Head to Toe
Pain, tenderness
1. Introduction, dress
2. Wash hands
3. Clean bed
_________Head_________
= partner
4. Head-deformities, ecchymosis, lesions, Hair- texture,
distribution, Scalp
5. Tenderness?
6. Palpate- tenderness, deformities, masses
__________Eyes __________________
=Perform on model + verbalize = UNILATERAL
7. Acuity- Glasses? Snellen chart, read reverse
8. Fields- Wiggle test “say now” – CN II
9. Inspect- eyebrows, eyelids, eyelashes, iris, pupils, sclera,
lacrimal glands, ducts, conjunctiva (bulbar + palpebral)
10. Alignment – penlight to nose
11. Pupillary reactions (direct + consensual) – CN 3, 4, 6
12. Extraocular movements – H – CN 3,4,6 (oculo, troch, abduc)
13. Pupillary accommodation (Far & near object)- watch pupils
14. Ophthalmoscope-> Optic disc - color, clarity of outline,
physiological cup, size, symmetry, papilledema. Retina-
arteries + veins, av junctions, lesions, masses, hemorrhage
or exudates. Fovea & macula – hemorrhage, cysts (look into
light)
__________Ear________________
= partner, unilateral
15.
16. Inspect ear (ant + post)
17. Inspect bone (mastoid process)
18. Tug helix and tragus = inflammation
19. Bone tenderness
20. Otoscope: cone of light, umbo, incus, short process of
malleus, manubrium of malleus, pars tensa, pars flaccida;
erythema, exudates
21. CN 8- vestibulocochlear: hearing acuity -> whisper test:
christmas, Weber (forehead), Rinne (bone, air)
_____________Nose & Sinuses_________________
=On model, unilateral
22. Inspect: deformity, asymmetry, inflammation
23. Palpate: tenderness, (close one nostril, breathe in)
24. Otoscope: nasal mucosa, septum, turbinates, hematoma
25. Palpate: maxillary + frontal sinus
26. Percuss: maxillary + frontal sinus
27. CN 7- facial: movements -> smile, frown, puff cheeks, raise
brows, show teeth, close eyes + resist
28. CN 5- trigeminal: clench jaw I’ll palpate temples, jaw side to
side, Pain= in ophthalmic, maxillary, mandibular w/ Q-tip
(sharp, dull) , Light touch= same process, Corneal reflex: CN
5 (sensory), CN 7 facial (motor) -> Q-tip & look up + away ->
touch cornea with whisp -> blinking
_____________Mouth & Throat____________________
=On model, unilateral
29. Inspect: lips-> color, moisture, lesions, cracking
30. Inspect inside: Gloves -> hard + soft palate, buccal mucosa,
gingiva, teeth, airway patency, Tonsils ->symmetry,
 hypertrophy + edema, erythema + exudates, pharynx,
Tongue w/ gauze -> dorsal, right, left, sublingual, CN 12-
Hypoglossal -> tongue fasciculations, tongue out + palpate
cheek
31. Inspect: Teeth -> tap crowns w/ tongue blade
32. Wiggle teeth
33. CN 9, 10 (glossopharyngeal, vagus) = Voice: say ah -> rise of
soft palate, Gag reflex -> tongue blade posteriorly to lateral
+ dorsal surface
________Neck & Lymph nodes___________
=bilateral on partner
34. Inspect: neck + trachea
35. Neck pulsations w/ sitting up
36. Auscultate: carotid
37. Palpate: trachea
38. Gloves. Palpate Lymph nodes: preauricular, postauricular,
occipital, parotid, tonsillar, submandibular, submental, a.
cervical, p. cervical, supraclavicular, infraclavicular,
epitrochlear
39. Inspect: Thyroid -> swallow water + extend neck (tangential
lighting), palpate: thyroid isthmus- front & back w/
fingertips -> thyroid + cricoid cartilage. Feel size, shape,
consistency, tenderness, nodules. If enlarged, auscultate for
bruits, palpate thrills.
