Clinical examination

The clinical exam step by step: how to take a history, how to measure vital signs and how to examine each system by inspection, palpation, percussion and auscultation. Every sign and maneuver with how to do it, what a positive result means and the anatomy it tests, in Durgical's 3D anatomy.

149 pages

• History taking and the interview
• General exam and vital signs
• Skin, head and neck
• Respiratory system
• Cardiovascular system
• Abdomen
• Systemic syndromes
• Kidney, genitourinary, breast and obstetric exam
• Musculoskeletal system
• Nervous system
• A to Z

History taking and the interview

How to interview and what goes in each part of the clinical history.

• The clinical history: its parts and their orderThe clinical history is the ordered record of what the patient tells, what the examiner finds and what is decided.History
• The medical interview: rapport, open questions and listeningThe interview is the conversation in which the clinician gets to know the patient and the problem; almost the whole diagnosis depends on it.History
• Chief complaint and history of present illnessThe chief complaint is the reason for the visit in the patient's words; the present illness is the full story of that problem.History
• Analysing a symptom: onset, site, character, radiation and moreEvery symptom is described with the same attributes so another clinician understands exactly what the patient feels.Topic
• Past medical, surgical, family and social historyThe past history gathers the patient's illnesses, operations and habits and the family's diseases that may explain the current problem.History
• Review of systemsThe review of systems is a quick head-to-toe check for symptoms the patient did not mention.History
• Medicines, allergies and habits: tobacco, alcohol and other substancesKnowing a patient's medicines, allergies and use of tobacco, alcohol or other substances prevents errors and explains many symptoms.History
• Gynecologic and obstetric historyThe gynaecologic and obstetric history covers a woman's menstrual history, pregnancies, contraception and screening.History
• Pediatric history: perinatal, growth, development and vaccinesA child's history adds questions about pregnancy, birth, feeding, growth, development and vaccines.History
• Comprehensive geriatric assessment: function, cognition, fallsIn an older person diseases are not enough: what they can do alone, memory, mood, nutrition and fall risk are assessed too.History
• From findings to diagnosis: problem list, differential and SOAP noteClinical reasoning puts together what the patient tells and what is found to reach the most likely diagnoses and a plan.Topic
• Nursing assessment: head-to-toe and focused assessmentNursing assessment is the first stage of the nursing process: gathering data about the patient to plan their care.Topic
• Interviewing in special situations: interpreters and breaking bad newsSpeaking through an interpreter or breaking bad news takes preparation, plain language and attention to the patient's emotions.Topic

General exam and vital signs

General inspection, vital signs, pain, hydration, consciousness and early warning scores.

• General inspection: appearance, posture, gait and consciousnessThe first look at the patient: how they appear, how they move and how alert they are, before any hands-on exam.Exam technique
• Vital signs: what they are and how to record themTemperature, pulse, breathing and blood pressure: four numbers that show how the body is working right now.Topic
• Body temperature and fever patternsHow temperature is measured, when there is a fever and what shapes the fever curve can take over several days.Vital sign
• Arterial pulse: rate, rhythm and amplitudeHow to feel and count the pulse, and what a fast, slow, irregular, weak or bounding pulse points to.Vital sign
• Respiratory rate and breathing patternsHow many times a patient breathes per minute, how deeply and how regularly, and which abnormal patterns to recognise.Vital sign
• Blood pressure measurementHow to measure blood pressure properly with a cuff and stethoscope, and how adult readings are classified.Vital sign
• Orthostatic vital signsBlood pressure and pulse lying down and then standing, to see whether the body copes with the change of position.Vital sign
• Pulse oximetryA finger sensor estimates how much oxygen the blood carries; quick and useful, but with pitfalls worth knowing.Vital sign
• Pain assessment and pain scalesHow to ask about pain and how to measure its intensity with numeric, visual and faces scales, children included.Vital sign
• Weight, height, body mass index and waist circumferenceHow to weigh, measure height and work out body mass index, and why waist size matters too.Exam technique
• Hydration status: signs of dehydrationWhat to look at and feel at the bedside to tell whether a patient is short of fluid, and by how much.Exam technique
• Capillary refill timePress the nail until it turns white and time how long the colour takes to return: it shows how blood reaches the skin.Sign
• Level of consciousness and the Glasgow Coma ScaleHow to describe how awake a patient is and how to score it with the Glasgow Coma Scale, from 3 to 15 points.Exam technique
• Diagnostic faciesSome diseases change the face in typical ways; recognising them points to the diagnosis at first glance.Sign
• Edema: pitting, grading and distributionSwelling from fluid in the tissues: how to look for pitting, how to grade it and what its site tells you.Sign
• Pallor, cyanosis and jaundiceThree colour changes of skin and mucosae that point to anemia, lack of oxygen or excess bilirubin.Sign
• Early warning scores: NEWS2 and qSOFASimple scores built from vital signs that help spot the deteriorating patient in time.Topic
• Vital signs in children: how they change with ageThe younger the child, the faster the pulse and breathing and the lower the blood pressure; normal depends on age.Topic

Skin, head and neck

Skin lesions, lymph nodes, thyroid, eyes, ears, mouth and pharynx.

