PHYSICAL EXAMINATION CHECKLIST

GENERAL EXAMINATION

Hand Splinter Haemorrhage | Koilonychias | Capillary Refill Time Clubbing Fingers

Peripheral Cyanosis | Tar Stains | Osler’s Nodes Palms | Janeway Lesion
Face Conjuctiva pallor | Jaundice mouth | Central cyanosis

CARDIOVASCULAR EXAMINATION

General Radial pulse – bpm, rhythm, volume, character (collapsing pulse?)

Blood pressure – systole & diastole by using sphygymomanometer
Jugular venous pressure –
Bilateral pitting edema – in lower limb
Precordium  Position: 45
 Exposure: chest to waist

Inspection
Surgical scar | Visible Pulsation | Apex beat | Thrill | Left Parasternal Heave

Auscultation
A (2R) – P (2L) – T (4L) – M (5L)
Peripheral Radial pulse – radial-radial delay & radial-femoral delay
Vascular Other pulse: brachial, femoral, popliteal, posterior tibial, dorsalis pedis

RESPIRATORY EXAMINATION

General Breathing – rate, effort, sound, pattern, nasal flaring

Flapping tremor
Anterior  Position: Sitting up
 Exposure: chest to waist

Inspection
Shape of chest (barrel, pigeon, funnel) | Surgical scars | Intercostal recession

Palpation
Position of trachea | Chest expansion | Tactile vocal fremitus

Percussion – resonant / hyper resonant / dull / stony dull

Percuss at supraclavicle, clavicle, ICS (2nd, 3rd, 5th & 6th)

Auscultation – bronchial / crackles / rhonchi

ICS (2nd & 4th) – diaphragm | Apical region (neck) – bell | Vocal fremitus
Posterior  Position: Sitting up + hug a pillow
 Exposure: chest to waist

Inspection
Shape of chest (normal / scoliosis / kyphosis) | Surgical scars

Palpation
Chest expansion | Tactile vocal fremitus

Percussion – resonant / hyper resonant / dull / stony dull

ICS – compare bilaterally

Auscultation – bronchial / crackles / rhonchi

ICS (2nd & 4th) – diaphragm | Vocal fremitus - diaphragm

ABDOMINAL EXAMINATION

 Position: Supine
 Exposure: Nipple line to mid-tight (respect: nipple line to symphysis
pubis)

Inspection
1) At the end of bed: symmetry, distension
2) Crouching: breathing pattern, visible pulsation
3) At the right side: shape, umbilicus (central/deviated/inverted/everted)
4) Discoloration
5) Dilated surface veins: spider naevi, caput medusa
6) Surgical scars: laparotomy, laparoscopic puncture marks,
appendectomy scars
7) Visible peristalsis
8) Scratch marks
9) Striae

Palpation
1) Superficial: mass, tenderness, guarding, raise temperature
2) Deep
3) Hepatomegaly
4) Spleenomegaly
5) Ballotable kidneys
 Percussion – dull / resonant
1) All 9 quadrants
2) Liver length (normal: 6-12 cm)
3) Traube’s space – splenomegaly
4) Ascites – fluid trill, shifting dullness

Auscultation
1) Bowel sound (at umbilicus, using diaphragm). Normal 1-3 sound/min
(hyperactive / high pitched tinkling or rushing / grumblings)
2) Renal bruit (above lateral 2” from umbilicus, using bell)
3) Aortic bruit (midway btwn umbilicus & xiphoid, using bell)
End with Inguinoscrotal examination
Per rectal examination

LYMPH NODES EXAMINATION

Method Use pulp of index & middle fingers, circular motion. Comment on:
 Site
 Size (normal: <0.5 cm)
 Tenderness
 Consistency: soft / rubbery / matted / craggy / stony hard
 Fixity to skin
Cervical LN  Patient position: Sitting up
 Examiner position : Stand behind

Palpation
Submental | Submandibular | Periauricular | Postauricular | Occipital |
Superior/Deep/Posterior Cervical Chain | Supraclavicular
Axillary LN  Patient position: Sitting up
 Examiner position : Stand in front

Palpation
Medial wall | Anterior wall | Lateral wall | Posterior wall | Upwards for deep
lymph nodes
 NERVOUS SYSTEM EXAMINATION

Sensory Dorsal column

 Light touch
 Proprioception
 Vibration
 Two-point discrimination

Spinothalamic
 Pain – sharp or dull
 Temperature – hand/foreram/arm & foot/leg/thigh

Parietal cortex
 Stereognosis
 Graphestesia
Motor Upper limb
 Inspection: exposure, bulk, fasciculation, involuntary movement
 Tone: at wrist, elbow & shoulder (hypotonia/hypertonia)
 Power: at shoulder, elbow, wrist, fingers
 Reflex: at biceps, triceps, brachoradialis
 Coordination: finger-nose test & rapid alternating movement

Lower limb
 Inspection: exposure, bulk, fasciculation, involuntary movement
 Tone: at ankle, knee & hip (hypotonia/hypertonia) –any clonus on
dorsiflex foot?
 Power: at hip, knee & ankle
 Reflex: at knee, ankle & plantar
 Coordination: heel-shin test
 Gait: normal walk, heel-to-toe, on toes, on heels, romberg’s test
Cranial Olfactory – sensory (eyes closed)
nerves Optic – sensory (visual acuity, visual fields, pupillary examination,
fundoscopy)
Occulomotor / Trochlear / Abducen – motor (H shaped movement)
Trigeminal – sensory, motor, corneal reflex & jaw jerk
Facial – sensory + motor (facial expression: wrinkle forehead, shut eyes tight,
grin)
Vestibulocochlear – sensory (Rinne & weber test)
Accessory – motor (trapezius & SCM)
Glossopharyngeal / Vagus – sensory + motor (uvula & aahhh)
Hypoglossal – motor (tongue wasted or deviated)