General & Dermatological Physical Exam
Below are the elements of the physical exam that we will be performing today.
Opening the encounter
The examiner introduces self to patient, explains what is about to happen, washes hands.
Vital Signs
1. Measurement: Pulse rate (radial), Respiratory Rate, Blood Pressure
Skin, and Nails
2. Inspection: Skin
Observations about the skin are made (arms, torso, legs) regarding color, mobility,
turgor, lesions (cherry angiomas, macules, papules, nodules etc.). If lesions present,
ask if any change in size, color, etc.
3. Inspection: Fingernails and hands (capillary refill) and toenails
Fingernails are examined for grooming, clubbing, & capillary refill. Hands are
examined (observing size, symmetry, swelling, and color). Feet and toenails examined
for onychomycosis.
Head & Hair
4. Inspection: Entire head, including scalp
Hair should be separated in at least three areas to note the condition of hair and scalp.
REVIEW OF FALL SEMESTER
LUNGS AND CARDIOVASCULAR SYSTEM
Thorax & Lungs
5. Inspection: Chest and back, during inspiration and expiration
6. Palpation: Clavicles, ribcage (apical, anterior, posterior, lateral)
7. Palpation: Tactile fremitus in posterior lung fields
8. Percussion: Posterior thorax (other areas as indicated)
9. Percussion Diaphragmatic excursion
10. Assessment: CVA tenderness
11. Auscultation: Systematically, bilaterally (superior and inferior, posterior and anterior),
including RML. If abnormal breath sounds are heard assess bronchophony (99), whispered
pectoriloquy (99), egophony (E-to-A)
Heart
12. Inspection and Palpation: Heaves, thrills, and PMI
13. Auscultation: 4 areas for heart sounds (diaphragm and bell, sitting and supine positions).
Note apical pulse.
14. Inspection: Neck vein distention and pulsations at 45 degrees
15. Auscultation: Carotids, (using bell)
Extremities
16. Palpation: Differences in skin temperature. Assess edema.
17. Palpation: Pulses B/L (radial, brachial, femoral, popliteal, post tibial, & dorsalis pedis).
1/2009 edited from General PE sequence. Synched to write-up.