropriate or inappropriate
(paranoia, delusions, obsessions, compulsions, phobias, illusions, hallucination, depersonalization, derealization)
O. Cognitive functions
- Orientation – as to time, place, person
- Memory – immediate, recent, remote
VITAL SIGNS
SYSTEMIC BLOOD PRESSURE
Prepare sphygmomanometer and stethoscope
Prepare paper and pen for immediate recording of blood pressure (BP)
Explain procedure in a reassuring manner
Ask permission
Ask for intake of the following 30-60 minutes prior to BP determination: caffeinated drinks, alcohol, illicit drugs,
antihypertensive meds, NSAIDs and steroids.
Ask for activities done 30-60 minutes prior to BP determination: smoking cigarettes, exercise or its equivalent
Ask and/or note for any condition the patient might be having prior to or during BP determination: anxiety, pain, bladder
distention, temperature change, noise
Instruct patient to rest for 5 minutes in a quiet and comfortably warm room
Instruct the patient to refrain from talking or doing anything from while blood pressure is taken
Avoid talking during the procedure
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RIGHT UPPER EXTREMITY BP

Move to the right side of the patient
If seated, patient: A. should be comfortable
B. should not sit with legs crossed
C. should be positioned with the feet flat on the floor
D. should sit with the back supported against the chair
E. should have his/her bared arm resting on a standard table or other support such that the arm on the
table is a little above the patient’s waist
F. should maintain the midpoint of the upper arm(brachial artery level) always at the level of the
heart(approximately at the 4th intercostal space at its junction with the sternum)
If supine, patient: A. should be positioned at a 30-45 degree angle

B. should maintain the midpoint of the upper arm(brachial artery level) always at the level of the
C. should be draped properly
If standing, patient: A. should be supported in such a way that the arm is at mid chest level
B. should maintain the midpoint of the upper arm(brachial artery level) always at the level of the
Remove clothing around patient’s arm and avoid rolling up the sleeve in such a manner that it forms a tight tourniquet
around the upper arm
Estimate by inspection, or measure with a tape, the circumference of the bare upper arm at midpoint between acromium
and olecranon
Select and use an approximately sized cuff. The length of the inflatable bladder inside the cuff should encircle 80% of the
upper arm, almost long enough to encircle the arm proper and the width of the inflatable bladder should be about 40%
(12-14 cm) of the upper arm circumference
Record if the available cuff is too small or too large
Use index and middle fingers to palpate for the patient’s brachial and radial arteries
Apply the cuff 2.5 cm above the antecubital fossa where the head of the stethoscope is to be placed
Ensure that the center of the inflatable bladder of the BP cuff is over the brachial artery pulsation
Wrap and secure the cuff snugly around the patient’s bare arm(make sure you are able to insert only 1 finger underneath
the cuff)
Place the manometer at eye level where it is easily visible. In cases of aneroid sphygmomanometer, hook the manometer
to the clothe cover of the inflatable bladder
Ensure the tubing from the cuff is unobstructed
MEASURE PALPATORY BP
Use index and middle fingers to palpate the radial artery
With the other hand, rapidly inflate cuff 10 mmHg increments while palpating radial artery pulse and note when the
pulse disappears.
Countercheck by further increasing by 20-30 mmHg above the level the pulse disappears during cuff inflation, after
which deflate cuff by 2-3mmHg/sec and note at which level the radial pulse reappears during deflation.
Read BP on the manometer and states palpatory (systolic) BP.
Deflate the cuff thereafter
MEASURE AUSCULTATORY BP
Waist 15-30 seconds after getting the palpatory BP
Place the earpieces of the stethoscope into your ear canals, angled forward to fit snugly
Palpate for the brachial artery again using index and middle finger
Place the head of the stethoscope(the low frequency bell over the brachial artery pulsation), just above and medial to
the antecubital fossa but below the edge of the cuff, and hold it firmly (but not too tightly) in place, making sure to
make an air seal with its full rim by ensuring that the head makes contact with the skin around its entire
circumference
Inflate the BP cuff rapidly and steadily to a pressure 20-30 mm Hg above the palpatory (systolic) BP previously
recorded
Partially unscrew(open) the valve and slowly deflate BP cuff by 2-3 mm Hg/sec while listening for the appearance of the
the Korotkoff sounds
As the pressure in the bladder falls, note the level of pressure on the manometer when the first Korotkoff sound is
heard (Phase I). Record this as the auscultatory systolic BP rounded off upward to the nearest 0-5 mmHg
Continue to deflate slowly by 2-3 mm Hg/sec and note the level on the manometer when the Korotkoff sound
disappears (Phase V). State and record this as the diastolic BP rounded off upward to the nearest 0-5 mmHg
GSVSAMSY 2016-2017
LEFT UPPER EXTREMITY BP

Stay on the left side of the patient.
Perform the above procedures correctly to the left upper extremity
State palpatory BP first
State auscultatory BP
Compare the BP on the left and the right upper extremities and state if the difference is within acceptable limits
RIGHT LOWER EXTREMITY BP (follow same procedure as BP taken in the upper extremities with
the following differences)
Position patient in prone or supine with leg slightly flex
Use a wide, long thigh cuff with a bladder size of 18 x 42 cm.
Apply the cuff to the mid-thigh
Center the bladder over the posterior surface
Wrap the cuff securely and snugly
Listen over the popliteal artery
State the BP on the right lower extremity
LOWER LEFT EXTREMITY BP
Perform the above procedures to the left lower extremity and state the BP on the left lower extremity
Compare the BP on the left and the right lower extremities and state if the difference is within acceptable limits
Compare the BP on the upper and the lower extremities and states if the difference is within acceptable limits
PULSE RATE
RADIAL PULSE
Position the patient’s arm in a relaxed position, palm downward or upward on top of the table, or the patient’s upper thigh, or
supported by your other
Locate radial artery using the pads of your index and middle fingers aligned longitudinally over the course of the artery by
applying gentle but firm pressure in the medial and ventral side of the patient’s wrist just below the base of his thumb. Do not
occlude the radial pulse
Counts the pulse rate for one full minute using a watch with a second hand
Simultaneously palpate radial pulses on both sides
Evaluate the pulse rhythm if regular or irregular
Compare the volume of pulsation on each artery and grade
0 – absent
1+ - weak or thread
2+ - normal
3+ - increased or strong
State and record
RESPIRATORY RATE
With the patient unaware, the respiratory rate is determined in a subtle way by pretending to continue counting pulse rate and
note the number of rise/fall (cycles) of the chest for 1 full minute and pattern if any
States respiratory rate
TEMPERATURE ( Choose one from the two methods BUT please note that there are other methods
to take the temperature such as temple, oral, rectal temperature determination)
With the use of a digital thermometer, takes the temperature
Tympanic membrane temperature
Do not attempt to take if patient has impacted cerumen, otitis media or interna or externa
Wash hands or use disinfectant and air dry
Ensures external auditory canal is free of cerumen
Prepare a new and undamaged probe cover
Turn on the thermometer
Straighten the external auditory canal by pulling the pinna upward then backward with one hand
Gently insert the probe to the external auditory canal and wait for the beep
Remove the probe
Read the temperature in the LED window and record
Immediately remove the probe cover and discard to a biohazard waste container
Clean digital thermometer with disinfectant
Return digital thermometer to the container
Thank the patient
Axillary temperature
Do not attempt to take if patient has axillary abscess, shoulder limitation/fracture, open sores, abrasions, or if the
patient is uncooperative
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Explain the procedure to the patient and get consent
Remove the patient’s clothing or gown as needed to access the axillary region
Pat the patient’s axilla dry with tissue or gauze if needed. Do not rub the area
Turn on the thermometer
Place the thermometer in the center of the armpit pointing the stem to the upper chest, making sure that the
temperature is touching only the skin and not the clothing
Firmly appose the arm to the chest to keep the thermometer in place until the beep is heard
Remove the probe
Read the temperature in the LED window and record
Clean digital thermometer with disinfectant
Return digital thermometer to the container
Thank the patient
ANTHROPROMETRIC MEASUREMENTS
Height : Measure the height of the patient in meters
STANDING
Ask the patient to remove shoes
Instruct patient to stand straight with feet together and place his back against the measuring tape against the wall
wherein the measuring tape is affixed, or
Instruct the patient to stand erect, feet together, with the head, shoulders, buttocks and heels touching the wall or the
measuring tape before measuring the height in centimeters
Measure the height in centimeters from the top of the head to the heels of the feet
Convert measurement to meters and record
SUPINE IN PATIENTS UNABLE TO STAND

