Physical Exam Script
HEAD
I'll start with introducing myself to the patient, which is Francisco. Francisco, my name is Lidia
Aleman, I will be doing your examination today. And I will begin with inspecting your face, and I
see that I don't see any discolorations or any lesions. Next, I will go and note his head, and I
note that it is midline, and it is symmetrical. Next, I will proceed into palpating the lymph nodes,
and I will begin normally with the preauricular lymph nodes, right in front of the ear, and
postauricular, right behind the ear. Then I will palpate her occipital lymph nodes in the back of
the head. And then I'm going to move forward and palpate the tonsillar lymph nodes. Come
under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the
anterior cervical lymph nodes, and the posterior cervical lymph nodes. And I will end with the
supraclavicular lymph nodes right about the clavicles. I do not feel any enlargement, and they
are equal bilaterally. Next, I will test the trigeminal nerve, which is cranial nerve number five. It
has a motor component, and I will palpate over the masseter muscle as he clenches his jaw. And
I don't feel any distortions, and he has great strength. Next, I will test the sensory portion of the
trigeminal nerve. And I'll ask Francisco to close his eyes and let me know where he feels my
touch. >> Forehead, right cheek, left cheek, chin, nose. >> Next, I will test his facial nerve, which
is cranial nerve number seven. And I'm going to ask him to do some facial expressions. And I'll
ask for him to begin with a smile, and I know that is symmetrical. Next, frown for me. OK. Now
raise your eyebrows and go ahead and puff up your cheeks, and you notice they're equal
bilaterally. And now I want you to pucker your lips, very tight pucker. So that looks good. Thank
you, Francisco.
EARS
Now, I'm going to inspect Francisco's ears, and I'm looking for any nodules or any skin lesions.
Let's look at your other ear, Francisco, and they look nice. And now I'm going to also note that
they're symmetrical, and I'm now going to look inside his ear canal with the otoscope. I'm going
to pull his ear up and back, and as I look in, I see that the external auditory canal is clear, there's
no swelling or redness or drainage or cerumen. The tympanic membrane is pearly gray, and
there is no effusion in the middle ear. I will do the same for his left ear, pull the ear up and back,
looking into the external auditory canal. I see there is no cerumen, there's no swelling or
redness, there is no drainage. His tympanic membrane is pearly grey, and there's no fluid in the
external auditory canal. So you have very normal eardrums and ears. Now I'm going to palpate
Francisco's pinna, For any nodules or tenderness, any tenderness, Francisco? >> No. >> And now
his tragus, in front of the ear, any tenderness? >> No. >> Thank you, next I will be testing his
acoustic nerve, which is cranial nerve number eight, and that is his hearing. So I will be
performing a whisper test, so I'm going to ask Francisco to cover one of his ears. And then I will
stand behind him, cover my mouth, and whisper three words. One, two, three. >> One, two,
three. >> And let's do the other side. Four, five, six. >> Four, five, six. >> And his hearing is intact
bilaterally.
, EYES
Now I'm going to assess Francisco's eyes, and first I'm going to look at his conjunctiva. I notice
that they're pink and clear, no drainage or lesions. And I'll also note that his sclera is white and
clear. Now I'm going to test Francisco's cranial nerve number two, the optic nerve, and this
covers central vision. And I will use this Snellen eye pocket chart. And I'll stand six feet away and
ask Francisco to cover one eye. And now read the lowest line possible. >> LTFPH. >> Repeat with
the other eye. >> LTFPH. >> And now with both eyes. >> LTFPH. >> And Francisco has normal
vision, 20/20 in his left eye, right eye, and with both eyes. And now I will check cranial nerve
number two, the optic nerve again, covers peripheral vision. So I would like Francisco to remain
sitting so we will be at the same eye level. And I'm going to ask him to look straight ahead and
not move his head, and first of all, do you see my hands now? >> No. >> Let me know when you
do. >> Yes. >> And then I'm going to cover above, do you see them now? >> No. >> Let me know
when you do. >> Yes. >> Now come from below, do you see them now? >> No. >> Let me know
when you do. >> Yes. >> OK, thank you. His peripheral vision is normal. Now I'm going to
continue and check cranial nerve number two again, the optic nerve, for his pupil response to
light. And I'm using the ophthalmoscope head and turning on my light. And I'm going to ask
Francisco to just stare at my nose. Now I'm going to come from the side with my light source,
and I notice that the pupil constricts, and then I will check the right eye as well. And his pupils
are about two to three millimeters, and they respond to light equally. Now I'm going to be
checking cranial nerves number three, which is the ocular motor, cranial nerve number four,
which is the trochlear, and cranial nerve number six, which is the abducens. And in doing so, I
will choose a star or an H pattern, and this is checking the extraocular muscles of the eye. So if
you will follow my finger, Francisco, with your eyes only. Thank you, and all EOMs are intact
equally.