____________Heart__________________
40. Expose chest
41. Pt supine, arms side
42. Inspect: chest + epigastrium tangentially
43. Palpate: PMI -> location, amplitude, duration
44. Palpate: Thrills using MCPs -> Aortic, Pulmonic, R.
ventricular, L. ventricular, Epigastrium
45. Palpate: Pulsations using finger pads -> Aortic, Pulmonic, R.
ventricular, L. ventricular, Epigastrium
46. Auscultate: w/ diaphragm (palpate carotid) -> Aortic,
Pulmonic, Erb’s point (deep breath), Tricuspid, Mitral >10s +
apical rate, L. axilla
47. Auscultate: w/ bell (palpate carotid) -> -> Aortic, Pulmonic,
Erb’s point (deep breath), Tricuspid, Mitral, L. Axilla
___________Peripheral vasculature___________
= UNILATERAL partner
48. Pt supine, arms side
49. Auscultate: w/ bell for bruits -> carotid, abdominal aorta,
renal, iliac, femoral
50. Inspect: arms, hands, fingers, fingernails, legs, feet, toes &
toenails -> size, symmetry, texture, cyanosis, clubbing,
edema, vascular pattern, hair distribution
51. Palpate: pulses -> carotid (x1) , brachial, radial, ulnar, abd
aorta, femoral, popliteal (x1), dorsalis pedis, posterior
tibialis
52. Palpate: legs + feet -> edema @ dorsum, ant ankle, distal
tibia shin, proximal tibia, calf – tenderness
____________Pulmonary/Thorax_________________
=Bilateral
53. Pt sit up, expose thorax
54. Eval A-P diameter.
55. Inspect: BEHIND Pt -> tidal respirations, thoracic shape,
symmetry, contour, trauma or abnormalities
56. Respiratory symmetry -> deep breath
 57. Respiratory expansion -> hands on posterior base, watch
thumbs
58. Palpate: tenderness? -> apices, posterior & lateral thorax,
deformities
59. Percuss: apices (hook fingers), posterior & lateral thorax
(ladder-like)
60. Auscultate: pt deep breath via mouth, w/ bell -> apices, w/
diaphragm - >5s lat vertebral column, scapular @ lung base,
>2s PAL, full breath
61. Inspect: INFRONT pt –> tidal respirations, thoracic shape,
symmetry, contour, trauma or abnormalities
62. Respiratory symmetry -> deep breath
63. Palpate: tenderness? -> anterior & lateral thorax,
deformities
64. Percuss: anterior thorax (ladder-like)
65. Auscultate: pt deep breath via mouth, w/bell - >3 sites
lateral to sternum, >2 sites along anterior axillary line
(ladder-like, full inspiration + expiration
_______________Abdomen___________________
66. Pt supine, arms side, legs straight, knees extended- stand on
Right side
67. Pain, tenderness
68. Expose abdomen
69. Inspect: contour, symmetry, lesions/skin changes, striae,
distension, vascular dilation, ecchymosis, pulsations,
guarding
70. Auscultate: w/ diaphragm, 4 quadrants for BS -> hepatic rub
@ R- MCL, splenic rub @ L-AAL
71. Auscultate: w/ bell for bruits -> abdominal aorta, renal,
iliacs
72. Percuss: 4 quadrants -> tympany, dullness
73. Percuss: Liver – RLQ in MCL, Inferior border w/ pen, 3 rd ICS
in MCL, mark superior border, measure liver span with
measuring tape.
74. Percuss: Spleen -> L costal margin in AAL, pt deep breaths.
Change in note?
75. Palpation: pt supine, legs straight, knees flexed, deep
breaths. Pain/tenderness? -> facial expressions. Light
palpation using finger pads + one hand. Deep palpation
using both hands. (4 quadrants)
76. Palpation: Abdominal aorta
77. Palpation: Lower liver border -> right hand RLQ in MCL,
superiorly + deep breaths. Move hand after exhalation
78. Palpation: Spleen -> right hand palpate, left hand support
lumbar. RLQ to L costal margin in AAL, deep breaths. Move
hand after exhalation.
79. State: Rectal exam is the last part of abd exam.
_____________Musculoskeletal_____________
=Unilateral
80. TMJ- Inspect. Palpate TMJ in auditory canal, open & close
mouth. Assess ROM (active)– chin, mouth, jaw
81. Neck- Inspect ant, post, lateral. Palpate -> spinous process
of C spine, paraspinal muscles, SCM, trapezius ms. ROM
(passive) & strength= flexion, extension, lateral bending,
rotation
82. CN 11, spinal accessory nerve. Shoulder shrug against
resistance, neck rotation w/ resistance on cheek
83. Spine: stand w/ feet together. Inspect lateral + posterior.
Palpate -> spinous processes, paravertebral ms, SI joint.
