General Examination Checklist

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Introduce yourself and examiner

Explain intention to patient and ask for consent
General Inspection:
Concious, alert with time place and person
Lying supine or propped 45 degress/ sitting
Cannula attached to limbs, which side
Respiratory distress and pain
Estimate height and weight or thin/medium/big size
Inspection of Palm of hand
a. Pale/Pink
b. Palmar erythema
c. Dry/Sweaty
d. Muscle wasting
e. Deformity
Inspection of Dorsum of hand
a. Warm/Cold
b. Muscle wasting
Inspection of fingers and nails
a. Clubbing/Leuconychia/Koilnychia/Splinter hemorrhage/Nicotine
stain
b. Capillary Refill (for adults)
Radial Pulse
a. Rate
b. Good/Poor Volume
c. Regular/Irregular Rhythm
Forearm
a. Venapuncture marks
b. Tattoo
c. Scars
d. Ecchymosis
Blood Pressure
Head
a. Jaundice/ Not Jaundice sclera
b. Pale/Pink Conjuctiva
Mouth
a. Angular stomatitis
b. Central Cyanosis
c. Oral Hygiene (Average/Poor etc)
d. Stomatitis
e. Glossitis
f. Palate
Neck
a. Lymph nodes enlargement
b. Swelling
c. Jugular Venous Pressure
d. Virchow nodes
Femoral Pulse
a. Volume
b. Rhythm
c. Radio-Femoral delay
Pitting edema (press at bony prominence)
a. Medial Maleolus
b. Mid-leg
c. Knee
d. Sacrum
Dorsalis Pedis and Posterior Tibialis

Cranial Nerve Examination

1. Introduce yourself and examiner

2. Explain intention to patient and ask for consent
3. Positioning of patient in sitting position.
First Cranial Nerve (Olfactory)
1. Ask patient to close one nostril and close both eyes.
2. Use a fragrant and move it towards unclosed nostril.
3. Ask patient whether they can smell the fragrant.
4. Do it to both nostril.
2nd Cranial Nerve (Optic)
1. Inspect for Exopthalmos
2. Test for Pupillary Reflex Test.
3. Ask patient to cover one eye. Tell the patient to say Yes if can see
fingers moving at a fixed position. Glasses are permitted.
4. Ask patient to cover one eye. Tell patient to say Yes when they can
see your fingers moving towards patients nose. Glasses are
permitted. Do the same for the other eye.
5. Test for Blind Spot. Glasses are permittent.
6. Ask patient to read from Snellen Chart.
3rd, 4th & 6th Cranial Nerve
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2.

Test for Horizontal and Vertical Nystagmus.

Move pen as if writing Letter H.
Test for Eye convergence. Ask for double vision.

5th Cranial Nerve (Trigeminal Nerve)

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7.

Touch Maxillary, Mandibular and areas. Ask patient to close eyes.

Corneal Reflex. Apply cotton wool to sclera. Patient with normal
reflex will blink both eyes immediately when sclera is touched.
2. Tap jaw for Jaw reflex. Absence of Jaw reflex is normal.
3. Clench Teeth. Feel for Temporalis Muscle.
7th Cranial Nerve (Facial Nerve)
1. Ask patient to:
a. Frown face
b. Smile
c. Puff cheek
d. Close eyes tightly. Try to open them.
8th Cranial Nerve
1. Whisper to one ear while closing the other ear. Ask patient what
you whispered.
2. Rinne Test. Using 512 Hz tuning fork, place vibrating tuning fork at
Mastoid process and tell patient to say when they can no longer
hear any noise. Quickly place the vibrating part of tuning fork 1-2
cm from auditory canal. Ask patient again the same thing.
3. Weber Test. Place tuning fork at middle of forehead and ask patient
to say which ear hear the noise better. Normal finding is when
noise are equally distributed to both ears.
9th Cranial Nerve
1. Open mouth. Inspect the uvula. Normal uvula should not deviate
from midline.
10th Cranial Nerve ( Vagus Nerve)
1. Gag reflex
11th Cranial Nerve
1. Ask the patient to shrug shoulder. Push down on the shoulder while
telling them to resist you.
2. Ask the patient to look to Right side. Push patient face in opposite
direction while telling them to resist your movement.
12th Cranial Nerve
1. Ask patient to push tongue against cheek. Push the tongue inwards
while telling the patient to resist your movement.

