HOW TO DO A QUICK PHYSICAL EXAM
1. HEENT exam
Head & Sinuses -Inspect and palpate head–for signs of trauma, scars, tenderness or abnormalities. And palpate sinuses for tenderness – I’m going to press on your forehead and cheeks. Please tell me if you feel pain anywhere.
Eyes – 1) Inspect the sclerae and conjunctiva for color and irritation. 2) Check for PERRLA – I’m going to shine this light in your eyes. Can you please look at that picture on the wall? 3) EOMI – Can you please follow my finger with your eyes? 4) Check visual acuity with a Snellen eye chart. 5) Do a funduscopic exam. Remember the rule “right-right-right” (ophthalmoscope in the examiner’s right hand–patient’s right eye–examiner’s right eye) and the rule “left-left-left” (ophthalmoscope in MD’s left hand–Pt’s left eye–examiner’s left eye)
Ears – 1) Inspect the external ear for discharge, skin changes, or masses. 2) Palpate the external ear for pain (otitis externa). Also, inspect and palpate the mastoid. 3) Examine the ear canal and tympanic membrane using an otoscope. Put a fresh speculum on. 4) Do the Rinne and Weber tests.
Nose – Inspect the nose; Palpate the nose and sinuses; inspect the nasal turbinates and the nasal septum with a light source.
Throat – 1) Look into mouth and Throat with a light source – Can you please open your mouth for me? Say Ahh. 2) Perform tooth tapping if needed.
2. Cardiovascular Exam
-Don’t lift up patient’s gown. Instead, pull the gown down the shoulder to expose only the area to be examined.
-Listen for carotid bruits (use the diaphragm of your stethoscope)
-Look for JVD
-Inspect the chest
-Palpate the chest for PMI, retrosternal heave, and thrills.
-Listen to at least two of the four cardiac areas ( AP-TM). Listen to the mitral area with the patient on his left side.
-Listen to the base of the heart with sitting and leaning forward.
-Check for pedal edema
-Check for peripheral pulses.
3. Pulmonary Exam
- Examine both front and back of the chest.
- Don’t percuss or auscultate through the pts gown.
- Don’t percuss or auscultate over the scapula.
- Allow a full inspiration and expiration in each area of the chest.
Inspect: For the shape of the chest, respiratory pattern, deformities.
Palpate: For tenderness, tactile fremitus
Percuss:
Auscultate:
Egophony. As you listen to each lung field, ask the pt to say, “EE”. If you hear “Ay”, egophony is present.
4. Abdominal exam
Inspect.
Auscultate (always auscultate before you palpate the abdomen). Also, auscultate over the renal, iliac, femoral artery, and aorta.
Percuss. For tympany, shifting dullness.
Palpate. Start with the point that is farthest from the pain; be gentle on the painful area, and don’t try to re-elicit the pain. Check for 1) rebound tenderness, guarding2) CVA tenderness, 3) obturator sign, 4) psoas sign, and 5) Murphy’s sign.
Check the liver span and the spleen.
5. Neurologic exam
- Mini-Mental Status Exam
- Cranial Nerves
- Motor (Strength) Exam
- Reflexes: Test and contralaterally compare biceps, triceps, brachioradialis, patellar, Achilles, and Babinski.
- Sensory: Test and contralaterally compare: 1) Pain: Sharp (pin) / dull (cotton swap), 2) Vibration, 3) Proprioception (position sense). May also test temperature, stereognosis; graphesthesia; and two-point discrimination.
- Cerebellum: Finger-to-nose, heel-to-shin, rapid alternating movements, Romberg sign, gait.
- Meningeal signs: Neck stiffness, Kernig, Brudzinski.
6. Joint Exam
See shoulder and knee examination videos for examples.
Inspect and compare the joint with the opposite side.
Palpate
Check for effusion
Check for crepitus
Check for range of motion (active and passive).
Useful scales
Reflexes (0-4) with zero being completely areflexic.
0 – No reflex
1+ -Hypoactive / Hyporeflexia
2+ -Normal reflexes
3+ -Hyperactive / Hyperreflexia
4+ -Hyperactive plus clonus
Strength (0-5) with zero representing the inability to move the lip.
Glasgow Comma Scale (GCS)