I have a practical exam on clinical propaedeutics so give all the possible information that need to be known
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Clinical Propaedeutics - Complete Exam Guide
This guide covers everything you need for a clinical propaedeutics practical exam: history taking, general examination, vital signs, cardiovascular, respiratory, abdominal, and neurological assessment.
1. HISTORY TAKING
A complete history follows a structured format. Missing any component is a common exam error.
Structure of the Clinical History
| Component | What to Cover |
|---|---|
| Chief Complaint (CC) | Main symptom in the patient's own words, with duration |
| History of Present Illness (HPI) | SOCRATES: Site, Onset, Character, Radiation, Associated symptoms, Timing/duration, Exacerbating/relieving factors, Severity (1-10) |
| Past Medical History (PMH) | Previous illnesses, hospitalizations, surgeries, chronic conditions |
| Medications | Current drugs (dose, frequency), over-the-counter, herbal |
| Allergies | Drug/food allergies + type of reaction (rash vs. anaphylaxis) |
| Family History | First-degree relatives; focus on cardiovascular disease, cancer, diabetes, genetic conditions |
| Social History | Smoking (pack-years), alcohol (units/week), recreational drugs, occupation, living situation, travel |
| Systemic Review (Review of Systems) | Head-to-toe questioning about all body systems |
Review of Systems Checklist (Goldman-Cecil Medicine)
- Change in weight or appetite
- Change in vision or hearing
- New or changing skin lesions
- Chest discomfort or palpitations
- Shortness of breath, dyspnea on exertion
- Abdominal discomfort, constipation, melena, diarrhea, hematochezia
- Urinary difficulty
- Change in menses
- Joint or muscle discomfort
- Sleep problems
- Mood/depression: "feeling down, depressed, or hopeless; loss of interest"
- Unsteadiness when walking or standing
Goldman-Cecil Medicine, p. 2037-2073
2. GENERAL PHYSICAL EXAMINATION
Principles
- Treat patients with respect and dignity
- Explain every step before performing it
- Have a chaperone present for intimate examinations
- Warm hands; expose the area being examined adequately
- Systematic approach: Inspection → Palpation → Percussion → Auscultation (exception: abdomen uses Inspection → Auscultation → Percussion → Palpation to avoid altering bowel sounds)
General Appearance
Observe before touching:
- Level of consciousness and orientation
- Distress (mild, moderate, severe)
- Nutritional status (cachectic, obese)
- Skin color: jaundice, pallor, cyanosis, plethora
- Posture and movement
- Hydration
- Any obvious deformities, assistive devices (oxygen, IV lines)
3. VITAL SIGNS
Vital signs are: pulse rate and rhythm, blood pressure, respiratory rate, and body temperature. Marked abnormalities require focused evaluation before the rest of the exam. (Goldman-Cecil Medicine)
Pulse (Heart Rate)
- Normal: 60-100 bpm
- Tachycardia: >100 bpm
- Bradycardia: <60 bpm
- Assess: rate, rhythm, volume, character, vessel wall
- Feel radial pulse for 30 seconds (x2) or 60 seconds if irregular
- Compare both radial pulses simultaneously (radio-radial delay - coarctation, subclavian stenosis)
- Radio-femoral delay: coarctation of the aorta
Pulse Character
| Character | Cause |
|---|---|
| Collapsing (water-hammer) | Aortic regurgitation, PDA, thyrotoxicosis |
| Slow-rising, plateau | Aortic stenosis |
| Bisferiens (two peaks) | Aortic regurgitation + stenosis, HOCM |
| Pulsus paradoxus (>10 mmHg drop on inspiration) | Cardiac tamponade, severe asthma |
| Pulsus alternans | Severe LV failure |
| Corrigan's pulse | Aortic regurgitation (visible neck pulse) |
Blood Pressure
- Normal: <120/80 mmHg
- Hypertension Stage 1: 130-139/80-89
- Hypertension Stage 2: ≥140/90
- Hypotension: systolic <90 mmHg
- Use correct cuff size; wrong size = false readings
