Exam Checklist
- Student observes proper patient draping
- Student takes blood pressure in both arms
- Student takes pulse
- Student checks for orthostatic changes
- Student assesses patient’s neck veins – elevate the bed to 30 degrees
- Student listens first and then palpates the carotid arteries
- Student inspects and palpates the precordium and palpates the PMI – sitting and lying down
- Student inspects and palpates the lower extremities for edema
- Student auscultates in all four cardiac areas - sitting and lying down:
- 2nd ICS, right sternal border - aortic area
- 2nd ICS, left sternal border - pulmonic area
- left lower sternal border - tricuspid area
- 5th ICS, midclavicular line - mitral area
- Student assesses the following pulses:
- brachial
- radial
- femoral
- popliteal
- dorsalis pedis
- posterior tibial
- Student assesses for lower extremity edema in both legs
Write-up Examples
The jugular venous pulse (JVP) is 3 cm above the sternal angle with the head of bed elevated to 30°. Carotid upstrokes are brisk, without bruits. The point of maximal impulse (PMI) is tapping, 7 cm lateral to the midsternal line in the 5th intercostal space (ICS). Good S1 and S2. No murmurs or extra sounds.
The JVP is 5 cm above the sternal angle with the head of bed elevated to 50°. Carotid upstrokes are brisk; a bruit is heard over the left carotid artery. The PMI is diffuse, 3 cm in diameter, palpated at the anterior axillary line in the 5th and 6th intercostal spaces. S1 and S2 are soft. S3 present. Harsh 2/6 holosystolic murmur best heard at the apex, radiating to the lower left sternal border (LLSB). No S4 or diastolic murmurs.
Notes
- Be mindful of the flow and the positioning of the patient during the exam.
- The patient needs to sit upright to hear an aortic regurgitation murmur.
- The patient needs to be in the left lateral decubitus position to accentuate a mitral stenosis murmur.
- Initially you may use sentences to describe the findings; later you will use phrases appropriate for most write-ups.
- Remember to only use approved medical abbreviations
Physical Examination Findings - SIM