Place patient in a supine position with the body fully extended
Measure the height in centimeters from the top of the head to the heels with a tape measure in centimeters
Convert measurement to meters and record
Weight: Measure the weight of the patient in kilograms
Instruct the patient to empty his/her bladder
Ask the patient to remove shoes
Prepare and use a calibrated weighing scale. Make sure the needle is at zero. Use a bed scale for patient who is bed
ridden
For serial weight measurements, obtain the time of the measurement at approximately the same time of the day and as
much as possible wearing the same amount of clothing.
Have the patient stand still at the middle of the platform of the weighing scale
Wait for the needle to stabilize, then read. Record the weight in kilograms.
Compute for the body mass index (BMI)
BMI = weight in kg/height in meter2
GSVSAMSY 2016-2017
Medicine 1
HENT/NECK Examination Checklist
I. HEAD
A. INSPECTION
Sit at the same level or slightly higher than the patient
Observe the position of patient’s head, note any tilting or abnormal head movement like nodding, jerking, or bobbing
motion
Note any characteristic facies by inspecting the position, size, shape and symmetry of the eyebrows, eyelids, palpebral
fissures, nasolabial fold and mouth as well the face and overall facial structure
Note any abnormal facial movements such as tics
Inspect the skull for size, shape and symmetry and systematically inspect the scalp from the frontal to the occipital area
by parting the hair by region noting for any scale lesion, nit or scab
Inspect the hair for any hair loss pattern
B. PALPATION
Palpate the skull through the scalp by gentle rotatory movement starting from the frontal area towards the occipital area.
Note whether there is any tenderness, or soft tissue swelling. Note for any bony prominence or depression in areas
where it is not expected.
If patient is seated higher than you, ask the patient to bow his/her head, so that you may reach it adequately.
You may sit or stand in front or behind the patient,
Palpate the patient’s hair and note for its texture, color, and distribution. Note whether it is smooth, symmetrically
distributed and not brittle.
In elderly, palpate for any tenderness, hardness, or thickening in the temporal artery.
II. EAR
A. INSPECTION, PALPATION, AND OTOSCOPY
1. Inspection and Palpation of the External Ear
Sit at the same level or slightly higher than the patient.
Inspect whether left and right ears have equal size and shape, and any skin lesion or mass.
Check for ear position whether the top of the ear just touches or hardly crosses the imaginary line drawn from the
outer cantus of the eye to the occiput.
Palpate the auricle between the thumb and forefinger. Note for any tenderness or lesion.
Palpate the mastoid process using the index and middle fingers. Note for any tenderness.
Press the tragus inward and toward the ear canal using the index and middle fingers to detect any tenderness.
2. Inspection of the External Auditory Canal using the Otoscope
Inspect the unaffected ear first.
Explain the procedure to the patient.
Ask patient to tip the head slightly toward the opposite shoulder away from the side being examined.
Choose the largest speculum the patient’s ear will comfortably accommodate.
With the other hand, straighten the ear canal by pulling the auricle gently upward and backward.
Turn on the otoscope light.
Grasp the otoscope with the dominant hand and hold its handle either in an upright position(for cooperative patients)
or against the patient’s head to help stabilize the otoscope(for restless patients)
Gently insert the otoscope in the external auditory canal(note for presence of wax, discharge, foreign bodies, redness
and/or swelling), carefully advancing it until the tympanic membrane is seen.
3. Inspection of the Tympanic Membrane noting for Major Landmarks and Color
Note and describe the color of the tympanic membrane
Note whether the tympanic membrane is intact and whether it is flat or concave and is not bulging.
Note for the presence of the cone of light (white light reflex).
Identify the malleus (umbo, manubrium and short process), pars tensa, pars flaccida, annulus, and malleolar folds.
Observe for any movement of the tympanic membrane as patient performs the Valsalva maneuver.
4. Repeat above steps for other ear.
B. HEARING ACUITY
1. Voice/ Whisper Test
Explain the procedure to the patient and secure consent.
Stand closely behind a seated patient (at most 2 feet distance) on the side of the ear to be tested.
Ask the patient to cover the other ear with his/her hand.
Whisper a few words then ask patient to repeat what was whisphered.
Perform the same procedure to the other ear.
2. Stopwatch/Tick Test
Stand closely behind a seated patient (at most 2 feet distance) on the side of the ear to be tested.
Ask the patient to cover the other ear with his/her hand
Hold a ticking watch/stopwatch near the ear being tested. Patient is told to say “yes” when the ticking is heard and
“no” when the ticking becomes inaudible as the examiner moves the watch slowly 2 feet from the ear being tested.
3. Weber Test
Strike the tuning fork(512 Hz) and place it firmly against the middle of the patient’s forehead or on top of the head at
the midline.
Ask the patient where the sound is heard, whether the sound is heard equally in both ears or there is lateralization
Interpret the findings
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B. HEARING ACUITY
4. Rinne Test
Explain the procedure to the patient and secure consent
Strike the tuning fork (512 Hz) and place it firmly against the patient’s mastoid process.
Instruct the patient to tell when the buzzing sound stops and note the duration.
Immediately move the still vibrating tuning fork (though vibrating weakly) near the external auditory meatus of the patient.
Instruct the patient to tell when the buzzing sound stops and note the duration.
Compare the duration of the bone conduction versus that of air conduction.
Interpret findings
III. NOSE
A. INSPECTION AND PALPATION
Explain the procedure to the patient and secure consent
Visually inspect and palpate the nose for deformity, symmetry, inflammation, or alar flaring.
Evaluate the patency of each nostril by pressing shut one side of the nose and then the other and asking the patient to sniff.
Inspect the internal nose by tipping the head back placing the thumb against the tip of the nose and looking through the
nares with the use of a penlight in the other hand or an otoscope.
Note for any septal deviation or perforation.
Inspect the nasal mucosa
Inspects the inferior and middle turbinates.
IV. SINUSES
A. PALPATION
Palpate the frontal sinuses for any tenderness by applying digital pressure with the thumb and index finger over the bony brow
sides of the nasal bone without pressing against the eye orbits.
Palpate the maxillary sinuses for any tenderness by applying digital pressure with the thumb and index finger over the maxillary
bones.
V. MOUTH/OROPHARYNX
A. INPECTION AND PALPATION OF THE OUTER STRUCTURES OF THE ORAL CAVITY
Locate the temporomandibular joints (TMJ). Place the fingertips just anterior to the tragus of each ear and ask the patient to open
mouth, and then slip your fingertips into the TMJ space and palpate it. Note for any tenderness, crepitus, locking or popping
motion.
Assess for malocclusion by instructing the patient to open and then shut his/her mouth and expose his/her teeth
Instruct the patient to move upper and lower jaws side to side
Inspect and palpate for enlargement or asymmetry of the salivary glands. Note for any tenderness, consistency of the glands, and if
the glands are fixed or movable.
Inspect and palpate the lips for symmetry, any lesion or tenderness.
B. EXAMINATION OF THE LIPS AND CHEEK(BUCCAL) AND ORAL MUCOSA
Instruct patient to open his/her mouth.
Examine the underside of the lips and anterior surface of the gums by displacing the lips with gloved fingers or gauze.
Examine the inner cheek by using a tongue blade or gloved finger to displace the cheek laterally and expose the surface.
C. EXAMINATION OF THE DORSAL SURFACE OF THE TONGUE, HARD AND SOFT PALATE (EVALUATING THE VAGUS AND
HYPOGLOSSAL NERVES)
Instruct the patient to protrude the tongue and say “ah” and note for its texture.
Note for the symmetry of the tongue and uvula when the tongue is protruded.
Inspect if the soft palate rises as the patient says “ah”.
Instruct the patient to tilt the head back with the mouth open and examine the palate with a penlight or dental mirror.
D. EXAMINATION OF THE OROPHARYNX, POSTERIOR TONGUE, AND UVULA (EVALUATING THE GLOSSOPHARYNGEAL
NERVE)
Using a penlight, inspect the posterior pharynx and uvula. If the patient has difficulty holding the tongue flat, gently depress with a
tongue blade being careful not to initiate a gag reflex.
Note the appearance of the oral mucosa and the tonsils.
Elicit a gag reflex by touching the posterior wall of the pharynx with a tongue blade or dental mirror.
E. INSPECTION OF THE LATERAL AND VENTRAL TONGUE
Inspect the mucosa by displacing the tongue laterally.
Instruct the patient to touch the hard palate with tongue tip and examine the ventral surface.
Palpate the oral mucosa of the mouth floor with a gloved finger.
VI. NECK
A. INSPECTION OF THE ANTERIOR NECK AREA (THYROID GLAND)
Sit facing the patient at the same level or slightly higher than the patient.
Instruct the patient to hold his/her head and neck area in a normal relaxed position and observe for any deviation or bulge in the
trachea as well as outlines of the thyroid and cricoid cartilages
Go to the side of the patient and inspect the neck laterally and observe for any deviation or bulge in the anterior neck area
Instruct patient to extend the neck slightly and swallow while observing the upward, symmetrical movement of the trachea
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VI. NECK
B. PALPATION OF THE THYROID GLAND
1. Anterior Approach
Stand in front of the patient, instruct the patient to relax and hold his neck in slight extension.
Locate the thyroid isthmus directly below the cricoid cartilage using the pads of the thumb and index fingers
Instruct the patient to swallow that will cause the isthmus to rise noting for its rubbery texture
Place your fingers laterally anterior to the sternocleidomastoid muscle and instruct patient to swallow and note for any
mass or bulge on the lateral lobes.
Palpate first the left thyroid gland lobe by asking the patient to tilt his/her head slightly forward and to the right.
Use left thumb in displacing the thyroid gland in a left lateral position while palpating the left lobe with your right thumb and
index finger afterwards and asking the patient to swallow.
Repeat the procedure on the right lobe.
2. Posterior Approach
Stand behind the patient with the patient’s neck slightly flexed to relax the neck muscles.
Put your thumbs at the back of the patient’s neck as you place your fingers below the cricoid cartilage palpating the thyroid
isthmus above it as you instruct the patient to swallow
Instruct the patient to turn his/her head slightly to the side and palpate the lobes. Use the fingers of the opposite side to
displace the gland in a lateral direction so that the fingers over the side being palpated can be more readily felt as the
patient is asked to swallow
Repeat the procedure on the right lobe
C. AUSCULTATION OF THE THYROID GLAND
Using the bell of the stethoscope, auscultate for bruit over each lobe that may be accompanied by a thrill
D. EXAMINATION OF THE LYMPHATICS OF THE HEAD AND NECK
Instructs patient to relax, with neck flexed slightly forward.
Simultaneously palpate (use the pads of index and middle fingers in a rotatory motion) the left and right side of the lymphatic
areas of the head and neck systematically following the sequence:
- Preauricular in front of the tragus of the ear
- Post auricular
- Occipital or suboccipital at the base of the skull
- Tonsillar at the angle of the lower jaw
- Submaxillary midway between the angle of the lower jaw and chin
- Submental midline behind the tip of the chin
- Superficial cervical chain over the sternocleidomastoid muscle by hooking the thumb and fingers around the muscle
- Supraclavicular that is within the angle formed by the clavicle and the sternocleidomastoid muscle
