RESPIRATORY EXAMINATION CHECKLIST

INTRODUCTION
Take consent & introduce yourself to the patient
Hand rub/sanitize hands
Look surrounding the patient/any connected medical devices
Adjust the bed rails
Position the patient at 450
Adequate exposure of the patient
GENERAL EXAMINATION
Skin color (pallor/peripheral cyanosis)
Palmar erythema
Finger clubbing
Hand deformity
Tobacco stain
Scar
Capillary refill time
Radial pulse
Temperature of the patient’s hand (warm/cold/sweating)
Fine/flapping tremor
Note any venepuncture mark (Mantoux test)
Scleral jaundice
Conjunctival pallor
Central cyanosis
Oral mucosa (moist/dry)
Oral hygiene
Lymph node examination
Signs of tachypneic (nasal flaring, use of accessory muscle, tripod position)
CHEST EXAMINATION
INSPECTION (anterior & posterior):
1. Respiratory rate
2. Chest shape
3. Chest movement bilaterally
4. Use of accessory muscle
5. Scar
PALPATION:
1. Tracheal deviation
2. Chest expansion
3. Vocal fremitus at anterior and lateral chest wall
4. Vocal fremitus at posterior chest wall
PERCUSSION:
1. Percuss anterior and lateral chest wall
 2. Percuss posterior chest wall
AUSCULTATION:
1. Auscultate anterior and lateral chest wall for air entry & any added sound
2. Auscultate posterior chest wall for air entry & any added sound
3. Auscultate for vocal resonance at anterior, lateral and posterior chest wall
LEG EXAMINATION
Pedal edema
Thank the patient for their time.
ABDOMINAL EXAMINATION CHECKLIST

1. Introduction and briefly explain the examination

2. Bring down bed rails
3. Pull curtain
4. Exposes patient appropriately
5. Positions patient appropriately and ensures that he/she is comfortable
6. Hand rub
7. Inspects general appearance
 Alert, conscious
 Abdominal distended
 Breathlessness
 Cachexia
 Obvious jaundice, pigmentation
8. Inspects and examines hands
 Nails: clubbing, leukonychia, koilonychia
 Palm: palmar erythema, Dupuytren contracture
 Tests for asterixis
 Arms: bruises, scratch marks (pruritus), loss of axillary hair
9. Inspects face
 Eyes: jaundice, pallor, Kayser-Fleischer ring, xanthelasma
 Parotid gland: enlargement
 Inspects mouth: angular stomatitis, glossitis, fetor hepaticus, oral ulcers,
pigmentation (Peutz-Jegher syndrome)
10. Palpates neck for lymphadenopathy
11. Inspects upper body (chest):
 Gynecomastia
 Spider naevi
12. Inspects abdomen:
 Abdominal distention
 Scars
 Bruises, pigmentation: Cullen sign, Grey-Turner sign
  Caput medusae
 Visible pulsations
 Inspect hernia orifice
13. Abdomen: light palpation
 Ask patient for any pain
 Kneel or sit upon palpating
14. Abdomen: deep palpation
 Inform patient his/her abdomen will be pressed harder
 Look at patient’s face
 Feel for any mass and describe (if any)
15. Palpates for liver edge
16. Palpates for tenderness over gallbladder region
17, Palpates for enlarged spleen
18. Ballots each kidney in turn
19. Examines for ascites
 Shifting dullness
 Fluid thrill
20. Inspect back of patient
21. Percusses liver area for liver span
22. Auscultates for abdominal sounds
23. Auscultates for aortic and renal bruits
24. Examine lower limbs for edema
25. Suggests examining the groins and genitals or carrying out a digital rectal
examination or CVS examination (which is more suitable)
*strikethrough words are emphasized more in surgical cases
CARDIOVASCULAR EXAMINATION CHECKLIST

