___ 16.

Lights dimmed before ophthalmoscopic exam; asks patient to look at a specific spot in the room ___ 17. Ophthalmoscope held properly using right and left hand for examining the right and left eye respectively ___ 18. Inspect optic disk, nerve and vessels In 4 quadrants ___ 19. Have patient look at light to observe macula Inspect anterior chambers, iris, lens, cornea ___ 20. Inspect optic disk, nerve and vessels in 4 quadrants c. Ears

Physical Examination Checklist

___ 21. Observe/palpate ears, preauricular and postauricular nodes and regions ___ 22. Stabilize the otoscope and cause no pain to patient from speculum ___ 23. Examine both ear canals and tympanic membrances with the otoscope ___ 24. Test auditory acuity, to Include the Weber and Rhinne tests d. Nose ___ 25. Inspect nasal vaults with speculum causing no pain to patient ___ 26. Test for patency of both nasal passages ___ 27. Test for frontal and maxillary sinus tenderness e. Mouth ___ 28. Inspect lips, gums, teeth, floor of mouth, tongue, pharynx and tonsils ___ 29. observe elevation of the palate ___ 30. Palpate salivary glands, tongue, tonsillar pillars and floor of mouth NECK Palpate lymph nodes one side at a time ___ 32. occipital ___ 33. Anterior cervical ___ 34. Posterior cervical ___ 35. Submental ___ 36. Supraclavicular and infraclavicular ___ 37. Palpate thyroid from the back of the patient while patient swallowing ___ 38. Palpate carotid arteries bilaterally but separately, and auscultate separately in its lower, middle and upper portions ___ 39. Test for the position of the trachea

GENERAL INSPECTION/VITAL SIGNS ___ 1. Wash hands before starting examination Measure blood pressure in one upper limb ___ 2. if elevated, measure in other arm and one lower extremity ___ 3. Place cuff snugly in correct anatomical location ___ 4. Measure respiratory rate for at least 15 seconds ___ 5. Palpate radial pulse for at least 15 seconds ___ 6. Palpate radial pulses simultaneously for symmetry ___ 7. Observe patient for state of health/illness, nutrition, distress, appearance appropriate for age, other behavioral or physical characteristics HEENT a. Head ___ 8. Inspect and palpate scalp thoroughly b. Eyes ___ 9. Patient postioned at height comfortable for examiner ___ 10. Inspect extraocular structures (lids, conjunctive, punctum, cornea) with lids at rest and after gently moving eyelids up and down ___ 11. Evaluate extraocular muscle function in 4 (up, down, right, left) directions ___ 12. Check for convergence and accommodation observe pupillary response to light both directly and consensually ___ 13. Observe pupillary responses to light both directly and consensually ___ 14. Estimate visual acuity in each eye separately Test visual fields in each eye separately and in 4 quadrants ___ 15. Test visual fields in each eye separately and in 4 quadrants
IVMS ICM Physical Examination Checklist

MUSCULOSKELETAL a. Upper extremity ___ 40. Inspect/palpate both hands and arms for deformities, symmetry, lesions, clubbing, skin color, temperature and texture, nailbeds, tenderness ___ 41. Palpate epitrochlear nodes ___ 42. Palpate axillary nodes bilaterally then wash hands ___ 43. Palpate bilaterally the axillary, brachial, and ulnar arteries ___ 44. Lower extremity ___ 45. Inspect and palpate both legs for deformities, lesions, tenderness, symmetry, skin color, texture and temperature ___ 46. Palpate bilaterally the femoral, popliteral, posterior tibial and dorsalis pedis arteries ___ 47. Palpate femoral and inguinal lymph nodes ___ 48. Ausculate bilaterally for femoral bruit ___ 49. Palpate for pitting edema C. Trunk ___ 50. Percuss spinous processes of the entire spine ___ 51. Percuss and/or palpate sacroiliac joints ___ 52. Palpate paraspinous muscles ___ 53. Test range of motion of spine: flexion, extensions, rotations and lateral flexion ___ 54. observe posture and curvatures ___ 55. Test flexion by having patient bend at waist to touch toes ___ 56. perform screening test for scoliosis. ___ 57. Test flexion, extension and rotation of the neck ___ 58. Test ROM of all joints ___ 59. Test Muscle tone and strength in flexion and extension at hands, wrists, elbows, shoulders, hips, knees, and ankles LUNGS ___ 60. inspect and palpate soft and bony structures of the chest wall ___ 61. Check thoracic expansion ___ 62. Ask patient to cross arms to move scapulae and expose lung fields ___ 63. Percuss all lung fields bilaterally, including lateral areas ___ 64. Measure diaphragmatic excursion bilaterally ___64.5 Auscultate all lung fields while patient breaths with,an open mouth ___ 65. Auscultate all lung fields while patient breathes with open mouth ___65.5 Perform Forced Expiratory Maneuver ___ 66. Test for egophony in all lung fields ___ 67. Test for vocal fremitus in all lung fields
IVMS ICM Physical Examination Checklist

