Physical Exam Checklist

Physical Exam Competency Checklist
Student Name__________________
General Skills
YES
NO
1. Students appearance and manner are appropriate and professional;

Student introduces himself/herself.
1._______
1._______
2. Student establishes rapport; explains purpose of exam.
2._______
2._______
3. Student shows concern for patients comfort and assures

privacy/confidentiality during the examination.
3._______
3._______
4. Student explains procedures and prepares the patient for use of

instruments; instructions to the patient are clear.
4._______
4._______
5. Exam sequence is logical and progresses from one region to another

without undue repetition.
5._______
5._______
6. Sequence includes comparison of symmetrical parts of the body.
6._______
6._______
7. Student examines patient using serial exposure appropriate to the steps of

the examination.
7._______
7._______
8. Balances need for palpation/percussion/auscultation to elicit information

with gentle examination technique.
8._______
8._______
Clinical Skill/Competency
Done
Correctly
Done
Incorrectly
Not
Done
1. Wash hands before starting examination.
1._______
1._______
1._______
2. Measure blood pressure in one upper limb.

Place cuff snugly in correct anatomical position.
2._______
2._______
2._______
3. Measure respiratory rate for at least 60 seconds.
3._______
3._______
3._______
4. Palpate radial pulse for at least 15 seconds.
4._______
4._______
4._______
5. Palpate radial pulses simultaneously for symmetry.
5._______
5._______
5._______
6. Inspect and palpate both hands (dorsal and palmar).
6._______
6._______
6._______
7. Inspect nails and nail beds. Check clubbing and capillary refill.
7._______
7._______
7._______
8. Inspect and palpate both arms and forearms with clothing removed,
including temperature
8._______
8._______
8._______
9. Palpate epitrochlear nodes.
9._______
9._______
9._______
10. Palpate axillary nodes (use proper technique to palpate axillary nodes).
10.______
10.______
10.______
11. Wash hands after palpating axillary nodes.
11.______
11.______
11.______
12. Palpate scalp thoroughly.
12.______
12.______
12.______
13. Assess scalp and hair for texture and consistency.
13.______
13.______
13.______
14. Inspect external ocular structures (lids, cornea, conjunctiva).
14.______
14.______
14.______
15. Gently move eyelids up and down to obtain better view.
15.______
15.______
15.______
SECTION A. GENERAL INSPECTION/VITAL SIGNS
SECTION B. HANDS/ARMS INSPECT NAILS/SKIN
SECTION C. HEAD AND NECK
EYES
Page1of9
Done
Correctly
Done
Incorrectly
Not
Done
16. Estimate visual acuity (near or far) bilaterally.
16.______
16.______
16.______
17. Test visual fields by confrontation.
17.______
17.______
17.______
18. Test visual fields in each eye separately in 4 (up, down, right, left)
directions.
18.______
18.______
18.______
19. Evaluate extraocular muscle function in 4 (up, down, right, left) directions. 19.______
19.______
19.______
20. Check for convergence and accommodation.
20.______
20.______
20.______
21. Observe pupillary response to light (direct).
21.______
21.______
21.______
22. Observe pupillary response to light (consensual).
22.______
22.______
22.______
23. Patient positioned at height comfortable for examiner.
23.______
23.______
23.______
24. Lights dimmed before ophthalmoscopic examination.
24.______
24.______
24.______
25. Ophthalmoscope held properly and index finger used to switch lenses.
25.______
25.______
25.______
26. Hold ophthalmoscope with right hand to inspect patients right eye.
26.______
26.______
26.______
27. Inspect anterior structures with ophthalmoscope.
27.______
27.______
27.______
28. Inspect optic nerve.
28.______
28.______
28.______
29. Trace vessels in four quadrants.
29.______
29.______
29.______
30. Observe macula.
30.______
30.______
30.______
31. Ophthalmoscope held at proper distance to visualize posterior structures

