Head to Toe

• Pt removes shirt.
• Inspect: Skin color/integrity
• (head, trunk, limbs – tan, intact, no cyanosis/jaundice. No lesions, moles, scars, tattoos, piercings, no venous distention).

• Palpate: Skin temperature (dorsal surface of hand), moisture, texture, turgor.
• (smooth, warm, dry with good turgor)

• Inspect & Palpate: Hair
• Shaved, shadow of new growth terminal hair.
• Scalp - no hair loss, scars, inflammation, redness.

Body - vellus hair (arms, legs, back, shoulders; more coarse on chest and abdomen)

• Inspect: Nails (hands & feet)
• Short, well-groomed, smooth, light pink, flat w/round edges, no ridging/pitting, adhered to nail bed.
• Base/angle = no clubbing.

Palpate: Cap refill (fingers/toes) < 3 seconds

• Inspect:
• Head = erect, midline, oval.
• Facial features = symmetrical, appropriately sized

• Inspect for muscle atrophy, tremors.
• Palpate jaw muscles for tone/strength when pt clenches teeth.
• Use cotton ball/paper clip to test superficial pain & touch.

• Symmetry of facial features with expression.
• Pt smile, frown, puff cheeks, wrinkle forehead.
• Able to taste salty & sweet. Are you able to taste salty and sweet?

• Inspect/Palpate:
• Neck - fullness
• Trachea - midline
• Thyroid - swallow (smooth, no nodules)
• Carotid pulse - 2+ bilaterally

• Auscultation:
• Carotid arteries - bruits (bell, light pressure)

• Inspect/Palpate:
• Preauricular
• Post-auricular
• Tonsillar
• Submandibular
• Submental
• Anterior cervical
• Posterior cervical
• Supraclavicular
• (nonpalpable, no redness, tenderness, or inflammation)

• Inspect/Palpate:
• Axillary nodes - Are you aware of any lumps?
• Epitrochlear
• (nonpalpable, no redness, tenderness, or inflammation)

• Verbalize:
• Palpate inguinal nodes (femoral areas) and popliteal nodes (behind the knees) bilaterally
• For palpable nodes, tenderness, redness, or inflammation

• Inspect: Eyelid, eyeball, conjunctiva, iris, pupil, lens, sclera, & lacrimal apparatus (bilateral)
• Test: Direct/consensual light response (pupil response)
• Test: EOMs (move eyes in 6 cardinal fields without nystagmus)
• Test: Corneal light reflex (light reflected symmetricially in both eyes)
• Verbalize: Snellen chart = distance vision, Rosenbaum chart = near vision
• Ophthalmoscope exam: Red reflex, macula (yellow dot surrounded by deep pink background)

• Vision tested with Snellen
• Ophthalmoscope exam of fundi

• EOMs in 6 cardinal fields of vision
• Inspection of eyelids for drooping
• Pupil size for equality and direct/consensual response to light and accommodation

• Inspect & Palpate: Auricles, mastoid, auditory meatus, alignment (equal size, appearance, alignment with inner canthus of eyes, smooth skin without tags/lesions, no discharge/odor, tenderness, or pain on palpation of tragus/mastoid)
• Otoscope exam: auditory canal/TM for color/landmarks (minimal cerumen, hair along outer 1/3, canal pink; TM & malleus pearly gray/translucent)
• Test: auditory acuity - whisper test

• Hearing and equilibrium
• Whisper test
• Weber and Rinne tests

• Inspect & Palpate: Nose bilaterally.
• Nares - size, discharge (nares symmetrical, no discharge)
• Nasal cavity, septum, middle meatus, turbinates (nasal cavity mucosa, meatus, and turbinates deep pink and moist)

• Sense of smell
• Are you able to smell coffee?

