PHYSICAL EXAMINATION PROGRESS CHECK:

Respiratory, Cardiovascular, and Abdomen Exams

INSTRUCTIONS:
- The instructor will verify all physical findings, either before or after student exam, but will not
interrupt student during exam for anything other than flagrant error or safety violation.
- This checklist must be completed in no more than 20 minutes.
- Some checklist items may be logically combined in performance, though listed separately for grading
purposes.
- Checklist items are listed in a specific order of performance. This order of performance is guided by
logic based on economy of motion, keeping the items related to a single organ system clustered
together, or patient modesty.
- This checklist is divided into several columns. In the column labeled Exam, a general name for the
exam or test being performed in that particular item is given. In the column labeled Behavior, the
behavior which must be demonstrated by the student is stated (inspect, percuss, auscultate, palpate,
etc.) In the column labeled Key Indicators of Performance, pertinent qualifiers are given which
delineate minimal conditions of acceptable performance of the required behavior. In the column
labeled S/U, the instructor will indicate whether or not that behavior was successfully performed.
GRADING CRITERIA:
- Successful completion of this progress check requires successful completion of each major
subdivision, highlighted in boldface type. Criteria for completion of each subdivision are given.
- Behaviors which require verbalization by the student are indicated by the symbol . Examples of
acceptable verbal behavior are given in quotes in the column entitled "Key Indicators of
Performance". Variations on the given example may be used, but the following terms may NOT be
used in verbal description: normal, abnormal, clear
- Some behaviors may be critical items, which are identified by the symbol, **. These are items
which involve patient safety or comfort, or are of such importance that their omission constitutes a
particularly serious error. Failure to successfully complete any critical item will result in an overall
grade of Unsatisfactory for this entire progress check.
- Exceeding the stated time limit will be considered unsuccessfully performance.
-Any unsuccessful completion of a critical item, inadequate performance of a subsections listed items
or exceeding time limits will be deemed a progress check failure and require retesting before moving
in to the next block of instruction.
Student________________

Preceptor_____________

Date_________________

Time_________________

PASS

/ FAIL

12/22/2016

Respiratory Exam (Bates 9th ed, pgs 241-277)

(8 of 11 non-critical AND all 3 critical items must be successfully completed for S)
Key Indicators of Performance
- Ensure female patient is draped for modesty
"Respirations are __ per minute and unlabored"
Respiratory rate &
Determine respiratory rate and
(Note use of accessory muscles/intercostal
effort
effort
retractions if seen)
Thorax (This portion of the exam is performed with the patient sitting)
3.
"I am inspecting for...."
- symmetry of anatomy
Inspect anterior and posterior
General Inspection
- contour, AP diameter
thorax
- skin lesions
- central cyanosis
4.
Palpate for symmetry of posterior Chest expands symmetrically
Chest expansion
chest expansion during deep
inspiration
5.
Palpate posterior chest wall for "No masses or tenderness noted"
Chest wall
masses, tenderness
6.
Palpate posterior chest for tactile Use ulnar side of hands.
Tactile fremitus
fremitus in 5 paired areas
Tactile fremitus is equal in all fields
7.
- Position pt with arms crossed across chest
- Pleximeter finger is the sole contact with the
chest wall
Percuss posterior lung fields for
Percussion
- Strike pleximeter finger sharply with finger of
resonance in 5 paired areas
opposite hand or with percussion hammer
- Compare symmetric regions
No dullness to percussion.
8.
No CVA tenderness noted bilaterally
CVA Tenderness
Percuss over CVA bilaterally
9.
- Instruct patient to breathe through open mouth
Auscultate symmetric lung fields
- Listen for full respiratory cycle with each
approximate locations are at Apex,
placement of stethoscope
Auscultation
just lateral to T2, 4, 6, 7, and two
- Stethoscope MUST contact skin directly
locations on far lateral walls at T7
- "Breath sounds are vesicular and symmetric"
and T9
OR "No adventitious breath sounds heard"
10.
Palpate anterior chest wall for
Anterior chest wall is without any masses,
Chest wall
masses, crepitus, tenderness, etc.
crepitus or tenderness.
11.
There is no lymphadenopathy in the anterior,
Palpate 4 walls of
Palpate anterior, posterior,
posterior, lateral, or central nodes.
axilla
lateral , and central axilla
12.
Palpate anterior chest wall for
Tactile Fremitus is equal in all fields
Tactile Fremitus
tactile fremitus in 3 paired areas
13.
Percuss anterior lung fields for Compare symmetric regions
Percussion
resonance in 3 paired areas
No dullness to percussion.
14
- Instruct patient to breathe through open mouth
Auscultate symmetric lung fields, - Listen for full respiratory cycle with each
including apices, mid axillary line
placement of stethoscope
Auscultation
4-5th ICS, and at least 3 other
- Stethoscope MUST contact skin directly
paired locations
- "Breath sounds are vesicular and symmetric"
OR "No adventitious breath sounds heard"
1.
2.