Introduce and brief

Pull the curtains
Bring down bed rails
Adequate exposure
Position patient: 45 degree propped up position
Hand rub
General inspection: stand at the end of bed (not necessarily)
Conscious level
Breathlessness
Obvious pallor, jaundice
Body built
Dysmorphic feature e.g. Marfanoid habitus
Connected to any medical device
General examination
Hands:
Nails: clubbing (grade it), splinter hemorrhage, peripheral cyanosis, CRT
Palms: Osler’s nodes, Janeway lesion
Radial pulse: heart rate, radio-radio delay, radio-femoral delay, collapsing pulse
Face: pallor, jaundice, corneal arcus, xanthelasma, central cyanosis
Neck: distended veins, JVP
CVS examination
Inspection: scar, chest shape (any deformities), visible pulsation, prosthetic clicks
Palpation
Apex beat: location and nature
Parasternal heave
Thrills at apex, left sternal edge, suprasternal notch
Auscultation
Place finger at carotid artery (lateral to thyroid cartilage)
Mitral area: 6th ICS mid-clavicular line
*different manoeuvre used to help differentiating MS and MR
Mitral stenosis:
- Use bell
- To accentuate the murmur:
o Ask patient to breath out and hold
o Ask patient to turn body to the left (bring heart closer to chest)
Mitral regurgitation:
- Use diaphragm
- To accentuate the murmur: ask patient to breath out and hold
- To look for radiation: auscultate at axilla area
Tricuspid area: lower left sternal edge
- Use diaphragm
Pulmonary area: upper left sternal edge
- Use diaphragm
Aortic area: upper right sternal edge
*different manoeuvre used to help differentiating AS and AR
Aortic stenosis:
- Use diaphragm
- To accentuate the murmur: ask patient to breath out and hold
- To listen for radiation of murmur: auscultate carotid arteries (different from
carotid bruit)
Aortic regurgitation:
- Use diaphragm
- To accentuate the murmur:
o Ask patient to breath out and hold
o Ask patient to sit up, then listen to 3rd left ICS
Auscultate for carotid bruit: use bell
Auscultate lung bases: use diaphragm to auscultate both lung bases at the back for
crepitation
Examine for leg edema
Suggest to do respiratory examination, palpate liver or anything suitable