BREASTS (Female and Male) ___ 68. Inspect with patient a) sitting with hands pressed to hips b) supine with arms at sides/relaxed and c) supine with ipsilateral arm behind the head ___ 69. Palpate, in positions b) and c) above, all four quadrants, nipples, areolae, tail, and attempt to express liquid from the nipple HEART ___ 70. observe precordium ___ 71. with the patient recumbent and at 30-45' of elevation, observe the superficial neck veins and measure ___ 72. Palpate, with the patient sitting, the aortic, pulmonary, right ventricular and apical areas ___ 73. Auscultate, with the patient sitting, the aortic, pulmonic, tricuspid, and mitral (apical) area with the diaphragm and for apex include bell ___ 74. Palpate with the patient supine the aortic, pulmonary, right ventricular and apical areas ___ 75. Auscultate with the patient supine the aortic, pulmonary, tricuspid and mitral (apical) areas using diaphragm and for the apex include bell ___ 76. With patient sitting and leaning forward, auscultate the aortic area during end expiration using the diaphragm ___ 77. With the patient in the left-lateral position, relocate and auscultate the apical area using the bell ABDOMEN ___ 78. Patient is taught to relax abdominal musculature ___ 79. Note abdominal contour ___ 80. auscultate, before palpation, all four quadrants and the aorta ___ 81. Watch patient's face as abdomen examined ___ 82. Palpate the epigastrium and all four quadrants ___ 83. Use proper technique to palpate for the spleen, liver and flanks ___ 84. Percuss and measure the liver span in the MCI NEUROLOGICAL Mental status ___ 85. Orientation to person, time and place ___ 86. If #83 abnormal, perform MiniMental Status Exam

Cranial Nerve ___ 87. Test Nerve I: Sense of smell (not usually done). Ask patient if there has been any change in smell or taste Test Nerve II: a. Visual acuity Done with HEENT b. visual fields c. ophthalmoscopic (disc, blood vessel, retina) Test III, IV, VII a. Pupillary reaction to light b. Extraocular movements Cerebellar Function Patient standing ___ 95. observe gait ___ 96. Have patient walk on toes ___ 97. Have patient walk on heels ___ 98. Have patient hop on each foot ___ 99. Observe tandem gait (heel-to-toe) ___100. Perform finger to nose and heel-to-shin test bilaterally ___101. Test fine rapid movements of fingers and feet ___102. Perform Romberg and pronator drift test Reflexes Deep tendon reflexes: (Test symmetrically) ___101. Test biceps and brachloradialis reflex ___102. Test triceps reflex ___103. Test patellar reflex Test achilles reflex ___104. Test cremasteric, abdominal and plantar superficial reflexes Motor: Done under Musculoskeletal Examination but will need to quantitate strength on a 5/5 scale Sensory ___105. Test light touch or pin prick on both sides of trunk ___106.Test light touch and pin prick on 4 limbs ___107.Test position sense at least in feet ___108. Test vibration sense in at least both ankles

Done with HEENT

Test Nerve V: Sensory functions ___ 88. Test light touch on cornea and the three branches of the nerve bilaterally Motor function V: ___ 89. Test contraction of masseter muscles or forced opening of mouth against resistance Test Nerve VII: Motor function in musculature of face: ___ 90. Raise eyebrows or forced eyelid closing ___ 91. Show teeth, puff out cheeks, or smile Test Nerve VIII: Hearing (done with HEENT examination) Test Nerves IX and X a. observe elevation of palate vocalizing "ah" (done with HEENT) Test Nerve XI: ___ 92. Test rotation of patient's head against strong resistance ___ 93. In bounced Test shoulder shrug against strong resistance (elbows bent) Test Nerve XII ___ 94. Observe midline protrusion of the tongue (This can be done with examination of the mouth)

MALE GENITALIA AND RECTUM ___111. Inspect penis, foreskin, meatus, scrotum ___112. Palpate penis, scrotum, testes, epididymes and other scrotal contents ___113. Examine for hernia Inspect anus ___114. Properly/comfortably insert index finger waiting for sphincter to relax ___115. Palpate prostate and a 360'arc of rectum ___116. Test stool sample on withdrawn examining finger for occult blood

IVMS ICM Physical Examination Checklist