This checklist represents the foundation, or skeleton of a physical exam, that should be tailored in real practice to your individual patient. In clinical practice, some elements of this exam are expanded or deleted depending on the chief complaint, or based on the history and physical exam. Please pay special attention to the overall flow of the exam, as well as the ways to maximize patient comfort and perform appropriate draping throughout the exam.
NEVER EXAMINE THE PATIENT OVER ANY PIECE OF CLOTHING!
General
- Washes hands BEFORE examining patient
Sitting
- Assesses orientation to person, place and time
- Takes blood pressure in ONE arm (for exam purposes)
- Brace the patient’s arm on your hip so that it is relaxed and at the level of the heart, providing the most accurate reading.
- Takes pulse rate and respiratory rate
- Pulse rate and respiratory rate may be taken simultaneously.
- Assesses cranial nerve II: Assesses vision using Snellen card (one eye at a time with corrective lenses if applicable)
- Assesses cranial nerve III, IV, VI: Evaluates extraocular muscle movements
- Assesses cranial nerve II: Assesses visual fields (one eye at a time)
- Assesses cranial nerve II and III: Assesses pupillary reflexes (direct and
consensual)- When assessing pupillary reflexes, have the patient look at a point in the distance. This will avoid constriction that can occur if they focus on your face or the light.
- Performs funduscopic examination
- When performing the funduscopic exam, remember hold the ophthalmoscope with your right hand and use your right eye when examining their right eye, bracing their forehead with your left hand.
- Assesses cranial nerve VIII (gross assessment by rubbing fingers)
- A gross assessment of hearing is done with the fingers extended at arm’s length, not close to the patient’s ears. Use your own hearing as a reference.
- Performs otoscopic examination
- As in the funduscopic exam, use your right hand to hold the otoscope when you examine the patient’s right ear. Pull gently out and up on their pinna with your left hand, while bracing the otoscope with your right hand.
- Assesses cranial nerve V (motor–jaw clench/sensory–facial sensation)
- Assesses cranial nerve VII (smiling or puff cheeks; eyes closed tightly or
eyebrows raised) - Assesses cranial nerve XII (stick out tongue and move from side to side)
- Inspects oral cavity and buccal mucosa using a tongue depressor and a light source
- Assesses cranial nerve IX & X (depress tongue elevation of posterior pa late)
- Assesses cranial nerve XI (shrug shoulders against resistance)
- Palpates lymph node chains in the head and neck (occipital, pre-auricular, post‐auricular, anterior cervical, deep cervical, posterior cervical, mandibular, submental and supraclavicular)
- When palpating lymph nodes anywhere in the body, use smooth motions; do not “walk” your fingers along the skin.
- Auscultates and palpates carotids one side at a time (it doesn't matter which one you do first. You are more likely to win the Powerball than flick an emboli from the carotids)
- Due to their low frequency, carotid bruits are best heard when you use gentle pressure with the bell of your stethoscope.
- Palpates thyroid gland from either front OR back
- Assesses posterior chest wall excursion (at least 1 level)
- Assesses posterior chest for tactile fremitus (at least 3 levels) either from side to side, comparing sounds on the same level, right to left OR on one side moving from one lung field level to the next
- Percuss either from side to side, comparing sounds on the same level, right to left OR percuss on one side moving from one lung field level to the next
- Percusses posterior chest (at least 3 levels) either from side to side, comparing sounds on the same level, right to left OR percuss on one side moving from one lung field level to the next
- Auscultates posterior chest for breath sounds
(at least 3 levels)- Listen either from side to side, comparing breath sounds on the same level, right to left OR listen on one side moving from one lung field level to the next.
- Auscultates anterior chest for breath sounds (at least 2 levels)
- Listen either from side to side, comparing breath sounds on the same level, right to left OR listen on one side moving from one lung field level to the next.
Sitting/Supine
- Palpates for PMI (either supine or sitting)
- The PMI may be assessed either sitting or laying. In patients where the PMI is difficult to appreciate, have them lay on their left side at 30-45 degrees during palpation.
- Auscultates heart in the 4 cardinal areas (supine AND sitting) aortic, pulmonic, tricuspid and mitral areas
- When laying the patient down, be sure to remember appropriate draping and to extend the foot support on the examination table (if applicable)
Supine
- Auscultates abdomen in all 4 quadrants
- Performs light palpation of abdomen in all 4 quadrants
- Performs deep palpation of abdomen in all 4 quadrants
- Percusses abdomen in all 4 quadrants
- Assesses liver size (NOT using scratch test) by palpation and percussion
- Palpates spleen
- _Provide posterior support and feel with the side of the hand.
