MOUNTAIN VIEW COLLEGE

School of Nursing
Valencia City, Bukidnon

HEALTH ASSESSMENT CHECKLIST

Name: ______________________________ Section: _____ Set: ____ Score: _______ Grade: ________

0 1 2 3 Comments
I. Preliminaries
1. Greet client by name.
2. Introduce self by name.
3. Explain the purpose of procedure.
II. General Survey
1. Observe general appearance as to the body build, height and
weight.
2. Observe overall hygiene and grooming, posture, gait and dress.
III. Integumentary System
1. Inspect both exposed/unexposed areas for skin color, odor &
integrity.
2. Inspect, palpate and describe skin lesions noting its location,
distribution, arrangement, type and color.
3. Palpate skin temperature, moisture and texture.
4. Note skin turgor. Gently pinch a fold of skin on an unexposed
area (such as below the clavicle) and note any tenting.
5. Assess for presence of edema. Press your index finger over the
bony prominence of the tibia or medial malleolus and note for
pitting.
6. Inspect hair color, quantity, distribution, condition of scalp,
lesions and pediculosis.
7. Palpate hair for texture and scalp for tenderness and mobility.
8. Inspect nails for color, condition, shape & angle of attachment.
9. Palpate for nail texture.
10. Assess capillary refill. Gently press on nail and note blanching,
then release and note speed of refill (color return).
IV. Head
1. Inspect the head for size and shape and symmetry of facial
features.
2. Palpate the skull for nodules, masses or depressions. Examiner
uses a gentle rotating motion with the fingertips. Begin at the
front and palpate down the midline to the occipital area, then
palpate on each side of the head.
3. Note symmetry of facial movements (cranial nerve VII). Ask the
client to elevate the eyebrows , frown, smile, etc.
4. While palpating the temporal and masseter muscles in turn,
examiner asks client to turn his head (sides, back and front)
against your resistance (cranial nerve V).
5. Test for pain. With client’s eyes closed, test the forehead and
cheeks on each side for pain sensation. Use a safety pin
substituting the blunt/sharp end. Ask client to report the
sensation felt.
6. Test for light touch. Using a fine wisp of cotton, ask the client to
respond by saying “Now or Ok” whenever you touch the skin.
Examiner applies the stimuli on one or both sides of the face.
V. Eyes
1. Note clarity and parallel alignment of the eyes. Note presence of

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 contact lenses.
2. Inspect the eyebrows for hair distribution and alignment;
eyelashes for evenness of distribution, inversion & eversion.
3. Observe the eyelids and note for edema and lesions.
4. Inspect eyeball and note for protrusion. Gently palpate below
eyebrow and note firmness of eyeball.
5. Inspect nasolacrimal glands and nasolacrimal ducts for swelling,
redness or drainage and palpate for swelling and tenderness.
6. Inspect the pupils for color, shape and symmetry of size (cranial
nerve III/IV). Examiner asks client to look straight ahead. Using
a penlight and approaching from the side, shine a light on the
pupil. Observe the response/reaction of the illuminated pupil and
also the other pupil.
7. Inspect bulbar and palpebral conjunctiva and note for color and
presence of foreign objects.
8. Note color of sclera.
9. Inspect cornea and lens by shining a light on the cornea from an
oblique angle. Note clarity and abrasions.
10. Test for corneal reflex. Ask the client to look up and away from
you. Approaching from the other side, out of client’s line of
vision and avoiding the eyelashes, touch the cornea lightly with
a wisp of rolled cotton, or take a needleless syringe filled with
air and shoot a puff of air over the cornea, note blinking and
tearing.
11. Test for blinking reflex. Brush your index finger across patient’s
eyelashes and note blinking.
12. Note for color and shape of iris.
13. Inspect the pupil s for color, symmetry of size and equality.
14. Test for pupillary reaction to light. Examiner asks the client to
look straight ahead. Using a penlight and approaching from the
side, shine a light on the pupil. Observe for reaction and speed in
both eyes.
15. Test for accommodation (adjustment of eye for various
distances). Hold your finger or an object in front of patient from
a distance of about 14 inches from patient. Instruct patient to
focus on finger or object while you move finger or object closer
to patient. Note convergence of eyes and constriction of pupils
as object gets closer.
16. Test for anterior chamber. Have patient look straight ahead as
you shine a light from the side across the eye. Note clarity and
shadowing from iris.
17. Check the visual acuity:
a. Distance vision). Examiner asks client to stand 20 feet from
the Snellen chart. Test the right eye, left eye, both eyes.
Record the readings, that is, the smallest line from which the
person is able to read with no more than 2 mistakes.
b. Near Vision. Have pt. hold newsprint about 14 inches away
and read. Test the right eye, left eye and both eyes.
c. Color vision. Have patient identify color bars on snellen eye
chart
d. Assess visual fields (Cranial nerves II). Stand in front of
patient, face to face about 1-1 ½ ft. apart. Ask client to fix
gaze straight ahead and cover one eye. Bring a pen or wiggle
your finger in from the periphery from four different fields
(superior, inferior, temporal, nasal). Have pt. say “now” once
fingers or object are seen. Measure degree of peripheral

