Introduce yourself, wash hands and make sure to stand at the patients right when appropriatePatient Sitting Vital signs: palpate radial pulse bilaterally for 15 secondsVital signs: measure respiratory rate for 15 secondsVital Signs: Measure BP in each arm, while holding the arm at heart levelHead- palpate and observe the scalpHead- palpate the following nodes with 2-3 circular palpations with three fingers: preauricular, posterior auricular, occipital, tonsillary, submandibular, submental, posterior cervical, and supraclavicular, anterior cervical.Head- Ask the patient to swallow while observing the thyroid gland.Head-Palpate the laryngeal cartilage to locate the thyroid glandHead- palpate the thyroid twice; once while the patient is swallowing and once without swallowing. Nose and Sinus- test openness of the nasal passages bilaterally. Instruct the patient to close one nostril while sniffing through the other.Nose and sinus: inspect nasal passages using otoscopeNose: palpate firmly the frontal sinus tenderness above each eyeNose: palpate firmly for maxillary sinus tenderness below each eyeMouth and throat: inspect with tongue blade and light: lips, gums, tongue, and teethMouth and throat: instruct the patient to breathe only through the mouth and inspect the posterior pharynx with the light.Mouth: observe elevation of the palate (CN IX and X) after instructing the patient to say ahMouth: inspect the opening of stensens duct (parotid) and the submandibular gland ductMouth: Test CN XII by asking the patient to stick out his/her tongue and move it from side to sideMouth: Test CN V by first positioning hands on masseter muscles and then asking the patient to bite down.Mouth: Test CN VII by asking the patient to show teeth and bite downMouth: Test CN IX by asking the patient to rotate his head against resistant and shrugging the shoulders.Eye: inspect each eye separately for condition of lid, cornea, and conjunctiva. Ask the patient to look up and down when holding the bottom lid down or top lid upNeuro: Test VII by asking the patient to force his eyelids closed against upper resistanceNeuro: Test CN II in each eye separately by using a visual screening chart.Eyes: Test visual fields each eye separatelyNeuro: Test CN III, IV, VI: by asking the patient to look in an H pattern without moving head.Eyes: Check for convergenceNeuro: Test CN III by doing a swinging flashlight test after dimming the light.Eyes: Position patient for ophthalmoscopyEyes: Hold the scope at a distance to see the red-reflexEyes: Examine each eye with the appropriate hand and eye. Ears- Inspect the external ear bilaterallyEars test auditory acuity (cochlear nucleus of CNVIII by whispering into each ear from two feetEars-Examine each ear with the otoscopeEars- conduct Rhinne test with 512 tuning forkEars conduct weber test with 256 Hz tuning forkCV: Evaluate the trunk, head, and neck to 30 degrees and have the patient turn to his left, and shine light obliquely to assess JVP.CV: expose the apical area and inspect for an observable apical impulseCV: Place palm on aortic area, pulmonic, tricuspid, and apical area to feel for impulse.CV: Auscultate the aortic, pulmonic, tricuspid, and mitral area with the diaphragm.CV: Auscultate the aortic, pulmonic, tricuspid, and mitral area with the bellCV: Instruct the patient to hold breath as you auscultate each carotid artery with the bell of stethoscopeCV: Palate the carotid pulse, bilaterallyPulmonary: Inspect the anterior chest for scars or asymmetryPulmonary: Percuss the anterior lung fields in one area on the upper chest, bilaterally, symmetrically, and alternately.Pulmonary: Auscultate the anterior lung fields, bilaterally, symmetrically, and alternately. Neuro: Check pronotar drift by having the patient close eyes and hold arms in front of chest with palms facing the ceiling.Neuro: Test Deltoid muscle strengthMSK: inspect, flex, and extend each elbowNeuro: Test Bicep muscle strength one at a timeNeuro: Test triceps muscle strength one at a timeMSK: inspect palms and backs of both handsNeuro: Check wrist extension/flexor strengthMSK: flex and extend each wristMSK: assess finger extension by asking the patient to spread the fingers with both hands facing downMSK: assess finger flexion by asking the patient to make a fist with each handMSK: inspect both first and wrists while you supinate and pronate the forearmsNeuro: Have the patient mimic you by