Observed Physical Exam

Question 1

Broad areas to cover

Answer 1

ORIENTATION
EYE
ENT
LUNGS
HEART
ABDOMEN
MUSCULOSKELETAL
STRENGTH
DEEP TENDON REFLEXES
SCALES

Question 2

ORIENTATION

Answer 2

1. Wash Hands
2. Introduction
3. Describe General Appearances
4. Blood Pressure
5. Pulse
6. Respiratory Rate

Question 3

EYE

Answer 3

7. Extra-ocular Muscles
8. Pupil Check to Light
9. Pupil Check to Far and Near
10. Conjunctiva
11. Fundoscopic Exam

Question 4

ENT

Answer 4

12. External Ear
13. Auditory Canal and Middle Ear
14. Hearing
15. Nose and Oral Cavity
16. Thyroid and Anterior/Posterior Cervical Adenopathy

Question 5

LUNGS

Answer 5

17. Auscultate Anterior Fields
      (2 places – 1 on each side)
18. Auscultate Posterior Fields 
      (6 places - 3 on each side)
19. Percussion of Posterior Fields
20. Costovertebral Angle Tenderness

Question 6

HEART

Answer 6

21. Auscultate Sitting (4 locations)
22. Auscultate Supine (4 locations)
    (Use diaphragm for all valves; use diaphragm
    and bell or equivalent, for mitral valve)
23. PMI
24. JVD and HJR
25. Peripheral Pulses
    (Carotid, Radial, Femoral, Dorsalis Pedis)

Question 7

ABDOMEN

Answer 7

26. Position Patient Correctly
      (Hands By Sides, Knees Flexed)
27. Auscultate for Bowel Sounds x 1
28. Palpation Four Quadrants
29. Hepatic and Spleen Size

Question 8

MUSCULOSKELETAL

Answer 8

RANGE OF MOTION

30. Cervical Spine
31. Shoulders
32. Elbows/Forearms
33. Wrists and Digits
34. Back
35. Hips
36. Knee
37. Ankle and Foot

Question 9

STRENGTH

Answer 9

38. Upper Extremity

39. Lower Extremity

Question 10

DEEP TENDON REFLEXES

Answer 10

40. Biceps
41. Triceps
42. Brachioradialis
43. Patellar
44. Achilles

Question 11

INSPECTION

Answer 11

45. Hands

46. Feet

Question 12

SCALES

Answer 12

47. Pulses 0-3
48. Reflexes 0-4
49. Muscle Strength 0-5
50. Murmurs 1-6

Question 13

Recommended Grading of Pulses

Answer 13

3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

Question 14

Gradations of Murmurs (p. 382)

Answer 14

Grade 1 Very faint, heard only after listener has “tune in”; May not be heard in all positions

Grade 2 Quiet, but heard immediately after placing the stethoscope on the chest

Grade 3 Moderately loud

Grade 4 Loud, with palpable thrill

Grade 5 Very loud, with thrill. May be heard when the stethoscope is partly off the chest

Grade 6 Very loud, with thrill. May be heard with stethoscope entirely off the chest

Question 15

Scale for Grading Reflexes

Answer 15

4+ Very brisk, hyperactive, with clonus (rhythmic oscillations between flexion and extension)

3+ Brisker than average; possibly but not necessarily indicative of disease

2+ Average; normal

1+ Somewhat diminished; low normal

0 No response

Question 16

Scale for Grading Muscle Strength

Answer 16

Muscle strength is graded on a 0 to 5 scale:
0-No muscular contraction detected
1-A barely detectable flicker or trace of contraction
2-Active movement of the body part with gravity eliminated
3-Active movement against gravity
4-Active movement against gravity and some resistance
5-Active movement against full resistance without evident fatigue.
This is normal muscle strength