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 vision using patient’s fixed gaze as a base.
e. Assess the extraocular muscles:
 Corneal light reflex test. Shine a light directly in patient’s
eye; note position of the light reflection off the cornea in
each eye.
 Cover and uncover test. Cover patient’s one eye and have
patient focus on object afar. Uncover eye and note any
drifting.
 Cardinal Fields of gaze test. Stand in front of patient and
instruct him or her to fix gaze straight ahead. Instruct him
to follow your finger or an object such as a pen through
the six cardinal fields. Note patient’s ability to do so, and
note any nystagmus.
f. Assess for extra ocular movements. Examiner positions
directly in front of the client and holds the penlight 1 ft. in
front of the client’s eyes at equidistance between client and
examiner. With the client’s head in a fixed position, move
the object in various points. Stop momentarily to note for
abnormal eye movements.
g. Palpate lacrimal glands below eyebrows and nasolacrimal
ducts on the inner canthus of eyes.
h. Palpate the eyeball gently below eyebrow and note for
firmness of eyeball.
VI. EARS
1. Inspect the auricles for color, symmetry of size and position.
Note the level at which the superior aspect of the auricle attaches
to the head in relation to the eye.
2. Palpate the auricles for texture, elasticity and tenderness.
Examiner pulls the auricle upward, downward and back. Fold
the pinna forward. Push in the tragus.
3. Check for auditory acuity :
a. Whisper test (for low-pitch deficits). Have patient cover
opposite ear being tested. Examiner stands about 1-2 ft.
behind patient, and whisper. Note patient’s ability to hear
sound.
b. Watch tick test (for high-pitch deficits). Have patient cover
opposite ear being tested. Hold ticking watch within 5 inches
from ear. Note patient’s ability to hear sound.
4. Perform the Weber’s test (cranial nerve VIII). Examiner holds
tuning fork by stem. Tap tuning fork prongs on palm of your
hand. Place vibrating tuning fork in the middle of the patient’s
forehead or on top of patient’s head. Note patient’s ability to
hear sound; note lateralization of sound.
5. Perform Rinne Test (cranial nerve VIII). Place vibrating tuning
fork on the mastoid process. Count the time until patient can no
longer hear tuning fork. Immediately bring vibrating tuning in
front of ear. Continue to note the length of time until patient no
longer hears sound.
6. Perform Romberg’s test (tests inner ear vestibular function).
Have patient stand with feet together, eyes opened and then eyes
closed for 20-30 seconds. Stand close by in case patient loses
balance. Note patient’s ability to maintain balance with minimal
sway.
VII. Nose & Sinuses
1. Inspect the external nose for any deviations in shape, size, &
color. Note for nasal flaring and drainage from the nares.

