physical examination

Introduction

Also see health maintenance for annual physical examination.

Procedure

Vitals: Temp: *, HR: *, RR: *, BP: **/**

General:

HEENT: NC/AT, pupils, extraocular muscles, conjunctiva, sclera, oropharynx, dentition, tongue (CN12), gag, ears, hearing (Weber test & Rinne test) sinuses, masseter, temporal arteries

Neck: supple, adenopathy?, trachea, JVD, thyromegaly?

Back: spine, CVA tenderness

Lungs: percussion, expansion, auscultation (bronchophony, egophony)

CVS: heart sounds, pulse, m/r/g, carotid bruits, PMI

Abdomen: BS, tenderness, distension?, hepatosplenomegaly?

Extremities: edema, clubbing, cyanosis, fingers & nails

Skin: moist/dry, tenting?, lesions, erythema, tattoos Pulses: radial, femoral, dorsalis pedis, posterior tibial

Lymphatics: axillary, inguinal

Neuro:

Alert, oriented X 3, MMSE if appropriate

CN II-XII (should have already been checked)

DTR: biceps: flexion at elbow (C5, C6) triceps: extension at elbow (C6, C7) brachioradialis: flexion & supination of forearm (C5, C6) patellar: extension at knee (L2, L3, L4) ankle: plantar flexion at ankle (S1)

Plantar flexion (Babinski)

check for clonus

check for tremor

motor:

• flexion at the elbow (C5, C6, biceps)
• extension at the elbow (C6, C7, C8, triceps)
• abduction at the shoulders (deltoids)
• shrugging of shoulders, turning of head (CN XI)
• extension at wrist (C6, C7, C8, radial nerve)
• handgrip (C7, C8, T1)
• finger abduction (C8, T1 & ulnar nerve)
• opposition of thumb (C8, T1 & median nerve)
• gait (if possible)
  • rise from a sitting position without arm support
  • heal to toe or tandem walk
  • walk on toes: tests plantar flexion
  • walk on heals: tests dorsiflexion
• if gait not testable:
  • flexion at the hip (L2, L3, L4, iliopsoas)
  • adduction at the hips (L2, L3, L4, adductors)
  • abduction at the hips (L4, L5, S1, gluteus medius & gluteus minimus)
  • extension at the hips (S1, gluteus maximus)
  • extension at the knee (L2, L3, L4, quadriceps)
  • flexion at the knee (L4, L5, S1, S2, hamstrings)
  • dorsiflexion at the ankle (L4, L5)
  • plantar flexion at the ankle (S1)
• finger to nose: tests for dysmetria (cerebellar)
• heel to shin, repeat with eyes closed to check position sense
• rapid alterating movements: tests for dysdiadochokinesis (cerebellar)

sensory: position sense, vibratory sensation

• Romberg
• pronator drift
• stereognosis
• 2 point discrimination: 5 mm on finger pads

Notes

• annual routine physical examination of no benefit
• routine testing beyond history & physical is not necessary
• preparticipation physical examination
  • evaluate for exertional symptoms
  • family history of sudden death
  • evaluate for cardiac murmur

More general terms

• examination

More specific terms

• annual physical examination; annual health examination
• disability examination
• head impulse, nystagmus & test of skew (HINTS)
• joint examination for osteoarthritis
• manual muscle testing (MMT)
• neurological examination
• physical examination of the hand & wrist
• physical examination, BkP
• skin examination
• sports physical examination

Additional terms

• physical examination technique

Component of

• history & physical (H&P)