NOSE
Now I'm going to be checking Francisco 's nose, and first I'm going to inspect his nose, and I do
see that it is midline. I don't see any obstruction or any noticeable fracture or swelling. And now
I will insert my speculum of the otoscope inside his nose. And I'm going to tip his nose up with
the thumb. And I'll look inside his left turbinates, and I do see some pink and moist turbinate’s
in his septum midline. You want to angle anteriorly, and I do see that his septum is straight,
there's no deviation. Let me cover his right side, once again, looking at the septum anteriorly, or
medially, and I do see that he does have a straight septum, and his turbinates on the lateral
aspect are nice and pink, and healthy, there's no swelling or bogginess. And now, we'll palpate
Francisco 's sinuses beginning with the frontal sinuses. Let me know if you feel any tenderness
there, Francisco. >> No. >> And his maxillary sinuses, any tenderness? >> No. >> Thank you.
THROAT/MOUTH
Now, I'm going to inspect Francisco's throat and mouth, and I'll begin with inspecting his lips,
which are pink, and moist. And now, he will open his mouth, and I am inspecting his teeth. I do
HEAD
I'll start with introducing myself to the patient, which is Francisco. Francisco, my name is Lidia
Aleman, I will be doing your examination today. And I will begin with inspecting your face, and I
see that I don't see any discolorations or any lesions. Next, I will go and note his head, and I
note that it is midline, and it is symmetrical. Next, I will proceed into palpating the lymph nodes,
and I will begin normally with the preauricular lymph nodes, right in front of the ear, and
postauricular, right behind the ear. Then I will palpate her occipital lymph nodes in the back of
the head. And then I'm going to move forward and palpate the tonsillar lymph nodes. Come
under the jawline, the submandibular lymph nodes, and the submental. Now I will go to the
anterior cervical lymph nodes, and the posterior cervical lymph nodes. And I will end with the
supraclavicular lymph nodes right about the clavicles. I do not feel any enlargement, and they
are equal bilaterally. Next, I will test the trigeminal nerve, which is cranial nerve number five. It
has a motor component, and I will palpate over the masseter muscle as he clenches his jaw. And
I don't feel any distortions, and he has great strength. Next, I will test the sensory portion of the
trigeminal nerve. And I'll ask Francisco to close his eyes and let me know where he feels my
touch. >> Forehead, right cheek, left cheek, chin, nose. >> Next, I will test his facial nerve, which
is cranial nerve number seven. And I'm going to ask him to do some facial expressions. And I'll
ask for him to begin with a smile, and I know that is symmetrical. Next, frown for me. OK. Now
raise your eyebrows and go ahead and puff up your cheeks, and you notice they're equal
bilaterally. And now I want you to pucker your lips, very tight pucker. So that looks good. Thank
you, Francisco.
EARS
Now, I'm going to inspect Francisco's ears, and I'm looking for any nodules or any skin lesions.