• Inspect & Palpate:
• Frontal, ethmoid, maxillary sinuses bilaterally
• (no swelling or tenderness on palpation)

• Inspect & Palpate: Lips
• Color, symmetry, characteristics
• (pink, symmetrical, smooth)

• Inspect:
• Mouth, mucosa, gums, teeth, oral cavity, tongue, hard palate, uvula (say "ah"), oropharynx
• Mucosa/oral cavity = pink, moist
• Gums = pink, tight margins at teeth
• Teeth = ivory, 30 teeth, firmly anchored
• Tongue = midline, no fasciculations, dull red color, moist, without masses, lesions, scars, swelling, or discoloration
• Uvula = midline w/elevation of soft palate
• Tonsils = 1+ bilaterally
• Oropharynx/hard palate = without redness, swelling, or lesions

• Ability to taste sour/bitter
• Swallow
• Symmetry of uvula
• Gutteral speech sounds

• Stick out tongue
• Say "light, tight, dynamite" to test lingual speech

• Inspect:
• Chest landmarks - Anterior, lateral, posterior chest
• Respiratory pattern and movement
• (ratio of AP to transverse diameter = 1:2, chest movement symmetrical, respirations = regular, even, unlabored, and symmetrical)

• Percuss: Anterior, posterior, lateral chest
• Auscultate: Breath sounds, verbalizing sounds heard
• (bronchovesicular medially, vesicular laterally, no adventitious breath sounds)
• Verbalize: Difference between bell & diaphragm
• (bell transmits low frequency sounds; diaphragm transmits higher frequency sounds)

• Pt supine
• Inspect: Chest wall - pulsations, heaves, thrusts
• Palpate: Precordium, apical impulse (Left 5th ICS, MCL)

• Auscultate:
• Aortic - Right 2nd ICS, Right sternal border, S2>S1
• Pulmonic - Left 2nd ICS, Left sternal border, S2>S1
• Erb's Point - Left 3rd ICS, Left sternal border, S2=S1
• Tricuspid - Left 4th ICS, Left sternal border, S1>S2
• Mitral - Left 5th ICS, MCL, S1>S2 at the apex

• Verbalize: Rate, rhythm, splitting, murmurs
• (rate=64, rhythm=regular, no splitting or murmurs)

Palpate: Temporal, brachial, radial, posterior tibial, dorsalis pedis pulses bilaterally

(pulses are 2+ bilaterally for temporal, brachial, radial, posterior tibial, and dorsalis pedis pulses)

Inspect: Contour, color, symmetry, surface motion, venous patterns

(flat, tan, symmetrical, surface motion smooth & even with respirations, venous return toward head above umbilicus and toward feet below umbilicus)

• Auscultate: Bowel sounds in all 4 quadrants, verbalize
• (audible & active in all 4 quadrants)
• Percuss: Liver, spleen, gastric bubble
• (dullness to percussion over liver & spleen; tympany over stomach)

• Palpate: Epigastrum for aortic pulsation
• (aortic pulsation palpable in epigastrum)
• Palpate: Liver, spleen, kidneys
• (liver, spleen, & kidneys nonpalpable)
• Pt in sitting position
• Percuss: CVA tenderness
• (no CVA tenderness on percussion)

• Verbalize: Inspection of gait (upon pt entering room)
• Inspect: Posture (erect)

• Hands: thumb opposition, finger abduction/adduction, wrist extension, hyperextension
• Elbows: flexion/extension
• Shoulders: shrug against resistance, forward flexion (forward then up over head), hyperextension (extend & stretch behind back), abduction (laterally over head)
• Neck: forward flexion (chin to chest), hyperextension (back looking at ceiling), lateral bending (ear to shoulder), rotation (side to side, chin to shoulder against resistance
• T&L Spine: forward flexion (touch toes), hyperextension (bend back at waist), lateral bending (side to side), rotation (turning at waist)

• Turning head and shrugging shoulders against resistance.

• Pt supine
• Hips & Knees: flexion, knee extended (raise leg over body); flexion, knee flexed (raise one knee to chest, while keeping other leg straight; abduction/adduction
• Feet: dorsiflexion (point toward ceiling), plantar flexion (point toward floor), flexion/extension (bend & straighten toes)

• Cranial nerves - covered in appropriate body sections
• Evaluate coordination:
• Rapid alternating rhythmic movement: Finger-to-nose test
• Sensory:
• Superficial touch (cotton ball to various bilateral areas of body)
• Vibration (vibrating tuning fork to areas of body on bony prominences)

• Deep Tendon Reflexes: (name and elicit reflex correctly)
• Brachial
• Brachioradial
• Triceps
• Patellar
• Achilles