Upper limb Examination

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Introduce yourself and examiner

Explain intention to patient and ask for consent
Positioning of patient can be propped up 45 degrees or sitting
Look
a. Expose both upper limbs.
b. Look for any deformity, muscle wasting and circulation.
c. Compare both upper limbs in length.
d. Examine for Pronator Drift. Ask patient to lift both limbs in front
of body and close one eye.
Motor Power Grading of Upper Limb
a. Examine Tone of upper limb
b. Estimate muscle power grading of Shoulder joint
i. Push up and down on shoulder with resistance
(chicken wing position)
ii. Pull front and back on shoulder with resistance
c. Estimate muscle power grading for Elbow Joint
i. Push against extension
ii. Pull against flexion
d. Estimate muscle power grading for Wrist Joint
i. Push up and down on wrist with resistance
e. Estimate Muscle power grading for Metacarpo-Phalangeal Joint
i. Push up and down on MCP Joint with resistance
f. Estimate Muscle power grading for Fingers
i. Enclosed Fingers
ii. Ask patient to make a circle with thumb and index
finger. Try to break that circle.
iii. Paper holding
g. Estimate gripping power of hand.
Ask patient to grip your finger and dont let go.
Sensation of Upper Limb
a. Test sensation of patient using cotton wool to areas of
dermatome of upper limb . First test it prick to centre of chest
or distal end of limb.
b. Test for prioprioception or Vibration sense using 128 Hz tuning
fork. Apply the vibrating tuning fork at bony prominences.
Reflexes of Upper Limb
a. Biceps Tendon reflex
b. Triceps Tendon Reflex
c. Supinator Tendon Reflex
Assessing coordination
a. Ask patient to move fingers as if playing piano.
b. Ask patient to rub both hands together.
c. Ask patient to tap hands on another hand then shift between
palm and dorsum of hand. Try to do it as fast as patient can.
d. Finger-Nose Test. Ask patient to touch their nose then touch
your finger alternately. Shift position of your finger
continuously.

Lower limb Examination

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Introduce yourself and examiner

Explain intention to patient and ask for consent
Positioning of patient can be propped up 45 degrees or sitting
Ask patient to walk normally to a distance. Assess the Gait.
Ask patient to walk back as if walking on a very small bridge.
Ask patient to stand in one spot then close your eyes. Observe for
swinging movement. Later pull back on patient looking for normal
proprioception reflex.
7. Look
a. Expose both upper limb
b. Look for any deformity
c. Compare both limb in length
8. Motor Power Grading of Upper Limb
a. Examine Tone of upper limb
b. Assess Clonus. Pull on the heel. Normal would yield no
response.
c. Estimate muscle power grading of Hip joint
i. Push and pull on hip joint with resistance
d. Estimate muscle power grading for Knee Joint
i. Push up against extension
ii. Pull down against flexion
e. Estimate muscle power grading for Ankle Joint
i. Push down and up on Ankle with resistance
ii. Push in and out during eversion and inversion
respectively on Ankle joint
f. Examine the Knee-Shin Test
9. Sensation of Upper Limb
a. Test sensation of patient using cotton wool to areas of
dermatome of upper limb
b. Test for prioprioception or Vibration sense using 128 Hz tuning
fork. Apply the vibrating tuning fork at bony prominences.
10. Reflexes of Upper Limb
a. Patella Tendon reflex
b. Ankle Jerk
c. Babinski Sign

Thyroid Examination
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Introduce yourself and examiner

Explain intention to patient and ask for consent
Positioning of patient in sitting position
Inspect the neck for:
a. Abnormal enlargement in the neck
b. Lymph nodes enlargement
c. Visible pulsation
d. Surgical Scars
e. Ask the patient to take a sip of water but tell them not to
swallow until you say so. Inspect the neck while patient is
swallowing the sip of water.
Palpate the neck for:
a. Trachea deviation
b. Thyroid border ( from behind)
c. Lymph nodes of the head and neck (from behind)
d. Ask the patient to take a sip of water but tell them not to
swallow until you say so. Palpate the thyroid border while
patient is swallowing.
Percuss superior part of Sternum.
Auscultate for Thyroid Bruit using Bell.
Put both hand in front while placing paper on top of them. Check for
tremors.
Examine hand for:
a. Warmth
b. Excessive sweating
c. Radial Pulse
Ask patient to follow motion of pen moving in H direction.
Do Eye Lid Lag test.
Ask patient to shrug shoulder while telling them to resist you pushing it
down.
Check Knee Jerk Reflex of Patient.
Ask the patient to squat then stand up.

Abdominal Examination
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Introduce yourself and examiner

Explain intention to patient and ask for consent
Positioning of patient must be lying flat on bed
Inspection of abdomen
a. Abdominal distension
b. Scars / Striae
c. Umbilicus (inverted/everted)
d. Caput Medusae (Dilated veins)
e. Peristaltic wave
Superficial Palpation ( 9 regions)
Deep Palpation ( 4 quadrant or 9 regions)
Liver
a. Palpation
i. Palpate Liver from Right Iliac Fossa to Right Costal
Margin
ii. Ask the patient to breathe through mouth
iii. Palpate when patient is inhaling
iv. Do not move hand until completed 2 breathe cycle
(inhale & exhale is 1 breath cycle)
v. Try to feel for mass with border of Index finger
vi. If mass palpable, comment on:
1. Number (one or multiple)
2. Site (regions of abdomen)
3. Size (ex: 5 cm by 5cm)
4. Shape (Irregular, circular)
5. Surface (Smooth, rubbery)
6. Edge (Visible and palpable)
7. Consistency (hard, firm, soft)
8. Tenderness
9. Fixity to skin, fat or muscle
10. Mobility
11. Reducibility
12. Temperature
13. Translucency & Pulsatility
*Note: Try to get over the mass under right costal margin, if
cant, the mass is definitely Liver
b.