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 2. Determine patency by both nasal cavities. Examiner asks client
to close the mouth, exert pressure on one nares and breathe
through the opposite nares. Repeat procedure on opposite nares.
3. Inspect the nasal cavities using a penlight. With one hand
holding the penlight, examiner instructs client to tilt the head
back. Inspect lining of the nares for redness or swelling, growths
and discharge. Note position of nasal septum between nasal
chambers, especially for deviation to right or left.
4. Test for olfaction sense (cranial nerve I). With client’s eyes
closed, examiner presents familiar non-irritating odors. Occlude
one nostril and under the other, hold one of several substances
for the client to smell. Ask if client smell anything, and if so,
what.
5. Inspect frontal and maxillary sinuses.
6. Transilluminate frontal sinuses by shining light upward under
eyebrow and maxillary sinuses by shining light below eyes while
looking for a red glow on the roof (palate) of the mouth.
7. Palpate frontal sinuses by pressing upward just below eyebrows
and maxillary sinuses by pressing below eyes and note for
tenderness.
8. Percuss frontal sinuses with direct or immediate percussion
above eyebrows and maxillary sinuses with direct or immediate
percussion below eyes and note for tenderness and tone.
VIII. Mouth and Pharynx
1. Inspect color, condition, lesion and odor of lips.
2. Have patient open and close mouth. Note occlusion and
number, color, condition of teeth.
3. Inspect color, condition, lesions of mucosa. Note condition
of gingival, bleeding, retraction, or hypertrophy.
4. Inspect color and condition of hard and soft palate
5. Inspect salivary ducts:
a. Stensen’s duct: Inspect inner aspect of cheek (buccal
mucosa) opposite the second upper molar.
b. Wharton’s duct: have patient lift tongue and inspect the
Floor of mouth.
6. Inspect color, texture and moisture of tongue.
7. Inspect for tongue movement (cranial nerve XII). Examiner
asks client to move the tongue from side to side. Ask client
to push the tongue against the inside of each cheek in turn as
you palpate externally for strength.
8. Inspect oropharynx for color, lesions and drainage.

9. Locate tonsils posterior to arches on sides of throat. Note

color, size and exudates.
10. Have patient say “ah” and note symmetrical rise of the uvula.
11. Test the gag reflex (Cranial nerve IX). With client’s mouth
open, examiner touches the back of the tongue with the
tongue blade. Also, ask client to swallow, say “ah” and
watch the movements of soft palate and pharynx.

12. Test for taste sensation (Cranial Nerve VII) on anterior two-
thirds of tongue for sweet, sour, salty and bitter.
13. Lightly palpate lips and tongue for consistency and
tenderness.
14. Palpate parotid, submandibular and sublingual glands.

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IX. Neck
1. Inspect neck in neutral and hyperextended positions and as
patient swallows.
2. Observe head movement. Examiner ask s client to:
a. Move the chin to chest /bend the head forward.
b. Move the head back so that the chin points upward/bend
head backward.
c. Move the head so that the ear is moved toward the
shoulder on each side/bent the head to the sides.
d. Turn the head to the right and to the left.
3. Test for Cranial Nerve XI. From behind, examiner looks for
atrophy or fasciculations in the trapezius muscles, and
compares one side with the other. Examiner asks client to
shrug both shoulders against the examiner’s hands.
4. Test for Brudzinski’s sign. Have patient lie supine with
her/his head flexed to her/his chest. Note for flexion of hips.
5. Examiner palpate s the entire neck for enlarged lymph
nodes. Examiner faces the client and slightly bends the head
forward or toward the side being examined to relax the soft
tissue muscles. Palpate the nodes using the pads of the
fingers. The fingers are moved in a gentle rotating motion.
6. Palpate the trachea for lateral deviation. The examiner places
the finger or thumb on the trachea on the suprasternal notch,
then moves the fingers laterally to the left and right in the
spaces bordered by the clavicle, the anterior aspect of the
sternocleidomastoid muscle and trachea.
7. Palpate the thyroid gland:
A. Anterior approach: to palpate the right lobe, slide
fingers to the right, gently displace trachea to right, and
palpate gland as patient swallows. To palpate left lobe,
slide fingers to the left, gently displace trachea to the left
and palpate gland as patient swallows.
B. Posterior approach: have patient tilt head to right, and
then gently displace trachea to right, slide fingers to
right, and palpate right thyroid lobe as patient swallows.
To palpate the left lobe, repeat the same technique but
have patient tilt head to left, displace trachea to left, and
palpate the left lobe.
8. Auscultate thyroid gland if palpable. Have patient hold
breath and then listen over the thyroid gland with the bell
portion of the stethoscopes for bruits.
X. Back
1. Inspect and palpate the spine and muscles of the back for shape
and form. From behind, examiner notes for any curves,
differences in the height of shoulders, iliac crests, skin creases.
Normally, an imaginary line can be drawn from the spinous
process of T1 through the gluteal cleft.
XI. thorax and lungs
1. Inspect the anterior, lateral and posterior chest and note for
respiratory rate, rhythm, depth, and symmetry of chest
movements. Inspect AP to lateral ratio, costal angle, spinal
deformities and condition of skin.
2. Check the tracheal position. Place your thumb and index finger
on either side of the trachea, and note position and distance
between trachea and sternocleidomastoid muscle.
3. Palpate the anterior chest for tenderness and crepitus.