- Confirm abnormal readings on repeat; assess both arms
- White coat hypertension and masked hypertension exist - confirm with out-of-office measurements (Goldman-Cecil Medicine)
- Orthostatic hypotension: drop ≥20 mmHg systolic or ≥10 mmHg diastolic after standing for 3 minutes
Respiratory Rate
- Normal: 12-20 breaths/min
- Tachypnea: >20/min
- Bradypnea: <12/min
- Count while patient is unaware (count while pretending to take the pulse) - counting changes the rate
- Observe work of breathing, use of accessory muscles, ability to complete sentences
Body Temperature
- Normal: 36.1-37.2°C (oral)
- Low-grade fever: 37.3-38.0°C
- Fever: >38.0°C
- Hyperthermia: >40°C (heat stroke, malignant hyperthermia)
- Hypothermia: <35°C
- Oral thermometers are preferred in hospital; tympanic thermometers have variability of ±1.2-1.6°C (Goldman-Cecil Medicine)
Oxygen Saturation (SpO2)
- Normal: ≥95% on room air
- Concern: <94%; critical: <90%
4. CARDIOVASCULAR EXAMINATION
Inspection
- JVP (Jugular Venous Pressure): examine at 45° angle; normal <4 cm above sternal angle
- Peripheral edema (pitting vs. non-pitting)
- Visible pulsations (carotid, epigastric)
- Precordial scars (median sternotomy, lateral thoracotomy)
- Chest wall deformity (pectus excavatum/carinatum)
JVP Assessment
- Use internal jugular vein (not external - more reliable)
- Elevated JVP suggests: right heart failure, cardiac tamponade, constrictive pericarditis, SVC obstruction
- Hepatojugular reflux (Abdominojugular test): press right upper quadrant for 10 sec; sustained rise ≥3 cm = positive; suggests heart failure (Goldman-Cecil Medicine)
| JVP Pattern | Significance |
|---|---|
| Elevated, no x/y descent + pulsus paradoxus | Cardiac tamponade |
| Elevated + sharp y descent + Kussmaul sign | Constrictive pericarditis |
| Positive hepatojugular reflux | Left ventricular systolic dysfunction |
Carotid Pulse Examination
- Assess volume and contour
- Increased volume: aortic regurgitation, AV fistula, hyperthyroidism, fever, anemia
- Bisferious quality: aortic regurgitation or AV fistula
- Delayed upstroke: valvular aortic stenosis
- Diminished amplitude: reduced stroke volume (Goldman-Cecil Medicine, p. 2652-2654)
Precordial Palpation
- Point of Maximal Impulse (PMI/Apex beat): normally 5th ICS, mid-clavicular line
- Displaced PMI (laterally/inferiorly) = cardiomegaly
- Best felt in left lateral decubitus position
- Low-frequency phenomena (heaves, lifts) felt with heel of palm
- Parasternal heave (3rd-4th ICS) = right ventricular hypertrophy
- Palpable S3 = advanced heart failure; palpable S4 = poor LV distensibility (Goldman-Cecil Medicine)
Auscultation - Heart Sounds
Normal Heart Sounds (Guyton and Hall)
- S1 ("lub"): Closure of mitral and tricuspid valves at START of systole
- Results from vibration of taut valves, ventricular walls, chordae tendineae
- Heard best at apex
- S2 ("dub"): Closure of aortic and pulmonary valves at END of systole
- Higher pitch and shorter duration than S1 (tauter semilunar valves)
- Heard best at base
- Splitting of S2: Normal physiological splitting on inspiration (A2 before P2)
- Wide splitting: RBBB, pulmonary stenosis, RV failure
- Fixed splitting: ASD
- Paradoxical splitting: LBBB, aortic stenosis, WPW
Extra Heart Sounds
| Sound | Timing | Mechanism | Clinical Meaning |
|---|---|---|---|
| S3 (ventricular gallop) | Early diastole | Rapid ventricular filling | Normal in young/athletes; pathological in heart failure, MR, VSD |
| S4 (atrial gallop) | Late diastole (pre-systolic) | Atrial contraction against stiff ventricle | LV hypertrophy, aortic stenosis, hypertension, MI |
| Opening snap | Early diastole | Mitral valve snapping open | Mitral stenosis |
| Ejection click | Early systole | Valve opening sound | Bicuspid aortic valve, pulmonary stenosis |
| Midsystolic click | Midsystole | Leaflet prolapse | Mitral valve prolapse |
