Head-to-Toe Physical Assessment Review

Cranial Nerve Screening

• CN I (olfactory)
  • Ask client to close eyes, occlude one nostril, identify familiar scent ("apple … alcohol").
  • Intact if odor correctly named; record “CN I intact.”
• CN II (optic) – not fully demonstrated in clip but recall: visual acuity, fields, fundoscopic exam.
• CN III, IV, VI (oculomotor, trochlear, abducens) – implied by pupillary & EOM check; remember PERRLA & 6-cardinal-fields.
• CN V (trigeminal)
  • Sensory: patient closes eyes; light touch with cotton ball to forehead, cheeks, chin.
  • Motor: clench jaw; palpate masseter, temporalis; test resistance while opening mouth.
• CN VII (facial) – smile, frown, puff cheeks; symmetry noted.
• CN VIII (vestibulocochlear) – not shown; would perform whisper, Weber/Rinne.
• CN IX & X (glossopharyngeal & vagus)
  • Observe swallow, absence of dysphagia.
  • Say “ahh”; uvula & soft palate rise midline.
  • Note gag reflex if tested.
  • Verbalize: “CN X (vagus) intact; no trouble swallowing.”
• CN XI (accessory)
  • Shrug shoulders, turn head against resistance; strength graded 5/5.
• CN XII (hypoglossal)
  • Stick out tongue; note midline, no fasciculations.
  • "Light, tight, dynamite" articulation for lingual clarity.

Oral & Pharyngeal Inspection

• Lips, buccal mucosa, hard & soft palate, uvula, pharynx  “pink & moist.”
• Tonsil size: 1+ bilaterally (normal).
• Tongue dorsal surface: pink with rugae; ventral surface moist, veins visible.
• Adequate dentition – note any missing/loose teeth.
• TMJ assessment
  • Palpate during opening/closing & side-to-side excursion.
  • No redness, swelling, crepitus, or pain reported.

Neck Examination

• Trachea midline; thyroid/swelling absent.
• Carotid arteries palpated one at a time, amplitude 2+, no bruit (would auscultate if >40 y o).
• Cervical ROM: flexion (chin-to-chest), extension, lateral rotation; “full ROM, no pain.”

Upper-Extremity Musculoskeletal Screen

• Shoulders: inspect/palpate; ROM – flex, extend, abduct, adduct, internal & external rotation; strength 5/5 against resistance; no crepitus.
• Elbows & wrists: no redness/swelling; ROM full.
• Hand/fingers: flex/extend, ulnar/radial deviation.
• Grip‐strength: squeeze examiner’s two fingers bilaterally – “great size strength.”

Peripheral Vascular & Nail Beds

• Radial & ulnar pulses palpated bilaterally, amplitude 2+; trick: if hard to feel, supinate hand.
• Capillary refill < 2 s; nail-bed angle < 160^{\circ} (no clubbing).

Skin / Turgor / Hydration

• Pinch skin over sternum or forearm; rapid recoil indicates good turgor (well-hydrated).
• Overall integument: dry, warm, intact, no lesions.

Thorax & Lung Assessment

• Thoracic shape: A-P : T ratio 1:2, elliptical, symmetrical.
• Auscultation sites
  • Anterior: 6 points (ladder pattern R ↔ L).
  • Posterior: 10 points (top to bases, comparing side ↔ side).
  • Lateral: 4–6 points; create “triangle” (1–3 each side).
  • Total ≈ 26 placements; instruct patient: “Every time you feel my stethoscope, take a deep breath—in & out. Tell me if you feel dizzy.”
• Technique pearls
  • Start just below clavicle unless clavicle unusually high.
  • Move breast tissue for women; ask to move arms forward to spread scapulae when listening posteriorly.
  • Clothing: loose T-shirt, soft sports bra, loose shorts for practical lab.
• Normal vesicular sounds noted; if adventitious heard, re-listen before documenting.

Cardiac Auscultation & PMI

• Listen with diaphragm then bell at 5 traditional sites:
  1. Aortic – 2nd ICS, RSB
  2. Pulmonic – 2nd ICS, LSB
  3. Erb’s Point – 3rd ICS, LSB
  4. Tricuspid – 4th ICS, LSB
  5. Mitral (apex) – 5th ICS, MCL
• Identify S1 vs S2 dominance (e.g., “S2 > S1 at base; S1 > S2 at apex”).
• Use bell to assess for murmurs, gallops; state “No murmurs, S3/S4 absent.”
• PMI (point of maximal impulse)
  • Palpate 5th ICS MCL; amplitude 2+, no thrill.
  • Auscultate apical pulse for 60 s; document rate & rhythm.
• Patient may lie on left side to accentuate mitral sounds.

Abdominal Assessment

• Supine with knees slightly flexed; drape appropriately.
• Visual inspection: flat/rounded, symmetric; umbilicus midline; no pulsations or lesions.
• Draw imaginary cross; start RLQ because that is ileocecal valve—loudest bowel sounds.
• Auscultate all 4 quadrants (before palpation); once a single active sound heard, move on.
• Palpation (light then deep): ask about tenderness; none reported.
• Verbalize liver, spleen, kidney assessment if required (not demonstrated).

Hip, Knee, Ankle, Foot

• Visual: no redness/swelling.
• Hip ROM: flex/extend, ab/adduct (standing or supine).
• Knee & ankle ROM; strength graded 5/5.
• Plantar & dorsiflexion against resistance; pedal pushes “gas & brake.”
• Dorsalis pedis & posterior tibial pulses palpated 2+ (implied though not in clip).

Gait & Functional Tests (brief)

• Not fully demo’d, but remember: normal gait, tandem walk, heel-to-toe, Romberg if neuro section required.

Vital Signs, Pulses & Respirations

• Radial pulse counted 60 s; respirations counted clandestinely directly after to avoid altered breathing pattern.
• Acceptable error range: ±2 for pulse, ±4 for respirations per rubric.
• Blood pressure & O$_2$ sat obtained separately during check-off.

Documentation / Rubric Reminders

• May use one 5 \times 7 note card; looking at it costs 1 point each glance.
• Only vitals may be written during exam.
• Missing an item = lose its full value; going back out of sequence costs 1 point but better than omission.
• Instructors may prompt: “Have you missed anything?” – use as cue to think.
• If request a 5- or 10-min warning, costs 1 point.

Patient-Care & Ethical Considerations

• Always explain what you are about to do; obtain permission.
• Provide privacy, appropriate draping; move breast tissue respectfully.
• Warn about dizziness during prolonged deep breathing; allow rest.
• Infection control: sanitize hands before & after, clean stethoscope.

Practical Tips & Mnemonics

• Head-to-toe order helps nerves settle; once past head section momentum improves.
• Use ladder-or zig-zag pattern for lungs; “APE To Man” mnemonic for heart valves.
• If pulses difficult, change wrist position or compare to opposite side.
• For crepitus documentation: “No redness or swelling; crepitus noted R shoulder on flexion.”
• Remember: assess – inspect, palpate, ROM, strength – each joint before moving on.