How Do You Perform A Thorough But Streamlined Medical Physical Exam?
• Otoscope — Here you want to view the ear canal (and while you’re at the ear, rub your fingers together to test hearing … then head to Weber and Rinne if you suspect a problem); then the nares; then the oropharynx. Use the otoscope then to start the eye exam. Check pupillary reflex, then have them follow the light to check extra-ocular muscles. Finish the otoscope theme by bringing the light towards the nasal bridge and back to check accommodation. • Stay with the eye for the next two — give them a Snell test if you have the card handy, and pull the lower eyelids down to look at the conjunctivae. • It’s the “head and neck” exam you start with, so let’s go to the neck…. Check for thyromegaly and then it’s … • Lymph node time. Check the neck, around the ears, then above the collar bone. This moves us towards the arm, where you can check for … • Axillary nodes. Now that the arms are in play, let’s perform steps 7 and 8 on them … • Skin … a) pallor? b) lesions? • Arms vasc
