Physical examination template

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

Introduction to the Physical Examination Page[edit | edit source]

The page name should be "(Disease name) physical examination", with only the first letter of the title capitalized.
Goal:To describe in detail the various aspects of the physical examination with attention to how the disease you are describing may present.
Remember this section is to describe what characteristics may be found on physical examination, not how to do a physical exam (unless you are including specialized signs, eg Chvostek's sign, in which case you may give a brief description).
You may describe a physical exam finding that is commonly present in a disease without adding additional information (e.g. appendicitis physical exam - RLQ abdominal tenderness). In some cases, some unique findings are suggestive of specific aspects / complications of the disease. If present, it is preferable that you mention what these unique findings suggest or when they may be present (e.g. appendicitis physical exam - rebound tenderness may be suggestive of peritonitis).
As with all microchapter pages linking to the main page, at the top of the edit box put {{CMG}}, your name template, and the microchapter navigation template you created at the beginning.
Remember to create links within Wikidoc by placing [[square brackets]] around key words which you want to link to other pages. Make sure you makes your links as specific as possible. For example if a sentence contained the phrase anterior spinal artery syndrome, the link should be to anterior spinal artery syndrome not anterior or artery or syndrome. For more information on how to create links click here.
Remember to follow the same format and capitalization of letters as outlined in the template below.
Below you will see examples of what you may describe as part of the physical examination.

Overview[edit | edit source]

The overview section should include the disease name in the first sentence.
The goal is to summarize the physical examination page in several sentences. This section can be the same as the physical examination segment on the overview page.
To see an example of an overview section on a physical examination page, click here.

Template[edit | edit source]

First Sentences:

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].

OR

Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].

OR

The presence of [finding(s)] on physical examination is diagnostic of [disease name].

OR

The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Examples:

Example 1: Patients with shigellosis usually appear lethargic. Physical examination of patients with shigellosis is usually remarkable for high-grade fever and signs of dehydration, such as tachycardia, tachypnea, hypotension, and dry mucus membranes.

Example 2: Common physical examination findings of cholecystitis include right upper abdominal tenderness and a positive Murphy sign.

Example 3: The presence of both upper motor neuron and lower motor neuron involvement on physical examination is diagnostic of amyotrophic lateral sclerosis.

Example 4: The presence of facial tenderness and fever on physical examination is highly suggestive of acute sinusitis.

Preferred Template Statements[edit | edit source]

Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].

Physical Examination[edit | edit source]

Appearance of the Patient[edit | edit source]

This section should give a general description of what a patient with the disease you are describing may look like.
If patients typically appear normal, you may write: Patients are usually well-appearing.
You may include a physical description such as obese, thin, cachectic, ill appearing, diaphoretic etc. Mention in which cases these findings are present (e.g. well-appearing in early stages of cancer, cachectic in late stage cancer)
For an example of the appearance of a patient section in the physical examination page, click here.

Vital Signs[edit | edit source]

^{Note: Vital signs traditionally include the temperature, blood pressure, heart rate, respiratory rate. The vital signs may also include oxygen saturation (at room air) and blood glycemia.}

High-grade / low-grade fever
Hypothermia / hyperthermia may be present
Tachycardia with regular pulse or (ir)regularly irregular pulse
Bradycardia with regular pulse or (ir)regularly irregular pulse
Tachypnea / bradypnea
Kussmal respirations may be present in _____ (advanced disease state)
Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure

Skin[edit | edit source]

Note: To describe a rash, always report additional details that include the color (e.g. erythematous), shape (e.g. flat / bullous), dermarcation (e.g. well-circumscribed / diffuse), location (e.g. truncal / on the face / on the extremities), enclosing fluid (e.g. vesicular / filled with pus, clear), and if possible smell (e.g. foul-smelling / odorless)

Description (Adapted from Dermatology Atlas)

Description (Adapted from Dermatology Atlas)
Description (Adapted from Dermatology Atlas)

HEENT[edit | edit source]

Abnormalities of the head/hair may include ___
Evidence of trauma
Icteric sclera
Nystagmus
Extra-ocular movements may be abnormal
Pupils non-reactive to light / non-reactive to accomodation / non-reactive to neither light nor accomodation
Ophthalmoscopic exam may be abnormal with findings of ___
Hearing acuity may be reduced
Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
Exudate from the ear canal
Tenderness upon palpation of the ear pinnae / tragus (anterior to ear canal)
Inflamed nares / congested nares
Purulent exudate from the nares
Facial tenderness
Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae

Neck[edit | edit source]

Jugular venous distension
Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
Thyromegaly / thyroid nodules
Hepatojugular reflux

Lungs[edit | edit source]

Asymmetric chest expansion / Decreased chest expansion
Lungs are hypo/hyperresonant
Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
Rhonchi
Vesicular breath sounds / Distant breath sounds
Expiratory/inspiratory wheezing with normal / delayed expiratory phase
Wheezing may be present
Egophony present/absent
Bronchophony present/absent
Normal/reduced tactile fremitus

Heart[edit | edit source]

Chest tenderness upon palpation
PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
Heave / thrill
Friction rub
S1
S2
S3
S4
Gallops
A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope

Abdomen[edit | edit source]

Abdominal distention
Abdominal tenderness in the right/left upper/lower abdominal quadrant
Rebound tenderness (positive Blumberg sign)
A palpable abdominal mass in the right/left upper/lower abdominal quadrant
Guarding may be present
Hepatomegaly / splenomegaly / hepatosplenomegaly
Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test

Back[edit | edit source]

Point tenderness over __ vertebrae (e.g. L3-L4)
Sacral edema
Costovertebral angle tenderness bilaterally/unilaterally (may also be referred to as Murphy's punch sign, which is different from Murphy's sign that suggests cholecystitis. To avoid confusion, write "costovertebral angle tenderness")
Buffalo hump

Genitourinary[edit | edit source]

A pelvic/adnexal mass may be palpated
Inflamed mucosa
Clear/(color), foul-smelling/odorless penile/vaginal discharge

^{Write additional pathognomonic findings, such as discharge that resembles cottage cheese for C. albicans vulvovaginitis / fish-odor for T. vaginalis ifnection}

Extremities[edit | edit source]

Clubbing
Cyanosis
Pitting/non-pitting edema of the upper/lower extremities
Muscle atrophy
Fasciculations in the upper/lower extremity

Neuromuscular[edit | edit source]

Patient is usually oriented to persons, place, and time
Altered mental status
Glasgow coma scale is ___ / 15
Clonus may be present
Hyperreflexia / hyporeflexia / areflexia
Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
Muscle rigidity
Proximal/distal muscle weakness unilaterally/bilaterally
____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
Unilateral/bilateral upper/lower extremity weakness
Unilateral/bilateral sensory loss in the upper/lower extremity
Positive straight leg raise test
Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
Positive/negative Trendelenburg sign
Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
Normal finger-to-nose test / Dysmetria
Absent/present dysdiadochokinesia (palm tapping test)

References[edit | edit source]

References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
For information on how to add references into your page, click here.