Heart-Lung & Abdominal Exam

Patient:_________________________________ date: _________

Insurance: _____________________________________ (dd/mm/yr)
Date of birth: ____________________________________ M/F

Check normal, circle & describe abnormal

CC & signicant history: ____________________________________________________

__________________________________________________________________________
Temp: __________, Pulse: _______, Resp: _________, BP: L: _____/_____, R: _____/_____

Percussion
Resonant: ___________________________________
Observation
Flat:________________________________________
Shape & symmetry, bony markings
Dull:________________________________________
Spinal shape & curvature (kyphosis, lordosis, scoliosis)
Hyperresonant: _______________________________
Skin: _______________________________________
Palpation
Effort of respiration (use of accessory muscles):
Spine/rib tenderness:_____________________________
______________________________________________
Anterior chest wall: _______________________________
Extremities: ____________________________________
Thoracic excursion: _______________________________
Digital clubbing_______________________________
clubbing_______________________________
Fremitus
Fremitus:: _______________________________________
Edema:: _____________________________________
Diaphramatic excursion: __________________________
Cyanosis: ____________________________________
Tracheal palpation/deviation: _______________________
Trophic changes: ______________________________
Abdominal aorta: _________________________________
Lung Auscultation
Wheeze (rhonchi):
(rhonchi): ________________________________
Crackles (rales):
(rales): _________________________________
Basilar crackles: _________________________________
Crepitus: ___________________________________
Stridor: ____________________________________
Heart Auscultation
Point of maximal impulse: _________________________
Carotid arteries: _________________________________
Abdominal aorta: _______________________________
Specific valves
Aortic: ____________________________________
Pulmonic
Pulmonic:______________________________________
:______________________________________
Erbs point:
point: ___________________________________
Tricuspid: ____________________________________
Mitral: _____________________________________
Sounds
S1 (lub): ____________________________________
S2 (dup):
(dup): ________________________________
Bruit
Bruit:: ____________________________________
Click: ____________________________________
Other: ___________________________________

Heart-Lung:: WNL

Abdomen:: WNL
Observation
Skin: __________________________________________
Symmetry/contour: ________________________________
Visible peristalsis
peristalsis:: _________________________________
Auscultation
Upper left
left:: ______________________________________
Upper right: _____________________________________
Lower right: _____________________________________
Lower left: ______________________________________
Vascular
Vascular:: _______________________________________
Aorta:
Aorta: _______________________________________
Renal: _______________________________________
Iliac: ________________________________________
Femoral: _____________________________________
Bowel sounds
sounds:: ____________________________________
Percussion
Liver
Liver:: __________________________________________
Spleen: ________________________________________
Murphys punch: _________________________________
Percussion note: _________________________________
Palpation (light then deep)
Abdominal tone:
tone: _________________________________
Cutaneous hypersentitivity:
hypersentitivity: _________________________
Light palpation: __________________________________
Deep palpation: _________________________________
Inguinal lymphnodes: _____________________________
Other: _________________________________________

Hernia evaluation
Umbilical: __________________________________
Inguinal direct:
direct: ______________________________
Inguinal indirect:
indirect: ____________________________
Femoral
Femoral:: __________________________________
Strength
Resisted exion: ____________________________
Reisi
Reisisted
sted L/R rotation: _______________________

_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
________________________________________________
________________________________________________
___________________________________________________________
__________________________________________________________
________________________________________________
________________________________________________
__________________________________________________
__________________________________________________

Acute abdomen special tests

Rigid abdomen:______________________________________
Rebound tenderness
tenderness:: _________________________________
Valsalva
Valsalva:: ___________________________________________
Murphys sign (GB):
(GB): __________________________________
Murphys punch (kidney): ______________________________
Carnetts test:
test: _______________________________________
Other: _____________________________________________

Right Upper Quadrant

Liver
Gall bladder
Duodenum
Head of pancreas
Right adrenal gland
Portion of right kidney
Hepatic exure of colon
Ascending colon
Transverse colon

Left Upper Quadrant

Left lobe of liver
Spleen
Stomach
Body or pancreas
Left adrenal gland
Portion of left kidney
Splenic exure of colon
Transverse colon
Descending colon

Right Lower Quadrant

Lower pole of right kidney
Cecum & appendix
Portion of ascending colon
Ovary & salpinx
Uterus
Right spermatic cord
Right ureter

Left Lower Quadrant

Lower pole of left kidney
Sigmoid colon
Portion of descending colon
Ovary & salpinx
Uterus
Left spermatic cord
Left ureter

This form is a comprehensive checklist of examination procedures. Each item should be utilized as a diagnostic option based on the patients presenting
symptoms and the clinical discretion of the examiner. Every procedure does not have to be performed on every patient. Some procedures may be
contraindicated in certain situations. Patient information contained within this form is considered strictly condential. Reproduction is permitted for personal use,
not for resale or redistribution. www.prohealthsys.com 2005 by Professional Health Systems Inc. All rights reserved. Dedicated to Clinical Excellence.

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