General physical Examination Checklist .pdf

Checklist of general physical examination for students

1. General Examination Checklist

1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent
General Inspection:
Conscious, alert with time place and person
Lying supine or propped 45 degress/ sitting
Cannula attached to limbs, which side
Respiratory distress and pain
Estimate height and weight or thin/medium/big size

3. Inspection of Palm of hand
a. Pale/Pink
b. Palmar erythema
c. Dry/Sweaty
d. Muscle wasting
e. Deformity

4. Inspection of Dorsum of hand
a. Warm/Cold
b. Muscle wasting
c. (take temp)

5. Inspection of fingers and nails
a. Clubbing/Leuconychia/Koilnychia/Splinter hemorrhage/Nicotine stain
b. Capillary Refill (for adults)

6. Radial Pulse
a. Rate
b. Good/Poor Volume
c. Regular/Irregular Rhythm

7. Forearm
a. Venapuncture marks
b. Tattoo
c. Scars
d. Ecchymosis

8. Blood Pressure
9. Head
a. Jaundice/ Not Jaundice sclera
b. Pale/Pink Conjuctiva

10. Mouth
a. Angular stomatitis
b. Central Cyanosis
c. Oral Hygiene (Average/Poor etc)
d. Stomatitis
e. Glossitis
f. Palate

11. Neck
a. Lymph nodes enlargement
b. Swelling
c. Jugular Venous Pressure
d. Virchow nodes

12. Femoral Pulse
a. Volume
b. Rhythm
c. Radio-Femoral delay

13. Pitting edema (press at bony prominence)
a. Medial Maleolus
b. Mid-leg
c. Knee
d. Sacrum

14. Dorsalis Pedis and Posterior Tibialis

2. Cranial Nerve Examination
1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent
3. Positioning of patient in sitting position.
First Cranial Nerve (Olfactory)
1. Ask patient to close one nostril and close both eyes.
2. Use a fragrant and move it towards unclosed nostril.
3. Ask patient whether they can smell the fragrant.
4. Do it to both nostril.

2
nd
Cranial Nerve (Optic)
1. Inspect for Exopthalmos
2. Test for Pupillary Reflex Test.
3. Ask patient to cover one eye. Tell the patient to say Yes if can see fingers moving at
a fixed position. Glasses are permitted.
4. Ask patient to cover one eye. Tell patient to say Yes when they can see your fingers
moving towards patient’s nose. Glasses are permitted. Do the same for the other
eye.
5. Test for Blind Spot. Glasses are permittent.
6. Ask patient to read from Snellen Chart.

3
rd
, 4
th
& 6
th
Cranial Nerve

1. Test for Horizontal and Vertical Nystagmus.
Move pen as if writing Letter H.
2. Test for Eye convergence. Ask for double vision.

5
th
Cranial Nerve (Trigeminal Nerve)

1. Touch Maxillary, Mandibular and areas. Ask patient to close eyes.
7. Corneal Reflex. Apply cotton wool to sclera. Patient with normal reflex will blink
both eyes immediately when sclera is touched.
2. Tap jaw for Jaw reflex. Absence of Jaw reflex is normal.
3. Clench Teeth. Feel for Temporalis Muscle.

7
th
Cranial Nerve (Facial Nerve)
1. Ask patient to:
a. Frown face
b. Smile
c. Puff cheek
d. Close eyes tightly. Try to open them.

8
th
Cranial Nerve
1. Whisper to one ear while closing the other ear. Ask patient what you whispered.
2. Rinne Test. Using 512 Hz tuning fork, place vibrating tuning fork at Mastoid process
and tell patient to say when they can no longer hear any noise. Quickly place the
vibrating part of tuning fork 1-2 cm from auditory canal. Ask patient again the same
thing.
3. Weber Test. Place tuning fork at middle of forehead and ask patient to say which
ear hear the noise better. Normal finding is when noise are equally distributed to
both ears.

9
th
Cranial Nerve
1. Open mouth. Inspect the uvula. Normal uvula should not deviate from midline.

10
th
Cranial Nerve ( Vagus Nerve)
1. Gag reflex

11
th
Cranial Nerve
1. Ask the patient to shrug shoulder. Push down on the shoulder while telling them to
resist you.
2. Ask the patient to look to Right side. Push patient face in opposite direction while
telling them to resist your movement.

12
th
Cranial Nerve
1. Ask patient to push tongue against cheek. Push the tongue inwards while telling
the patient to resist your movement.

3. Upper limb Examination
1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent
3. Positioning of patient can be propped up 45 degrees or sitting
4. Look
a. Expose both upper limbs.
b. Look for any deformity, muscle wasting and circulation.
c. Compare both upper limbs in length.
d. Examine for Pronator Drift. Ask patient to lift both limbs in front of body and
close one eye.