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 4. Palpate the chest for respiratory excursion. Feel for equal
expansion of the chest; if absent, decreased, or unequal, move up
the chest
Anterior chest: place hands vertically on the chest with
fingers spread on the costal margin and thumbs together
at the costal angle (like butterfly).
5. Palpate the anterior chest for tactile fremitus. Place balls of your
hands with your fingers hyperextended or the ulnar surface of
your hand on the patient’s chest. Have patient say “99” as you
palpate vibrations. Note level which fremitus is palpable,
increased, diminished, or absent.
6. Percuss the anterior thorax. Use indirect or mediate percussion,
Percuss over intercostals spaces. Note areas of resonance,
hyperresonance or dullness.
7. Auscultate the anterior chest. Use the diaphragm portion of the
stethoscope. Listen to one full respiratory cycle at each site.
Note for normal, abnormal and adventitious sounds.
8. Percuss the lateral thorax.
9. Auscultate the lateral chest.
10. Palpate the posterior chest for tenderness and crepitus.
11. Palpate the posterior chest for respiratory excursion. Place hands
vertically on the chest with fingers spread and the thumbs
together at the spine at the 8th – 10th rib (like a butterfly).
12. Palpate the posterior chest for tactile fremitus.
13. Percuss the posterior thorax.
14. Percuss for diaphragmatic excursion. Have patient take a deep
breath and hold it while percussing downward along the scapular
line until dullness is produced at the level of diaphragm. This
point is marked with a pencil. The procedure is repeated on the
other side of the chest. Then, have patient take a few normal
breaths and then expel the last breath completely and hold it.
Meanwhile, percussion is done upward from the marked point to
assess and mark the diaphragmatic excursion during deep
expiration on each side.
15. Auscultate the posterior chest.
16. Auscultate for abnormal vocal sounds:
a. Egophony. Ask the patient to say "eeee" while you auscultate the
lungs through the stethoscope at various places.
b. Whispered pectoriloquy. Ask patient to whisper one, two, and three
while you auscultate the lungs.
c. Bronchophony. Ask the patient to say "99" while you auscultate the
lungs.
XII. Breasts and Axilla
1. Inspect the breast of the client in various positions. Note size,
shape, symmetry, lesions, discharge, venous pattern, dimpling or
retraction.
a. Sitting, arms at side.
b. Sitting, arms over head.
c. Sitting, hands on hips
d. Sitting, leaning forward
e. Supine, with pillow under shoulder of breast being examined.
f. Sitting, pushing hands together.
2. Inspect position, direction, discharge or lesions of nipples and
areola. Note presence of supernumerary nipples.
3. Inspect the Axilla and note for color and presence of lesions.
4. Palpate the breasts (male/female) for masses and tenderness.
Position patient supine with arm over head and small pillow

