LDIA1kIC nSICAL LkAMINA1ICN

name of aLlenL ________________________________ Age __ Sex __ Ward/8ed # ______ uaLe _________ Lxamlner ______________________________
Medlcal lmpresslon __________________________________________________________________________

I nSICLCGIC (VI1AL SIGNS)
88 breaLhs/mln (lnfanLs young chlldren abd mov'L older chlldren Lhoraclc mov'L 23 yrs
aplcal/brachlal 23 yrs radlal)
8 bpm Cradlng (0+4)
1 C oral/axlllary/recLal
8

II Growth]Anthropometr|c Measurements
PelghL cm WelghL cm MuAC cm
for 9 mosPC cm CC cm AC cm

III Genera| Appearance
LCC rConsclous rurowsy rSLuporous rComaLose rCLhers ____________
Coherence coherenL/lncoherenL
CrlenLaLlon rorlenLed rdlsorlenLed Lo Llme/person/place
Ceneral appearance rdlsLress ranxleLy rcardloresplraLory rpaln (raLlng )
uevelopmenL endo/meso/ecLo r looks acc Lo age r looks younger/older
Pyglene nuLrlLlon well nourlshed/obese/cachexlc
LmoLlonal SLaLe rcalm rworrled rresLless rLense roLhers _____________
CalL rcoordlnaLed runcoordlnaLed rsLaggerlng rshuffllng rsLumbllng runable Lo walk
alone rwalks wlLh asslsLlve devlces

IV Sk|n
(skln sclera con[uncLlva nall beds Longue buccal mucosa palms soles)
allor [
!aundlce [
llushed [
CyanoLlc [
Ceneral Skln color dark/medlum/falr
1exLure rsmooLh rrough roLhers _______________
MolsLure rdry rweL/clammy rolly
CLhers rvernlx caseosa rlanugo rmllla rsLork blLe rmongollan spoLs
rpeLechlae/ecchymoses _________________________________________
rleslons/rashes ________________________________________________
redema (plLLlng/nonplLLlng) _____________________________________
mllla Llny whlLe papules cheek chln nose mlllarla/sudamlna mlnuLe veslcles face eryLhema Loxlcum plnk popular
rash w/ veslcles back buLLocks abd Mongollan spoLs deep blue sacral gluLeal sLork blLe flaL deep plnk back of neck

V Accessory Structures
Palr color ___________ quallLy flne/coarse/dry LexLure rough/smooLh elasLlclLy
easlly breakable/Lough dlsLrlbuLlon rnormal rpaLches [ _____________ hyglene
nalls color ________ shape normal/club/spoon/flaL LexLure rough/smooLh
hyglene
uermaLoglyphlcs rnormal (3 flexlon creases) r(+) Lransplanar crease (1 horlzonLal
crease)

VI Lymph Nodes
SM submaxlllary C cervlcal A axlllary l lngulnal
Slze moblllLy 1 Lenderness any ln enlarged nodules
SM (LllL head sllghLly downward)
C (LllL head sllghLly upward)
A (arms relaxed [ slde buL sllghLly abducLed)
l (suplne)
Lender enlarged warm nodes usually lndlcaLe lnflammaLlon proxlmal Lo Lhelr locaLlon

VII nead
Pead Lo 8ody 8aLlo (for lnfanLs)
ConflguraLlon rnormocephallc roLhers __________ rmasses ___________
lonLanelles (closed open sunken bulglng boneLobone) A
Scalp rclean rdandruff rllce rleslons rslgns of Lrauma/dlscoloraLlon

VIII Neck
1rachea rallgned rdevlaLed [
(lace Lhumb lndex flnger on each slde of Lhe neck sllde flngers back forLh)
1hyrold renlarged (L/8/bllaLeral) rnonpalpable rLender
(lace pads of lndex mlddle flngers below crlcold carLllage feel for lsLhmus rlslng durlng swallowlng)
rLonlc neck reflex
Lymph nodes rnonpalpable rpalpable/enlarged rLender
CLhers rnormal/G 8CM [ rneck rlgldlLy rnvL 8 L rMasses