• Skin examination: primary and secondary lesionsHow the skin is looked at and felt, and how its lesions are named so that any colleague understands what you saw.Exam technique
• The ABCDE of pigmented lesionsFive features of a mole (asymmetry, border, colour, diameter and evolution) that raise suspicion of melanoma and call for assessment.Sign
• Digital clubbing and nail signsWhen fingertips swell and nails curve, a lung, heart or liver disease is usually behind it.Sign
• Lymph node examinationHow the nodes of the neck, armpits and groin are felt, and which features make an enlarged node worrying.Exam technique
• Thyroid examinationHow the thyroid is looked at and felt in the neck, why the patient is asked to swallow, and which findings suggest goitre or a nodule.Exam technique
• Eye exam: visual acuity, visual fields and eye movementsThree simple tests of how much each eye sees, which part of the field it sees and whether the eyes move together.Exam technique
• Fundoscopy: the optic disc, papilledema and retinopathyAn ophthalmoscope shows the back of the eye: the optic nerve, vessels and retina, where diabetes, hypertension and brain pressure show up.Exam technique
• Otoscopy and the Rinne and Weber testsLooking into the ear with an otoscope and using a tuning fork to tell whether hearing loss is conductive or sensorineural.Maneuver
• Mouth and pharynx examinationHow lips, gums, teeth, tongue, palate, tonsils and throat are checked, and which findings get reported.Exam technique

Respiratory system

Inspection, palpation, percussion and auscultation of the chest, and the pleuropulmonary syndromes.

• Chest inspection: shape, expansion, accessory muscles and retractionsLook at the chest and the breathing before touching: shape, symmetry, rate and effort say a lot about the lungs.Exam technique
• Chest palpation: expansion and tactile fremitusThe hands check whether both sides of the chest expand equally and whether the voice vibrates equally over both lungs.Exam technique
• Chest percussion: resonance, dullness and hyperresonanceTapping the chest makes a sound that changes when air, fluid or solid tissue lies underneath.Exam technique
• Lung auscultation: normal breath soundsThe stethoscope lets the examiner hear air moving in and out; knowing normal sounds is the basis for spotting abnormal ones.Exam technique
• Adventitious sounds: crackles, wheezes, rhonchi, stridor and pleural rubSounds that do not exist in healthy lungs; each type points to a different mechanism: fluid, narrow airways or inflamed pleura.Sign
• Voice sounds: bronchophony, egophony and whispered pectoriloquyThe examiner listens while the patient speaks or whispers: if the voice comes through clearly, the lung beneath is solid.Sign
• Respiratory symptoms: cough, sputum, hemoptysis and dyspneaThe key questions about cough, phlegm, coughing up blood and breathlessness, and what each answer suggests.Topic
• The pleuropulmonary syndromes: the comparison table to knowFive syndromes and what each step of the chest exam finds in them: the most-asked table.Topic
• Consolidation syndromeWhen the air sacs fill with fluid or cells, the lung becomes solid and sounds and vibrates differently on exam.Syndrome
• Pleural effusion syndromeFluid between the lung and the chest wall: the base sounds dull and voice and breath sounds are barely heard.Syndrome
• Pneumothorax syndromeAir between the lung and the chest wall: the lung collapses, that side sounds hollow and breathing cannot be heard.Syndrome
• Atelectasis syndromePart of the lung collapses and loses air: that side of the chest pulls in and the trachea shifts toward it.Syndrome
• Bronchial obstruction syndromeThe airways narrow and air is hard to breathe out: long expiration, wheezes and a chest that fills with air.Syndrome
• Respiratory distress and respiratory failure: the signsThe signs that breathing takes too much effort, and the ones warning that the patient is tiring out.Syndrome
• Pulmonary hyperinflation syndrome (emphysema)The lungs stay full of trapped air: barrel chest, a hollow percussion note and breathing that is almost inaudible.Syndrome
• Cavitation syndromeA cavity inside the lung, sometimes with air and fluid, that drains into a bronchus and produces a lot of sputum.Syndrome

Cardiovascular system

Precordium, heart sounds and murmurs, jugular venous pulse, peripheral pulses and cardiovascular syndromes.