Medicine 1
Eye Examination Checklist
EYES
Prepare materials: penlight, pocket held card, ophthalmoscope.
Give proper instruction to patient
Ask patient to be seated at a height such that their eyes are essentially on the same level as the examiner own when the
latter is seating/standing next to the patient
Assessment of visual acuity (Central Vision)
Position patient 20 feet from Snellen chart and ask patient to read OR ask patient to hold pocket card 14 inches away and
read
Test one eye at a time initially without correction (sc) then with correction (cc) while covering the other eye with an occluder
shield or any opaque card
Ask patient to read each line from the largest print down to the smaller characters
Choose the lowest line where majority of the letters are read accurately and record visual acuity as a fraction
Repeat the steps for the other eye
Interpret the results
Perform the following in cases of patient’s failure to read the largest letter at 20 feet:
- Bring patient closer to chart ( to 10 feet, then 2 feet at a time, until the top letter can be seen
- Counting fingers (CF) if the patient cannot read at 5/200
- Hand movements (HM) if the patient cannot count fingers
- Light perception (LP) if the patient cannot see hand movements
Assessment of visual acuity (Peripheral Vision) - Visual Fields by Confrontation Method (Static)
Sit or stand opposite the patient at eye level at a distance of 1 meter or 2 feet and
instructs patient to cover right eye with card or an occlude shield while examiner covers his/her left eye, the patient and
examiner should be looking at each other’s eye
Examiner should fully extend his/her arm midway between patient and himself/herself and then moves arm slowly centrally.
Examiner asks patient to point at fingers once seen
Examiner holds up a few fingers in that position and instructs patient to say how many fingers are seen
Repeat steps in all four quadrants (nasal superior, nasal inferior, temporal superior, temporal inferior)
Repeat steps for other eye.
Report and interpret findings
Observation of External Structures:
Inspect eyebrows for loss/extraordinary growth of hair; presence of seborrhea. Inspect eyelashes for any matting or loss.
Inspect eyelids for symmetry and presence of crusting, redness, swelling
Instruct patient to look up. Pull down lower lid of each eye to expose inferior sclera and conjunctiva. Using a penlight,
inspect sclera and conjunctiva of lower eyeball for color, swelling and vascularity.
Instruct patient to look down. Examiner pulls up upper lid of each eye to expose superior sclera and conjunctiva. Using a
penlight, inspect sclera & conjunctiva of upper eyeball for color, vascularity, and swelling
Recognize conjunctival presentation, report and interpret findings.
Inspect orbits and eyes for position, alignment, symmetry, size, and shape. Standing behind the patient, look for proptosis
by instructing the patient to tilt back head. Examine the height of the cornea in relation to the brow for asymmetry between
two eyes.
Inspect cornea with oblique and direct lighting, and note for any opacities visible in the pupil.
Inspect size, shape, markings, definition, and color of the iris.
Testing Extra-Ocular Movements
Instruct the patient to follow examiner’s index finger with their eyes only i.e. their head remains in one position)
Move finger slowly to extreme position of each of the six (6) cardinal positions of gaze. The path may trace out the letter H.
Observe for under or over action of the extraocular muscles
Inspecs for normal or abnormal movements in each position.
Pupillary Testing
Dim the lights in room
Instruct patient to look into distance and not to focus on the light.
Illuminate both eyes with oblique lighting to discern pupil size and shape.
Shine bright light into each pupil from a point slightly lateral to the patient’s line of vision
Check for pupillary constriction in the eye that light is shined into (direct reaction).
Note the consensual response of the opposite pupil constricting simultaneously with the tested pupil. Repeat steps for the
other eye.
Perform the swinging flashlight test and reports findings
Hold your index finger approximately 2 feet from the patient’s eyes
Instruct patient to focus on the index finger as you move it towards the patient’s nose.Note for pupillary constriction as the
finger moves closer(accommodation) and crossing of the eyes(convergence)
Evaluate pupillary response to accommodation in each eye.
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Eye Examination Checklist
Ophthalmoscopic Examination
Darken the room.
Instruct patient to fix eyes on a specific point in the distance and try not to move eyes correct setting.
Hold the ophthalmoscope with your right hand when examining the patient’s right eye and use the ophthalmoscope with
your left hand when examining the patient’s left eye.
Turn on the light source of the ophthalmoscope. Turn the aperture wheel to the spot that is generally used for undilated
fundus examination. Set ophthalmoscope at 0. Use ophthalmoscope with ease and dexterity.
Position yourself at arm’s length from the patient. When examining the right eye of the patient, place your left hand on the
patient’s forehead with the left over the patient’s right eyebrow to assist stability. Alternatively, place your left hand on the
patient’s shoulder for stability.
From an angle of about 15 to 20 degrees lateral to the patient’s line of vision, shine the ophthalmoscope towards the pupil
of the right eye and look through the ophthalmoscope’s viewing hole.
Note for orange glow in pupil, the red reflex, and check for opacities blocking the red reflex.
Move closer to patient’s eye while slowly rotating the adjustment wheel of the ophthalmoscope using the index finger up or
down until the structures become clear. Turn the diopter disc counterclockwise for convex (plus) lenses, which are printed in
black, or turn the diopter disc clockwise for concave(minus) lenses, which are printed in red, until the sharpest focus is
achieved
Examine retina, optic disc, retinal vessels, peripheral retina and macular area.
Repeat steps for left eye
Describes disc margin, reports cup/disk ratio, A:V ratio , absence/presence of hemorrhages, exudates, cotton wool
spots, copper wiring, AV nicking
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Dermatology Examination Checklist
INSTRUCTIONS:
PREPARATION
Asks permission
Explains what exactly is to be done to the patient
Ensures privacy and patient’s comfort
Ensures adequate lighting and exposure.
EXAMINATION OF THE SKIN, HAIR, NAILS
Skin
Performs overall inspection of entire skin surface in a properly exposed patient in an adequately brightly lit examination room
using additional penlight, ruler and magnifying lens
Inspect patient from different angles: front view, right side, right side with right arm raised to expose axillary area, back view, left
side, left side with right arm raised to expose axillary area
Note skin color
Describe and identify lesions as
• Primary
flat, non-palpable (macule , patch)
elevated, palpable (papule, plaque)
nodule, tumor, cyst
wheal
fluid filled (vesicle, bullae, pustule, cyst)
• Secondary
crust, scale
loss of skin surface (erosion, ulcer, fissure)
excoriation
atrophy
comedone
scar
keloid
lichenification
• Vascualr
purpura
teleangiectasia
Describe lesion/s as to
• Size
• Shape
• Location
• Configuration
nummular – round/discoid/coin-shaped
linear/striate
target or iris or concentric ring
serpiginous
annular
grouped or clustering
arcuate
• Color
• Blanching
• Texture
• Elevation or depression,
• Exudates
• Pattern of distribution
location
regionalized
generalized
• Grouping
• Odor
• Symmetry
Palpates skin surfaces for the following: :moisture, temperature, texture, turgor, mobility
SKIN SY 2016-2017
Medicine 1
Dermatology Examination Checklist
Nails
Inspect and palpate nails for the following:
• Color
• Shape (concave or convex, clubbing)
• Pigmentation of nails and beds
• Length
• Symmetry
• Ridging
• Beading
• Pealing
• Redness
• Swelling
• Tenderness
• Abnormal growths ( cysts, tumors, and wart-like growths)
Inspect and palpate the periungal fold and cuticles
Hair
Inspect and palpate hair on face, scalp, axillary, body (chest), pubic, rectal areas for the following:
• Color
• Quantity
• Distribution
• Texture
• Nits infestation
Note area of hair loss or excess hair growth
SKIN SY 2016-2017
Breast Examination Checklist
Skills
I. PREPARATION
Greet patient appropriately and introduce self
Explain the procedure to the patient
Stand in front of the patient
Encourage the patient to ask questions to allay anxiety
Warm hands prior to palpation of the breast
Expose patient’s chest and breast after securing permission
II. BREAST INSPECTION
Instruct the patient to sit comfortably with both arms on the side.
Observe for the breasts’ symmetry, size, shape, skin color, texture, vascular pattern, or any lump or skin lesion.
Ask the patient to move and observe if the breast size and symmetry remains the same.
Observe for the areola’s color, size, shape, surface characteristic, direction and symmetry of the nipples.
Note any nipple retraction or discharge. If ever, ask patient when it was noted.
Note any bluish or reddish vascular pattern that should be symmetrical and diffuse.
Inspect the breasts from different angles and positions. Note any change in symmetry brought about by the change in position.
Instruct the patient to raise arms over his/her head and continue to inspect the breasts
Instruct the patient to lean over with support while sitting or standing and inspect the breasts
Instruct the patient to place his/hands onto his/her hips and inspect the breasts
Inspect the patient in supine position and note the parameters above
III. BREAST PALPATION
A. Palpation using FOUR POSSIBLE PATTERNS
1. CIRCULAR MOTION - begin from the nipple area towards the outside; move the fingers without lifting it until the examination
is complete.
2. HORIZONTAL LINE MOTION – begin from the tail of Spence and upper area of the breast towards the lower part
3. VERTICAL LINE MOTION – move the examining fingers up and down vertically, in rows, from the lateral side to the medial
side until all the breast area is covered
4. WEDGE or SPOKE – begin from the periphery towards the areola until all the quadrants have been palpated completely.
B. Patient is seated
Palpate the breast one by one using the non-dominant hand to support the inferior side of the breast while the dominant hand
palpates it from the superior side starting from the chest wall towards the nipple area.
Adduct the patient’s arm and support it on top of your opposite arm
Palpate the axillary area using the hand of the supporting arm for any nodes from the anterior, medial, and posterior axillary line
by rolling the soft tissue against the chest wall and the examining finger. At the same time, palpate the anterior aspect of the axilla
using the other hand to gain access to the nodes near the pectoralis muscle followed by palpation of the subclavian and
supraclavicular nodes.
C. Patient is supine
Position the patient in a supine position with the arm placed over and behind the patient’s head on the same side of the breast
being examined.
Place a small pillow under the shoulder of the side of the breast being examined to displace breast tissue evenly over the chest
wall.
Palpate the breast lightly at first then follow with deep palpation in all quadrants including the tail of Spence.
Palpate the areola for any underlying mass and compress the skin surrounding the nipple using both hands to assess for any
mass and nipple discharge.
Palpate any breast lump and note its location using the clock orientation or quadrants, distance from the nipple in centimeters,
number size in centimeters, shape (round, irregular), consistency(soft, hard, rubbery), discreteness from the surrounding tissues,
mobility(fixed, mobile), skin color over the lump, tenderness, and any retraction signs(skin dimpling, creasing, changes in the breast
or nipple contour such as flattening, retraction) with change of position.
Palpate for any lymph node in the axillary area and note its location, size, contour, consistency, discreteness, mobility,
tenderness.
BREAST21016-2017
Medicine 1
Neurological Examination Checklist
SKILLS
CEREBRUM MENTAL STATUS EXAM - includes

