head and neck:

operative case:
1. head inspection:

hair loss, eyebrow loss

xanthalasma, jaundice, pallor

nasal deformity, deviation, discharge

ear deformity, discharge

rashes in the face

angular stomatitis, central cyanosis

mouth hygiene, ulcers, uvual deviation, jaundice, no tonsillar

hypertrophy

2. neck palpation:

thyroid gland, swallowing

neck lymph nodes

carotid

JVP

head and neck: 1

 upper limb general
operative case:
1. nails: clubbing, splinter hemorrhage, koilonychia

2. hands:

peripheral cyanosis, pallor, palmar erythema, tar stain

tremor fine and coarse

thenar and hypothenar atrophy

capillary refilling time

temperature of the hand

3. pulses

radial pulse and rate

radioradial delay

brachial pulse

collapsing pulse

4. lymph nodes:

brachial lymph nodes

axillary lymph nodes

💡 do not forget to examine both limbs

💡 to complete my examination i should do radiofemoral delay test

upper limb general 1

 lower limb general
1. nails: clubbing, splinter hemorrhage, koilonychia

2. palpation:

temperature

ulcers in the hidden area

ulcers in the pressure area (heel and sole of toes)

edema test

tenderness

3. pulses:

dorsalis pedis pulse

tibialis posterior pulse

💡 do not forget to examine both lower limbs

💡 to complete my examination i should do popliteal artery pulse also

lower limb general 1

 CVS
operating case:
1. inspection:

scars and deformities

visible pulses

symmetry of the chest

2. palpation

apex beat

thrill in all 4 areas (should be absent)

heave

heave maneuver for the RV, take a breath and stop it

3. auscultation:

all 4 areas of the heart with the diaphragm

murmur radiations to the neck(AS) and left axillary area (MR)

S3 with the bell in apex beat area

CVS 1
 💡 do not forget to check pulse of carotid artery simultaneously of heart
auscultation

💡 to complete the examination i should do blood pressure measure,

heart rate

💡 patient sleep at degree of 45

CVS 2
 RS
operative case:
1. inspection:

a. end of the bed: scars, deformities, breathing pattern, chest movement

with breathing

b. side of the bed: scars in the axillary area

2. palpation:

chest expansion (upper and lower chest)

trachea: position, cricosternal distance (3fingers), tracheal tug (should be

absence)

apex beat

3. percussion: 6 areas begin with lung apex and should be resonant

4. auscultation:

vesicular breathing sound

vocal resonant (44)

a egophony

whispering

comment as no additional sounds like pleural rub, wheeze, crackle

💡 do not forget to warm up the stethoscope before using it

💡 in tracheal tug test put the fingers in the area between sternum and
cricoid cartilage and ask the patient to take a deep breath assessing
the downward movement of the trachea

RS 1
 GIT
inspection:
1. exposure should be from nipple line to mid thigh

2. during inspection looking at the end of the bed for the symmetry of the
abdomen and from the side of the bed for type of breathing

palpation:
1. during palpation it doesnt matter to start with or opposite to clock wise
instead it should be far from the area of pain

2. during palpation the arm should be flat and do not do palpation with
standing position

percussion:
1. when trying to attempt shifting dullness you should wait for up to 20-30sec
after turning the patient to start percussion

auscultation:

operative case:
1. inspection:

a. end of the bed: symmetry of abdominal movement (abdominothoracic)

b. side of the bed:

scars

stria

deformities

cough reflex for hernia

2. palpation:

superficial palpation for tenderness and masses

GIT 1
 deep palpation for tenderness and masses

liver palpation (respiration with each palpation)

liver span (percussion)

murphy sign (gallbladder)

splenomegaly (with reinforcement)

kidney (with reinforcement)

GIT 2
 bladder (begin from umbilicus)

3. percussion:

for ascites

shifting dullness

transmitted thrills

4. auscultation:

a. bruit:

McBurney area

aortic bruit (aortic aneurysm)

renal bruit (renal stenosis)

liver bruit

b. bowel sound

💡 to complete the examination i should do DRE, back of the abdomen,

left supracalvicular lymph node

GIT 3
 coordination
operative case:
1. finger to nose

2. heel to shin

3. saying complicated words like ‫قسطنطينية‬

4. gait

5. flipping hand

6. nystagmus

7. writing letters on the palm

coordination 1
 upper limb motor
operative case:
1. inspection:

atrophy in thenar and hypothenar

tremor

fasciculations

pronator drift

2. tone:

both hands

movements of each joint under relaxation of the patient

3. power:

both hands

movements of each joint under resistance

4. reflexes:

biceps reflex

triceps reflex

supinator reflex

finger reflex

Hoffman test

upper limb motor 1

 💡 muscle tone should be +2 result
muscle power should be 5 grade
Hoffman test should result negative

upper limb motor 2

 lower limb motor
operative case:
1. inspection:

muscle waste

abnormal movements

fasciculations

2. tone: shaking leg, flex the knee, flex the ankle (the body of the patient is
relaxed)

3. power: movement of joints against resistance

4. reflex: knee, ankle of both legs

5. Babinski test

💡 ask the examiner: shall i do gait exam, walking on heal, walking on

toes, tandem gait

lower limb motor 1

 facial nerve
operative case:
1. inspection:

look for any asymmetry

eyebrow elevation for forehead creases

closure and opening of the eye against resistance

nasolabial fold

smile to see any facial deviation

2. list the findings

3. explain LMNL and UMNL

facial nerve 1
 trigeminal nerve
operative case:
1. sensory:

light touch with a cotton on the face (at least 6 areas)

pain with sharp object

2. motor:

closure of the mouth and assess the bulk of masseter

open mouth against resistance to assess the power of masseter

2. corneal reflex: both eyes should close at the same time

3. jaw jerk

trigeminal nerve 1