• Precordial inspection and palpation: apex beat, heaves and thrillsLooking at and feeling the chest over the heart tells a lot: where the apex beats, whether a ventricle is enlarged and whether a murmur vibrates.Exam technique
• Cardiac auscultation: the areas and the orderListening to the heart at four set places on the chest, always in the same order, so no sound or murmur is missed.Exam technique
• Heart sounds: S1, S2 and its splitting, S3 and S4The heart's two normal beats are its valves closing; extra sounds point to stiff or overloaded ventricles.Sign
• Murmurs: timing, grade, location and radiationA murmur is the sound of turbulent blood flow; describing it well almost always tells which valve is failing.Sign
• Valve murmurs: the table to knowThe seven most-tested murmurs side by side in one table: when they sound, where, where they travel and what changes them.Topic
• Dynamic auscultation: Valsalva, squatting, standing and handgripChanging the patient's posture or effort while listening alters murmurs and helps tell which one it is.Maneuver
• Jugular venous pressure and the venous pulseThe height of the pulsation in the neck vein estimates the pressure inside the right heart, with no needles.Exam technique
• Hepatojugular (abdominojugular) refluxPressing the abdomen gently and steadily and watching whether the neck vein rises and stays up shows whether the right heart can take more blood.Maneuver
• Abnormal pulses: paradoxus, alternans, parvus et tardus, boundingThe shape of the pulse, not just its rate, gives away heart problems: a pulse that weakens on inspiration, alternates or arrives late.Sign
• Peripheral pulses and the ankle–brachial indexFeeling the pulses in arms and legs and comparing ankle and arm blood pressure uncovers blocked arteries.Exam technique
• Allen testBefore puncturing the artery at the wrist, check that the hand's other artery can supply it on its own.Maneuver
• Signs of deep vein thrombosis: Homans and the Wells scoreA swollen, warm, painful leg on one side may be a clot; a simple score helps decide whether to look for it.Sign
• Varicose veins: the Trendelenburg (Brodie–Trendelenburg) testEmptying the veins with the leg raised, applying a tourniquet and watching how they fill on standing shows where the valves fail.Maneuver
• Heart failure syndrome: left- and right-sided signsWhen the heart cannot pump well, fluid builds up behind it: in the lungs if the left side fails, in the body if the right side fails.Syndrome
• Cardiac tamponade: Beck triad and pulsus paradoxusFluid or blood under pressure in the sac around the heart stops it from filling; it is an emergency recognized at the bedside.Syndrome
• Shock: the clinical signs and the typesShock means the blood cannot deliver enough oxygen to the organs; it shows in the skin, the mind, the urine and the pulse.Syndrome
• Chest pain: ischemic, pericardial, pleural and other patternsNot all chest pain comes from the heart, but the cardiac and life-threatening kinds must be recognized fast.Syndrome
• Acute limb ischemia and chronic arterial insufficiencyA leg that suddenly turns cold, pale and pulseless is an emergency; pain on walking that stops with rest is the chronic form.Syndrome
• Hypertensive emergency: target-organ signsVery high blood pressure is an emergency when it is already harming the brain, eyes, heart, aorta or kidney; the exam looks for that harm.Syndrome

Abdomen

The abdominal exam, its named signs and the acute abdomen.