Level of consciousness
Normal or conscious – alert and responds to questions spontaneously and
promptly, oriented to time, place and person and is easily awakened from
sleep
Confused – disoriented with slow response to questions, with impaired thinking
and with difficulty following commands
Lethargic – drowsy but can be easily aroused by minimal stimuli either by voice or
touch and can sustain arousal without requiring constant stimulation
Somnolent – more drowsy and needs constant stimulation to maintain arousal
Obtunded – sleeps more than usual, responds to verbal or painful stimuli and with
incomprehensible verbal responses
Stupor – responsive only to repeated and vigorous stimuli(mostly painful),
responding only by grimacing or by drawing away from the painful stimuli;
patient has deep tendon reflexes(DTRs)
Comatose – no response to any stimuli, no gag, no corneal and DTRs, with
Glasgow Coma Scale(GCS) of 3
GLASGOW COMA SCALE (GCS)
Components Patient Response Score
EYE OPENING Spontaneous 4

To speech 3
To pain 2
None 1
VERBAL RESPONSE Oriented/ normal 5

Confused 4
Inappropriate words 3
Incomprehensible sounds 2
None 1
MOTOR RESPONSE Obeys commands 6

(of unaffected limb) Localizes to painful stimuli 5
Withdraws 4
Decorticate 3
Decerebrate 2
None 1
Orientation
Memory
Language
Speech
Insight
Judgment
Abstract Thinking
Calculation
1
NEURO EXAM SY 2016-2017
Medicine 1
CEREBELLUM MOTOR COORDINATION EXAM – includes
Finger to Nose Test
Sit in front of the patient at arm’s length
Do the following procedure several times
Instruct patient to extend one arm in front and touch the tip of his
nose followed by touching the end of the examiner’s index
finger held at arm’s length; the examiner to move his index finger from
place to place while the patient’s finger is trying to touch the tip of the
examiner’s index finger; do the same procedure on the opposite arm
Note the smoothness and accuracy of movements of the patient
Note for any jerky movements(dyssynergia) or overshooting the target(dysmetria)
Note any tremor at rest or any intention tremor
Rapid Alternating Pronation/ Supination Test
Position patient seated with both hands resting on his lap or on top of the
examining table
Instruct the patient to quickly and repeatedly pronate and supinate both hands
at the same time for several times
Heel-Shin Test
Place the patient on supine or standing position
Instruct the patient to place one heel on the opposite knee then slide the heel
down the front of the shin up to the ankle then back; Do this also on
the opposite leg
Do the procedure several times
CEREBELLUM TEST FOR BALANCE/EQUILIBRIUM – includes

Observation of the Patient’s Gait
As the patient enters the room, observe how the patient walks towards you
Ask the patient to walk around the room and closely observe the following:
posture or characteristic bearing of the body, stance(position of the feet),
stability, how high the feet are raised off the floor upon walking, leg swing
trajectory, leg stiffness and degree of knee bending, arm swing
Tandem Gait
Ask the patient to walk a straight line while touching the heel of one foot to the
toe of the other with each step
Romberg’s Test – Vestibular portion of Cranial Nerve(CN) VIII
With both eyes open, ask the patient to stand with feet close together. Note any
swaying or difficulty in maintaining balance
Ask the patient to close both eyes with the feet close together. Note any swaying
or difficulty in maintaining balance. Slight swaying is acceptable and regarded
as a negative result
During the entire test, you should stand on the side of the patient
extending both your arms(one in front and the other arm at the patient’s back)
to support the patient if ever the patient cannot maintain balance
CRANIAL NERVES I. OLFACTORY – sensory

Instruct the patient to occlude each nostril one at a time by pressing with his finger and to
close both eyes
Let the patient identify and distinguish between familiar odors, such as coffee, cologne one
at a time; avoid using irritating substances such as vinegar, or ammonia
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Medicine 1
II. OPTIC – sensory - please see eye exam checklist
Visual acuity – central and peripheral
Funduscopy
Pupillary light reflexes – direct and consensual
II. OCULOMOTOR-motor – please see eye exam checklist

Pupillary light reflexes – direct and consensual
Accomodation and Convergence
Extraocular movements
IV. ABDUCENS-motor – please see eye exam checklist

VI. TROCHLEAR-motor – please see eye exam checklist

V. TRIGEMINAL – mixed
Sensory(ophthalmic, maxillary, mandibular divisions)
Instruct the patient to close both eyes while you alternatively brush cotton and lightly
pinprick the facial nerves innervated by the three sensory divisions: ophthalmic on the
forehead, maxillary on the cheek area, mandibular on the jaw area)
As the stimuli is applied, tell the patient to identify and discriminate which sensation is
being produced and locate to which it is applied
Motor
Instruct the patient to clench teeth while you palpate the masseter and temporal
muscles for firmness on both sides; there SHOULD BE NO jaw deviation
CORNEAL REFLEX – SENSORY COMPONENT IS THE OPHTHALMIC BRANCH OF

THE TRIGEMINAL NERVE and MOTOR COMPONENT IS THE FACIAL NERVE
Instruct the patient to open both eyes and direct attention to a distant object and try not
to blink
Use a wisp of cotton or a thin strand of cotton from a cotton-tipped applicator to lightly
touch the cornea of the patient of the patient(sensory) expecting a forceful blink as a
response(motor)
VII. FACIAL – mixed

Sensory
Instruct the patient to protrude the tongue with both eyes closed while you apply salt or
sugar to both sides of the anterior 2/3 of the tongue one at a time; Ask the patient to
discriminate tastes between salty and sweet
Motor
Instruct the patient to perform voluntary facial movements such as frowning, smiling,
wrinkling forehead, puffing the cheeks, whistling, and note for any asymmetry for any
localized paralysis
Instruct patient to close both eyes as tightly as possible and try to open the patient’s
Eyes
CRANIAL NERVES VIII. VESTIBULOCOCHLEAR – sensory

Vestibular Component – Rombeg’s Test – please see above
Cochlear Component – Hearing Acuity, Weber and Rinne Tests - please see HENT/Neck Exam
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Medicine 1
IX – GLOSSOPHARYNGEAL – mixed
Sensory- bitter taste at the posterior 1/3 of tongue
Motor – together with CN X(Vagus nerve)
Instruct patient to say “ah”, and note if the soft palate rises and if the uvula is not deviated
Elicit a GAG REFLEX by touching the posterior wall of the pharynx with the tongue blade or
dental mirror
X. VAGUS – mixed
Sensory – innervates the skin of the external acoustic meatus and the internal surfaces of the
laryngopharynx and larynx; provides visceral sensation to the heart and abdominal viscera
Motor – innervates muscles of the palate, pharynx, and larynx
Evaluate the clarity of the patient’s speech by asking the latter to say “lululu, lalala, lilili”
Instruct patient to say “ah”, and note if the soft palate rises and if the uvula is not deviated
(together with CN IX – Glossopharyngeal)
Elicit a GAG REFLEX by touching the posterior wall of the pharynx with the tongue blade or
dental mirror (together with CN IX – Glossopharyngeal)
XI- SPINAL ACCESSORY – motor