| Pericardial friction rub | Throughout | Inflamed pericardial layers | Pericarditis |
Murmurs
Describe every murmur with: timing, location, radiation, intensity (Levine 1-6), quality, effect of breathing/position/Valsalva
| Grade | Description |
|---|---|
| 1/6 | Barely audible, requires special conditions |
| 2/6 | Soft but audible immediately |
| 3/6 | Moderately loud, no thrill |
| 4/6 | Loud + palpable thrill |
| 5/6 | Very loud, heard with stethoscope edge on chest |
| 6/6 | Audible without stethoscope |
| Murmur | Timing | Location | Radiation | Character |
|---|---|---|---|---|
| Aortic Stenosis | Systolic (ejection) | 2nd R ICS | Neck/carotids | Harsh, crescendo-decrescendo |
| Aortic Regurgitation | Diastolic (early) | 3rd L ICS (Erb's point) | - | Blowing, decrescendo |
| Mitral Stenosis | Diastolic (mid-late) | Apex | - | Rumbling, low-pitched; opening snap |
| Mitral Regurgitation | Systolic (pan) | Apex | Axilla | Blowing, plateau |
| Tricuspid Regurgitation | Systolic (pan) | Lower L sternal border | - | Increases with inspiration |
| Pulmonary Stenosis | Systolic (ejection) | 2nd L ICS | - | Harsh |
Auscultation areas: Aortic (2nd R ICS), Pulmonary (2nd L ICS), Erb's point (3rd L ICS), Tricuspid (lower L sternal border), Mitral (apex - 5th ICS MCL)
5. RESPIRATORY EXAMINATION
Inspection
- Respiratory rate, depth, effort
- Chest shape: barrel chest (COPD), pectus excavatum/carinatum, kyphoscoliosis
- Symmetry of chest movement
- Accessory muscle use (SCM, scalenes)
- Paradoxical breathing (sign of respiratory fatigue)
- Cyanosis (central vs. peripheral)
- Clubbing (chronic lung disease, lung cancer, cyanotic heart disease)
Palpation
- Tracheal position: midline or deviated?
- Deviated toward lesion: collapse, fibrosis
- Deviated away from lesion: large effusion, tension pneumothorax
- Chest expansion: place hands on posterior chest, thumbs at midline; normal = equal, >5 cm expansion
- Tactile vocal fremitus: feel vibrations when patient says "99"; increased in consolidation, decreased in effusion/pneumothorax
Percussion
| Note | Cause |
|---|---|
| Resonant | Normal lung |
| Hyper-resonant | Pneumothorax, emphysema |
| Dull | Consolidation (pneumonia) |
| Stony dull | Pleural effusion |
Percuss: lung apex → front → sides → back. Compare sides symmetrically.
Auscultation - Lung Sounds (Murray & Nadel's)
Normal Breath Sounds
- Normal (vesicular): Louder on inspiration, soft/inaudible on expiration; heard over lung periphery
- Generated by turbulent airflow in lobar/segmental bronchi (NOT alveolar)
- Tracheal: Tubular, "white noise," heard in both phases; best below suprasternal notch
Transmitted Sounds (Voice)
| Test | Normal | Abnormal (Consolidation) |
|---|---|---|
| Bronchophony | Muffled "99" | Loud, clear "99" |
| Egophony | "ee" sounds like "ee" | "ee" sounds like "ay" (E-to-A change) |
| Whispered pectoriloquy | Inaudible whisper | Clear whispered words |
Abnormal Breath Sounds
- Bronchial breath sounds in peripheral areas: consolidation (pneumonia, edema, hemorrhage); assumes patent airway
- Diminished/absent: effusion, pneumothorax, peripheral bulla, obstructing mass
Adventitious (Added) Sounds (Murray & Nadel's)
Two generic categories:
Discontinuous:
| Sound | Description | Cause |
|---|---|---|
| Fine crackles | High-pitched, brief; like opening velcro; end-inspiratory | Pulmonary fibrosis, early pulmonary edema, early pneumonia |
| Coarse crackles | Low-pitched, longer, bubbling; early inspiratory | COPD, bronchiectasis, secretions |
Continuous:
| Sound | Description | Cause |
|---|---|---|
| Wheeze | High-pitched, musical; mainly expiratory | Airway narrowing (asthma, COPD) |
| Rhonchi | Low-pitched, snoring; clears with coughing | Secretions in large airways |
| Stridor | High-pitched; inspiratory | Upper airway obstruction (foreign body, croup, epiglottitis) |