• Abdominal regions and quadrants: what lies under eachImaginary lines divide the abdomen into four quadrants or nine regions, so you can say where it hurts and which organ may be involved.Topic
• Abdominal inspectionLooking at the abdomen in good light before touching it: shape, skin, scars, veins, movements and hernias.Exam technique
• Abdominal auscultation: bowel sounds and bruitsListening to the abdomen with a stethoscope before touching it, to hear the gut working and any bruits over the arteries.Exam technique
• Abdominal percussion: liver span and tympanyTapping on the abdomen with the fingers to tell whether air (hollow sound) or an organ or fluid (dull sound) lies beneath.Exam technique
• Abdominal palpation: light and deep, guarding and massesFeeling the abdomen first gently and then more firmly to look for tenderness, tense muscles, enlarged organs and masses.Exam technique
• Murphy signPressing below the right ribs while the patient breathes in deeply makes the pain cut the breath short: it suggests an inflamed gallbladder.Sign
• McBurney pointA spot in the lower right abdomen; marked pain when it is pressed suggests appendicitis.Sign
• Rebound tenderness (Blumberg sign)It hurts more when the hand is lifted suddenly than when it presses the abdomen: a sign that the peritoneum is irritated.Sign
• Rovsing, psoas and obturator signsThree maneuvers that look for pain at a distance or on moving the right hip; they raise suspicion of appendicitis and show where the appendix lies.Sign
• Cullen and Grey Turner signsBruising around the umbilicus (Cullen) or on the flanks (Grey Turner) that points to blood inside or behind the abdomen.Sign
• Ascites: shifting dullness and fluid waveManeuvers to tell whether a swollen abdomen holds free fluid: the dull note moves with position, and a tap on one side is felt on the other.Maneuver
• Palpation of the liver and spleenTechniques to feel the edge of the liver and spleen under the ribs as the patient breathes in deeply, and tell whether they are enlarged.Maneuver
• Costovertebral angle tenderness (fist percussion)A gentle blow with the fist over a hand laid on the lower back, over the kidney; marked pain suggests an inflamed or blocked kidney.Sign
• Examination of the groin and abdominal wall for herniasChecking the groin, umbilicus and scars, standing and while coughing, to find bulges pushing through weak spots in the wall.Exam technique
• Digital rectal examinationAn exam with a gloved, lubricated finger inside the rectum to check the anus, the rectum and, in men, the prostate.Exam technique
• Courvoisier signIn someone with jaundice, a large gallbladder that can be felt and does not hurt points to a tumor blocking the bile duct, not to stones.Sign
• Acute abdomen and peritoneal irritationSevere, recent abdominal pain that may need urgent surgery; the exam looks for signs that the peritoneum is inflamed.Syndrome
• Bowel obstruction syndromeBowel contents cannot move forward: colicky pain, vomiting, a swollen belly and no passing of gas or stool.Syndrome
• Portal hypertension and the signs of chronic liver diseaseWhen blood cannot flow well through the liver, pressure in the portal vein rises: varices, ascites and a large spleen appear.Syndrome
• Jaundice: prehepatic, hepatic and posthepaticYellow skin and eyes from too much bilirubin; the color of the urine and stool helps show where the problem is.Syndrome
• Upper and lower gastrointestinal bleedingBleeding in the gut: vomiting blood, black stools or red blood from the rectum. The first step is to see whether the patient is stable.Syndrome

Systemic syndromes

Anemia, bleeding, sepsis, thyroid, adrenal and fluid status, seen at the bedside.

• Anemia syndromeToo few red cells or too little hemoglobin: tiredness, pallor, breathlessness on effort and palpitations.Syndrome
• Bleeding syndromes: platelet vs coagulation patternAbnormal bleeding: the kind of skin lesion and the site of bleeding show whether platelets or clotting factors are failing.Syndrome
• Fever, infection and sepsis: the bedside signsSepsis is an infection that harms the organs; warning signs are fast breathing, confusion and low blood pressure.Syndrome
• Hyperthyroidism and hypothyroidism: the signsThe thyroid sets the body's speed: with too much hormone everything speeds up, with too little everything slows down.Syndrome
• Cushing syndrome and adrenal insufficiency: the signsToo much cortisol (Cushing) or too little adrenal hormone (Addison): two opposite pictures you can recognize on examination.Syndrome
• Dehydration and fluid overloadToo little fluid (thirst, dry mouth, little urine) or too much (swelling, breathlessness): the exam helps tell them apart.Syndrome

Kidney, genitourinary, breast and obstetric exam

Urinary symptoms, kidney and bladder, genitals, breast, the pelvic exam and Leopold maneuvers.

• Urinary symptoms: dysuria, frequency, oliguria and hematuriaBurning when passing urine, passing urine very often, passing very little, or seeing blood: what each symptom means and how to ask about it.Topic
• Kidney palpation: bimanual palpation and ballottementThe kidney is felt with one hand under the back and one on the belly while the patient breathes in deeply. If it can be felt, it may be enlarged.Maneuver
• Bladder examination: the distended bladderA full bladder that cannot empty forms a round lump above the pubic bone. It can be seen, felt, and sounds dull when tapped.Exam technique
• Male genital exam: transillumination, cremasteric reflex, Prehn signA respectful check of the penis, scrotum and testes, with consent and a chaperone, to find lumps, hernias or a twisted testis.Exam technique
• Clinical breast examinationA check of both breasts and armpits, with consent and a chaperone, to find lumps, skin or nipple changes and lymph nodes.Exam technique
• Gynecologic examination: speculum and bimanual examA check of the external genitals, of the cervix with a speculum, and of the uterus and ovaries with two hands, always with consent and a chaperone.Exam technique
• Leopold maneuversFour hand maneuvers on a pregnant abdomen that show how the baby lies inside the uterus.Maneuver
• Nephrotic vs nephritic syndromeTwo ways the kidney's filter is damaged: one leaks a lot of protein and causes swelling; the other inflames, with blood in the urine and high blood pressure.Syndrome
• Uremic syndrome and the signs of chronic kidney diseaseWhen the kidneys fail, waste builds up in the blood and brings pallor, itching, nausea, bad breath, confusion and high blood pressure.Syndrome

Musculoskeletal system

The joint exam and the special tests of the hand, spine, shoulder, hip, knee and ankle.