Place hands on the patient’s shoulders and instruct patient to raise his/her shoulders as
resistance is applied
Note the sternocleidomastoid muscles symmetry and palpate for its tone
Ask the patient to turn head and touch chin to the shoulder then apply resistance. Test both sides.
XII. HYPOGLOSSAL – motor

Inspect the dorsal tongue by asking the patient to protrude the tongue and say “ah,”
and note if the tongue is midline or is deviated.
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Medicine 1
MOTOR MOTOR EXAM- includes the following:
Observation for muscles for symmetry
Muscle bulk, presence of involuntary movements(tremors, fasciculations, clonus)
Muscle tone
Muscle tenderness
Muscle strength
Hand grasp and Toe and Foot Dorsiflexion may be enough as screening procedures in
the assessment of muscle strength. Additional testing can be done if some muscles are
weak or if the patient complains of focal weakness
HAND GRASP
Cross your hands with both the index and middle fingers extended
Instruct the patient to grasp your left index and middle fingers with his left hand and your
right index and middle fingers with his right hand
Try to pull your fingers from the patient’s grip and assess how easy or difficult you can
pull from the tightness of the patient’s grip
TOE AND FOOT DORSIFLEXION
Place the patient in a supine position and try to dorsiflex the big toe and foot as you put
some resistance into it
Make sure that you always compare muscle strength of the left and the right sides of the
body
Grading of manual muscle testing(MMT)
0 - no evidence of movement
1 – trace muscle contraction
2 – able to move the limb when gravity eliminated
3 – complete range of movement against gravity but without resistance
4 - complete range of movement against gravity with some resistance
5 - complete range of movement against gravity with maximum resistance
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Medicine 1
SENSORY Sensory Function Testing – includes the following:
Light touch sensation
Show patient the materials to be used and explain the procedure
Instruct the patient to close both eyes for the remainder of the examination
Brush the patient’s skin lightly with your fingertip or a cotton or a soft brush
Ask the patient to identify the presence of the sensation(“Do you feel anything?”) and
locate specifically the skin surface that was touched by the stimulus(“Where do you feel
it?”)
You may start testing light touch simultaneously on both sides and then one side at a time
and ask patient to compare the degree of sensation
Start the exam from the dorsum of the hand, to the ventral surface of the forearm, expose
the abdomen to test the four quadrants, to the toes going to the dorsum of the foot, to
the shin of the lower legs
SENSORY Superficial pain sensation

Instruct the patient to continue closing both eyes
Familiarize the patient with the stimulus
Instruct the patient to close both eyes
Apply alternatingly the hypodermic needle point(sharp) and hub(dull) against the patient’s
skin using only minimal pressure necessary to elicit a response being careful not to pierce
the skin
Apply the stimulus with a pause of several seconds in between to allow patient to feel the
stimulus
Ask the patient to identify the stimulus whether it is sharp or dull.
Perform the test on both sides and ask the patient to compare the degree of sensation
Deep pain sensation
Grasp the patient’s bicep tendon between your thumb and index finger and squeeze hard
enough to elicit feelings of pressure/pain
FOR COMATOSE PATIENT, apply gradual pressure using a pen over patient’s thumb nail
bed or big toe nail bed; note for any facial grimace, or decorticate, or decerebrate
posturing, implying an intact sensory pathway
Temperature
Instruct the patient to close his/her eyes
Fill one test tube with warm water and the other with cold water
Alternatively apply one test tube with a warm water and the other with cold water against
the patient’s skin
Ask the patient to identify the stimulus whether it is warm or cold.
Do the same procedure on the other side
Vibration sense
Both of the patient’s eyes should still be closed
Strike the tuning fork against your hand and apply the base to one of the patient’s bony
prominences such as the clavicles, sternum, finger joints, wrists, ankles, toes
Place your fingers beneath the bony prominence if possible in order for you to feel the
vibration and accurately evaluate the patient’s response
Instruct the patient to tell you if the vibration of the tuning fork is sensed as it occurs (tell the
patient to say yes if there is) and when it stops totally(instruct the patient to say none)
Joint position sense (Propioception)
Orient the patient with what is up and what is down prior to instructing the patient to close
his/her eyes
Grasp the most distal joints(either the fingers or the toes) on the side and move it up or
down relative to its stationary position
Ask the patient to identify movement of the distal joint
If the patient is unable to identify, use more proximal joints
Sensory association
Place a familiar object on the patient’s hand and ask the patient to identify it by touch alone
(stereognosis)
Touch one finger of the patient and ask the latter to identify which finger is being touched
and which side(topognosia)
Trace a letter or number on the patient’s palm and ask to identify it( graphognosia)
Perform the same procedures on the other side
Two-point discrimination
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Medicine 1
Press alternately one or two needles against the patient’s skin asking the patient how
many needles are being felt
Perform the same procedure on the other side
Note if the patient can sense whether one or two areas of the skin is being tested
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Medicine 1
REFLEXES DEEP TENDON REFLEXES – include the following:
Biceps reflex
Flex the patient’s arm slightly at the elbow and forearm either rested on top of the patient’s
leg or resting on top of your forearm
Place your thumb over the bicep tendon in the antecubital fossa
Strike the thumb with the pointed end of the reflex hammer to elicit reflex(forearm flexes at
the elbow) ; Do the same procedure on the other side
REFLEXES Triceps Reflex
Flex the patient’s forearm and hold the arm across the patient’s chest OR allow the patient’s
arm to hang loosely while you support it by placing your hand under the biceps
Using the blunt end of the reflex hammer, strike the triceps tendon located just above the
olecranon process to elicit the reflex(forearm extends slightly at the elbow)
Brachioradialis Reflex
Place patient’s forearm in a relaxed position with the palm facing down resting on the patient’s
leg OR support patient’s forearm in a relaxed position with your hand
Place your thumb over the brachioradialis tendon located just above the styloid process of the
radius
Strike the thumb with over the brachioradialis tendon with the pointed end of the reflex hammer
to elicit the reflex(twitching of the muscles)
Patellar Reflex
Ask the patient to sit on the side of the bed with legs dangling OR place patient on a supine
position and place your other arm under the patient’s knee to be evaluated to relax it
With the blunted end of the reflex hammer, strike the patellar tendon located just below the
knee cap to elicit the reflex( leg extension at the knee)
To enhance the reflex response, ask patient to hook together the flexed fingers of his right and
left hands and pull them apart as strongly as possible for at least ten seconds(Jendrassik
maneuver) while you tap on the tendon
Achilles Reflex
Ask the patient to sit on the side of the bed with legs dangling OR place patient on a supine
position and support the foot to be evaluated in a dorsiflexed position
Strike the Achilles tendon above the heel to elicit the reflex(plantar flexion visually or can be
felt by placing your hand against the sole of the foot as the reflex is tested)
Grading of reflexes: 0 - absent
+1 - hyporeflexia
+2 – brisk response; normal
+3 – a very brisk respone; may or may not be normal
+4 – tap elicits a repeating reflex (unsustained clonus)
+5 – sustained clonus
SUPERFICIAL REFLEXES – include the following:
Cutaneous reflexes
Superficial Abdominal Reflex
Place the patient in supine position
Stand on the patient’s right side
Expose the patient’s abdomen adequately up to the symphysis pubis
Gently stroke the right upper quadrant of the abdomen with an end of the reflex hammer or an edge
of a tongue blade upward and away from the umbilicus
Observe for contraction of the rectus abdominal muscles and pulling of the umbilicus toward the
stroked side
Do the same procedure on the left upper, left lower, and right lower quadrants
Observe for contraction of the rectus abdominal muscles and pulling of the umbilicus toward the
stroked side
Cremasteric Reflex
PRIMITIVE REFLEXES – include the following:
Babinski
Position the patient supine or seated with legs dangling at the end of the examining table
Use the handle of the reflex hammer to firmly stroke the outer border of the sole of the foot
Note the response – normal or negative reflex in adults when there is toe flexion; positive if
there is toe extension or fanning
Do the same procedure on the other foot
Chaddock, Gordon, Oppenheim
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Medicine 1
OTHERS TESTS FOR MENINGEAL IRRITATION – carried out on patients who have headaches, fever, or
behavioral changes suspected of having meningeal irritation caused by meningitis or subarachnoid
hemorrhage
Brudzinski sign
Place the patient in a supine position
Flex the head of the patient
Note if the maneuver will elicit severe pain in the back of the neck and flexion of the hip and the
lower extremities
Kernig’s sign
Place the patient in a supine position
Slowly elevate the straightened lower extremity of the patient
Note if the maneuver will elicit severe pain in the lower back of the patient. Please note that this
can be positive in cases of low back muscle spasm, and herniated disc
9

