ICM Comprehensive Physical Examination Checklist 2010-2011

Testing begins February 2011.

The Rules:
The checklist below is simply a compiled list of all the checklist items you have seen
on your individual skill session handouts. The details of each of these items are NOT
here. For specifics regarding technique or possible abnormalities that may be
identified, refer to your individual skill session handouts. Most items are graded as
Done, Done Incorrectly, or Not Done. If the physical exam item is listed below, you
must state aloud what you are doing so that everyone is clear on what you are
examining. If you do not state it, the grader WILL NOT GUESS what you intended to
examine. (see the posted video as an example) The SP in the room and the rater
watching you on camera will be grading you based on this checklist. The
examination is videotaped, and you will have access to view your exam and
checklist with comments through the B-Line software program, available only in the
LRC, once all examinations have been completed. The order in which you complete
all of these tasks is not important. We discussed several ways to help remember
different items based on the position of the patient but, ultimately, the order in
which you complete the examination is up to you. The key to success is to
PRACTICE these techniques. Practice on friends and family members, practice on
each other, ask the second year TAs to be your patient…anyone. A careful, detailed
physical examination is key to diagnosing and treating your future patients.
Through the years, you will refine and adjust your examination techniques and add
more maneuvers (yes, there’s more!:)), but for now, you are off to a great start.

Checklist Items:
1. Introduce yourself and greet patient by using Mr. or Ms. and their last name.
2. Wash hands with waterless soap or soap and water prior to shaking hands.
3. Use speech that is easily heard and understood.
4. Describe to the patient what you are doing during the examination, especially
when it is not obvious.
5. Demonstrates sensitivity to your patient’s needs during the exam.
• Establishes rapport with the patient
• Drape the patient properly during certain parts of the exam
• Watch the patient’s face during the exam for signs of discomfort.

6. Check radial pulse.

a. State rate and regular
7. Count respirations.
a. State rate and unlabored
8. In general you are a well-nourished healthy adult female/male with no acute
distress
9. Estimate the systolic blood pressure.
10.Check blood pressure in one arm.
11.Inspect the patient’s skin.
a. Im gonna examine your skin as I go through the exam
12.Palpate the cranium.
13.Examine scalp and hair.
14.Palpate frontal and maxillary sinuses for tenderness.
15.Evaluate Cranial Nerve V (Trigeminal) Motor & Sensory
a. Examine TMJ
b. Bite down hard: Temporalis/Masseter
c. V1/V2/V3 sensory areas, close eyes, can you feel this same or different
16.Evaluate Cranial Nerve VII (Facial)

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 a. raise eyebrows, show teeth/smile, frown, and puff out his/her cheeks.
b. Test strength of eye closure with eyes closed
17.Inspect the eyelid, sclera and conjunctivae of each eye.
a. Pull lower eyelid down and make patient look up. And opposite
18.Evaluate visual acuity.
a. Gross Visual Acuity (count # fingers),
i. Cover 1 eye and ask to count fingers
b. Visual fields with wiggling fingers
19.Inspect each eye using the Ophthalmoscope.
a. Red reflex
b. Optic disc- sharp vs blurred
20.Evaluate Cranial Nerve II & III (Optic & Oculomotor)
a. Pupilary constriction/dialation test. Direct / consensual / swinging
b. Inspect the cornea, iris and lens of each eye. Oblique lighting
c. Trace H and check convergence
21.Evaluate Cranial Nerves III, IV and VI (Oculomotor, Trochlear and Abducens)
22.Examine the Ears
a. Palpate, ask for pain or tenderness
b. Otoscope take a look at tympanic membrane
23.Evaluate Cranial Nerve VIII ( Acoustic or Vetibulocochlear)
a. Gross hearing. Rub fingers
b. Weber/Rinne
24.Examine both nares with a light source.
a. Tilt head back and examine with light source
25.Evaluate Cranial Nerve IX and X ( Glossopharyngeal and Vagus)
a. Examine the mouth with a light source and tongue blade.
i. Examine teeth, gingiva, buccal mucosa
ii. Posterior pharynx and soft and hard palate
iii. Inspect tongue
iv. Subglossal area (lift tongue)
26.Evaluate Cranial Nerve XII (Hypoglossal)
27.Evaluates Cranial Nerve XI (Spinal Accessory)
28.Identify and palpate all lymph nodes of the head and neck region: anterior
cervical, posterior cervical, tonsillar, occipital, submental, submandibular,
preauricular, post auricular, supraclavicular,
29.Palpate the trachea.
a. Which is midline
30.Palpate the thyroid.
a. Behind patient while swallowing

UNDRAPE

31.Percuss the Posterior lung field. (3 locations each side Comparing, side to
side)
• Make sure medial to scapula
• Check for chest expansion
• Tactile fremitus (99)
• Check for Costovertebral Tenderness (CVAT).
32.Auscultate alternate sides of posterior lung fields (at least 3 locations
bilaterally).
a. Breathe through mouth

LIE THE PATIENT DOWN

GET A DRAPE NOW AND UNDRESS
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 33.Percuss the anterior lung field. (2 places each Comparing, side to side)
34.Auscultate alternate sides of anterior lung field (at least 2 locations
bilaterally).
a. Breathe through mouth
35.Conduct the cardiovascular exam from the right hand side of the patient’s
bed.
36.Auscultate and identify the aortic valve. Must use diaphragm and bell.
37.Auscultate and identify the pulmonic valve. Must use diaphragm and bell.
38.Auscultate and identify the tricuspid valve. Must use diaphragm and bell.
39.Auscultate and identify the mitral valve. Must use diaphragm and bell.
40.Auscultate carotid pulses individually, then palpate individually.
a. ASK to hold breath, say no bruits
41.Inspect, then Palpate the anterior chest wall.
a. Ask for tenderness, Anterior compression and lateral compression
42.Inspect the jugular veins for JVD.
a. Recline 30 degrees and ask to look away
b. Shine penlight to accentuate
43.Palpate the axillary lymph nodes (4 sites of axillae).
44.Palpate PMI.
a. Left lateral decubitis position mid clavicular line
b. Woman lift breast

REDRESS

45.Palpate both radial pulses.