in eye (i.e., within less than 1 inch from eye).
31.______
31.______
31.______
32. Hold ophthalmoscope with left hand to inspect patients left eye.
32.______
32.______
32.______
33. Inspect anterior structures with ophthalmoscope.
33.______
33.______
33.______
34. Inspect optic nerve.
34.______
34.______
34.______
35. Trace vessels in four quadrants.
35.______
35.______
35.______
36. Observe macula.
36.______
36.______
36.______
37. Observe auricles and postauricular regions bilaterally.
37.______
37.______
37.______
38. Palpate auricles bilaterally.
38.______
38.______
38.______
39. Test auditory acuity.
39.______
39.______
39.______
40. Use proper technique to test each ear separately.
40.______
40.______
40.______
41. Examine ears bilaterally with otoscope.
41.______
41.______
41.______
42. Insert speculum without causing pain to the patient.
42.______
42.______
42.______
43. Stabilize otoscope upon insertion.
43.______
43.______
43.______
44. Test for patency of both nasal passages.
44.______
44.______
44.______
45. Palpate for frontal sinus tenderness.
45.______
45.______
45.______
46. Palpate for maxillary sinus tenderness.
46.______
46.______
46.______
47. Inspect nasal vaults with nasal speculum on otoscope.
47.______
47.______
47.______
48. Insert speculum without causing pain to the patient.
48.______
48.______
48.______
49. Use proper technique to visualize nasal vaults.
49.______
49.______
49.______
EARS
NOSE
(CN I asked here __________ )
Page2of9
Done
Correctly
Done
Incorrectly
Not
Done
50. Inspect lips, gums, tongue, teeth.
50.______
50.______
50.______
51. Inspect floor of mouth and base of tongue.
51.______
51.______
51.______
52. Inspect posterior pharynx.
52.______
52.______
52.______
53. Examine patient without causing discomfort.
53.______
53.______
53.______
54. Observe elevation of the palate by asking patient to say ah.
54.______
54.______
54.______
Palpate lymph nodes:

55. Preauricular nodes
55.______
55.______
56.______
56. Posterior auricular nodes
56.______
56.______
56.______
57. Occipital nodes
57.______
57.______
57.______
58. Tonsillar nodes
58.______
58.______
58.______
59. Submaxillary nodes
59.______
59.______
59.______
60. Submental nodes
60.______
60.______
60.______
61. Anterior cervical nodes (superficial and deep)
61.______
61.______
61.______
62. Posterior cervical nodes
62.______
62.______
62.______
63. Supraclavicular nodes
63.______
63.______
63.______
64. Infraclavicular nodes
64.______
64.______
64.______
65. Palpate thyroid with swallowing.
65.______
65.______
65.______
66. Palpate thyroid without swallowing.
66.______
66.______
66.______
67. Palpate thyroid from front and back of patient.
67.______
67.______
67.______
68. Palpate thyroid in correct anatomical location.
68.______
68.______
68.______
69. Palpate carotids bilaterally.
69.______
69.______
69.______
70. Auscultate carotids bilaterally.
70.______
70.______
70.______
71. Palpate spinous processes of thoracic and lumbar vertebrae.
71.______
71.______
71.______
72. Perform fist percussion of: thoracic, lumbar, and sacral vertebrae;
sacroiliac joints bilaterally; and costovertebral angles.
72.______
72.______
72.______
73. Inspect thoracic expansion.
73.______
73.______
73.______
74. Palpate chest expansion, symmetry.
74.______
74.______
74.______
75. Ask patient to cross arms to move scapula and expose lung fields.
75.______
75.______
75.______
76. Percuss posterior lung fields.
76.______
76.______
76.______
77. Percuss fields bilaterally and symmetrically, in all areas.
77.______
77.______
77.______
78. Measure maximum excursion of the diaphragm bilaterally.
78.______
78.______
78.______
79. Instruct patient to breathe through open mouth.
79.______
79.______
79.______
MOUTH
NECK
SECTION D. BACK
THORAX
SECTION E. LUNGS
Page3of9
Done
Correctly
Done
Incorrectly
Not
Done
80. Auscultate posterior lung fields.
80.______
80.______
80.______
81. Auscultate bilaterally and symmetrically, in all areas with patient