Ik Lyes
AllgnmenL rmedlal rlaLeral
alpebral slanL presenL/absenL
LplcanLhal lold presenL/absenL
Llds rsymmeLrlcal redema/swelllng L/8 rpLosls L/8
erlorblLal reglon redema rsunken rdlscoloraLlon
Con[uncLlva (/8) rplnklsh rpale rleslons rdlscharge
Sclera anlcLerlc/sublcLerlc/lcLerlc rhemorrhages
Lacrlmal apparaLus rLearlng rswelllng robsLrucLlon
Cornea lens opaque/clear rleslons
uplls equal/unequal 8 mm L mm
LlghL reacLlon 8brlsk/slugglsh/flxed Lbrlsk/slugglsh/flxed
AccommodaLlon runlform runequal
Convergence requal runequal rnone
vlsual aculLy (6 yrs) rgrossly normal rlmpalred
8eflexes ( ) corneal llghL reflex ( ) cover LesL ( ) alLernaLe cover LesL ( ) perlpheral
vlslon ( ) color vlslon ( ) corneal reflex
*1esLs for 8lnocular vlslon*
a corneal llghL reflex shlne a llghL dlrecLly lnLo Lhe eyes from a dlsLance of abouL 16 ln
b cover LesL have a chlld flxaLe on near (13 ln) or dlsLanL (20 ln) ob[ecL cover one eye observe mov'L of uncovered
eye
c alLernaLe cover LesL rapldly cover one eye Lhen Lhe oLher eye several Llmes observe mov'L of covered eye when lL's
uncovered (same as cover LesL)
d perlpheral vlslon have chlld look sLralghL ahead move an ob[ such as your flnger from beyond chlld's fleld of vlslon
lnLo vlew ask Lhe chlld Lo slgnal as soon as Lhe ob[ecL ls seen esLlmaLe from sLralghL llne of vlslon Lo 1
sL
deLecLlon of
perlpheral vlslon |n per quadranL 30 70 G 60 F 90|

k Lars
| 3 yrs up back 3 yrs down back top of p|nna hor|zonta| w|th outer canthus of the eye |
lnnae rnormoseL rsymmeLrlcal rLenderness rgross abnormallLles
LxLernal Canal rlmpacLed cerumen rdlscharged (foul/serous/purulenL) rabnormal
openlngs
Cross Pearlng rsymmeLrlcal rdeafness/decreased 8 L
8eflexes ( ) 8lnne ( ) Weber

kI Nose
Slze/placemenL/allgnmenL rswelllng rdevlaLed 8 L
nasolablal lold rsymmeLrlcal rshallow 8 L
SepLum rmldllne rdevlaLed 8 L rperforaLed
Mucosa rplnklsh rpale rred rdlschargeserous/purulenL/mucold/bloody
aLency rboLh paLenL robsLrucLlon 8 L
Cross Smell rsymmeLrlcal rdeflclenL 8 L
Slnuses (fronLal maxlllary) rLender rnonLender
8eflexes ( ) sneeze ( ) glabellar (brlskly Lap brldge of nose eyes close)
*AnLerlor vesLlbule LllL head backward push Llp of nose up lllumlnaLe cavlLy wlLh flashllghL 1o deLecL perforaLed
sepLum shlne llghL lnLo one narls observe for admlLLance of llghL Lhrough perforaLlon

kII Mouth and 1hroat
Llps pale/cyanoLlc/reddlsh rswelllng rdry/cracked rleslons
1ongue mldllne/devlaLed 8 L raLrophy rfasclculaLlon rleslons
1eeLh compleLe/mlsslng rcarles rdenLures rbraces/reLalners
Cums rplnk rpale rbleedlng rLenderness rpaln
Cral Mucosa plnk/pale/cyanoLlc/reddlsh
Speech lnLacL/slurred/aphaslc/oLhers
8eflexes ( ) gag ( ) rooLlng (34 up Lo 12 mos) ( ) sucklng ( ) exLruslon (4 mos)
uvula rmldllne rdevlaLed 8 L
haryngeal Mucosa plnklsh/pale/reddlsh
1onslls rswelllng rredness rgradlng

