1. Introduction to History and Physical Exam
Robert Woodward, MD MBA
Program Coodinator
Clinical Practice Preceptorship

2. Goal and Objectives Goal: Objectives:
To introduce the student to the history and physical exam
Objectives:
The student shall be able to recognize components of the routine history and physical exam
The student shall feel comfortable observing a physical exam in the preceptor’s office

3. History Inpatient Outpatient (SOAP note) Chief Complaint
History of Present Illness
Past Medical History
Social History
Review of Systems
Outpatient (SOAP note)
Subjective
Objective
Assessment
Plan

4. Components Vital Signs General Appearance HEENT and Neck
BP, RR, Temp, Pulse
? Pain Scale
General Appearance
Age, nutrition, clean, etc
HEENT and Neck
Pulmonary and Thorax
Cardiovascular
Abdominal
Peripheral Vascular
Musculoskeletal
Neurological
Genital/Rectal
Breasts and Axillae

5. Vital Signs Pulse- Take radial pulse and count beats for 1 min
Respiratory Rate- Count Respirations for 1 min
Temperature- In adults, use oral thermometer!
Blood Pressure

6. Blood Pressure Cuff

7. Otoscope

8. Normal Eardrum

9. Ophthalmoscope

10. HEENT and Neck Head –inspect and palpate Ears- external and internal
Eyes- inspect, check fundi, pupil reflexes, peripheral vision
Nose- inspect and palpate
Throat- inspect with light and tongue depressor
(brush your teeth)
Neck- feel for lymph nodes and thyroid

11. Pulmonary Lungs- 3 lobes on right, 2 on left
Inspection (to look) for deformities
Palpation (to touch) for masses, vibration
Percussion (to tap on)
Cut your finger nails
Auscultation (to listen to a body part with a stethoscope) both front and back

12. Auscultation
Lung
Alternate both sides and go down the back and do lower lateral areas
Test for Bronchophony- “99”-loud and clear
Normal is muffled and indistinct through chest wall
Test for Ergophony “EE”- sounds like “AY”
Normal is a muffled long “E” sound
Whispered Pectoriloquy- whispers heard clearly
Normal is faint and indistinct

13. Auscultation

14. Cardiac Exam Inspection
Palpation for Point of Maximum Impulse or Thrills
Auscultation
Aortic, Pulmonic, Tricuspid, Mitral areas
S1, S2, murmurs, gallops, rubs

15. Abdominal Exam Inspection Auscultation**** Percussion
Light and Deep Palpation
Liver Span, Spleen
Special tests
Eg. for appendicitis
                                                                                      

16. Musculoskeletal Exam Inspection Tone Palpation Range of Motion
Passive and Active
Strength

17. Neurological Exam Mental Status (Mini Mental Status Exam)
Cranial Nerves I-XII
Muscle Tone
Strength
Reflexes- Bicep, Tricep, Brachioradialis, Knee, Ankle
Sensation- Pain, Cold, Soft Touch, Vibration
Higher Cerebral Function
Cerebellar Function- Coordination

18. Contact Physicians Schedule visit in: Get White Jacket October
November/December
January/February
March/April
Get White Jacket
Consider getting stethescope