Exam
Prepare patient

12/22/2016

Behavior
Have patient undress to waist

**

**

*
*

Cardiovascular (Bates 9th ed, pgs 279-335)

(6 of 8 non-critical items AND all 10 critical items must be successfully completed for "S")
Exam
Behavior
Prepare Patient
Have patient undress to waist
Perform
Check Blood pressure and
orthostatic BP and
pulse in both arms while
pulse evaluation
lying down &
One arm while standing
Note whether patient is
symptomatic

Key Indicators of Performance

1.
- Ensure female patient is draped for modesty
2.
- Progress from lying to standing
- Use appropriate size cuff
- Place cuff above antecubitus with arrow
positioned over brachial artery
- Place stethoscope over artery
- Record values taken in both arms
- Wait minimum of 1 min. and maximum of 3 min.
between positions.
-record b/p, pulse from one arm only while standing
Sitting position (Stand to right side of exam table throughout exam)
3.
Auscultate with
Auscultate heart
diaphragm at 4 valvular
- Name the valvular areas as you auscultate over them
positions and L 3rd ICS
4.
Auscultate with inspiration - "I am listening for physiologic split of S " OR
2
Auscultate heart
at L 3rd ICS (with the
- "There is a physiologic split of S2"
diaphragm)
5.
Auscultate with bell at 4
Auscultate heart
valvular positions and L
3rd ICS
6.
- Patient must sit up, lean forward and hold an
Auscultate for
Auscultate with
expired breath.
Aortic
diaphragm at 3rd Left ICS - There is no murmur of Aortic Regurgitation
regurgitation
appreciated
7. Valsalva for
- Have the patient valsalva or bear down. HCM will
Auscultate with
Hypertrophic
cause a murmur to become louder with this maneuver.
rd
diaphragm at 3 Left ICS
Cardiomyopathy
- There is no murmur with valsalva.
8.
- NOTE: This could alternatively be performed in
Auscultate carotid arteries supine position
Auscultate carotids
with bell
- "I am listening for carotid bruits" OR
- "There are no carotid bruits"
Supine position (30 or 45 angle) { Stand to right side of exam table throughout exam}
9. Estimate height of Measure with head
Jugular venous pulsation visible at ___cm above the
J JVP
elevated to 30
s sternal angle with the patient at 30
10.
Inspect precordium using - "I am looking for precordial heaves and the point of
Inspect precordium tangential lighting if
maximum impulse (PMI)"
needed
11.
Palpate with ball of right
- "There are no lifts, heaves, or thrills; PMI is nonhand for lifts, heaves,
displaced."
Palpate precordium
thrills at 4 valvular areas.
Locate PMI
12.
Auscultate with
Auscultate heart
diaphragm at 4 valvular
positions and L 3rd ICS

12/22/2016

**

**

**

**

**

**

Exam
13.
Auscultate heart
14.

Auscultate heart

15.
Quality of heart
sounds
16.
Peripheral pulses
17.
Peripheral vessels
18.
Peripheral vessels

Behavior
Key Indicators of Performance
Auscultate with bell at 4
valvular positions and L
3rd ICS
Auscultate with bell in left - Place bell over mitral region
lateral decubitus position
- "There are no gallops (S3 or S4) heard"
Verbalize at least once
- "Rate and rhythm are regular, without murmurs,
during auscultation of all
gallops, or rubs" OR other appropriate description of
areas the quality and rate of
heart sounds heard
heart sounds
- Include at a minimum carotid, radial, femoral, dorsalis
Palpate bilateral peripheral
pedis, and posterior tibial pulses
pulses
- "Pulses are full and equal bilaterally" OR other
appropriate description of quality of pulses
Inspect nail beds for
- There is no peripheral cyanosis or clubbing; capillary
cyanosis, clubbing and
refill is less than 2 seconds"
capillary refill
Inspect/palpate legs for
- Use backs of hands to compare temperature of legs
edema, hair distribution,
- "I am inspecting for edema, hair distribution, skin
skin condition,
condition, temperature and varicosities.
temperature, varicosities,

**
**
**

**

Abdomen (Bates 9th ed, pgs 359-427)

(6 of 10 non-critical AND all 4 critical items must be successfully completed for S)
1.