46.Palpate both femoral pulses.
47.Palpate the inguinal lymph nodes. (both sides)
48.Palpate both popliteal pulses.
a. Flex the knee
49.Palpate both dorsalis pedis pulses.
50.Palpate both posterior tibial pulses.
51.Conduct the abdominal exam from the right hand side of the patient’s bed.
52.Inspect abdomen
53.Auscultate bowel sounds in a minimum of one location prior to palpation.
54.Auscultate for bruits in at least 5 areas, naming the artery being examined at
each site.
a. 1 aortic
b. 2 renal
c. 2 iliac
55.Percuss the abdomen lightly before palpation.
a. Ask for tenderness or pain
56.Palpate the abdomen gently (4 quadrants), then palpate the abdomen deeply
(4 quadrants).
a. Start farthest away from pain, ask for any pain
57.Percuss the liver span and state size in centimeters.
58.Palpate for liver edge.
a. Start at iliac crest and deep breath in and out and move hand up
59.Palpate for spleen edge.
a. Lean patient over and support back with other hand, feel spleen same
as liver

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 UPPER MUSCULOSKELETAL
(Inspect, active ROM, passive ROM+palpate, strength test)

60.Hip Joint
a) Perform straight leg raise
a. Push up leg and dorsiflex
b) Evaluate range of motion of the hips.
a. Flex to chest
b. Internal and external rotation
c. flex
d. Abduct
e. Adduct past midline

c) SIT UP PATIENT

d) Test strength of both hips.

a. Move up against my hand (flexion)
b. Move down towards my hand (extension)
c. Abduction
d. Adduction

61.Shoulder Joint
a. Evaluate active range of motion of both shoulders.
i. Bring arms all the way up over head
ii. Touch back of head
iii. Touch lower back
b. Evaluate Passive and Palpate both shoulder joints.
c. Test strength of the shoulder girdle.
i. Chicken wings
62.Elbow
a. Evaluate range of motion of both elbows.
i. Put both hands out flexed then supinate and pronate
b. Palpate both elbow joints while passive range of motion.
c. then test strength of both elbows. (armwrestle)
63.Wrist Joint
a. Evaluate active range of motion of both wrists.
i. Flexion
ii. Extension
iii. Ulnar and radial deviation (don’t need to strength test this one)
b. Passive and Palpate the joints of both wrists.
c. Test strength of both wrists.
64.Hands
a. Evaluate active range of motion of both hands.
i. Make fist
ii. Extend and flex
b. Palpate MCP joints of both hands. (with thumb)
c. Palpate PIPs and DIPs of both hands.
i. Make a box
ii. Inspect the patient’s finger nails and finger pads. Note capillary
refill.
d. Test grip strength of both hands.
e. Test finger spread and close strength
Some Neuro Exam
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 65.Perform discrimination test. (both hands)
66.Test finger to nose ability. (both hands)
67.Test rapid alternating movement of both hands.
68.Test brachioradialis reflex. (both arms)
69.Test biceps reflex. (both arms)
70.Test triceps reflex. (both arms)
71.Test upper and lower extremities sensation to light touch.
72.Test upper and lower extremities sensation to sharp/dull.
73.Test heel to shin ability. (both sides)

LOWER MUSCULOSKELETAL
(Inspect, active ROM, passive ROM+palpate, strength test)

74.Knee
a. Evaluate active range of motion of both knees.
b. Passive and Palpate both knee joints.
i. Palpate joint line
ii. Patella
iii. Tibial tendon
iv. Tibial tuberosity
v. Fibula head
c. Test strength of both knees.
d. Test patellar reflex. (both knees)
75.Ankle
a. Evaluate active range of motion of both ankles.
i. Dorsi
ii. Plantar
iii. Lateral/medial rotation
b. Palpate both ankle joints.
i. Joint line
ii. Medial/lateral malleolus
iii. Test for ligament laxity by passive ROM of inversion and
eversion
c. Palpate the Achilles tendon of each foot.
d. Test strength of both ankles.
e. Test ankle reflex. (both feet)
f. Test for Babinski (plantar response) on both feet.

76.Foot
a. Active ROM of foot
i. Curl toes
b. Palpate the metatarsals of both feet.
c. Also take a look at the toenails
d. do cap refill
e. Test vibratory sensation. (both feet)
f. Test position sense. (both feet)

STAND UP PATIENT

77.Evaluate active range of motion of the C-spine.

a. Shin to neck
b. Look up
c. Flex left/right
78.Evaluate active range of motion of the back.
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 79.Palpate spinous processes of the spine. (cervical, thoracic, lumbar) AND
palpate paravertebral musculature (entire paraspinal area).
80.Shoulder height symmetric
81.Symmetric iliac crest
82.Back ROM (hands on hips)
a. Bend down touch toes
b. Bend back
c. Lean right/left
d. Twist right/left

83.Evaluate normal gait.

84.Evaluate tandem gait.
85.Test Romberg.
86.Test Pronator drift. (may be combined with Romberg)
a. Make sure to tap arms too

DONE

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