breathing through open mouth.
81.______
81.______
81.______
82. Percuss lateral lung fields bilaterally.
82.______
82.______
82.______
83. Auscultate lateral lung fields bilaterally.
83.______
83.______
83.______
84. Percuss anterior lung fields.
84.______
84.______
84.______
85. Percuss fields bilaterally and symmetrically.
85.______
85.______
85.______
86. Auscultate apices in supraclavicular fossae.
86.______
86.______
86.______
87. Auscultate anterior lung fields.
87.______
87.______
87.______
88. Auscultate fields bilaterally and symmetrically.
88.______
88.______
88.______
LATERAL LUNG FIELDS
ANTERIOR LUNG FIELDS
SECTION F. BREASTS (Female) Note: This section is not tested as part of physical diagnosis
competency exam.
Inspect both breasts:
1. Patient sitting, arms at side
2. Patient sitting, arms above head
3. Patient leaning forward
4. Patient sitting, hands pressed to hips
5. Four quadrants
6. Nipple
7. Areola
Palpate breasts with patient in recumbent position:
8. Ask patient to put arm behind head to aid examination
9. Four quadrants and tail
10. Nipple
11. Areola
12. Attempt to express material from nipple
13. Examine all areas completely and symmetrically
BREASTS (Male)
1. Palpate all four quadrants of each breast
2. Palpate nipples bilaterally
3. Palpate areolae
SECTION G. HEART
89. Observe precordium.
89.______
89.______
89.______
90.______
90.______
90.______
91.______
91.______
91.______
92.______
92.______
92.______
93.______
93.______
93.______
Auscultate with patient sitting:

Use diaphragm of stethoscope:
94. Aortic area
94.______
94.______
94.______
95. Pulmonic area
95.______
95.______
95.______
96. Tricuspid area
96.______
96.______
96.______
97. Mitral (apical) area
97.______
97.______
97.______
Palpate with patient sitting:

90. Aortic area (2nd ICS - right)
nd
91. Pulmonic area (2
rd
-3
ICS left)
92. Right ventricular area (4th 5th ICS, LLSB)

th
93. Mitral (apical) area (5
ICS left MCL)
Page4of9
Done
Correctly
Done
Incorrectly
Use bell of stethoscope (patient still sitting):

98. Aortic area
98.______
98.______
98.______
99. Pulmonic area
99.______
99.______
99.______
100. Tricuspid area
100._____
100._____
100._____
101._____
101._____
101._____
102. Observe neck veins (with patient lying at 30-45 angle).
102._____
102._____
102._____
Palpate with patient recumbent:

103. Aortic area (2nd ICS right)
103._____
103._____
103._____
104._____
104._____
104._____
105. Right ventricular area (4th 5th ICS, LLSB)
105._____
105._____
105._____
106. Mitral (apical) area (5th ICS left MCL)
106._____
106._____
106._____
107. Right ventricular heave and left ventricular lift
107._____
107._____
107._____
Auscultate with patient recumbent:

Use diaphragm of stethoscope:
108. Aortic area
108._____
108._____
108._____
109. Pulmonic area
109._____
109._____
109._____
110. Tricuspid area
110._____
110._____
110._____
111._____
111._____
111._____
Use bell of stethoscope:

112. Aortic area
112._____
112._____
112._____
113. Pulmonic area
113._____
113._____
113._____
114. Tricuspid area
114._____
114._____
114._____
115._____
115._____
115._____
116. Ask patient to roll to left lateral position.
116._____
116._____
116._____
117. Relocate apex.
117._____
117._____
117._____
118. Auscultate apex with bell.
118._____
118._____
118._____
119. Auscultate apex with diaphragm.
119._____
119._____
119._____
120. Inspect abdomen and teach patient to relax abdomen.
120._____
120._____
120._____
121. Watch patients face while examining abdomen.
121._____
121._____
121._____
122. Auscultate before manipulation or palpation.
122._____
122._____
122._____
Auscultate for bruits:

123. Left upper quadrant to include LEFT renal artery
123._____
123._____
123._____
124. Right upper quadrant to include RIGHT renal artery
124._____
124._____
124._____
125. Right lower quadrant to include RIGHT iliac artery
125._____
125._____
125._____
126. Left lower quadrant to include LEFT iliac artery
126._____
126._____
126._____
127. Aorta
127._____
127._____
127._____
128. Auscultate for bowel sounds in four quadrants and epigastrium.
128._____
128._____
128._____
nd
104. Pulmonic area (2
rd
-3
ICS left)
Not
Done
SECTION H. ABDOMEN
Page5of9
Done
Correctly
Done
Incorrectly
Not
Done
Palpate (superficially):
129. Left upper quadrant
129._____
129._____
129._____
130. Epigastrium
130._____
130._____
130._____
131. Right upper quadrant
131._____
131._____
131._____
132. Right lower quadrant
132._____
132._____
132._____
133. Left lower quadrant
133._____
133.__ ___
133._____
Palpate deeply:
134. Left upper quadrant
134._____
134._____
134._____
135. Epigastrium to include aorta
135._____
135._____
135._____
136. Right upper quadrant
136._____
136._____
136._____
137. Right lower quadrant
137._____
137._____
137._____
138. Left lower quadrant
138._____
138._____
138._____
139. Percuss liver span
139._____
139._____
139._____
140. Use proper technique to palpate liver edge
140._____
140._____
140._____
141. Use proper technique to palpate tip of spleen
141._____
141._____
141._____
142. Use proper technique to palpate flanks
142._____
142._____
142._____
143. Inspect and palpate bilaterally with outer clothes removed.
143._____
143._____
143._____
144. Inspect feet including toes and heels.
144._____
144._____
144._____
Palpate pulses bilaterally:

145. Femoral
145._____
145._____
145._____
146. Popliteal
146._____
146._____
146._____
147. Posterior tibial
147._____
147._____
147._____
148. Dorsalis pedis
148._____
148._____
148._____
149. Palpate inguinal lymph nodes.
149._____
149._____
149._____
150. Auscultate for femoral bruit.
150._____
150._____
150._____
151. Check for peripheral pitting edema.
151._____
151._____
151._____
152. Use proper technique to check for pitting edema.
152._____
152._____
152._____
SECTION I. LOWER LIMBS
SECTION J NEUROLOGICAL/MUSCULOSKELETAL SCREENING EXAM

MENTAL STATUS (Can be done at any point in examination)
153. Orientation: Time, place, person
153._____
153._____
153._____
154. Serial 7s
154._____
154._____
154._____
155. Memory: immediate, recent and past
155._____
155._____
155._____
156. Information
156._____
156._____
156._____
157. Abstract reasoning
157._____
157._____
157._____
Page6of9
Done
Correctly
Done
Incorrectly
158. Observe gait.
158._____
158._____
158._____
159. Have patient walk on toes.
159._____
159._____
159._____
160. Have patient walk on heels.
160._____
160._____
160._____
161. Have patient hop on each foot.
161._____
161._____
161._____
162. Have patient do a deep knee bend.
162._____
162._____
162._____
163. Observe tandem gait (heel-to-toe).
163._____
163._____
163._____
164. Perform Romberg test.
164._____
164._____
164._____
165. Test flexion by having patient bend at waist to touch toes.
165._____
165._____
165._____
166. Test extension by having patient bend backwards.
166._____
166._____
166._____
167. Have patient bend sideways and rotate at hips.
167._____
167._____
167._____
168. Observe posture and curvature.
168._____
168._____
168._____
169. Perform screening test for scoliosis.
169._____
169._____
169._____
170. Test flexion, extension, and rotation of neck.
170._____
170._____
170._____
171._____
171._____
171._____
172. Test CN-V (Sensory): Light touch on cornea (offer to test)
172._____
172._____
172._____
173. Test CN-V (Sensory): Light touch on face
173._____
173._____
173._____
174. Test CN-V (Motor): Test contraction of masseter muscles, or forced