Exam
Position and
exposure

2.

Behavior

Key Indicators of Performance

- Perform examination with patient in supine position
- Expose abdomen from xiphoid to suprapubic area

Inspect abdomen for

contour, skin lesions (scars, - "Abdomen is..." (at a minimum, describe contour and
Inspection
striae, rashes), visible
skin condition)
peristalsis or pulsations
3.
- Auscultation must precede percussion or palpation
Listen for bowel sounds in
Auscultation
- "Bowel sounds are present/absent" (must listen for a
4 quadrants
minimum of 2 min before declaring BS absent)
4.
Auscultate with bell for
bruits over the following
Abdominal vessels
vessels:
- Stethoscope must be placed in correct locations for
abdominal aorta
credit
(NOTE: This is part
renal arteries
of the CV organ
iliac arteries
- "No bruits noted"
system but for
femoral arteries while
regional grouping is
you are palpating the
included in an
femoral artery to locate - The femoral artery is palpable, equal pulses
abdominal exam
it for this exam,
bilaterally and there is no inguinal adenopathy
during a complete
examine the femoral
physical)
pulse and the inguinal
nodes at the same time.

12/22/2016

**

5.

- Must assess all 4 quadrants. Should be done prior to

palpation.
6.
- Liver span must be percussed in the MCL.
- Pleximeter finger is sole contact with abdominal wall.
- Strike pleximeter finger sharply with finger of
Percuss liver location and
opposite hand or percussion hammer.
Percussion
size
- May confirm liver size with scratch test if time
permits.
- Liver location should be within 1 cm of preceptors
findings.
MUST FLEX PATIENTS KNEES FOR THIS EXAM
7.
Palpate lightly in all 4
quadrants for tenderness,
- "There is no tenderness, guarding, rigidity or masses
Light palpation
muscle rigidity, and
to light palpation"
superficial masses.
8.
Palpate more deeply in all - If mass detected, describe fully
Deep palpation
4 quadrants for delineation - "There is no tenderness, guarding, rigidity, or masses
of any organs or masses
to deep palpation."
9.
Palpate for rebound
Rebound tenderness
- "There is no rebound tenderness"
tenderness in the RLQ
10.
Palpate abdominal aorta for - "The abdominal aorta is __ cm wide, without lateral
Abdominal aorta
width and pulsations
expansion of pulsation"
11.
- May use hook method or abdominal approach
- Should not cause undue pain
Liver border
Palpate liver edge
- "Liver is not palpable, non-tender" OR
- "Liver edge is [smooth, nodular....]
12.
Palpate for possible spleen
Spleen size
- "Spleen is not palpable, non-tender..."
enlargement
13.
Special Tests
Instructor will ask you to perform any TWO of the following exams
Percussion, general

Murphys test
Iliopsoas sign
Obturator sign
Heel tap

Shifting dullness
Rovsings sign

12/22/2016

Percuss general abdominal

tympany

Palpate liver for tenderness with deep

inspiration
Hand on Right thigh, have pt raise leg
against resistance
Flex hip and internally rotate.
With pts legs fully extended, heel raised off
the table in your hand, strike the bottom of
the foot.
Pt lying supine, percuss the abdomen flanks
for dullness and periumbilical for tympany.
Move pt to R or L lateral decubitus position.
Percuss for a shift of tympany.
Palpate deeply in LLQ To elicit rebound
pain in RLQ

State the findings you expect in a positive test.

What does it test for?
State findings of a positive test
What does it test for?
State findings of a positive test.
What does it test for?
State findings expected on a positive test.
What does it test for?
State finding expected on a positive test
What does it test for?.
State expected finding of a positive test.
What does it test for?

**

**
**

**

THE INSTRUCTOR MAY WISH TO VERIFY YOUR FINDINGS WHEN YOUR

PERFORMANCE CHECK IS COMPLETE.

Comments:_______________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________

12/22/2016