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9.

Percussion
i. Percuss Liver from Right Iliac Fossa
OR
Percuss Liver from Sternal Angle

ii. Measure Liver Span (Normal Liver is 7-12 cm)

Spleen
a. Palpation
i. Palpate Spleen from Right Iliac Fossa (if mass present)
OR
Palpate Spleen from Umbilicus (if no mass present)
ii. Ask patient to breathe through mouth
iii. Palpate until reaching 9,10, 11 left costal margin
iv. If Spleen not palpable then, do not move hand, ask the
patient to move to his Right side
v. Palpate Spleen with right hand while left hand pulling
left costal margin from posterior aspect
b. Percussion
i. Percuss Traube Space
Dull percussion indicate Spleen
Kidney Ballot
a. Bimanual Technique

10. Shifting Dullness and Fluid Thrill

11. Abdominal Auscultation
a. Auscultate right or left side of umbilicus from bowel sound
b. Auscultate for Kidney Bruit
12. End the examination by doing External Genitalia, Groin Hernia Examination
and Per Rectal

Cardiovascular Examination
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4.

Introduce yourself and examiner

Explain intention to patient and ask for consent, ask to take off shirt
Propped the patient 45 degrees
Inspection of Chest and Precordium
a. Median Sternotomy scar and leg scars
b. Pacemaker
c. Visible palpitation
d. Jugular Venous Pressure (may be done in general examination)
e. Chest deformity
f. Dilated veins
5. Palpation of Chest
a. Identify Apex beat (Supine, Left Lateral if cant find Apex beat)
b. Show the position of Apex beat
c. Parasternal heave
d. Pulmonary heave
e. Aortic heave
6. Auscultation of heart
a. Auscultate Mitral and Pulmonary areas with Diaphragm,
thumb at carotid artery
b. Running commentary on Mitral and Pulmonary areas
1st and 2nd heart sound heard with normal intensity
c.

Auscultate Mitral area until axilla with Diaphragm, thumb at

carotid artery
d. Running commentary on Mitral area until axilla
No pansystolic murmur radiating to axilla suggesting
mitral regurgitation
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l.

Auscultate Mitral area with Bell in Left Lateral Position,

thumb at carotid artery
Running Commentary on Mitral Area with Bell
No rumbling of mid-diastolic murmur suggesting of
Mitral Stenosis
Auscultate Tricuspid area with Diaphragm while asking patient
to inhale and hold breath, thumb at carotid artery
Running commentary on Tricuspid area with Diaphragm
No pansystolic murmur intensifying with respiration
suggesting of Tricuspid Regurgitation
Auscultate Pulmonary and Aortic areas with diaphragm,
thumb at carotid artery
Auscultate neck at Carotid artery area, left and right with Bell
Running commentary on Carotid artery area
No ejection systolic murmur radiating to carotid
arteries suggesting of Aortic Stenosis

Auscultate Lower Sternal border with diaphragm, thumb at

carotid artery while asking patient, bend 45 degrees forward,
inspire and expire full breath and hold for a while
m. Running commentary on Lower sternal border with Diaphragm
No blowing early diastolic murmur suggesting of Aortic
Regurgitation

Respiratory Examination
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2.

Introduce yourself and examiner

Explain intention to patient and ask for consent
Ask patient to take off shirt
3. Positioning of patient can be propped up 45 degrees or sitting
4. Count Respiratory Rate for 15 seconds
5. Inspect chest
a. Shape of chest =the chest shape is elliptical
Barrel shape chest
Transverse diameter of chest is greater than AP
diameter
b. Chest symmetry
c. Scars
d. Nodules
e. Dilated vein
f. Chest wall move with respiration
g. No respiratory distress
6. Palpation of chest
a. Examine Trachea
Trachea is in midline & not deviated
=could you please look straight &head still.it will be
quite uncomfortable,please bear with me
b.

Identify Apex beat

apex beat is felt below the nipple and not displaced

c.

Identify breathing movement by placing both palm at upper

chest
The chest movement is symmetry

d.

Identify chest expansion by placing both palm at lower chest

The chest expansion is 5cm and symmetry

e.

Test for Tactile fremitus.

Place medial part of both hands at intercostals space. Ask
patient to say 999.
tactile fremitus is equal on both side
7. Percussion of Chest
a. Percuss at area above clavicle
b. Percuss at clavicle
c. Percuss at area below clavicle. 2nd intercostals space
downwards.
there is resonance upon percussion on both side of the
chest
8. Auscultation of Lungs (Only with Bell)
a. Auscultate upper, middle and lower part of chest alternating
between right and left. Begin at normal side first.
b. Compare of loudness of breath sounds between right and left
c. Listen for any abnormal sounds
Vestibular sound are heard with normal intensity
there is normal vestibular breath sound &no added
breath sound including bronchi breath sound
Eg:rhonchi crepitation
d.

Assess vocal resonance by auscultating while asking patient to

say nine, nine, nine

vocal resonance are normal on both side