kIII Chest and Lungs
lnsplraLlonLxplraLlon 8aLlo
8reaLhlng aLLern refforLless rLachypnea rCheyneSLokes rapnea rdyspnea ruse of
accessory muscles
ChesL shape AL raLlo normal/barrel/funnel/plgeon
ChesL expanslon symmeLrlcal/decreased or lagglng 8 L
vocal/1acLlle lremlLus symmeLrlcal/decreased or lagglng 8 L
ercusslon r8esonanL [
r uull [
r PypperresonanL [
8reaLh Sounds rveslcular [
r 8ronchoveslcular [
r 8ronchlal [
Abnormal 8reaLh Sounds r wheeze/ronchl [
r rales/crackles [
r pleural/precordlal frlcLlon rub
Llver uullness [
Cardlac uullness [
8reasL equal/unequal pale/reddlsh rmasses [ redema
rdlscharge (serous/purulenL) rdlmpllng rLender
nlpple Areola lnverLed/flaLLened/reLracLed rdevlaLlon 8 L redema
Axlllary lymph nodes palpable/nonpalpable rLenderness rswelllng
* AlLered 8reaLhlng aLLerns*
(8aLe) 1achypnea qulck shallow
(8aLe) 8radypnea abnormally shallow
(8aLe) Apnea cessaLlon
(volume) PypervenLllaLlon overexpanslon rapld deep
(volume) PypovenLllaLlon underexpanslon shallow
(8hyLhm) CheyneSLokes rhyLhmlc waxlng wanlng very deep Lo very shallow apnea
(Lase/LfforL) uyspnea dlfflculL labored (+) dlsLress
(Lase/LfforL) CrLhopnea can only breaLhe uprlghL (slLLlng or sLandlng)
* AdvenLlLlous 8reaLh Sounds *
Crackles (rales) halr rolllng" d/L (+) fluld mucus lower Lls lL
Curgles (ronchl) snorlng" d/L narrowed alr passages 2 Lo blockage all Lls lL
lrlcLlon rub graLlng/creaklng" lower anLerlor laLeral chesL
Wheeze squeaky" Ll d7L bronchoconsLrlcLlon all Lls

kIV neart
recordlal area flaL/bulglng normodynamlc/hyperdynamlc rheave rLhrlll
Ml [
PearL sounds dlsLlncL/falnL S1 __ S2 [ base S1 __ S2 [ apex r exLra hearL sounds
(S3 S4) rmurmurs (gradlng besL heard [ )
Caplllary reflll Llme s

*varlous aLLerns of P8 or ulse*
O1achycardla raLe 8radycardla G raLe
Oulsus alLernans sLrong beaL followed by weak beaL
Oulsus bldemlnus coupled rhyLhm ln whlch beaL ls felL ln palrs because of premaLure beaL
Oulsus paradoxus lnLenslLy or force of pulse G wlLh lnsplraLlon
OSlnus arrhyLhmla raLe wlLh lnsplraLlon G wlLh explraLlon
OWaLerPammer or Corrlgan's pulse esp forceful beaL caused by a very wlde pulse pressure
OulcroLlc pulse double radlal pulse for every aplcal beaL
O1hready pulse rapld weak pulse LhaL seems Lo appear dlsappear
*Murmurs lnLenslLy Cradlng*
l very falnL frequenLly noL heard lf slLLlng up
ll usu 8eadlly heard sllghLly louder Lhan C1 audlble ln all poslLlons
lll loud () Lhrlll
lv loud (+) Lhrlll
v loud enough wlLh sLeLhoscope barely on chesL (+) Lhrlll
vl loud enough wlLh sLeLhoscope noL Louchlng chesL wlLh human ear close Lo chesL (+) Lhrlll