| Pleural rub | Creaking, leathery; both phases | Pleuritis, pulmonary embolism |
6. ABDOMINAL EXAMINATION
Order: Inspection → Auscultation → Percussion → Palpation (auscultation before palpation to avoid altering bowel sounds)
Inspection
- Contour: flat, scaphoid, distended, obese
- Distension causes: Gas, Fat, Feces, Fluid (ascites), Fetus, Flatus, Fibroids ("6 F's")
- Visible peristalsis (intestinal obstruction)
- Scars: describe location (McBurney, Kocher, midline)
- Caput medusae (portal hypertension)
- Striae, hernias (umbilical, inguinal, femoral, incisional)
- Skin: jaundice, spider angiomas, bruising (Cullen's sign - periumbilical; Grey Turner's sign - flank = retroperitoneal hemorrhage/pancreatitis)
Auscultation
- Bowel sounds: normal (gurgling every 5-10 sec); absent (ileus); hyperactive (early obstruction, gastroenteritis)
- Bruits: renal (renal artery stenosis), hepatic (hepatic carcinoma), aortic (aortic aneurysm)
Percussion
- Liver size: upper border (6th rib, midclavicular) to lower border; normal 6-12 cm
- Spleen: Traube's space (left lower chest/upper abdomen) - dullness = splenomegaly
- Ascites: shifting dullness (>500 mL); fluid wave (large ascites); resonant central with dull flanks
- Bladder: suprapubic dullness when full
Palpation
- Begin in right iliac fossa (away from pain) and move toward suspected area
- Light palpation first, then deep
- Liver: start from RIF, move up toward RHC; palpate on expiration; describe lower edge in finger-breadths below costal margin
- Spleen: start from RIF; spleen enlarges toward RIF; use right lateral decubitus position if not palpable initially
- Kidneys: bimanual ballottement; normally not palpable (right kidney may be in thin patients)
- Aorta: midline pulsation; wide (>3 cm) and expansile = AAA
Special Signs
| Sign | Test | Positive = |
|---|---|---|
| Murphy's sign | Press sub-costal RUQ; ask patient to inhale; positive if patient stops on inspiration due to pain | Acute cholecystitis |
| Rovsing's sign | Press LIF; pain felt in RIF | Appendicitis |
| Psoas sign | Extend right hip; pain = | Retrocecal appendicitis |
| Obturator sign | Flex + internally rotate right hip; pain = | Pelvic appendicitis |
| Rebound tenderness (Blumberg) | Remove hand quickly after palpation; pain worse on release | Peritoneal irritation |
| McBurney's point | Maximal tenderness at 1/3 way from ASIS to umbilicus | Appendicitis |
Rectal Examination
- Inspect perianal area, anal tone, contents of rectum, prostate (men), uterus/cervix (women via pelvis)
7. NEUROLOGICAL EXAMINATION
Mental Status
- GCS (Glasgow Coma Scale): Eyes (1-4) + Verbal (1-5) + Motor (1-6) = max 15; <8 = coma
- Orientation (person, place, time)
- Cognition: Mini-Mental State Examination (MMSE); normal ≥24/30
- Speech: dysarthria (motor), dysphasia/aphasia (language), dysphonia (voice)
- Mood, affect, insight
Cranial Nerves (CN I-XII)
| CN | Name | How to Test |
|---|---|---|
| I | Olfactory | Test smell in each nostril (coffee, vanilla) - test in head trauma, suspected PD |
| II | Optic | Visual acuity (Snellen chart), visual fields by confrontation, fundoscopy, pupillary light reflex (RAPD: swinging flashlight test) |
| III, IV, VI | Oculomotor, Trochlear, Abducens | Eye movements (H-pattern), pupil size and reactivity, ptosis, nystagmus |
| V | Trigeminal | Facial sensation (3 divisions), corneal reflex, jaw clench (masseter), jaw open against resistance |
| VII | Facial | Facial symmetry: raise eyebrows, close eyes tight, show teeth, puff cheeks; forehead sparing = UMN lesion; no sparing = LMN (Bell's palsy) |
| VIII | Vestibulocochlear | Hearing: whisper test, Rinne (tuning fork on mastoid then air) and Weber tests; Rinne: normal = air > bone (AC>BC); Weber: lateralizes to better ear in SNHL, to worse ear in conductive hearing loss |
| IX, X | Glossopharyngeal, Vagus | Gag reflex, voice quality (hoarse = vagus), uvula (deviates away from lesion), swallowing |