• Joint examination: inspection, palpation and range of motionLook at, feel and move each joint, always against the healthy side, to tell whether the problem is inside the joint or around it.Exam technique
• Phalen and Tinel signsTwo simple wrist maneuvers that bring on tingling in the fingers when the median nerve is squeezed in the carpal tunnel.Maneuver
• Finkelstein testBending the thumb while the wrist tilts toward the little finger causes sharp pain at the edge of the wrist when the thumb tendons are inflamed.Maneuver
• Lasègue sign (straight leg raise) and Bragard signLifting the straight leg of a person lying down: pain that shoots down the back of the leg means a lumbar nerve root is irritated.Maneuver
• Shoulder tests: Neer, Hawkins, Jobe and drop armFour maneuvers that show whether shoulder pain comes from a tendon pinched under the acromion or from a torn rotator cuff.Maneuver
• Lachman test and anterior drawerPulling the shin forward with the knee bent shows whether the anterior cruciate ligament is torn: the tibia slides too far and without a firm stop.Maneuver
• Meniscal tests: McMurray and ApleyBending and twisting the knee while feeling the joint line can produce a painful click when a meniscus is torn.Maneuver
• Knee effusion: patellar tap and bulge signTwo maneuvers to tell whether there is fluid inside the knee: the kneecap that bounces when there is a lot and the bulge that appears when there is little.Maneuver
• Ortolani and Barlow maneuversTwo gentle maneuvers on a newborn's hip: one puts a dislocated hip back in place (Ortolani) and the other shows whether an unstable hip slips out (Barlow).Maneuver
• Trendelenburg sign and gaitWhen a person stands on one leg and the hip on the other side drops, the gluteus medius of the standing leg is weak.Sign
• FABER (Patrick) and FADIR testsTwo maneuvers with the leg bent in different positions to tell whether pain comes from the hip, the hip labrum or the sacroiliac joint.Maneuver
• Spine examination: the Adams forward-bend test and Schober testBending forward reveals the rib hump of scoliosis (Adams), and measuring how much the low-back skin stretches shows whether the lumbar spine is stiff (Schober).Maneuver
• Thompson testSqueezing the calf of a person lying face down should point the foot downward; if the foot does not move, the Achilles tendon is torn.Maneuver
• Ottawa ankle and knee rulesA few questions and spots to press help decide whether a twisted ankle or knee needs an X-ray.Topic
• Compartment syndrome: the early signsWhen pressure rises inside a group of muscles wrapped in fascia, the pain is huge and gets worse when they are stretched: it is an emergency.Syndrome
• Hand deformities: Heberden, Bouchard, swan neck, boutonnièreThe shape of the fingers tells which arthritis a person has: hard nodes in osteoarthritis and bent or drifting fingers in rheumatoid arthritis.Sign
• Inspection of gait and posture (orthopedic)Watching a person stand and walk shows a lot: limps from pain, weak muscles, unequal legs or a crooked spine.Exam technique

Nervous system

Mental status, cranial nerves, motor, reflexes, sensation, cerebellum, meningeal signs and neurological syndromes.