opening of mouth against resistance
174._____
174._____
174._____
175. Test CN-VII (Motor): Raise eyebrows, or forced eyelid closing
175._____
175._____
175._____
176. Test CN-VII (Motor): Show teeth, puff out cheeks, or smile
176._____
176._____
176._____
177. Test CN-XI: Rotation of patients head against resistance
177._____
177._____
177._____
178. Test CN-XI: Shoulder shrug against resistance
178._____
178._____
178._____
179. Test CN-XII: Observe midline protrusion of tongue (do with EENT exam) 179._____
179._____
179._____
PATIENT STANDING
Not
Done
SPINE
CRANIAL NERVES
171. Test CN-I: (Sense of smell not usually done); Adequate to ask patient
if he/she has experienced a change in smell and/or taste
Test CN-II (Done during EENT exam)
a. Visual acuity
b. Visual fields
c. Ophthalmoscopic (disc, blood vessels, retina)
Test CN-III, IV, VI (Done during EENT exam)
a. Pupillary reaction to light
b. Extraocular movements
Test CN-VIII (Hearing done with EENT exam)

Test CN-IX and X: Observe elevation of palate vocalizing ah (EENT exam)
Page7of9
Done
Correctly
Done
Incorrectly
Not
Done
180. Test for upper limb strength.
180._____
180._____
180_____
181. Test for drift of outstretched arms with eyes closed (can combine with
Romberg test).
181._____
181._____
181._____
182. Test distal strength on dorsiflexed wrist.
182._____
182._____
182._____
183. Test patients grip bilaterally.
183._____
183._____
183._____
184. Test strength of finger adduction and abduction.
184._____
184._____
184._____
185. Test thenar and hypothenar strength.
185._____
185._____
185._____
186. Test fine rapid movements fingers.
186._____
186._____
186._____
187._____
187._____
187._____
Deep tendon reflexes (test symmetrically):

188. Test biceps reflex
188._____
188._____
188._____
189. Test brachioradialis reflex
189._____
189._____
189._____
190. Test triceps reflex
190._____
190._____
190._____
191. Test patellar reflex
191._____
191._____
191._____
192. Test achilles reflex
192._____
192._____
192._____
Cutaneous reflexes:
193. Test plantar reflex
193._____
193._____
193._____
194. Test rapid alternating movements hands.
194._____
194._____
194._____
195. Test finger-to-nose bilaterally.
195._____
195._____
195._____
196. Test heel-to-shin bilaterally.
196._____
196._____
196._____
197. Test light touch or pin prick on both sides of trunk.
197._____
197._____
197._____
198. Test alternating light touch and pin prick on four limbs.
198._____
198._____
198._____
199. Test position sense at least in feet.
199._____
199._____
199._____
200. Test vibration sense in at least both ankles
200._____
200._____
200._____
MOTOR STATUS Examine functional groups of muscles for bulk,

tone, consistency, and strength
UPPER LIMB
LOWER LIMB (Mainly done with patient standing)