*Dengan Dato Sapari, he expects you to demonstrate hepatojugular reflux while checking for
JVP, elicit for any hepatomegaly and lungs crepitation. Then, you can say ‘I would like to
end my examination by doing respi examination’.
*Dengan Dr Syed, you can leave auscultating lung bases, liver palpation and said ‘I would
like to end my examination by auscultating lung bases and palpate liver’.
LOWER LIMB EXAMINATION CHECKLIST (CNS)
Introduce and brief
Sanitize or wash hands
Pull curtains
Bring down bed rail
Adequate exposure: ideally wears only undergarment
Position: lie supine
General inspection
Abnormal posture
Abnormal movements e.g. tremors, dystonia, myoclonus, tics, chorea,
dyskinesia, athetosis, akithesia, asterixis
Muscle wasting
Neurocutaneous stigmata
Bedside: walking aid, wheelchair
Neurological examination
Fasciculation:
*Dr Syed - tap on large muscles, wait for 2 – 3 secs between taps to
see any contractions
*Dato Sapari – just inspect for any contraction
Tone
Examine tone at: hip, knee, ankle
Abnormalities: hypertonia, hypotonia
Examine for clonus
Power
Hip: flexion, extension
Knee: flexion, extension
Ankle: dorsiflexion, plantar flexion
Tarsal joint: inversion, eversion
Big toe: dorsiflexion, plantarflexion
Reflexes
Knee jerk
Ankle jerk
Plantar response
Sensations
Light touch
Pain
Vibration
Proprioception
Cerebellar function
Heel-to-shin test
Writing ‘8’ (optional)
Romberg’s test and gait (ask permission from examiner first)
Thank patient
UPPER LIMB EXAMINATION CHECKLIST (CNS)
Introduce and brief
Sanitize or wash hands
Pull curtains
Bring down bed rail
Adequate exposure: ideally wears only undergarment
Position: lie supine
General inspection
Abnormal posture
Abnormal movements e.g. tremors, dystonia, myoclonus, tics, chorea,
dyskinesia, athetosis, akithesia, asterixis
Muscle wasting
Neurocutaneous stigmata
Bedside: walking aid, wheelchair
Neurological examination
Fasciculation:
*Dr Syed - tap on large muscles, wait for 2 – 3 secs between taps to
see any contractions
*Dato Sapari – just inspect for any contraction
Tone
Examine tone at: shoulder, elbow, wrist
Abnormalities: hypertonia (clasp-knife, cogwheel rigidity, spastic),
hypotonia (flaccid)
Power
Shoulder: abduction, adduction
Elbow: flexion, extension
Wrist: flexion, extension
Fingers: abduction, adduction
Reflexes
Biceps
Triceps
Brachioradialis
Sensations
Light touch
Pain
Vibration
Proprioception
Cerebellar function
Finger-nose test – look for abnormalities e.g. termor, past-pointing
Rapid alternating movement – look for dysdiadochokinesis
Romberg’s test and gait (ask permission from examiner first)
Thank patient
CRANIAL NERVE EXAMINATION
Introduce and brief
Pull curtains
Pull down bed rails
Sanitize or wash hands
CN I: Olfactory nerve - smell
CN II: Optic nerve
Visual acuity: Snellen chart
Visual field and blindspot: hat pin
Pupillary reflexes and RAPD
CN III (Oculomotor), CN IV (Trochlear), CN VI (Abducens) – LR6SO4
Ptosis
Accomodation
Extraocular muscle movements
Diplopia
Nystagmus
CN V: Trigeminal nerve
Corneal reflex
Facial sensation: light touch and pain
Muscles of mastication
CN VII: Facial nerve
Facial asymmetry – abnormal: drooping corner of mouth
Wrinkle the forehead (frontalis muscle) – abnormal: loos of wrinkling
Puff out the cheeks (buccinators) – abnormal: weak
Close the eyes against resistance (orbicularis oculi) – abnormal: weak
Close the mouth against resistance (orbicularis oris) – abnormal: weak
Shrug the neck (platysma muscle) – abnormal: weak
CN VIII: Vestibulocochlear nerve
Hearing test– abnormal: cannot hear
Rinne’s test– abnormal: cannot hear
Weber’s test– abnormal: cannot hear
CN IX (Glossopharyngeal), CN X (Vagus)
Inspect palate and uvula – abnormal: deviated
Gag reflex – abnormal: absent
CN XI: Accessory nerve
Shoulder power
Sternocleidomastoid power
CN XII: Hypoglossal nerve
Inspect tongue at rest – look for any wasting and fasciculation
Tongue deviation upon protrusion – abnormal: deviated
Thank the patient
*If no abnormal finding: cranial nerve _ was intact
BREAST EXAMINATION CHECKLIST
Introduce and brief
Pull curtains
Bring down bed rails
Sanitize or wash hands
Adequate exposure: undress patient until waist
Position: propped up position 45 degree
Inspection
Patient’s arms at side
Symmetry
Obvious lump
Skin changes: dimpling, ulceration, peau d’orange
Nipple changes: retraction, ulceration, eczematous changes, discharge
(can ask patient to squeeze for you)
Scars (must go around to inspect carefully)
Dilated veins
Satellite nodules
Patient sits up and leans forward
Skin tethering
Patient raises hands above head
Axillary clearance scar
Axillary swelling
Palpation
Start from normal side
Palpate quadrant by quadrant
Describe any swelling: site, size, shape, surface, margin, consistency,
mobility, attachment to skin, tenderness
Fixation to pectoralis major: ask patient to press arms against waist, try to
move the lump at the direction perpendicular to the pectoralis muscle
fibers
Palpate axillae for lymphadenopathy – examine medial, lateral,anterior,
posterior
Complete examination with examine lymph nodes in the neck, supraclavicular
fossae, spine for tenderness, lungs for pleural effusion and abdomen for
hepatomegaly and ascites
NECK EXAMINATION CHECKLIST
Introduce and brief
Pull curtains
Bring down bed rail
Sanitize or wash hands
Adequate exposure: perempuan bertudung pakai anak tudung je
Position patient: sit up
Inspection
From the front of patient
Swelling: site, estimated size, shape, movement with swallowing and
protrusion of tongue, any swelling elsewhere
Scars
Skin changes
Dilated upper chest veins
Plethoric face
Palpation
Go to patient’s back
Swelling (palpate one side by one side) – site, shape, size (measure), surface,
margin, consistency, mobility, thrills, can get below or not (ask patient to
swallow while palpating for the inferior border), fixation to
sternocleidomastoid
Lymph nodes (one side by one side)
Both carotid arteries
Go to the front of patient
Tracheal deviation
Percussion
Retrosternal extension
Auscultation
Bruit over the superior pole of the swelling (highest vascularity area)
Both carotid arteries for bruits
Thyroid status examination (only in IM)
Hands
Thyroid acropachy
Fine tremors
Sweaty palms
Radial pule: rate and rhythm
Reflexes
Proximal myopathy
Eyes
From back, look for proptosis
From the front, look for lid retraction (visible upper sclera),
exophthalmus (visible inferior limbus), chemosis (conjunctivae
edema)
Lid lag
Ophthalmoplegia
Legs
Pretibial myxoedema
Surgery: complete examination with thyroid status examination
IM: complete examination with CVS examination
STOMA EXAMINATION CHECKLIST
Introduce and brief
Pull curtains
Bring down bed rail
Sanitize or wash hands
Adequate exposure: nipple line to mid-thigh
Position patient: lie flat
Inspection
Stoma
Site
Lumen: single or double
Color: pink or dusky
Presence of spout
Contents: color, consistency, amount
Surrounding skin
Complications e.g. parastomal hernia (ask patient to cough), prolapse,
retraction
Scars
Palpation – mention you would want to proceed with abdominal examination.
Auscultation
Bowel sound
Thank the patient
Complete examination with per rectal examination (for patency) or abdominal
examination (if not done earlier)

