1. BP and pulse in right and left arms
2. Respiration rate and effort assessment
1. BP and pulse in left arm
2. Nails, skin of hands
3. Appearance/simple range of motion of hands; Marfan thumb sign
4. Bilateral hand grip strength
5. Alternating pronation & supination of hands on thighs
6. Skin and appearance of arms
7. Epitrochlear nodes
8. Elbow appearance and slow passive
9. Axillary nodes
10. Shoulder range of motion maneuver
11. Shoulder elevation strength
12. Arm drift and finger-nose touching (eyes closed)
13. Skin and hair of head and face
14. Eyebrow elevation and closed eyelid observation
15. Vision and visual fields
16. Extraoccular movements
17. Observe conjunctivae, slcerae, and irises with flashlight
18. Observe anterior chamber depth, pupillary size & reaction
19. Ophthalmoscopic exam (preferably dilate pupils and repeat at end of physical exam or use special scope)
20. Inspect ears and test hearing with finger rub and Schwabach/Rinne
21. Otoscopic exam
22. Inspect nose and test patency
23. Internal nose exam with otoscope
24. Observe facial symmetry and perform double simultaneous facial touch
25. Inspect lips, "show teeth", puff out cheeks
26. Oral mucosa, dentition, bite/wiggle vertical tongue blade
27. Superior and inferior tongue surface
28. Tongue extension and cheek pointing
29. Palate, posterior pharynx, and palatal motion
30. Skin/configuration of neck
31. Neck range of motion and resistance to extension and rotation
32. Carotid palpation and auscultation
33. Jugular venous pulse configuration and pressure
34. Inspect thyroid during water swallow with pt's. head extended
1. Palpate thyroid during water swallow with pt's head extended
2. Neck node palpation
3. Skin and configuration of back; lateral palpation of respiratory motion
4. Auscultatory percussion of back
5. Auscultate posterior, lateral, and anterior lungs (going under gown from behind)
6. Auscultate heart in four positions (going under gown from behind)
1. Jugular vein pulse configuration and pressure
2. Skin and configuration of anterior chest
3. Inspect and palpate breasts
4. Inspect and palpate precordium (apex and left parasternal)
5. Auscultate precordium in four main positions
6. Repeat palpation and auscultation in left lateral position
7. Inspect/auscultate abdomen
8. Palpate and auscultate femoral arteries
9. Palpate for inguinal nodes
10. Observe and palpate for hernias with Valsalva maneuver
11. Auscultatory percussion of liver, spleen, and bladder
12. Light percussion survey of abdomen
13. Percuss liver span and splenic dullness
14. Light and deep palpation survey of abdomen
15. Palpate liver
16. Palpate spleen
17. Palpate aorta
18. Skin, hair, and nails of feet
19. Configuration and ROM of feet and ankles
20. Great toe dorsiflexion strength
21. Pedal pulses
22. Observe skin of legs and check for edema
23. Inspect knees and test flexion and extension
24. Patrick maneuver
25. Heel-knee-shin testing
26. Hip flexor strength
27. Sharp-dull sense on feet
28. Vibration sense on index toes
29. Babinski reflex
1. Biceps, triceps, quadriceps, and ankle stretch reflexes
2. Ability to stand up without using hands
1. Observe back configuration and forward flexion ROM
2. One footed standing, each leg
3. Romberg test
4. Observe normal walking and tandem walking
1. Examine genitalia if indicated
2. Perform rectal exam if indicated (left lateral or standing position)
3. Vaginal, pelvic exam in female if indicated