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 under shoulder of breast being examined. Use 3 levels of
palpation: light, medium and deeper. Using your finger pads,
move in circular fashion across breast using vertical strip
method, pie edge method or concentric circle method. Be sure to
cover entire breast area from the sternum to the midaxillary line
and from the clavicle to the 6th or 7th intercostals space. Wear
gloves if open lesions or discharge present.
5. Gently palpate the nipple. Note elasticity, tenderness and
discharge.
6. Palpate Axilla and Clavicular nodes. If nodes are palpable, note
size, shape, tenderness, mobility and consistency.
XIII. Cardiovascular System.
1. Inspect the carotid artery and jugular venous system.
2. Measure jugular venous pressure. Position patient with the head
of bed at 30 to 45 degree angle. Place a ruler vertically,
perpendicular to the chest at the angle of Louis (sternal angle).
Identify the highest level of the jugular vein pulsation; if unable
to see pulsations, use the highest level of jugular vein distension.
Place another ruler horizontally at the point of the highest level
of the venous pulsation. Measure the distance up from the chest
wall.
3. Inspect the precordium. Look for pulsations on the precordium,
paying particular attention to the apex area.
4. Palpate the neck.
A. Carotid. Lightly palpate each carotid separately. Note rate,
rhythm, amplitude, contour, symmetry, elasticity and thrills.
B. Jugulars. Palpate jugular veins and check direction of fill.
5. Palpate the precordium. Identify and palpate each cardiac site for
pulsations, thrusts, heaves and thrills.
6. Percuss the precordium. Use direct or mediate percussion to
determine cardiac borders.
7. Auscultate the vascular structures of the neck. Have client hold
breath. Auscultate the carotid with the bell portion of the
stethoscope for bruits. Auscultate the jugulars with the bell
portion of the stethoscope for venous hums.
8. Auscultate the precordium. Note rate, rhythm, extra sounds or
murmurs. Auscultate at each site (apex, LLSB, Erb’s point base
left and base right). Note s1, s2, extra sounds or murmurs. Listen
at each site with both the bell and the diaphragm.
XIV. Abdomen
1. Inspect the abdomen. Have patient empty the bladder. Position
patient supine; knees can be slightly flexed to relax the
abdomen. Inspect the abdomen from side and foot of bed. Note
size, shape, symmetry, movements (respirations, peristalsis and
pulsations), and surface characteristics such as color, hair
distribution, lesions, and striae.
2. Inspect the umbilicus, noting position, contour, color and
discharge. Ask patient to raise head off bed, note any bulges
(hernias).
3. Test the abdominal reflexes. Using a tongue blade, stroke the
abdomen upward and toward the umbilicus in each quadrant.
4. Test for Cutaneous Hypersensitivity. Grasp a fold of skin or
touch the abdominal surface with an open safety pin to assess for
pain. Assess the entire abdominal surface.
5. Measure the Abdominal girth. With the tape measure the
examiner measure the abdominal circumference using the