slapping front and back of hand against thighNeuro: finger to nose testNeuro: Test hip flexor strength, one at a timeNeuro: Test knee extension/flexion one at a timeNeuro: demonstrate the difference between sharp and dull pain using a broken cotton tipped swabNeuro: Instruct the patient to close eyes and then test CN V1 V2 V3Neuro: Test sensation on front of trunk: light touch, sharp, dullNeuro: Test sensation in each upper and lower arm, light, sharp, dullNeuro: Test sensation on upper/lower legs, sharp, light, dullNeuro: Test Biceps reflex bilaterallyNeuro: Test brachioradialis reflex bilaterallyNeuro: Test triceps reflex bilaterallyNeuro: Test patellar reflex bilaterallyNeuro: Test Achilles reflex bilaterallyNeuro: Babinskis signNeuro: Demonstrate up and down of toes and test proprioception.Neuro: Demonstrate the vibration of 128Hz fork on bony wristNeuro: Close eyes and teach vibration on each great toe with 128HzPulmonary: inspect the posterior thorax for scars or asymmetryPulmonary: percuss the posterior lung fields, symmetrically and alternatively, over the upper, middle, and lower lung fields, comparing the left side and the right side for each level.Pulmonary: Fist percuss your hand with palm placed on the costovertebral angle bilaterally. Ask the patient if she feels any painPulmonary: Ask the patient to breathe through an open mouth as you auscultate the posterior lung fields, bilaterally, symmetrically, and alternatively, comparing each side.Patient laying downMSK: assess hip flexion on each leg moving the thigh up toward the trunk. MSK: Hold the knee at a 90 degree angle and move the ankle medially to assess the external rotation and laterally to assess the hip internal rotation in both legs.MSK: flex and extend each kneeMSK: inspect the midfoot, toes and plantar surfaces of both feet.MSK: plantarflex and dorsiflex the anklesCV: palpate the femoral pulse, bilaterallyCV: palpate the popliteal pulse, bilaterallyCV: Palpate the dorsalis pedis pulses bilaterallyCV: palpate the posterior tibial pulse bilaterallyCV: check each shin for pitting edema by pressing on the lower tibia for 3-5 seconds. Must be done on the bone.Neuro: Heel-to-knee-shin testAbdominal: Have the patient lie back and expose the entire abdominal areaAbdominal: inspect the abdomen for contour, markings, venous markings, and changes with respirationAbdominal: Auscultate each of the four quadrants of the abdomenAbdominal: percuss the abdomen in 4 quadrantsAbdominal: Palpate the left upper, lower, right upper and lower quadrants with light and deep pressures. Make sure the dominant hand on top of the non-dominant handAbdominal: palpate the spleen by instructing the patient to inhale as you begin palpating. Instruct the patient to exhale as you deepen your palpationAbdominal: percuss the liver spanAbdominal: palpate the liver by placing hands on the right UQ. Ask the patient to inhale as you palpate. Instruct the patient to exhale as you deepen your palpation then inhale again while Patient standing:MSK: observe shoulder flexion by asking the patient to bring arms forward and raise them overhead and then ask to return to lapMSK: observe external rotation by instructing the patient to clasp both hands behind an extended neck and pull the elbows backMSK: shoulder internal rotation by instructing the patient to place both hands behind the back as high up on the back as possible. Observe the entire range of motion from behind with patients gown open. MSK: examine the spin by assessing neck flexion by instructing the patient to place chin on the chest.MSK: assess neck extension by asking the patient to look up at the ceilingMSK: observe right and left rotation of the neckMSK: Assess lateral bending of the neck by asking the patient to incline ear toward each shoulderMSK: stand behind the patient and ask him/her to open the gown in the back. MSK: assess thoracolumbar lateral flexion by asking the patient to stand and bend the torso to the right and to the leftMSK: observe lumbar flexion by asking the patient to bend forward at the waist and to attempt to touch the toesMSK: observe lumbar extension by asking the patient to bend backwardsNeuro: Have the patient stand and put feet together and arms at sides and close eyes for 5-7 seconds.Neuro: Have the patient walk across the roomNeuro: Ask the patient to walk away on tip toes and walk back on heelsNeuro: Ask the patient to walk heel-to-toe.