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physical examination

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 [1] - routine testing beyond history & physical is not necessary [2] - preparticipation physical examination - evaluate for exertional symptoms - family history of sudden death - evaluate for cardiac murmur

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physical examination technique

Specific

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

General

examination

References

  1. Annual Physical Past Its Prime...Again? Medscape. Jan 15, 2015. http://www.medscape.com/viewarticle/838223
  2. Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2022,

Component-of

history & physical (H&P)