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 umbilicus as the baseline.
6. Auscultate for bowel sounds. Always auscultate prior to
palpation. Quadrant off the abdomen with the umbilicus as the
midpoint. Use the diaphragm portion of the stethoscope to listen
for bowel sounds in all four quadrants. Listen for at least 5
minutes before stating patient has absent bowel sounds.
7. Auscultate for arterial and venous vascular sounds. Use the bell
portion of the stethoscope.
a. Bruits: Auscultate the abdominal aorta, renal artery, iliac
artery and femoral artery.
b. Listen for venous hum over the liver in the RUQ.
8. Percuss the abdomen. Use indirect or mediate percussion.
Percuss the abdomen in all four quadrants, Percuss tender areas
last. Note areas of dullness and tympany.
9. Percuss the liver. Perform scratch test to locate lower edge of the
liver. Place diaphragm of the stethoscope over the liver in the
RUQ while gently scratching the abdomen with your other hand,
working from the RUQ at the midclavicular line, moving
upwards toward the liver. Mark the point on the abdomen once
the scratch sound is detected. Use indirect or mediate percussion
to determine liver size. Locate the upper edge of the liver by
percussing downward at the midclavicular line from the 4th
intercostals space from resonance to dullness, mark upper border
of liver. Locate the lower edge of the liver by percussing upward
at the midclavicular line from the RLQ from tympany to
dullness; mark the lower border of liver. Measure the distance
between upper and lower marks to obtain liver span. If the liver
span is greater than 12cm at the midclavicular line, a midsternal
measurement can be obtained using the above technique at the
midsternal line.
10. Percuss the spleen. Identify area of splenic dullness. Position
patient on right side, Percuss down the midaxillary line from an
area of resonance over the lung to dullness over the spleen.
11. Test for Balance’s Sign. Percuss the left upper quadrant for
dullness. Note tenderness.
12. Test for Shifting of Dullness. Have patient lie supine and
Percuss the abdomen then have the patient lie on his/her right
side and Percuss again. Next have the patient turn on his/her left
side and Percuss the abdomen. Note for dullness an tympany.
13. Test for Puddle Sign. Ask patient to kneel with his/her hands on
the examining table then percuss the umbilicus for dullness.
14. Percuss the Bladder for dullness at the midline above the
symphysis pubis. You should not be able to Percuss the bladder
above the level of pubic symphysis after the patient has voided.
15. Percuss Costovertebral Angle (CVA). Place nondominant hand
over kidney. Make a fist with dominant hand and strike
nondominant hand. Note any tenderness.
16. Palpate abdomen.
A. Light palpation: lightly palpate about ½ inch in each
quadrant; palpating painful area last. Note surface
characteristics and areas of tenderness.
B. Deep palpation: palpate greater than ½ inch in each quadrant.
Use single hand technique or bimanual technique.
17. Palpate abdominal aorta for pulsations. Palpate in the epigastric
area at the midline
18. Palpate the liver. Stand at the right side. Place left hand under

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 the patient’s back at the CVA, and place right hand along the
costal margin at the right midclavicular line. Have patient take
breath while you press your right hand in and up, while at the
same time with your left hand, and press upward to elevate the
liver.
19. Palpate the spleen. Stand at the right side of your patient. Place
right hand under the patient’s back at the left CVA, and place
left hand along the left costal margin. Have patient take a deep
breath while you press inward along the costal margin.
20. Palpate the kidneys.
 Right kidney: stand at the right side of your patient, and
place your right hand under patient at the CVA and your left
hand below the right costal margin. Capture the kidney by
pressing hands together as the patient breathes.

 Left kidney: use the same technique. Place your left hand
under the patient at the left CVA, and the right hand below
the left costal margin.
21. Palpate the Bladder. Palpate above the symphysis pubis at the
midline.
22. Palpate the Inguinal Lymph Nodes. Palpate the horizontal lymph
nodes in the groin and vertical lymph nodes along the inner
aspect of the thigh.
23. Test the Abdominal Reflexes. Using a tongue blade, stroke the
abdomen upward and toward the umbilicus in each quadrant.
24. Test for Fluid Wave. Have the patient place her/his hand
vertically in the middle of her/his abdomen. Place your hands on
each side of the patient’s abdomen and tap one side while
palpating the other side.
25. Test for Ballottement. Using bimanual technique, place one hand
on the abdomen over mass and push inward toward mass. Place
the other hand at the opposite end of object.
26. Test for Kehr’s sign. With patient supine, move patient’s arm
upward. Note referred pain to left shoulder.
27. Test for Murphy’s sign. Stand at the right side of patient and
palpate at the right midclavicular line under the costal angle as
the patient takes a deep breath. Note pain and restricted
breathing.
28. Test for McBurney’s Sign. Perform rebound tenderness test at
the McBurney’s point and assess for pain.
29. Test for Rovsing’s Sign. Place your hand in LLQ and press
deeply for 5 seconds.
30. Obturator Muscle Test. Have patient lie supine. Flex his right
leg at hip and knee. Place one hand just above the patient’s knee
and other hand at ankle, and rotate leg internally and externally.
31. Iliopsoas Muscle Test. As patient lies supine, place your hand
over her/his lower right lower thigh. Ask patient to raise her/his
right leg by flexing hip while you push downward. Assess for
pain in RLQ.
XV. Lower Extremity/Motor System
1. Inspect position, posture. Inspect normal curves of the spine
with the patient standing.
a.Test for Kyphosis or Scoliosis by having patient bend at the
waist and assume a “dive” position. Stand behind patient and
inspect and palpate spinal curvature.
b.Test for Lordosis: Have patient stand against a wall and flatten

