Physical+Exam

=Greeting=
 * Introduce self
 * wash hands
 * find out something personal about pt
 * Asks what brings them in today
 * Ask if they are in pain right now

=Examine Patient=
 * General health
 * age
 * weight
 * gender, brief description

=Vital Signs= > Systolic is highest pressure w/ audible sounds, diastolic lowest pressure > Bell vs diaphragm?
 * Pulse-Radial Artery
 * respiratory rate--be sneaky!
 * Blood pressure--get right size cuff, where korsakov sounds


 * May wish to compare pulses in both sides

=HEENT=

Eyes

 * Ask if wear glasses
 * Visual acuity scale-cover one side w/ palm--CNII
 * Visual fields-close eye
 * extraocular eye movement--figure 'X'--CN III, IV, VI
 * Accommodation
 * Check sclera, conjunctiva
 * Examine pupils: size, shape
 * Use flashlight to see adaptation
 * swinging flashlight test--?

Ears
rub fingers together otoscopic examination bone conduction: frenum of lips, fossa of skull, protuberance behind ear

Nose

 * ask about changes in sense of smell
 * otoscopic examination: bullae, look for polyps

Throat

 * Use flashlight
 * Then use tongue suppressor
 * bimanual palpation of floor of oral cavity
 * observe elevation of palate (CN ???????)

Facial Nerve
> Smile, frown, bare clenched teeth, raise eyebrows, puff cheeks
 * Funny faces:
 * move jaw side to side, clench jaw, feel for muscle tone
 * Assess sensation: forehead, cheek, jaw

Neck
Palpate lymph nodes Palpate thyroid Check for carotid bruits! watch swallowing range of motion strength

Pulmonary

 * Readjust Gown
 * Ask about back pain
 * Measure lung expansion w/ pinched skin
 * Percuss lungs
 * Percuss diaphragmatic range both sides
 * Fremitus
 * Aortic/pulmonary insufficiency--2nd intercostal

Cardiac
> R/L 2nd intercostal, L 3rd intercostal, PMI > diaphragm, then bell
 * recline for JVD
 * observe for heaves
 * feel for PMI
 * auscultate
 * feel precordium, suprasternal notch
 * PMI at lateral decubitus position€ w/bell->Mitral murmurs

Abdominal

 * OBserve: shape, movement, scars
 * auscultation: diaphragm
 * auscultation: abdominal aorta, femoral arteries
 * percuss liver
 * percuss spleen
 * light palpation
 * deep palpation

Musculoskeletal

 * tone
 * range of motion
 * strength

> abduction, adduction,
 * hands
 * fingers:

Reflexes

 * biceps
 * triceps
 * brachoradialis
 * achilles
 * patellar

Coordination
Romberg Test Babinski test knee-shin palmar deviation

History Taking Symptoms Chest Exam