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This is an outline of material you need to know for your lab practicum
(at the end of the course.) You will pick one system at random and examine
that system on your partner. Although you cannot have this guide in front
of you, you will beexpected to examine key aspects of the system using
these guidelines. In addition, the examiner will ask you some questions
pertaining to the system. Your examiners do not want this to generate
high anxiety, but rather it should serve to assist you in your review
of the basics of physical assessment of key systems.
Physical
Assessment Performance Checklist
Heart
1. Palpation
Locate and palpate
the PMI. Can you see a pulsation?
What is the normal size?
What is the significance of an enlarged PMI or one that is displaced
to the left
2. Locate,
name, and auscultate the following areas:
Aortic
Pulmonic
ErbOs point
Tricuspid
Mitral (apical)
3. Discussion:
Describe S1, S2,
and split S2
Describe S3, and S4 gallops and their significance. Where is each
heard best? Which is coupled with 8, and which is coupled with S2? Describe
indications for using diaphragm and bell
Describe a pericardial friction rub?
Blood
Vessels
1. Inspection
Inspect for jugular
venous distention
Describe criteria for jugular venous distention
Check for edema
Describe classification of edema (+1 to +4)
Check skin color and look for ulceration
Describe differences in skin in arterial versus venous insufficiency
2. Palpation
Check skin temperature
(With dorsum of your hand)
Palpate peripheral pulses. Describe amplitude (+l to +4)
Carotid
Brachial
Radial
Ulnar
Aortic
Femoral
Popliteal
Dorsalis pedis
Posterior tibialis
Check for capillary refill
3. Discussion
Describe and demonstrate
HomanOs sign. Discuss the limitations of its usefulness
4. Auscultation
Auscultate for
a carotid bruit
Chest and Lungs
1. Inspection
Observe respirations
Inspect trachea for deviation
Describe normal anterior-posterior diameter and variations in shape
of thorax
2. Palpation
Palpate respiratory
expansion
Palpate tactile fremitus
Describe when tactile framitus may be present or absent
3. Percussion
Measure diaphragmatic
excursion
4. Auscultation
Auscultate the
posterior thorax using correct technique
Describe which Jobs may be auscultated only via the anterior thorax
Describe normal breath sounds: bronchial, bronchovesicular, vesicular
Describe abnormal breath sounds: crackles, Meezes, rhonchi, stridor,
and pleural friction rub and Yihen bronchial breath sounds are abnormal
Skin
1. Complete matching
exercise
Neurological
1. Complete the neurological evaluation checklist used by HMC(Glasgow
Coma Scale)
Check pupil size
(in mm.) and reaction time (normal, sluggish,
absent)
Check limb powder
Upper by checking strength of handgrip
Lower by checking plantar flexion against resistance
Evaluate best verbal and best motor response and eye opening
Tally number
2. Inspection, palpation, and neurologic tests
Cerebellar tests
Check Romberg
for balance
Check heel-toe walking
Check rapid alternating movements
Reflexes
Biceps
Triceps
Brachioradialis
Abdominal
Patellar
Achilles
Describe clonus
Plantar
Describe significance of Babinski
Sensory function:
Check
superficial pain
touch
vibration
two-point discrimination
position sense
Cranial nerves
Evaluate function
of I-XII
Musculoskeletal
1. Put all joints through range of motion and name each position
2. Demonstrate technique used to auscultate for broken bones
Abdomen
1. Inspection
Check contour, symmetry,
and movement visible on the surface
2. Auscultation
Auscultate for
one minute in all four quadrants
Auscultate for one minute in all four quadrants
- What is the
normal range for number of clicks and gurgles per minute?
- What is the normal range for number of clicks and gurgles per minute?
- What constitutes hypoactive and hyperactive bowel sounds?
- What constitutes hypoactive and hyperactive bowel sounds?
3. Percussion
- Percuss the
liver span and measure at the midclavicular line
- What should normal span be?
- Identify borders of liver using scratch-assisted auscultation
- Percuss the gastric bubble
4. Palpation
Demonstrate light
palpation
Point to area where each underlying organ is located: stomach, liver,
gallbladder, spleen, kidneys, pancreas, ovaries, and appendix
Demonstrate how you would elicit rebound tenderness
What does rebound tenderness suggest?
Lymphatics
Using text as a guide, locate and palpate all superficial lymph node chains
and groups
Eyes
1. Examination of
the eyes
Check sclera and
conjunctiva for color
Check visual acuity using the Snelien eye chart
Check visual fields by confrontation Check corneal reflex
Perform ophthalmoscopic exam
2. Examination of
ears
Examine external
ear
Perform otoscopic exam
Perform Weber(tuning fork midline on skull)and Rinne test(tuning fork
over mastoid process)
3. Examination of
nose
Check for discharge,
patency of nares, and deviated septum
Mouth, Pharynx, and Neck
1. Inspection
Check lips for
ulcers and lesions
Check teeth for caries, chips, wear
Check gums fbr ulcers, lesions, and bleeding
Check tongue for position, lesions, cracking
Check neck for shape, symmetry, jugular venous pulsations
2. Palpation
Palpate thyroid
and cricoid cartilages and thyroid gland
Breasts and Axillae
1. Perform self-breast
exam
2. Perform Breast exam on partner
3. Perform breast exam on synthetic models
Genitalia
1. Perform gynecologic
and rectal exam on lab model
2. Discuss exam of male genitalia, anus and rectum
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