Faculty of Medicine and Surgery
Medicine 1
Pulmonary Examination Checklist

PHYSICAL EXAMINATION OF THE RESPIRATORY SYSTEM

I. RULE OUT THE PRESENCE OF RESPIRATORY DISTESS/ IMPENDING RESPIRATORY FAILURE
A. Signs of Respiratory Distress/Impending Respiratory Failure:
Abdominal paradox
Central cyanosis
Altered sensorium
Preference for the upright position/ tripod position
Prominence of the sternocleidomastoid muscle
Retractions
Speaks in phrases (ask the patient a question and note how he responds
State if respiratory distress/failure is present or absent
II. ONCE RESPIRATORY DISTRESS / FAILURE HAS BEEN RULED OUT, PROCEED WITH THE STRUCTURED PE OF
THE CHEST
A. PREPARATION
Wash hands
Greets patient, introduce self
Explain procedure, ask for permission/ consent
Ask patient to remove shirt/ blouse- provide drapes if necessary
B. INSPECTION
Comment on RR and pattern other than abdominal paradox i.e. Cheyne stokes, bradypnea
Describe the appearance of the chest- symmetry/ masses/ bulges/ scars/ lesions- both anterior and posterior
Compare antero-posterior to lateral diameter. Describe the configuration or deformities of the chest/rib cage. State which is
wider.
Identify extrapulmonary signs: body habitus – blue bloater; pink puffer; facial features – Horner’s syndrome; extremities –
unilateral leg edema, nail nicotine stains, cyanosis, clubbing
C. INSPECTION/ PALPATION
1. TRACHEA
Stand in front of the patient or sit opposite the patient at same level
Instruct the patient to sit up, lean forward, and keep the head straight
Check the position of the trachea: Place the simultaneously the tip of your left index finger in the right fossa between the
medial end of the sternocleidomastoid muscle(SCM) and the lateral aspect of the trachea and the tip of your right index
finger in the left fossa between the medial end of the SCM and the lateral aspect of the trachea
Compare the depth of right fossa to the left for symmetry
State if trachea is midline
2. CHEST EXPANSION
a. ANTERIOR CHEST: While facing the patient, place your hands with extended thumbs along the inferior edges of the
costal margins and xiphoid with the tips of the thumbs nearly touching
Ask patient to take a deep breath, and observe for movement of your hands
Describe if anterior chest movement is symmetrical/ asymmetrical
b. POSTERIOR CHEST: Move toward the back of the patient and locate inferior angle of the scapula
Palpate for the 10th ICS along the midscapular line
Place both hands with extended thumbs against the chest wall along the 10th ICS, grasping the posterior chest
Move both hands medially (towards the vertebral line) so as to form a crease along the mid-back
Ask the patient to take a deep breath
Observe for movement of your hands with the chest wall movement
Describe if posterior chest expansion is symmetrical/ asymmetrical
3.PALPATION FOR CHEST WALL TENDERNESS /MASSES

Locate the sternal angle of Louis
Identify and count the intercostal spaces anteriorly and later posteriorly
Palpate gently across anterior and posterior chest for any chest wall tenderness or mass
Describe if there are any points of tenderness/ bulges/ masses
4. PALPATION FOR TACTILE FREMITI

Instruct patient to cross his arms across his chest
Move toward the back of the patient
Place the ulnar surfaces of your hands simultaneously in the upper posterior chest, medial to the scapula
Ask the patient to say “ninety-nine” or “tres-tres”
Feel for vibration in the area (tactile fremiti)
PULMOPE2016-2017

Faculty of Medicine and Surgery
Medicine 1
Pulmonary Examination Checklist
Move hands to a lower position in the chest, and do the same procedure
Always compare one side to the other while moving from upper to mid chest area, medial to the scapula
Once below the level of T7 or 7th ICS, examine for tactile fremiti along the scapular lines and posterior axillary lines, always
comparing one side to the other
State if the tactile fremiti are equal
D. PERCUSSION
1. POSTERIOR CHEST: Remind patient to keep his arms crossed
Beginning at the upper lung field, align finger (of pleximeter hand) along intercostal space along the paravertebral line,
making sure that it is only the distal 3rd of the finger resting on the chest wall
Strike the distal 3rd of the finger with the tips of the fingers of the free hand (plexor)
Listens for percussion sound produced
Do the same procedure, moving from one side of the chest to the other, from the upper to the lower lung fields
2. ANTERIOR CHEST: Go in front of the patient

Percuss beginning at the upper lung field below the clavicles, moving from one side of the chest to the other
Continue to percuss from the upper to the lower lung fields
Note the percussion sound
3. DIAPHRAGMATIC EXCURSION
Go toward the back of the patient
Instruct patient to cross his arms across his chest
Ask the patient to take a deep breath and hold it
Percuss along the scapular line and locate the area of dullness which is the level of the diaphragm
Mark that level
Instruct patient to do normal breathing
Instruct patient to exhale as much as possible
Percuss upward from marked point and locate the area of dullness
Mark that level and measure the difference between the 2 levels
Report the difference as the extent of diaphragmatic excursion
Move to opposite side and repeat procedure
E. AUSCULTATION
1. BREATH SOUNDS
a.) POSTERIOR CHEST: Make sure that patient still has his arms crossed over his chest
Ask patient to take slow deep breaths through his mouth
Auscultate posterior chest with the diaphragm of the stethoscope in the same areas used in palpation and percussion
(moving from upper lung field to lower, always comparing one side to the other)
Listen to 2-3 respiratory cycles before moving to next position
State if there are adventitious breath sounds
b.) ANTERIOR CHEST: Auscultate chest with the diaphragm of the stethoscope in the same areas used in palpation and
percussion (moving from upper lung field to lower, always comparing one side to the other)
Listen to 2-3 respiratory cycles before moving to next position
State if there are adventitious breath sounds
2. VOCAL FREMITI
Repeat the same procedure for the anterior and posterior chest but instruct the patient to say “tres-tres” or “ninety-nine”
instead of taking deep breaths
Listen for vocal fremiti
State if vocal fremiti are equal
3. Accomplish LUNG AUSCULTOGRAM
PULMOPE2016-2017