Let's look at your other ear, Francisco, and they look nice. And now I'm going to also note that
they're symmetrical, and I'm now going to look inside his ear canal with the otoscope. I'm going
to pull his ear up and back, and as I look in, I see that the external auditory canal is clear, there's
no swelling or redness or drainage or cerumen. The tympanic membrane is pearly gray, and
there is no effusion in the middle ear. I will do the same for his left ear, pull the ear up and back,
looking into the external auditory canal. I see there is no cerumen, there's no swelling or
redness, there is no drainage. His tympanic membrane is pearly grey, and there's no fluid in the
external auditory canal. So you have very normal eardrums and ears. Now I'm going to palpate
Francisco's pinna, For any nodules or tenderness, any tenderness, Francisco? >> No. >> And now
his tragus, in front of the ear, any tenderness? >> No. >> Thank you, next I will be testing his
acoustic nerve, which is cranial nerve number eight, and that is his hearing. So I will be
performing a whisper test, so I'm going to ask Francisco to cover one of his ears. And then I will
stand behind him, cover my mouth, and whisper three words. One, two, three. >> One, two,
three. >> And let's do the other side. Four, five, six. >> Four, five, six. >> And his hearing is intact
bilaterally.
, EYES
Now I'm going to assess Francisco's eyes, and first I'm going to look at his conjunctiva. I notice
that they're pink and clear, no drainage or lesions. And I'll also note that his sclera is white and
clear. Now I'm going to test Francisco's cranial nerve number two, the optic nerve, and this
covers central vision. And I will use this Snellen eye pocket chart. And I'll stand six feet away and
ask Francisco to cover one eye. And now read the lowest line possible. >> LTFPH. >> Repeat with
the other eye. >> LTFPH. >> And now with both eyes. >> LTFPH. >> And Francisco has normal
vision, 20/20 in his left eye, right eye, and with both eyes. And now I will check cranial nerve
number two, the optic nerve again, covers peripheral vision. So I would like Francisco to remain
sitting so we will be at the same eye level. And I'm going to ask him to look straight ahead and
not move his head, and first of all, do you see my hands now? >> No. >> Let me know when you
do. >> Yes. >> And then I'm going to cover above, do you see them now? >> No. >> Let me know
when you do. >> Yes. >> Now come from below, do you see them now? >> No. >> Let me know
when you do. >> Yes. >> OK, thank you. His peripheral vision is normal. Now I'm going to
continue and check cranial nerve number two again, the optic nerve, for his pupil response to
light. And I'm using the ophthalmoscope head and turning on my light. And I'm going to ask
Francisco to just stare at my nose. Now I'm going to come from the side with my light source,
and I notice that the pupil constricts, and then I will check the right eye as well. And his pupils
are about two to three millimeters, and they respond to light equally. Now I'm going to be
checking cranial nerves number three, which is the ocular motor, cranial nerve number four,
which is the trochlear, and cranial nerve number six, which is the abducens. And in doing so, I
will choose a star or an H pattern, and this is checking the extraocular muscles of the eye. So if
you will follow my finger, Francisco, with your eyes only. Thank you, and all EOMs are intact
equally.
NOSE
Now I'm going to be checking Francisco 's nose, and first I'm going to inspect his nose, and I do
see that it is midline. I don't see any obstruction or any noticeable fracture or swelling. And now
I will insert my speculum of the otoscope inside his nose. And I'm going to tip his nose up with
the thumb. And I'll look inside his left turbinates, and I do see some pink and moist turbinate’s
in his septum midline. You want to angle anteriorly, and I do see that his septum is straight,
there's no deviation. Let me cover his right side, once again, looking at the septum anteriorly, or
medially, and I do see that he does have a straight septum, and his turbinates on the lateral
aspect are nice and pink, and healthy, there's no swelling or bogginess. And now, we'll palpate
Francisco 's sinuses beginning with the frontal sinuses. Let me know if you feel any tenderness
there, Francisco. >> No. >> And his maxillary sinuses, any tenderness? >> No. >> Thank you.
THROAT/MOUTH
Now, I'm going to inspect Francisco's throat and mouth, and I'll begin with inspecting his lips,
which are pink, and moist. And now, he will open his mouth, and I am inspecting his teeth. I do