• The neurological examination: order and screening examAn ordered check of the mind, cranial nerves, strength, reflexes, sensation, coordination and gait.Exam technique
• Mental status: orientation, attention and screening testsAn assessment of the patient's consciousness, attention, orientation, memory and language.Exam technique
• Cranial nerve examinationSimple tests that check the twelve nerves that leave the brain and brainstem.Exam technique
• Motor examination: bulk, tone and strength gradingA check of muscle bulk, stiffness or floppiness of the muscles, and strength graded from 0 to 5.Exam technique
• Deep tendon reflexes and their gradingA tap of the hammer on a tendon that triggers an automatic contraction; it checks nerves, roots and spinal cord.Exam technique
• Sensory examination: modalities and dermatomesA check of touch, pain, temperature, vibration and position sense to find where sensation fails.Exam technique
• Babinski signWhen the sole is stroked, the big toe goes up instead of down; in adults it means damage to the brain or spinal cord motor pathway.Sign
• Hoffmann sign and clonusTwo signs of brisk reflexes: the thumb flexes when the middle fingernail is flicked, and the foot beats on its own when stretched.Sign
• Romberg testThe patient stands with the feet together and closes the eyes; losing balance means position sense is failing.Maneuver
• Cerebellar tests: finger–nose, heel–shin and rapid alternating movementsSimple aiming and rhythm tasks that show whether the cerebellum is coordinating movement well.Maneuver
• Pronator driftWith the arms outstretched and the eyes closed, an arm that turns in and sinks shows subtle weakness of the motor pathway.Maneuver
• Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddlingThe way a person walks reveals where the problem is: brain, basal ganglia, cerebellum, nerves or muscles.Sign
• Meningeal signs: neck stiffness, Kernig and BrudzinskiManoeuvres that look for pain or resistance when inflamed meninges are stretched, as in meningitis.Sign
• Pupils: light reflex and abnormal pupils (Marcus Gunn, Horner, Argyll Robertson)A check of pupil size and response to light, which localises lesions of the eye, the nerves and the brain.Sign
• Recognising a stroke: BE-FAST and the NIH Stroke ScaleSudden signs of a brain attack: balance, eyes, face, arm and speech; every minute counts.Topic
• Upper vs lower motor neuron syndromeTwo patterns of weakness: one with stiffness and brisk reflexes (brain or cord) and one with floppiness and wasting (nerves).Syndrome
• Spinal cord syndromes: complete, Brown-Séquard, central, anteriorPatterns of weakness and sensory loss that show which part of the spinal cord is damaged.Syndrome
• Parkinsonian syndromeSlowness of movement with a resting tremor, stiffness and problems with gait and balance.Syndrome
• Cerebellar syndromeClumsy coordination: staggering gait, tremor when aiming, broken-up speech and abnormal eye movements.Syndrome
• Intracranial hypertension syndromeRaised pressure inside the skull: headache, vomiting, blurred vision and drowsiness; it can be fatal.Syndrome
• Meningeal syndromeSevere headache, stiff neck, discomfort with light and vomiting, with or without fever, from irritated meninges.Syndrome