Medicine 1
Cardiovascular Examination Checklist
Introduce self and greet the patient
Explain the procedure and secure consent
EXAMINATION OF THE NECK VESSELS
I. Jugular Venous Pressure (JVP)
A. Identification of the JVP
1. Examiner to stay on the right side of the patient
2. Position patient properly
Page | 1 a.)Patient supine in bed and raise the patient’s head slightly on a pillow
b.)Raise the head of the bed about 30-45o angle
3. Turn the patient’s head slightly towards the left, exposing the right side of the neck
4. Using a tangential white light over the right side of the patient’s neck, identify the right internal jugular vein pulsation
5. Identify the highest point of the right jugular venous pulsation (meniscus)
B. Measurement of the JVP
1. Identify the sternal angle of Louis by starting from the suprasternal notch and slides finger down until a hump is felt
2. Place a ruler horizontally and parallel to the meniscus
3. Place another ruler graduated in centimeters(cm) vertically on top of the sternal Angle of Louis and at a 90-degree angle
to the previously placed horizontal ruler parallel to the meniscus of the JVP
4. Note the vertical distance in cm above the angle of Louis at which the rulers intersect and state the JVP in cm water.
5. Note the different waveforms of the JVP and draw.
II. Carotid Artery Pulse (CAP)
A. Assess the right carotid artery pulse (CAP)
1. Position the patient sitting or supine. If supine, elevate the trunk about 30-45 degrees.
2. Elevate patient’s chin and turn face to the left side without tightening the neck muscles
3. Inspect for visible carotid pulsations.
4. With index and middle fingers, locate the right carotid artery by palpating between the trachea and the anterior border of
the sternocleidomastoid muscle at the level of the cricoid cartilage.
5. With your other hand, bend the patient’s head slightly to the side being examined.
6. Apply varying degrees of pressure in palpating the pulse until the maximum pulsation is appreciated.
B. Assess the left carotid artery pulse (CAP) – locate the carotid pulse on the left side using the same techniques as above
C. NEVER PRESS ON BOTH CAROTID ARTERIES AT THE SAME TIME.
D. Compare the following parameters: amplitude, contour, rate or speed of pulse rise/upstroke, rate or speed of pulse
fall/downstroke, thrill, bruit. For detection of bruit, place bell of the stethoscope just behind the upper end of the thyroid cartilage
immediately below the angle of the jaw.
E. Draw the CAP as part of the cardiac auscultogram
III. EXAMINATION OF THE PERIPHERAL PULSES
A. Brachial Pulse
1. Face the sitting or recumbent patient.
2. Support the patient’s forearm with your left hand.
3. With the patient’s right upper arm abducted, the elbow slightly flexed, and the forearm externally rotated, palpate for the
patient’s brachial artery with your right hand.
4. Use the pads of your index and middle fingers (curling over the anterior aspect of the patient’s elbow to apply gentle but
firm pressure) to palpate along the course of the artery just medial to the biceps tendon and lateral to the medical epicondyle of the
humerus.
5. Locate the brachial pulse on the left side using the same technique as above with the positions of hand switched.
6. Simultaneously palpate the brachial pulses on both sides.
7. Compare the volume of pulsation on each artery, and grade the volume of pulsation.
8. Note for any thrill.
B. Radial Pulse
1. Position the patient’s arm in a relaxed position, palm downward or upward on top of the table , or on top of the patient’s
upper thigh, or supported by your other hand.
2. Locate the right radial artery using the pads of your index and middle fingers aligned longitudinally over the course of the
artery by applying gentle but firm pressure in the medial and ventral side of the patient’s wrist just below the base of his thumb. Do
not occlude the radial pulse.
3. Count the pulse rate on the right side for one full minute using a watch with a second hand.
4. Locate the radial pulse on the left side using the same technique as above, and count the pulse rate on the left side for one
full minute using a watch with a second hand.
5. Simultaneously palpate the radial pulses on both sides.
6. Evaluate the pulse rhythm and volume of pulsation on each artery. Grade the volume of pulsation.
C. Femoral Pulse
1. Stand on the right side of the patient who is reclining on the bed in a 45-degree angle.
2. Ask permission to expose the groin area.
3. Expose the groin area.
4. Use the pads of the index and middle fingers to locate the right femoral artery by applying firm pressure at a point inferior to
the inguinal ligament midway the anterior superior iliac spine and the symphysis pubis.
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C. Femoral Pulse
5. Locate the femoral pulse on the left side using the same techniques as above
6. Simultaneously palpate the femoral pulses on both sides.
8. Note for any thrill.
D. Popliteal Pulse
1. Put the patient in a supine position
Page | 2 2. Using both hands, palpate the popliteal artery one at a time
3. Flex slightly the patient’s knee
4. Place the index and middle fingers of both hands in the midline behind the patient’s knee
5. Press deeply into the popliteal fossa to palpate for the popliteal artery
6. Do the same steps above on the other side
7. Note for the volume of pulsation on both sides.
E. Posterior Tibial Pulse
2. Stand at the foot or the side of the examining bed or table
3. Use the pads of the index and middle fingers to locate the right posterior tibial artery by applying firm pressure anteriorly
around the ankle, indenting the soft tissues in the space between the medial malleolus and the Achilles tendon, above the
calcaneus.
4. Apply your thumb to the opposite side of the ankle in a grasping manner to provide stability.
5. Locate the posterior tibial pulse on the left side using the same techniques as above
6. Simultaneously palpate the posterior tibial pulses on both sides.
F. Dorsalis Pedis Pulse
2. Stand at the foot or the side of the examining bed or table
3. Use the pads of the index and middle fingers to locate the right dorsalis pedis artery by applying firm pressure on the
median dorsum of the foot.
4. Use the other hand to dorsiflex the foot to various degrees to separate the dorsalis pedis artery from the tendon overlying
it.
5. Locate the dorsalis pedis pulse on the left side using the same techniques as above
6. Simultaneously palpate the dorsalis pedis pulses on both sides.
7. Compare the volume of pulsation on each artery, and grade the volume of pulsation
G. Grading of the volume of pulsation: (-) no pulse; + weak pulse ; ++ normal pulse; +++ very strong pulse
H. Pulse Deficit Determination
1. One examiner palpates for the radial pulse and counts the pulse rate for one full minute.
2. Another examiner with prewarmed stethoscope simultaneously listens to the the apical impulse and counts the heart rate
for one full minute.
3. The first and the second examiner should start at the same time when counting the radial pulse rate and heart rate,
respectively.
4. Compare and record the rate and rhythm of the radial and apical pulse.
EXAMIINATION OF THE PRECORDIUM
Stands on the right side of the patient
With the patient in supine position, exposes the chest of the patient as far as decency permits
I. PRECORDIAL INSPECTION
1. Illuminate the precordium from a single source(penlight) shining transversely or tangentially toward you across the patient’s
anterior chest surface.
2. At eye level, checks for precordial bulging and visible pulsations
3. Look for the apex beat
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II. PRECORDIAL PALPATION
A. VISIBLE APEX BEAT
1. Palpate for the apical impulse using the tip of the right middle and index fingers
2. While palpating the visible apex beat, palpate for the angle of Louis with the other hand
3. From the angle of Louis, slide fingers laterally to the left parasternal intercostal spaces and determine what intercostal space
the apex beat is located
4. Using a graduated ruler in cm., note how far away from the left midclavicular line and from the midsternal line is the apex
Page | 3 beat
B. NON-VISIBLE APEX BEAT
1. Starting from the sternal angle of Louis, using the tip of the right middle and index fingers, locate and palpate for the apex
beat in the 5th left intercostal midclavicular line OR adjust accordingly laterally to the same intercostal space anterior, mid or
posterior axillary line or the 6th intercostal space anterior, mid or posterior axillary line
C. APEX BEAT DESCRIPTION
1. Location
2. Diameter - Estimate this by applying the tips of the fingers directly on top of
the apex beat and note the number of fingers needed to cover the apex beat OR use a ruler graduated in cm and measure the
diameter of the apex beat in cm; Describe this in finger breaths or in cm. A normal apical impulse is within 2 finger breaths or within
2 cm diameter.
3. AMPLITUDE - With fingertips, feel for the apex beat and note the height of pulsation of the apex beat, whether norma,
hypodynamicl or hyperdynamic (very strong)
4. DURATION - While palpating the apex beat, auscultate for the first and second heart sound and note the duration of systole;
Note how much of systole does the apex beat occupy; the normal duration is when the apex beat occupies only up to half of systole
while sustained duration is when the apex beat occupies almost the entire of systole
D. HEAVES
1. Using the heel of right hand, palpate for abnormally strong pulsation (left ventricular heave) over the area of the apex beat
2. Using the heel of right hand, palpates for abnormally strong pulsation (right ventricular heave) over the left side of the lower
sternum
E. THRILLS
1. Using the ball of hand, feel for fine vibratory sensations over the different clinical valve areas
a.) apex beat of the 5th ICS, LMCL for mitral valve thrill
b.) left lower sternum for tricuspid valve thrill
c.) 2nd ICS LPSL for pulmonic valve thrill
d.) 2nd ICS RPSL for aortic valve thrill
F. LIFTS
1. Using the right middle and index finger pads, palpate for abnormal pulsation over the 2nd ICS LPSL for pulmonary artery lift
2. Using the right middle and index finger pads, palpate for abnormal pulsation over the 2nd ICS RPSL for aortic artery
dilatation
3. Using the right middle and index finger pads, palpate for abnormal pulsation over the 3rd and 4th ICS LPSL for left atrial lift
III. PRECORDIAL AUSCULTATION
A. IDENTIFYING AUSCULATORY AREAS
1. Using the angle of Louis, locate and identify the different auscultatory valve areas:
a.) At the area of the apex beat of the 5th ICS LMCL, identify the auscultatory area for the mitral valve
b.) At the left lower parasternum, identify the auscultatory area for the tricuspid valve
c.) At the 2nd ICS LPSL identify the auscultatory area for the pulmonic valve
d.) At the 2nd ICS RPSL identify the auscultatory area for the aortic valve
B. PRECORDIAL AUSCULTATION PROPER
1. Using the diaphragm of the stethoscope, auscultate at the different auscultatory valvular areas for the different heart sounds
(either from apex to base or base to apex in an inching manner).
2. Describe the 1st heart sound in the mitral and tricuspid area (apex)
3. Describe the 2nd heart sound in the mitral and tricuspid area (apex)
4. Describe the 1st heart sound in the aortic and pulmonic area (base)
5. Describe the 2nd heart sound in the aortic and pulmonic area (base)
6. Compare the character of the heart sounds between the apical and the basal area
7. Note for the time interval between the 1st and 2nd heart sounds (systole)
8. Note for the time interval between the 2nd and 1st heart sounds ( diastole)
9. Note for splitting of the 2nd heart sound especially at the 2nd ICS LPSL and its relationship with respiration
C. PRECORDIAL AUSCULTATION MANUEVERS
1. Ask patient to assume a left lateral decubitus position to accentuate heart sounds in the apical area(tricuspid and mitral)
2. Ask patient to lean forward to accentuate heart sounds in the base
D. DETECTING ABNORMAL HEART SOUNDS
1. Using the bell of the stethoscope, auscultate for 3rd and 4th heart sounds at the mitral and tricuspid valve areas
a.) 3rd heart sounds are low pitch sounds that follow the second heart
b.) 4th heart sounds are low pitch sounds that follow the 3rd heart sound and are closer to the 1st heart sound than to the
second heart sound
2. Using the diaphragm for high pitch and the bell for low pitch sounds, auscultate for other abnormal sounds
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3. Note for turbulent sounds (murmurs) noted during systole and diastole over the different valvular areas
4. Note the character (high/low pitch), duration of the murmur(s), and grading of the murmur(s)
5. Slowly inch away and notes the radiation of the murmur
6. Perform appropriate maneuvers(dynamic auscultation)
a.) Valsalva maneuver- ask patient to take a deep breath then hold, pinch nose, close mouth and strain down; note change in
murmur during Valsalva; note change in murmur after Valsalva release
b.) Carvallo’s sign-ask patient to inhale deep while listening for any change in the heart sounds
Page | 4 7. Describe noted murmur according to the following characteristics:
a.) Location and Radiation – identify point of maximum intensity and slowly inch away and note radiation of the murmur
b.) Intensity or loudness – 1/6 to 6/6
c.) duration – short or long
d.) pitch or frequency – high, low, mixed
e.) quality – blowing, rumbling, etc.
f.) timing – systole or diastole or continuous
g.) configuration – crescendo, decrescendo, plateau
IV. DRAW PRECORDIAL EXAMINATION FINDINGS (AUSCULTOGRAM)
1. Draw the JVP
2. Draw the CAP
3. Describe the dynamicity of the precordium
4. Write the apex beat location, character, presence/absence of heaves, thrills, lifts
5. Draw the heart sounds (normal and abnormal) in the apical area
6. Draw the heart sounds (normal and abnormal) in the basal area
7. Draw the duration of the systole and diastole
8. Draw murmurs if present
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Abdominal and Rectal Examination Checklist
PREPARATION
Greet patient appropriately and introduce yourself
Remind patient to empty the bladder
Instruct patient to assume the proper relaxed position (supine, back flat, legs stretched or knees flexed, arms at the sides or
folded across the chest)
Stay at the right side of the patient during the examination
Drape patient appropriately exposing the abdomen from xiphoid process to symphysis pubis
Have the patient point to painful areas prior to examination and examine these areas last
PERFORM EXAMINATION IN THE PROPER SEQUENCE: Inspection, Auscultation, Percussion, Palpation
INSPECTION
Inspect abdomen for:
- Contour : flat, scaphoid or concave, protuberant/ rounded/convex, any abnormal bulges
- Symmetry: symmetrical or asymmetrical
- Skin findings: striae, scars, dilated veins, ecchymosis of the abdominal wall skin in the flanks(Grey Turner’s
sign), ecchymosis in the periumbilical area(Cullen’s sign)
- Visible pulsations
- Visible peristalsis
- Umbilicus: flat, everted
AUSCULTATION
Use diaphragm of the warmed stethoscope lightly on the abdomen and listen for bowel sounds: absent, hypoactive, hyperactive;
presence of borborygmi
Use bell of the warmed stethoscope and listen for bruits( murmurs of arterial origin)
- in the midline above the umbilicus(aortic)
- 3-4 cm left lateral (left renal artery)
- 3-4 cm right lateral and above the umbilicus (right renal artery)
- over the left lateral area below the umbilicus(left iliac artery)
- over the right lateral area below the umbilicus(right iliac artery)
- over the right inguinal area for the right femoral artery
- over the left inguinal area for the left femoral artery
Use diaphragm of the warmed stethoscope and listen for friction rubs(high pitched, grating sounds associated with respiration and
indicate inflammation of the peritoneal surface of the organ involved) over the liver and splenic areas
Use the bell of the warmed stethoscope and listen for venous hum (soft-pitched continuous sound) heard in the epigastric area. This
venous hum is appreciated in patients with portal hypertension.
PERCUSSION
Percuss the right upper quadrant to check for gas in the hepatic flexure
Percuss the left upper quadrant to check for gas in the stomach or the splenic flexure
Percuss the left lower quadrant to check for gas in the sigmoid
Percuss the right lower quadrant to check for gas in the cecum
Percuss the periumbilical region to check for gas within the small bowel loops
Note for areas of tympany or dullness
LIVER PERCUSSION
Percuss downward along the right midclavicular line (MCL) 2nd right intercostal space (ICS) until the top edge of liver dullness (from
area of resonance to area of dullness); in females, gently displace the breast as necessary to be sure that the percussion note heard
is resonant
Mark the top edge of liver dullness with a tape or pen
Percuss lightly upward from the abdomen below the umbilicus along the right MCL until the bottom edge of liver dullness is detected
Mark the lower edge of liver dullness with a tape or pen
Measure the vertical span of liver dullness in cm
SPLEEN PERCUSSION
Percuss the 9th ICS in the left anterior axillary line (AAL). It is normally tympanitic.
Instruct the patient to take a deep breath and percuss the 9th ICS in the the left AAL again
Note if there is dullness instead of tympany during inspiration (dullness indicates splenomegaly)
PALPATION
Have the patient point to painful areas prior to examination and palpate these areas last
Warm your hands prior to palpation
Palpate with fingers together, flat on the abdominal surface
Avoid short and quick movements or jabs
Palpate the abdomen initially with a light then with a deep but gentle, dipping motion
Palpate all quadrants
ABDOMINAL/RECTAL EXAM SY2016-2017