ROM (active) flexion, extension, lateral bending, rotation
84. Shoulders: Inspect shoulders, hands to side, shoulder plantarflex, toe flexion & extension (active), inversion +
girdles, scapulae. Palpate: L hand -> sternoclavicular joint, eversion of subtalar (hold calcaneus, move foot),
spinae of scapulae, clavicle, acromioclavicular joint, inversion/eversion of tarsal joint (hold calcaneus, move
coracoid process, medial border of scapulae, greater foot), strength: dorsiflex, plantarflex
tubercle, bicipital groove, deltoid. 90. CN 1 (olfactory) = smell, patency of nares, 2 different
-ROM (active, passive) arms up, behind, lift laterally, in aromas (essential oils)
front, behind hips elbows out, behind head elbows out. 91. CN 2 - done
-Adduction: abducted w/ resistance, abducted w/ resistance 92. CN 3, 4, 5 - done
85. Elbows: Inspect anterior/posterior. Palpate extensor surface 93. 6 - done
of ulna, lat + medial epicondyle, olecranon process + 94. 7 -done
grooves. ROM (active, passive) = flexion, extension, 95. 8 -done
supination, pronation. Ms strength= flexion, extension, 96. 9, 10 - done
supination, pronation 97. 11 – shrug shoulders against resistance, neck rotation w/
86. Hands and wrists: Inspect -> Palpate: distal radius, ulna, hand on dorsum
anatomical snuff box, carpal bones, 1-5 MCP, Phalanges, 98. 12 – done
thumb IP, all IP, PIP, DIPs. ROM (active), make fist, extend
fingers, abduct + adduct, wrist flexion + extension (active,
passive), ulnar + radial deviation palm up. Thumb position,
grip strength.
87. Hips: Inspect -> pt standing, anterior + post. Palpate, pt
supine = greater trochanter, ASIS. ROM (active, passive) ->
knee flexion, abduction, adduction, internal rotation,
external rotation, extension (active) standing). Ms strength
(flex, abduct, adduct)
88. Knees: Inspect -> standing, anterior + post. Palpate + name,
patella, tibial plateau, popliteal space, patellar tendon, tibial
tuberosity, medial & lateral collateral ligaments. ROM
(active, passive) -> flexion, extension, ms strength
89. Feet and Ankles: Inspect -> arch (sitting, standing), Palpate -
> pt sitting, tibia, fibula, achilles tendon, tarsal bones, 1-5 th
metatarsals, PMD phalanges, All MTPs, DIPs, PIPs, great toe
IP, plantar surface. ROM (active, passive) dorsiflex,
___________________Motor Function_____________ 109. Pallesthesia (vibration) -> eyes closed -> DIP on
index fingers (C6,7), IP of great toe (L5) – DORSAL . If
99. Inspect: Muscles -> limbs + trunk: bulk, atrophy, contours,
abnormal, proceed proximally along joints of the affected
involuntary movement, abnormalities in position or posture
extremity and note affected dermatomes
100. ROM -> Shoulders (abduction, adduction), Elbows
110. Proprioception (position sense) -> eyes closed)
(flexion, extension), Wrist (flexion, extension), Hand (grip
grasp index finger, IP of great toe. Up or down. If abnormal,
strength), Fingers (abduct, adduct, thumb opposition), Hip
proceed proximally along joints of affected extremity and
(flexion, abduction, adduction), Knee (flexion, extension),
note affected dermatomes.
Ankle (dorsiflex, plantarflex).
111. Stereognosis -> eyes closed. Hand patient cotton
101. Already done
ball. Don’t tell them what it is, ask them to identify it
102. Gait: Pt walk across room: posture, balance, arm
112. Graphesthesia-> close closed. Draw letter on palmar
swinging, leg movement, Pt to tandem walk, check for
surface, ask pt what letter it was
ataxia
113. Two-point discrimination- eyes closed -> cotton tip -
103. Leg strength: toe walk + heel walk, rise from sitting
Index finger, great toe- PALMAR. Did you feel 1 or 2 stimuli?
position

________________Coordination_______________________
___________Reflexes_________________
104. Tap my finger at various locations (3- eyes open),
heel to shin (open, closed) 114. DTRs Biceps, Triceps, Brachioradialis, Quadriceps,
Achilles
________________Sensory Function_______________________
115. Superficial reflexes-> plantar/Babinski
105. Pain (cotton end)-> “sharp or dull” , test sensation
__________Final_______________________
first to see if patient appreciates the difference. Close eyes,
begin assessing sites. C5, T1, C6, C7, C8, T4, T10, L2, L3, L4, 116. Clean bed
L5, S1 (I will use these same points for question 105 to 108) 117. Cover up patient
106. Crude touch (cotton wisp) -> say “now” , test
sensation to see if patient appreciates difference. Close eyes
107. Point localization (finger) -> identify location of
stimuli. Close eyes
108. Point extinction (finger)-> can you feel this on one
side or both sides?. Close eyes
CN I – Olfactory
CN II – Optic
CN III – Oculomotor
CN IV – Trochlear
CN V – Trigeminal
CN VI – Abducens
CN VII – Facial
CN VIII – Vestibulocochlear
CN IX – Glossopharyngeal
CN X – Vagus
CN XI – Accessory
CN XII – Hypoglossal