2014-15 MASTER PE CHECKLIST MS2

italicized = not required, more comprehensive maneuvers, (GU and breast exams not included)

DOCTOR-PATIENT INTERACTIONS
Introduce yourself to the patient
Throughout the exam, communicate with clear, easy-tounderstand instructions
Throughout the exam, place your hands on the examinee
respectfully and reassuringly
Throughout the exam, use appropriate draping techniques to
preserve privacy and comfort
GENERAL APPEARANCE - VITAL SIGNS
Wash hands before starting the examination
Inspect and describe general appearance (development, comfort,
look ill or well, etc.)
Count radial pulse
Count respiratory rate
Measure blood pressure (by palpation and auscultation)
SKIN
Inspect skin during all parts of the exam.
Palpate and describe any lesions.
HEAD AND FACE
Inspect head and face, including hair and scalp
EYES
Inspect lids, lashes, brows, sclerae, conjunctivae
Test pupillary response to light (CN II, III)
Test extraocular movements (CN III, IV, VI)
Visualize the retina (optic disc, cup, vessels, macula)
EARS, NOSE AND MOUTH
Examine the external ear
Screen hearing with the whisper test or fingers rubbing
Examine ear canal and tympanic membrane with otoscope
Percuss or palpate for sinus tenderness
Assess patency of nares
Inspect nose, septum, and turbinates
Inspect mouth, including lips, gums, teeth, tongue, floor of the
mouth, and posterior pharynx
Inspect tongue, asking patient to protrude (CN XII)

Inspect palate & uvula symmetry while patient says aaa (CN X)
Palpate the mouth with gloved fingers (if any abnormalities noted
or the patient uses tobacco)
NECK
Inspect and palpate for tracheal deviation (before palpating,
place hand on the shoulder in a respectful manner)
Check range of motion of the neck
Auscultate carotid arteries with bell of the stethoscope
Palpate neck (and head) lymph nodes: submandibular,
submental, anterior cervical, posterior cervical, pre- and
posterior auricular, occipital, supraclavicular
Palpate carotids separately
Inspect thyroid gland while patient swallows
Palpate thyroid while patient swallows
PULMONARY
Drape patient appropriately to preserve privacy and comfort
Palpate posteriorly for symmetrical chest expansion
Check for tactile fremitus (generally performed only if
abnormality on percussion or auscultation)
Percuss posterior lung fields
Auscultate posterior, lateral, and anterior lung fields
CARDIOVASCULAR (patient supine, head elevated to 30o)
Drape patient appropriately to preserve privacy and comfort
Inspect the neck for venous pulsations and estimate JVP
Check for hepatojugular reflux
Inspect anterior chest and precordium
Palpate precordium for apical impulse, lifts, heaves and/or thrills
Auscultate precordium in aortic, pulmonic, triscuspid and mitral
areas with the diaphragm of the stethoscope; repeat with bell
Listen for radiation of murmurs, if present, to carotids or axilla
Check for lower extremity edema
Check pulses
**Arterial pulses (carotid, radial, brachial, aortic popliteal, posterior tibial,
dorsalis pedis) can be done during cardiac portion of exam or interspersed
throughout **
7.2013 Nye

2014-15 MASTER PE CHECKLIST MS2

italicized = not required, more comprehensive maneuvers, (GU and breast exams not included)

ABDOMEN (supine with patients legs bent)

Drape patient appropriately to preserve privacy and comfort
Inspect the abdomen
Auscultate the abdomen
Percuss the abdomen in four quadrants
Percuss the liver span
Palpate the abdomen in four quadrants, lightly then more
deeply, starting away from any area of tenderness
Palpate for the liver and spleen
Palpate the aorta
BACK (sitting or standing)
Inspect back for curvature, asymmetry, masses
Palpate spinous processes and paraspinal musculature
Percuss for costovertebral angle tenderness
Test range of forward flexion of back (touch toes while standing)
UPPER EXTREMITIES (sitting or standing)
Drape patient appropriately to preserve privacy and comfort
Inspect shoulders, arms, hands, nails
Assess muscle bulk & tone
Palpate acromioclavicular joint, clavicle, spine of scapula, deltoid
Test range of motion of the shoulders (standing)
Perform the empty can and drop arm tests on a shoulder
Palpate lateral and medial epicondyles of the elbows
Test range of motion of the elbows, wrist and fingers
Palpate radial and brachial arteries
LOWER EXTREMITIES (sitting, standing, supine)
Assess hip strength observing patient stand from seated position
Inspect legs for alignment and symmetry while patient standing
Drape patient appropriately to preserve privacy and comfort
Assess leg muscle bulk & tone (supine)
Palpate iliac crest, and greater trochanter
Test range of motion of hips (flexion, extension, internal &
external rotation, abduction and adduction)
Palpate the joint line of the knee, the medial and lateral
collateral ligaments
Test range of motion of knees (flexion and extension)
Perform a Lachman test

Perform varus and valgus stress tests

Palpate pulses: dorsalis pedis, posterior tibial, and popliteal
NEUROLOGIC

Comprehensive Neuro exam will be learned in BMB

block. The Essential exam is below. Can be performed separately or
integrated by region.

Mental Status
Orientation (place & date)
Language: Naming (two objects)
Language: Comprehension (3-step command)
Language: Fluency (speaking in full sentences)
Language: Repetition (no ifs, ands or buts)
Cranial Nerves (may be tested during head & neck exam)
II Check visual fields (4 quadrants, both eyes open)
II, III Check pupillary response to light (direct & consensual)
III, IV, VI Check extraocular movements (letter H)
VII Facial motor (eyelid closure, wrinkle forehead, show teeth)
Motor
Tone: Muscle tone (upper/lower extremity)
Strength: Finger extension
Strength: Ankle flexion
Strength: Pronator Drift (extend arms, palms up, eyes closed)
Strength: Finger and toe taps (done one extremity at a time)
Reflexes
Biceps, triceps, brachioradialis, patellar, Achilles
Sensory
Light touch (check distal extremities; include double
simultaneous stimulation with eyes closed)
Romberg (stand with feet together and close eyes)
Coordination and gait
Finger-to-nose test (check accuracy fully extending)
Observe stance and gait (including tandem, heel and toe
walking)

7.2013 Nye