| XI | Spinal Accessory | SCM (rotate head), trapezius (shoulder shrug against resistance) |
| XII | Hypoglossal | Tongue protrusion (deviates toward lesion in LMN, away in UMN) |
(Bradley and Daroff's Neurology in Clinical Practice)
Motor System
- Inspection: wasting, fasciculations, hypertrophy, posture
- Tone: passive movement of limbs; spasticity (velocity-dependent, "clasp-knife") vs. rigidity ("lead-pipe" or "cogwheel" in Parkinsonism) vs. hypotonia
- Power: MRC scale 0-5 for each muscle group; compare bilaterally
| MRC Grade | Description |
|---|---|
| 0 | No contraction |
| 1 | Flicker only |
| 2 | Movement with gravity eliminated |
| 3 | Movement against gravity (not resistance) |
| 4 | Movement against some resistance |
| 5 | Normal power |
- Upper Limb: shoulder abduction (C5), elbow flexion (C5-6), elbow extension (C7), wrist extension (C7), finger abduction (T1)
- Lower Limb: hip flexion (L1-2), knee extension (L3-4), dorsiflexion (L4-5), plantarflexion (S1-2)
Reflexes
Deep Tendon Reflexes:
| Reflex | Nerve Root | How to Elicit |
|---|---|---|
| Biceps | C5-6 | Tap on thumb over biceps tendon |
| Brachioradialis (Supinator) | C6 | Tap styloid process/radial periosteum |
| Triceps | C7 | Tap triceps tendon with arm partially flexed |
| Knee (Patellar) | L3-4 | Tap patellar tendon |
| Ankle (Achilles) | S1-2 | Tap Achilles tendon; foot dorsiflexed |
Grade: 0 (absent), 1 (reduced), 2 (normal), 3 (brisk), 4 (clonus)
Superficial Reflexes:
- Plantar reflex (Babinski): stroke lateral sole; normal = plantarflexion; extensor response (big toe up, fanning of toes) = UMN lesion
- Abdominal reflexes: stroking quadrants; absent in UMN lesion
- Cremasteric reflex: stroke inner thigh; testicular retraction (L1-2)
UMN vs. LMN Signs:
| Feature | UMN | LMN |
|---|---|---|
| Tone | Increased (spasticity) | Decreased (flaccidity) |
| Power | Weakness | Weakness/paralysis |
| Reflexes | Hyperreflexia | Hyporeflexia/areflexia |
| Babinski | Extensor | Absent/flexor |
| Wasting | Late/minimal | Early, marked |
| Fasciculations | Absent | Present |
Coordination
- Finger-nose test: dysmetria (cerebellar)
- Heel-shin test: lower limb ataxia
- Dysdiadochokinesia: rapid alternating hand movements; impaired in cerebellar lesions
- Romberg test: stand feet together, arms out, eyes closed; falls = proprioceptive/vestibular problem (NOT cerebellar if patient cannot maintain posture with eyes open either)
Gait
- Normal: observe speed, stride length, arm swing, turn
- Hemiplegic: arm flexed, leg circumducts (UMN)
- Parkinsonian: shuffling, reduced arm swing, festinant
- Cerebellar (ataxic): wide-based, stumbling, veers to side of lesion
- Steppage: foot drop, high steps (peripheral neuropathy, L4/5 lesion)
- Scissors gait: UMN bilateral, legs cross each other
- Antalgic: shortened stance phase on affected side (pain)
- Trendelenburg: hip abductor weakness, pelvis drops on swing side
Sensation
- Primary modalities: light touch (cotton wool), pain (pin-prick), temperature, vibration (128 Hz tuning fork on bony prominence), proprioception (joint position sense)
- Higher integrative: graphesthesia (letter/number written on palm), stereognosis (identify object by touch), two-point discrimination, sensory extinction
- Dermatomal testing for spinal levels
8. SPECIAL PHYSICAL SIGNS TO KNOW
Hands and Peripheral Signs
| Sign | Condition |
|---|---|
| Clubbing | Lung cancer, bronchiectasis, cystic fibrosis, cyanotic heart disease, IBD, liver cirrhosis, endocarditis |
| Splinter hemorrhages | Infective endocarditis, trauma |
| Osler's nodes | Infective endocarditis (painful, finger pads) |
| Janeway lesions | Infective endocarditis (painless, palms/soles) |
| Leukonychia | Hypoalbuminemia (liver disease) |
| Koilonychia | Iron-deficiency anemia |
| Dupuytren's contracture | Liver disease, manual labor, idiopathic |