5. Motor Power Grading of Upper Limb
a. Examine Tone of upper limb
b. Estimate muscle power grading of Shoulder joint
i. Push up and down on shoulder with resistance
(chicken wing position)
ii. Pull front and back on shoulder with resistance
c. Estimate muscle power grading for Elbow Joint
i. Push against extension
ii. Pull against flexion
d. Estimate muscle power grading for Wrist Joint
i. Push up and down on wrist with resistance
e. Estimate Muscle power grading for Metacarpo-Phalangeal Joint
i. Push up and down on MCP Joint with resistance
f. Estimate Muscle power grading for Fingers
i. Enclosed Fingers
ii. Ask patient to make a circle with thumb and index finger. Try to
break that circle.
iii. Paper holding
g. Estimate gripping power of hand.
Ask patient to grip your finger and don’t let go.

6. Sensation of Upper Limb
a. Test sensation of patient using cotton wool to areas of dermatome of upper
limb . First test it prick to centre of chest or distal end of limb.
b. Test for prioprioception or Vibration sense using 128 Hz tuning fork. Apply the
vibrating tuning fork at bony prominences.

7. Reflexes of Upper Limb
a. Biceps Tendon reflex
b. Triceps Tendon Reflex
c. Supinator Tendon Reflex

8. Assessing coordination
a. Ask patient to move fingers as if playing piano.
b. Ask patient to rub both hands together.
c. Ask patient to tap hands on another hand then shift between palm and
dorsum of hand. Try to do it as fast as patient can.
d. Finger-Nose Test. Ask patient to touch their nose then touch your finger
alternately. Shift position of your finger continuously.

4. Lower limb Examination
1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent
3. Positioning of patient can be propped up 45 degrees or sitting
4. Ask patient to walk normally to a distance. Assess the Gait.
5. Ask patient to walk back as if walking on a very small bridge.
6. Ask patient to stand in one spot then close your eyes. Observe for swinging movement.
Later pull back on patient looking for normal proprioception reflex.

7. Look
a. Expose both upper limb
b. Look for any deformity
c. Compare both limb in length

8. Motor Power Grading of Upper Limb
a. Examine Tone of upper limb
b. Assess Clonus. Pull on the heel. Normal would yield no response.
c. Estimate muscle power grading of Hip joint
i. Push and pull on hip joint with resistance
d. Estimate muscle power grading for Knee Joint
i. Push up against extension
ii. Pull down against flexion
e. Estimate muscle power grading for Ankle Joint
i. Push down and up on Ankle with resistance
ii. Push in and out during eversion and inversion respectively on Ankle
joint
f. Examine the Knee-Shin Test

9. Sensation of Upper Limb
a. Test sensation of patient using cotton wool to areas of dermatome of upper
limb
b. Test for prioprioception or Vibration sense using 128 Hz tuning fork. Apply the
vibrating tuning fork at bony prominences.

10. Reflexes of Upper Limb
a. Patella Tendon reflex
b. Ankle Jerk
c. Babinski Sign

5. Thyroid Examination

1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent
3. Positioning of patient in sitting position
4. Inspect the neck for:
a. Abnormal enlargement in the neck
b. Lymph nodes enlargement
c. Visible pulsation
d. Surgical Scars
e. Ask the patient to take a sip of water but tell them not to swallow until you
say so. Inspect the neck while patient is swallowing the sip of water.

5. Palpate the neck for:
a. Trachea deviation
b. Thyroid border ( from behind)
c. Lymph nodes of the head and neck (from behind)
d. Ask the patient to take a sip of water but tell them not to swallow until you
say so. Palpate the thyroid border while patient is swallowing.

6. Percuss superior part of Sternum.
7. Auscultate for Thyroid Bruit using Bell.
8. Put both hand in front while placing paper on top of them. Check for tremors.
9. Examine hand for:
a. Warmth
b. Excessive sweating
c. Radial Pulse
10. Ask patient to follow motion of pen moving in H direction.
11. Do Eye Lid Lag test.
12. Ask patient to shrug shoulder while telling them to resist you pushing it down.
13. Check Knee Jerk Reflex of Patient.
14. Ask the patient to squat then stand up.

6. Abdominal Examination
1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent
3. Positioning of patient must be lying flat on bed
4. Inspection of abdomen
a. Abdominal distension
b. Scars / Striae
c. Umbilicus (inverted/everted)
d. Caput Medusae (Dilated veins)
e. Peristaltic wave

5. Superficial Palpation ( 9 regions)
6. Deep Palpation ( 4 quadrant or 9 regions)
7. Liver
a. Palpation
i. Palpate Liver from Right Iliac Fossa to Right Costal Margin
ii. Ask the patient to breathe through mouth
iii. Palpate when patient is inhaling
iv. Do not move hand until completed 2 breathe cycle (inhale & exhale
is 1 breath cycle)
v. Try to feel for mass with border of Index finger
vi. If mass palpable, comment on:
1. Number (one or multiple)
2. Site (regions of abdomen)
3. Size (ex: 5 cm by 5cm)
4. Shape (Irregular, circular)
5. Surface (Smooth, rubbery)
6. Edge (Visible and palpable)
7. Consistency (hard, firm, soft)
8. Tenderness
9. Fixity to skin, fat or muscle
10. Mobility
11. Reducibility
12. Temperature
13. Translucency & Pulsatility
*Note: Try to get over the mass under right costal margin, if
can’t, the mass is definitely Liver

b. Percussion
i. Percuss Liver from Right Iliac Fossa
OR
Percuss Liver from Sternal Angle

ii. Measure Liver Span (Normal Liver is 7-12 cm)