Have
Have
Have
Have
patient
patient
patient
patient
walk on toes
walk on heels
hop on each foot
do deep knee bend
187. Test fine rapid movements feet.
REFLEXES
CEREBELLAR FUNCTION
Observe tandem gait (done with patient standing)
SENSORY STATUS
(Romberg done with patient standing)
Page8of9
SECTION K. MALE GENITALIA AND RECTUM
Note: This section not tested as part of physical diagnosis
competency exam.
Inspect:
1. Penis (lift to examine under surface)
2. Retract foreskin (or have patient retract)
3. Meatus
4. Scrotum
5. Inguinal canal
Palpate:
6. Penis
7. Scrotum (include testes, epididymis, and spermatic cord)
8. Hernia examination (including inguinal canal)
Perform rectal examination:
9. Inspect anus
10. Exert pressure on external sphincter anteriorly and pause to allow sphincter to relax.
11. Palpate prostate.
12. Rotate examining finger through an arc of 360 degrees
13. Perform stool guaiac test
POINT SCORE_________________________________
TECHNIQUE___________________________________
SEQUENCE AND EFFICIENCY_____________________
DATE AND TIME:
PROCTOR:
Page9of9

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Physical Exam Competency Checklist

1. Students appearance and manner are appropriate and professional;

2. Student establishes rapport; explains purpose of exam.

3. Student shows concern for patients comfort and assures

4. Student explains procedures and prepares the patient for use of

5. Exam sequence is logical and progresses from one region to another

6. Sequence includes comparison of symmetrical parts of the body.

7. Student examines patient using serial exposure appropriate to the steps of

8. Balances need for palpation/percussion/auscultation to elicit information

1. Wash hands before starting examination.

2. Measure blood pressure in one upper limb.

3. Measure respiratory rate for at least 60 seconds.

4. Palpate radial pulse for at least 15 seconds.

5. Palpate radial pulses simultaneously for symmetry.

6. Inspect and palpate both hands (dorsal and palmar).

9. Palpate epitrochlear nodes.

11. Wash hands after palpating axillary nodes.

12. Palpate scalp thoroughly.

13. Assess scalp and hair for texture and consistency.

14. Inspect external ocular structures (lids, cornea, conjunctiva).

15. Gently move eyelids up and down to obtain better view.

SECTION A. GENERAL INSPECTION/VITAL SIGNS

SECTION B. HANDS/ARMS INSPECT NAILS/SKIN

SECTION C. HEAD AND NECK

16. Estimate visual acuity (near or far) bilaterally.

17. Test visual fields by confrontation.

20. Check for convergence and accommodation.

21. Observe pupillary response to light (direct).

22. Observe pupillary response to light (consensual).

23. Patient positioned at height comfortable for examiner.

24. Lights dimmed before ophthalmoscopic examination.

27. Inspect anterior structures with ophthalmoscope.

28. Inspect optic nerve.

29. Trace vessels in four quadrants.

30. Observe macula.

31. Ophthalmoscope held at proper distance to visualize posterior structures

33. Inspect anterior structures with ophthalmoscope.

34. Inspect optic nerve.

35. Trace vessels in four quadrants.

36. Observe macula.

37. Observe auricles and postauricular regions bilaterally.

38. Palpate auricles bilaterally.

39. Test auditory acuity.

40. Use proper technique to test each ear separately.

41. Examine ears bilaterally with otoscope.

42. Insert speculum without causing pain to the patient.

43. Stabilize otoscope upon insertion.

44. Test for patency of both nasal passages.

45. Palpate for frontal sinus tenderness.

46. Palpate for maxillary sinus tenderness.

47. Inspect nasal vaults with nasal speculum on otoscope.

48. Insert speculum without causing pain to the patient.

49. Use proper technique to visualize nasal vaults.

50. Inspect lips, gums, tongue, teeth.

51. Inspect floor of mouth and base of tongue.

52. Inspect posterior pharynx.

53. Examine patient without causing discomfort.

54. Observe elevation of the palate by asking patient to say ah.

Palpate lymph nodes:

56. Posterior auricular nodes

57. Occipital nodes

58. Tonsillar nodes

59. Submaxillary nodes