Colostomy Ileostomy
Bowel Large bowel Small bowel
Usual site Left iliac fossa Right iliac fossa
Presence of No, bowel is flushed to the skin Yes, to prevent irritation of skin by
spout bowel contents
Contents More well-formed stools Watery, greenish contents
Calibre Larger Smaller
INGUINAL HERNIA EXAMINATION

Introduce and brief

Pull curtains
Bring down bed rail
Sanitize or wash hands
Adequate exposure: remove pants and undergarment completely
Position patient: stands upright
Inspection both groins (Position yourself professionally, avoid standing directly in
front of the patient’s genitalia to inspect. Try to squat slightly lateral)
Swelling
Site in relation to pubic tubercle (PT)
Estimated size
Shape
Overlying skin
Cough impulse by asking to look opposite side (professionalism) and cough
Palpation (Make yourself at patient’s side. One hand support from behind and feel
using another hand)
Assess the lump
Site
Size (measure)
Shape
Consistency
Margin
Mobility
Tenderness
Cough impulse
If there is scrotal swelling, assess whether the swelling is:
Separable from testis
Can get above the swelling
Transillumination
Deep ring occlusion test
HAND EXAMINATION CHECKLIST
Introduce and brief
Pull curtains
Bring down bed rail
Sanitize or wash hands
Adequate exposure: both upper limbs should be exposed (roll up sleeves)
Position patient: patient sits down with hands put on table/pillow
Look
Deformity: features of RA, OA, contractures, claw hand
Scars: carpal tunnel release etc
Swellings over hand: site, size, shape, surface, margin, consistency, mobility,
attachment, overlying skin, transillumination, slip sign, pulsatility, fluctuancy
Muscle wasting
Feel
Temperature of hands
Tenderness: wrist, DRU, MCP, PIP, DIP, anatomical snuffbox
Move:
Screening test:
Forearm supinated, flex and extend all fingers
Forearm pronated, finger extension with wrist extended
Supination and pronation
Flex and extend elbow
OK sign
Median nerve
Ceiling test (for APB)
Thumb opposition (opponens pollicis)
Tinel’s sign
Phalen’s sign
Benedict’s/pointing index sign (paralysed lumbricals)
Ulnar nerve
Froment’s test
Finger abduction and adduction against resistance
Radial nerve
Finger extension and wrist extension against resistance
Special test
Finkelstein test: for DeQuervain’s tenosynovitis
Thank the patient
Complete examination with cervical spine examination or neurovascular examination
of upper limb
KNEE EXAMINATION CHECKLIST
Introduce and brief
Pull curtains
Bring down bed rail
Sanitize or wash hands
Adequate exposure: ideally only wear undergarment
Position patient: patient initially stands upright
Look - While patient stands upright
From front
Deformity – genu varum, genu valgum
Muscle wasting: quadriceps
Scar
Swelling of knee joint
Skin changes
From side
Swelling
From back
Swelling: Baker’s cyst
Scar
Gait
Feel – patient sits on chair/edge of bed
Temperature of knee joints
Feel for crepitus in the knee joints while passively flex and extend the knees.
Inspect for inverted J sign.
Patellar apprehension test: push the patella to lateral while extending the knee
Patient lies down
Knee fully extended
Effusion: fluid shift, cross fluctuance, patellar tap
Palpate the patella: facet, surface
Patellar grinding test
Measure quadriceps circumference if suspect wasting: 4 finger breadths above
patella
Knee flexed at 90degree
Palpate: tibial tuberosity, patellar tendon, joint line (medial and lateral one by
one), quadriceps tendon, femoral condyles, MCL, LCL
Move
ROM + power:
Flexion (n: 0 – 130)
Extension (n: 0 -180)
Deformity:
Fixed flexion deformity: measure with gniometer
Genu recuvatum: measure the degree
Special tests
Posterior sag sign – inspect from the side
Anterior + posterior drawer tests
Lachman test
Varus and valgus stress test
McMurray test – medial and lateral meniscus
Thank the patient
Complete the examination with hip examination or lower limb neurovascular
examination