- Examines peripheral pulses: brachial, radial, femoral, popliteal, posterior
tibial, dorsalis pedis - Inspects and palpates for peripheral edema in both lower extremities
Sitting
- Assesses motor strength in upper extremities (at least 3 muscle groups)
- Assesses motor strength in lower extremities (at least 3 muscle groups)
- When assessing strength, support the joint, and position self to gain maximal leverage.
- Examines upper extremity reflexes: biceps, triceps, brachioradialis
- Examines lower extremity reflexes: knee, ankle, plantar
- Examines fingers for signs of clubbing or cyanosis
- Performs at least ONE coordination test (Finger-to-nose, rapid alternating movements, heel-to-knee-to-shin)
- When performing the FTNT, make sure the patient maximally extends their arm as you assess for dysmmetria.
Standing
- Performs Station using the Romberg test (test of the proprioception receptors & pathways function NOT cerebellar function)
- Assesses gait or ambulation (includes normal gait with turning, walking on toes/heels and tandem gait)
General
- Utilizes proper draping during entire exam
- Washes hands AFTER examining the patient
Normal PE Writeup
Commonly used acronyms are in bold.
General Survey: Well-Developed, Well-Nourished young man in No Apparent Distress
Vitals: BP 120/80 on right, 120/80 on left; HR 80 regular (supine);
BP 120/80 HR 80 regular (sitting); RR 16; T 37.0°C
Skin: (-) lesions, hair normal, nails normal
HEENT: (Head): Normo-Cephalic, Atraumatic; (Eyes): Acuity 20/20 bilaterally, visual fields full bilaterally, sclera anicteric, normal conjunctiva, Pupils Equal, Round, Reactive to Light and Accommodation, Extra-Ocular Movements Intact, Fundi normal bilaterally: disks sharp, vessels normal; (Ears): Canals normal bilaterally, Tympanic Membranes clear bilaterally, acuity normal bilaterally; (Nose): (-) deviated septum, normal mucosa/turbinates, no maxillary/ frontal sinus tenderness; (Throat): Oropharynx, including tonsils clear, normal dentition
Neck: Supple, trachea midline, (-) lymphadenopathy, (-) thyromegaly, (-) JVD (Jugular Venous Distention), carotids 2+ bilaterally without thrill or bruit
Breasts: Symmetric, (-) masses, (-) nipple discharge, (-) axillary adenopathy
Lungs: Normal chest wall excursion, (-) use of accessory muscles, (-) tactile fremitus, lungs clear to Auscultation and Percussion
Cardiac: Regular Rate and Rhythm, Point of Maximal Impulse (apical impulse) not displaced, normal S1/S2 (include splitting), no murmurs, rubs, gallops (S3/S4)
Abdomen: Soft, Non-Tender, Non-distended, Normoactive Bowel Sounds, (-) rebound tenderness, no hepatomegaly or splenomegaly, liver span (in cm) at midclavicular line, aorta normal, (-) renal artery bruits
Back: (-) scoliosis, (-) spinal tenderness, (-) Costo-Vertebral Angle Tenderness
Rectal: (-) hemorrhoids, normal tone, (-) masses, prostate smooth without nodules (males), guaiac negative stool
GU (Genitourinary, man): (-) lesions, (-) penile discharge, normal urethra, testicles equal in size and without mass, (-) hernia
GU (Genitourinary, woman): (-) lesions, (-) discharge, normal cervix, (-) cervical motion tenderness, normal ovaries and uterus, (-) hernia
Extremities: (-) Cyanosis, Clubbing, Edema, pulses 2+ bilaterally (brachial, radial, femoral, popliteal, dorsalis pedis, posterior tibial), normal capillary refill, (-) joint swelling/redness/warmth/tenderness, normal active Range Of Motion of joints
LN (Lymph Nodes): (-) cervical/supraclavicular/axillary/inguinal lymphadenopathy
Neuro: Alert and Oriented to person, place, time (AOx3). CN II-XII intact; Motor 5/5 in all groups with normal tone; Sensation intact to light touch/pin/ vibration/cold/proprioception throughout; Reflexes 2+ throughout (biceps, triceps, brachioradialis, knee, ankle), (-) Babinski response (or normal plantar reflexes)