A to Z

• Abdominal auscultation: bowel sounds and bruitsAbdomen · Exam technique
• Abdominal inspectionAbdomen · Exam technique
• Abdominal palpation: light and deep, guarding and massesAbdomen · Exam technique
• Abdominal percussion: liver span and tympanyAbdomen · Exam technique
• Abdominal regions and quadrants: what lies under eachAbdomen · Topic
• Abnormal gaits: hemiparetic, parkinsonian, ataxic, steppage, waddlingNervous system · Sign
• Abnormal pulses: paradoxus, alternans, parvus et tardus, boundingCardiovascular system · Sign
• Acute abdomen and peritoneal irritationAbdomen · Syndrome
• Acute limb ischemia and chronic arterial insufficiencyCardiovascular system · Syndrome
• Adventitious sounds: crackles, wheezes, rhonchi, stridor and pleural rubRespiratory system · Sign
• Allen testCardiovascular system · Maneuver
• Analysing a symptom: onset, site, character, radiation and moreHistory taking and the interview · Topic
• Anemia syndromeSystemic syndromes · Syndrome
• Arterial pulse: rate, rhythm and amplitudeGeneral exam and vital signs · Vital sign
• Ascites: shifting dullness and fluid waveAbdomen · Maneuver
• Atelectasis syndromeRespiratory system · Syndrome
• Babinski signNervous system · Sign
• Bladder examination: the distended bladderKidney, genitourinary, breast and obstetric exam · Exam technique
• Bleeding syndromes: platelet vs coagulation patternSystemic syndromes · Syndrome
• Blood pressure measurementGeneral exam and vital signs · Vital sign
• Body temperature and fever patternsGeneral exam and vital signs · Vital sign
• Bowel obstruction syndromeAbdomen · Syndrome
• Bronchial obstruction syndromeRespiratory system · Syndrome
• Capillary refill timeGeneral exam and vital signs · Sign
• Cardiac auscultation: the areas and the orderCardiovascular system · Exam technique
• Cardiac tamponade: Beck triad and pulsus paradoxusCardiovascular system · Syndrome
• Cavitation syndromeRespiratory system · Syndrome
• Cerebellar syndromeNervous system · Syndrome
• Cerebellar tests: finger–nose, heel–shin and rapid alternating movementsNervous system · Maneuver
• Chest inspection: shape, expansion, accessory muscles and retractionsRespiratory system · Exam technique
• Chest pain: ischemic, pericardial, pleural and other patternsCardiovascular system · Syndrome
• Chest palpation: expansion and tactile fremitusRespiratory system · Exam technique
• Chest percussion: resonance, dullness and hyperresonanceRespiratory system · Exam technique
• Chief complaint and history of present illnessHistory taking and the interview · History
• Clinical breast examinationKidney, genitourinary, breast and obstetric exam · Exam technique
• Compartment syndrome: the early signsMusculoskeletal system · Syndrome
• Comprehensive geriatric assessment: function, cognition, fallsHistory taking and the interview · History
• Consolidation syndromeRespiratory system · Syndrome
• Costovertebral angle tenderness (fist percussion)Abdomen · Sign
• Courvoisier signAbdomen · Sign
• Cranial nerve examinationNervous system · Exam technique
• Cullen and Grey Turner signsAbdomen · Sign
• Cushing syndrome and adrenal insufficiency: the signsSystemic syndromes · Syndrome
• Deep tendon reflexes and their gradingNervous system · Exam technique
• Dehydration and fluid overloadSystemic syndromes · Syndrome
• Diagnostic faciesGeneral exam and vital signs · Sign
• Digital clubbing and nail signsSkin, head and neck · Sign
• Digital rectal examinationAbdomen · Exam technique
• Dynamic auscultation: Valsalva, squatting, standing and handgripCardiovascular system · Maneuver
• Early warning scores: NEWS2 and qSOFAGeneral exam and vital signs · Topic
• Edema: pitting, grading and distributionGeneral exam and vital signs · Sign
• Examination of the groin and abdominal wall for herniasAbdomen · Exam technique
• Eye exam: visual acuity, visual fields and eye movementsSkin, head and neck · Exam technique
• FABER (Patrick) and FADIR testsMusculoskeletal system · Maneuver
• Fever, infection and sepsis: the bedside signsSystemic syndromes · Syndrome
• Finkelstein testMusculoskeletal system · Maneuver
• From findings to diagnosis: problem list, differential and SOAP noteHistory taking and the interview · Topic
• Fundoscopy: the optic disc, papilledema and retinopathySkin, head and neck · Exam technique
• General inspection: appearance, posture, gait and consciousnessGeneral exam and vital signs · Exam technique
• Gynecologic and obstetric historyHistory taking and the interview · History
• Gynecologic examination: speculum and bimanual examKidney, genitourinary, breast and obstetric exam · Exam technique
• Hand deformities: Heberden, Bouchard, swan neck, boutonnièreMusculoskeletal system · Sign
• Heart failure syndrome: left- and right-sided signsCardiovascular system · Syndrome
• Heart sounds: S1, S2 and its splitting, S3 and S4Cardiovascular system · Sign
• Hepatojugular (abdominojugular) refluxCardiovascular system · Maneuver
• Hoffmann sign and clonusNervous system · Sign
• Hydration status: signs of dehydrationGeneral exam and vital signs · Exam technique
• Hypertensive emergency: target-organ signsCardiovascular system · Syndrome
• Hyperthyroidism and hypothyroidism: the signsSystemic syndromes · Syndrome
• Inspection of gait and posture (orthopedic)Musculoskeletal system · Exam technique
• Interviewing in special situations: interpreters and breaking bad newsHistory taking and the interview · Topic
• Intracranial hypertension syndromeNervous system · Syndrome
• Jaundice: prehepatic, hepatic and posthepaticAbdomen · Syndrome
• Joint examination: inspection, palpation and range of motionMusculoskeletal system · Exam technique
• Jugular venous pressure and the venous pulseCardiovascular system · Exam technique