Medicine 1
LIVER PALPATION: CONVENTIONAL METHOD

Palpate by placing right hand well below the lower border of the liver dullness
Press hand gently in and up
Instruct the patient to take a deep breath and feel the liver edge as it comes down to meet the palpating fingertips
Evaluate liver edge and surface
LIVER PALPATION: HOOKING METHOD

Hook the right costal margin of the patient by pressing your fingers of both hands in and up toward the right costal margin
Instruct the patient to take a deep breath and feel the liver edge as it descends to meet the hooked fingers
Describe the liver edge and surface (note the sharpness of the liver edge and report any nodularities or tenderness)
SPLEEN PALPATION
Place the patient in a supine position with knees flexed or right lateral decubitus position
Reach across with your left arm placing your left hand beneath the patient over the left costovertebral angle (CVA) or left flank.
Press left hand upward anteriorly toward the abdominal wall.
Press your right hand below the left costal margin Instruct the patient to take a deep breath and feel the edge of the spleen as it
comes down to meet your fingertips.
EXAMINATION OF THE KIDNEYS

KIDNEY PALPATION: EXAMINER ON THE RIGHT SIDE
LEFT KIDNEY
Place the patient in a supine position with knees flexed
Stay at the right side of the patient
Reach across with your left hand and place it beneath the patient over the left CVA or left flank
Instruct patient to take a deep breath as your left hand pushes anteriorly the left flank
Simultaneously, using your right hand, palpate deeply down just below the left costal margin
At the height of inspiration, capture the edge of the left kidney by pressing the fingers of both hands
Describe the left kidney edge( smooth, firm, tender or non-tender)
Instruct the patient to exhale and try to feel the kidney edge as it slips beneath the fingers as it moves back in place
RIGHT KIDNEY
Stay at the right side of the patient
Place the supinated left hand beneath the patient at the level of 11th and 12th ribs
Instruct patient to take a deep breath as your left hand pushes anteriorly.
Simultaneously, use the right hand to palpate deeply down just below the right costal margin
At the height of inspiration, capture the edge of the right kidney by pressing the fingers of both hands
Describe the right kidney edge( smooth, firm, tender or non-tender)
KIDNEY PALPATION: EXAMINER ON THE LEFT SIDE

LEFT KIDNEY
Stay at the left side of the patient
Place the supinated right hand behind the patient, just below and parallel to 12th rib with the fingertips reaching the CVA and with the
same hand, try to lift the kidney anteriorly
Instruct patient to take a deep breath as your right hand pushes anteriorly.
Simultaneously, use the left hand to palpate deeply down just below the left costal margin
At the height of inspiration, capture the edge of the left kidney by pressing the fingers of both hands
Describe the left kidney edge( smooth, firm, tender or non-tender)
KIDNEY PERCUSSION: DIRECT METHOD USING FIST

Instruct the patient to assume a sitting position
Go to the back of the patient
Strike the heel of the palm of the hand directly on the CVA on the left side, then on the right side to elicit tenderness
Observe patient for presence of CVA tenderness

Medicine 1
KIDNEY PERCUSSION: INDIRECT METHOD USING FIST
Instruct the patient to assume a sitting position
Go to the back of the patient
Place the palm of your left hand over the left CVA and then strike the left hand with the ulnar surface of your right fist
Do the same procedure on the right CVA
Observe patient for presence of CVA tenderness
RECTAL EXAMINATION
Explain procedure to the patient
Instruct the patient to assume left lateral decubitus position, extend patient’s left leg and flex right leg at the hip and knee joints
Drape patient appropriately
Wear gloves on both hands
Inspect perianal area for skin tag, skin lesions, external hemorrhoids, lumps, opening of fistula
Perform digital examination:
- Lubricate entire index finger
- Insert lubricated finger gently into the anal canal pointing toward the sacrum initially, before inspecting the
whole circumference
- Note for the anal sphincteric tone
- Palpate anus on 4 quadrants and note for masses, tenderness, internal hemorrhoids, prostate (males) –
size, consistency, tenderness, nodule; cervix (female); blood on examining finger, color of stools
Wipes perianal area after examination

Vital Signs & Measurements Checklist

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UNIVERSITY OF SANTO TOMAS

Faculty of Medicine & Surgery

RIGHT UPPER EXTREMITY BP

If supine, patient: A. should be positioned at a 30-45 degree angle

LEFT UPPER EXTREMITY BP

Wash hands or use disinfectant and air dry

SUPINE IN PATIENTS UNABLE TO STAND

CEREBRUM MENTAL STATUS EXAM - includes

EYE OPENING Spontaneous 4

VERBAL RESPONSE Oriented/ normal 5

MOTOR RESPONSE Obeys commands 6

CEREBELLUM TEST FOR BALANCE/EQUILIBRIUM – includes

CRANIAL NERVES I. OLFACTORY – sensory

II. OCULOMOTOR-motor – please see eye exam checklist

IV. ABDUCENS-motor – please see eye exam checklist

VI. TROCHLEAR-motor – please see eye exam checklist

CORNEAL REFLEX – SENSORY COMPONENT IS THE OPHTHALMIC BRANCH OF

VII. FACIAL – mixed

CRANIAL NERVES VIII. VESTIBULOCOCHLEAR – sensory

XI- SPINAL ACCESSORY – motor

XII. HYPOGLOSSAL – motor

SENSORY Superficial pain sensation

PHYSICAL EXAMINATION OF THE RESPIRATORY SYSTEM

3.PALPATION FOR CHEST WALL TENDERNESS /MASSES

4. PALPATION FOR TACTILE FREMITI

2. ANTERIOR CHEST: Go in front of the patient

ABDOMINAL/RECTAL EXAM SY2016-2017

LIVER PALPATION: CONVENTIONAL METHOD

LIVER PALPATION: HOOKING METHOD

EXAMINATION OF THE KIDNEYS

KIDNEY PALPATION: EXAMINER ON THE LEFT SIDE

KIDNEY PERCUSSION: DIRECT METHOD USING FIST

ABDOMINAL/RECTAL EXAM SY2016-2017

ABDOMINAL/RECTAL EXAM SY2016-2017

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