8. Spleen
a. Palpation
i. Palpate Spleen from Right Iliac Fossa (if mass present)
OR
Palpate Spleen from Umbilicus (if no mass present)
ii. Ask patient to breathe through mouth
iii. Palpate until reaching 9,10, 11 left costal margin
iv. If Spleen not palpable then, do not move hand, ask the patient to
move to his Right side
v. Palpate Spleen with right hand while left hand pulling left costal
margin from posterior aspect
b. Percussion
i. Percuss Traube Space
Dull percussion indicate Spleen

9. Kidney Ballot
a. Bimanual Technique

10. Shifting Dullness and Fluid Thrill
11. Abdominal Auscultation
a. Auscultate right or left side of umbilicus from bowel sound
b. Auscultate for Kidney Bruit

12. End the examination by doing External Genitalia, Groin Hernia Examination and Per Rectal

7. Cardiovascular Examination
1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent, ask to take off shirt
3. Propped the patient 45 degrees
4. Inspection of Chest and Precordium
a. Median Sternotomy scar and leg scars
b. Pacemaker
c. Visible palpitation
d. Jugular Venous Pressure (may be done in general examination)
e. Chest deformity
f. Dilated veins

5. Palpation of Chest
a. Identify Apex beat (Supine, Left Lateral if can’t find Apex beat)
b. Show the position of Apex beat
c. Parasternal heave
d. Pulmonary heave
e. Aortic heave

6. Auscultation of heart
a. Auscultate Mitral and Pulmonary areas with Diaphragm, thumb at carotid
artery
b. Running commentary on Mitral and Pulmonary areas
“1
st
and 2
nd
heart sound heard with normal intensity”

c. Auscultate Mitral area until axilla with Diaphragm, thumb at carotid artery
d. Running commentary on Mitral area until axilla
“No pansystolic murmur radiating to axilla suggesting mitral regurgitation”

e. Auscultate Mitral area with Bell in Left Lateral Position, thumb at carotid
artery
f. Running Commentary on Mitral Area with Bell
“No rumbling of mid-diastolic murmur suggesting of Mitral Stenosis”

g. Auscultate Tricuspid area with Diaphragm while asking patient to inhale and
hold breath, thumb at carotid artery
h. Running commentary on Tricuspid area with Diaphragm
“No pansystolic murmur intensifying with respiration suggesting of Tricuspid
Regurgitation”

i. Auscultate Pulmonary and Aortic areas with diaphragm, thumb at carotid
artery
j. Auscultate neck at Carotid artery area, left and right with Bell
k. Running commentary on Carotid artery area
“No ejection systolic murmur radiating to carotid arteries suggesting of
Aortic Stenosis”

l. Auscultate Lower Sternal border with diaphragm, thumb at carotid artery
while asking patient, bend 45 degrees forward, inspire and expire full breath
and hold for a while
m. Running commentary on Lower sternal border with Diaphragm
“No blowing early diastolic murmur suggesting of Aortic Regurgitation”

8. Respiratory Examination
1. Introduce yourself and examiner
2. Explain intention to patient and ask for consent
Ask patient to take off shirt

3. Positioning of patient can be propped up 45 degrees or sitting
4. Count Respiratory Rate for 15 seconds

5. Inspect chest
a. Shape of chest
Barrel shape chest
“Transverse diameter of chest is greater than AP diameter”
b. Chest symmetry
c. Scars
d. Nodules

6. Palpation of chest
a. Examine Trachea
“Trachea is not deviated”

b. Identify Apex beat

c. Identify breathing movement by placing both palm at upper chest
“The chest movement is symmetry”

d. Identify chest expansion by placing both palm at lower chest
“The chest expansion is 5cm and symmetry”

e. Test for Tactile fremitus.
Place medial part of both hands at intercostals space. Ask patient to say 999.

7. Percussion of Chest
a. Percuss at area above clavicle
b. Percuss at clavicle
c. Percuss at area below clavicle. 2
nd
intercostals space downwards.

8. Auscultation of Lungs (Only with Bell)
a. Auscultate upper, middle and lower part of chest alternating between right
and left. Begin at normal side first.
b. Compare of loudness of breath sounds between right and left
c. Listen for any abnormal sounds
“Vestibular sound are heard with normal intensity”

d. Assess vocal resonance by auscultating while asking patient to say ‘nine, nine,
nine’