| Froment's sign | Ulnar nerve palsy (adductor pollicis weakness) (Bailey & Love) |
| Asterixis (flapping tremor) | Hepatic encephalopathy, CO2 retention, uremia |
| Palmar erythema | Liver disease, pregnancy, RA |
| Thenar wasting | Median nerve palsy/CTS |
| Hypothenar wasting | Ulnar nerve palsy |
Face and Head Signs
| Sign | Condition |
|---|---|
| Malar flush | Mitral stenosis |
| Xanthelasma | Hypercholesterolemia |
| Corneal arcus | Hypercholesterolemia (in young), normal in elderly |
| Miosis (constricted pupil) | Opiates, Horner's syndrome, pilocarpine |
| Mydriasis (dilated pupil) | CN III palsy, anticholinergics, cocaine |
| Horner's syndrome | Ptosis, miosis, anhidrosis, enophthalmos (sympathetic chain lesion) |
| Kayser-Fleischer rings | Wilson's disease |
| Jaundice in sclerae | Hyperbilirubinemia >35 μmol/L |
9. COMMON CLINICAL SYNDROMES AND PATTERNS
Respiratory Pattern Recognition
| Breathing Pattern | Description | Cause |
|---|---|---|
| Kussmaul | Deep, rapid, labored | Metabolic acidosis (DKA) |
| Cheyne-Stokes | Cycles of apnea → crescendo-decrescendo | Heart failure, brain damage, uremia |
| Biot's (ataxic) | Irregular, unpredictable | Brainstem damage |
| Apneustic | Prolonged inspiratory hold | Pontine lesion |
| Tachypnea | >20/min | PE, pneumonia, anxiety, acidosis |
Consolidation vs. Effusion vs. Pneumothorax
| Feature | Consolidation | Pleural Effusion | Pneumothorax |
|---|---|---|---|
| Trachea | Midline or toward | Deviated away (large) | Deviated away (tension) |
| Expansion | Decreased | Decreased | Decreased |
| Tactile fremitus | Increased | Decreased/absent | Decreased/absent |
| Percussion | Dull | Stony dull | Hyper-resonant |
| Breath sounds | Bronchial | Diminished/absent | Absent |
| Adventitious sounds | Fine crackles | None | None |
| Voice sounds | Increased (bronchophony, egophony) | Decreased; aegophony at upper border | Absent |
10. BASIC DIAGNOSTIC METHODS
ECG Interpretation - Systematic Approach
- Rate (bpm = 300/number of large squares between R waves)
- Rhythm (regular vs. irregular)
- P waves (present, shape, relationship to QRS)
- PR interval (normal 120-200 ms)
- QRS duration (normal <120 ms)
- QRS axis
- ST segment changes (elevation = acute injury/STEMI; depression = ischemia/strain)
- T waves (inversion, peaked)
- QTc interval (normal men <440 ms, women <460 ms)
- Interpretation
Basic Lab Values to Know
| Value | Normal Range |
|---|---|
| Hemoglobin | Men: 13.5-17.5 g/dL; Women: 12.0-15.5 g/dL |
| WBC | 4,500-11,000/μL |
| Platelets | 150,000-400,000/μL |
| Sodium | 135-145 mEq/L |
| Potassium | 3.5-5.0 mEq/L |
| Creatinine | Men: 0.7-1.2 mg/dL; Women: 0.5-1.0 mg/dL |
| Glucose (fasting) | 70-100 mg/dL (<5.6 mmol/L) |
| Total bilirubin | <1.2 mg/dL |
| AST/ALT | <40 U/L |
| Albumin | 3.5-5.0 g/dL |
| INR | 0.8-1.2 (therapeutic anticoagulation: 2-3) |
11. QUICK EXAM TIPS
- Always introduce yourself, explain what you are doing, and gain consent
- Wash hands / use gloves - examiners mark this
- Expose the area adequately but maintain dignity
- Start examination away from the pain (abdominal exam begins in RIF regardless)
- Compare both sides for all assessments
- Mention key negatives (e.g., "no JVP elevation," "no peripheral edema")
- Synthesize at the end: "My findings are consistent with..."
- For respiratory exam: inspect chest, hands, face before touching the chest
- For cardiovascular exam: the sequence is general inspection → pulse → BP → JVP → precordial exam
- For neurological exam: always test for drift (arms extended, supinated, eyes closed) as a quick screen for hemiparesis (Bradley and Daroff)
Sources: Goldman-Cecil Medicine (26th ed.) | Guyton and Hall Textbook of Medical Physiology | Murray & Nadel's Respiratory Medicine | Bradley and Daroff's Neurology in Clinical Practice | Bailey and Love's Surgery (28th ed.)
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