kV Abdomen
ConLour flaL/globular/proLuberanL/scaphold
Slze cm
Skln good/falr/poor Lurgor rdllaLed velns rsLrlae rscars rrashes rleslons
umblllcus rhernlaLlon rsunken rbulglng rdlscharge rclean rflsLulas
8owel Sounds /mln (average) normoacLlve/hypoacLlve/hyperacLlve
AorLlc pulsaLlons (eplgasLrum sllghLly lefL of mldllne)
Llver (12 cm below 8CM) palpable/nonpalpable Spleen (12 cm below LCM)
palpable/nonpalpable
ercusslon rLympanlLlc [ rhyperLympanlLlc [ rdull [ rfluld wave
rshlfLlng dullness
alpaLlon rmuscle guardlng rdlrecL Lenderness rrebound Lenderness
CLhers ( ) abdomlnal reflex r brulL [

kVI Gen|ta||a
,f
enlle slze
ureLhral meaLus [ rdlscharge
Clans shafL rswelllng rleslons [ rlnflammaLlon
ScroLum slze cm [ rdry skln rLenderness rswelllng/enlargemenL [
rleslons [
CLhers rhernla rhydrocele
f
LxLernal genlLalla (mons publs cllLorls labla ma[ora labla mlnora)
reddlsh/plnklsh/pale rswelllng/edema rmasses [
ureLhral meaLus [ rdlscharge (purulenL/serous/foul
smelllng)
vaglnal orlflce rdlscharge (purulenL/serous/foulsmelllng)

lngulnal lymph nodes palpable/nonpalpable rswelllng rLenderness
Pernlas rlngulnal rfemoral

kVII Anus
llrmness flrm/saggy
CLhers rleslons rbleedlng ( ) anal reflex

kVIII 8ack and Lxtrem|t|es
Splne CurvaLure normal/lordosls/scollosls/kyphosls
!olnLs exLremlLles symmeLrlcal/shorLer [ warm [ /cool [
rpaln [ rdecreased 8CM [
rswelllng/redness [ rLenderness [
Muscle sLrengLh normal/hyperLonlc/flaccld rfasclculaLlons/Llcs/Lremors rweakness
[ rparalysls [
CLhers rhlp dysplasla rCrLolanl (4 mos) rfooL deformlLles rCvA Lenderness
8eflexes ( ) planLar reflex ( ) palmar reflex ( ) Lrunk lncurvaLlon ( ) sLarLle
*looL Ankle ueformlLles*
es lanus (flaLfooL) n ln lnfanLs muscular weakness ln older chlldren
es valgus enLlre fooL everslon sole on ground
es varus enLlre fooL lnverslon sole on ground
MeLaLarsus valgus forefooL everslon heel remalns sLralghL (Loelng ouL/duck walk)
1allpes valgus everslon of fooL only lnner slde on ground
1allpes varus fooL everslon only ouLer sole on ground
1allpes equlnus planLar flexlon/exLenslon ball Loes on ground
1allpes calcaneus fooL dorslflexlon heel on ground
*genu varum (bowleg) 2" genu valgus (knockknees) 3"

uLL 1LnuCn 8LlLLxLS
8lceps 8 L
1rlceps 8 L
8rachloradlalls 8 L
aLellar 8 L
Achllles 8 L
Ankle clonus 8 L
kernlg's
8rudzlnskl's

C8AnlAL nL8vLS
l ClfacLory (odor ldenLlflcaLlon)
ll CpLlc (llghL percepLlon vlsual aculLy perlpheral vlslon color vlslon opLlc dlsc)
lll lv vl CculomoLor 1rochlear Abducens (LCM mov'L)
v 1rlgemlnal (corneal and bllnk reflexes sensaLlon llghL)
vll laclal (faclal expresslons LasLe [ anLerlor 2/3 of Longue)
vlll vesLlbulocochlear (hearlng verLlgo)
lx Clossopharyngeal (gag reflex LasLe [ posLerlor 1/3 of Longue)
x vagus (volce hoarseness gag swallowlng reflexes) mldllne uvular
sLlmulaLlon mov'L upward Lo sLlmulaLe slde
xl Accessory (shoulder sLrengLh)
xll Pypoglossal (Longue sLrengLh)