• Kidney palpation: bimanual palpation and ballottementKidney, genitourinary, breast and obstetric exam · Maneuver
• Knee effusion: patellar tap and bulge signMusculoskeletal system · Maneuver
• Lachman test and anterior drawerMusculoskeletal system · Maneuver
• Lasègue sign (straight leg raise) and Bragard signMusculoskeletal system · Maneuver
• Leopold maneuversKidney, genitourinary, breast and obstetric exam · Maneuver
• Level of consciousness and the Glasgow Coma ScaleGeneral exam and vital signs · Exam technique
• Lung auscultation: normal breath soundsRespiratory system · Exam technique
• Lymph node examinationSkin, head and neck · Exam technique
• Male genital exam: transillumination, cremasteric reflex, Prehn signKidney, genitourinary, breast and obstetric exam · Exam technique
• McBurney pointAbdomen · Sign
• Medicines, allergies and habits: tobacco, alcohol and other substancesHistory taking and the interview · History
• Meningeal signs: neck stiffness, Kernig and BrudzinskiNervous system · Sign
• Meningeal syndromeNervous system · Syndrome
• Meniscal tests: McMurray and ApleyMusculoskeletal system · Maneuver
• Mental status: orientation, attention and screening testsNervous system · Exam technique
• Motor examination: bulk, tone and strength gradingNervous system · Exam technique
• Mouth and pharynx examinationSkin, head and neck · Exam technique
• Murmurs: timing, grade, location and radiationCardiovascular system · Sign
• Murphy signAbdomen · Sign
• Nephrotic vs nephritic syndromeKidney, genitourinary, breast and obstetric exam · Syndrome
• Nursing assessment: head-to-toe and focused assessmentHistory taking and the interview · Topic
• Orthostatic vital signsGeneral exam and vital signs · Vital sign
• Ortolani and Barlow maneuversMusculoskeletal system · Maneuver
• Otoscopy and the Rinne and Weber testsSkin, head and neck · Maneuver
• Ottawa ankle and knee rulesMusculoskeletal system · Topic
• Pain assessment and pain scalesGeneral exam and vital signs · Vital sign
• Pallor, cyanosis and jaundiceGeneral exam and vital signs · Sign
• Palpation of the liver and spleenAbdomen · Maneuver
• Parkinsonian syndromeNervous system · Syndrome
• Past medical, surgical, family and social historyHistory taking and the interview · History
• Pediatric history: perinatal, growth, development and vaccinesHistory taking and the interview · History
• Peripheral pulses and the ankle–brachial indexCardiovascular system · Exam technique
• Phalen and Tinel signsMusculoskeletal system · Maneuver
• Pleural effusion syndromeRespiratory system · Syndrome
• Pneumothorax syndromeRespiratory system · Syndrome
• Portal hypertension and the signs of chronic liver diseaseAbdomen · Syndrome
• Precordial inspection and palpation: apex beat, heaves and thrillsCardiovascular system · Exam technique
• Pronator driftNervous system · Maneuver
• Pulmonary hyperinflation syndrome (emphysema)Respiratory system · Syndrome
• Pulse oximetryGeneral exam and vital signs · Vital sign
• Pupils: light reflex and abnormal pupils (Marcus Gunn, Horner, Argyll Robertson)Nervous system · Sign
• Rebound tenderness (Blumberg sign)Abdomen · Sign
• Recognising a stroke: BE-FAST and the NIH Stroke ScaleNervous system · Topic
• Respiratory distress and respiratory failure: the signsRespiratory system · Syndrome
• Respiratory rate and breathing patternsGeneral exam and vital signs · Vital sign
• Respiratory symptoms: cough, sputum, hemoptysis and dyspneaRespiratory system · Topic
• Review of systemsHistory taking and the interview · History
• Romberg testNervous system · Maneuver
• Rovsing, psoas and obturator signsAbdomen · Sign
• Sensory examination: modalities and dermatomesNervous system · Exam technique
• Shock: the clinical signs and the typesCardiovascular system · Syndrome
• Shoulder tests: Neer, Hawkins, Jobe and drop armMusculoskeletal system · Maneuver
• Signs of deep vein thrombosis: Homans and the Wells scoreCardiovascular system · Sign
• Skin examination: primary and secondary lesionsSkin, head and neck · Exam technique
• Spinal cord syndromes: complete, Brown-Séquard, central, anteriorNervous system · Syndrome
• Spine examination: the Adams forward-bend test and Schober testMusculoskeletal system · Maneuver
• The ABCDE of pigmented lesionsSkin, head and neck · Sign
• The clinical history: its parts and their orderHistory taking and the interview · History
• The medical interview: rapport, open questions and listeningHistory taking and the interview · History
• The neurological examination: order and screening examNervous system · Exam technique
• The pleuropulmonary syndromes: the comparison table to knowRespiratory system · Topic
• Thompson testMusculoskeletal system · Maneuver
• Thyroid examinationSkin, head and neck · Exam technique
• Trendelenburg sign and gaitMusculoskeletal system · Sign
• Upper and lower gastrointestinal bleedingAbdomen · Syndrome
• Upper vs lower motor neuron syndromeNervous system · Syndrome
• Uremic syndrome and the signs of chronic kidney diseaseKidney, genitourinary, breast and obstetric exam · Syndrome
• Urinary symptoms: dysuria, frequency, oliguria and hematuriaKidney, genitourinary, breast and obstetric exam · Topic
• Valve murmurs: the table to knowCardiovascular system · Topic
• Varicose veins: the Trendelenburg (Brodie–Trendelenburg) testCardiovascular system · Maneuver
• Vital signs in children: how they change with ageGeneral exam and vital signs · Topic
• Vital signs: what they are and how to record themGeneral exam and vital signs · Topic
• Voice sounds: bronchophony, egophony and whispered pectoriloquyRespiratory system · Sign
• Weight, height, body mass index and waist circumferenceGeneral exam and vital signs · Exam technique

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Representative model, for educational purposes only.