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 her or his back against it while you attempt to slide your hand
behind patient’s back.
c.Assess for Knee Deviation: note position of knees, and draw
an imaginary line from the anterior or superior iliac crest
through the knees to the feet. Imaginary line should transect
patella.
2. Assess Gait. Inspect the patient as he or she walks. Note posture,
head position, conformity of phases, toe position, arm swing,
cadence, and coordination of movements, stride length, and base
of support.
3. Assess Cerebellar Function.
A. Test for Balance. Inspect gait and note balance.
 Have patient tandem walk, heel to toe.
 Have patient heel-and-toe walk
 Have patient do deep knee bend
 Have patient hop in place.
B. Test for Muscle Coordination. Determine patient’s dominant
side.
 Have patient perform RAMS by patting thigh with
one hand, alternating with supination and pronation.
 Have patient perform finger-thumb opposition.
 Have patient perform rhythmic toe tapping
 Have patient perform running heel of foot down shin
of opposite leg.
C. Test for Accuracy of Movement. Have patient perform point
-to -point localization.
C1. Finger to nose
C2. Finger to finger. Stand in front of patient, hold your
finger about 12 inches in front and instruct patient to touch
your finger, repeat at various positions.
4. Take limb measurements.
A. Length
 Arms. Measure from the acromion process to the tip
of the middle finger.
 Legs. Measure from the anterior superior iliac crest,
crossing over knee to the medial malleolus.
B. Circumference. Determine patient’s dominant side. Measure
midpoint of extremity and circumference of arms and thighs
and lower leg.
5. Assess Muscles
A. Tone: palpate muscles of upper and lower extremities in
relaxed and contracted state.
B. Strength:
 Upper Extremities: Test hand grip by crossing your
index and middle fingers and asking patient to
squeeze.
 Lower Extremities: have patient raise leg against
your hand as you apply resistance.
 Comprehensive muscle strength: as the patient
performs ROM, apply resistance to part being
moved, and then grade strength 0-5.
6. Assess Joints. Test ROM of joints, and note condition of skin,
erythema, edema, heat, deformity, crepitus, tenderness and
stability of all joints. Demonstrate movement of each joint for
patient then have patient return movement.
A. Temporomandibular joint (hinge joint and gliding joint).

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  Inspect, palpate, and test ROM and muscle strength.
 Assess flexion (depression), extension (elevation),
side-to-side movement, protraction (pushing out), and
retraction (pulling in) of jaw.
 Palpate strength of masseter and temporalis muscles
as patient clenches teeth.
 Ask patient to laterally move the jaw left and right
and then open the mouth against resistance. Feel for
contraction of temporal and masseter muscles to test
integrity of cranial nerve V (Trigeminal).
B. Sternoclavicular joint (gliding joint).inspect and palpate for
location to midline, color, swelling, pain and masses with
patient sitting.
C. Spine. Inspect and palpate spinous processes and
paravertebral muscles for tenderness or pain. Test ROM.
 Cervical Spine: test ROM by having patient flex,
extend, hyperextend, bend laterally, put ear to
shoulder, and rotate, and turn head side to side. To
test muscle strength, repeat against resistance.
 Thoracic and lumbar spine: test Rom by having
patient flex, extend, hyperextend, bend laterally, and
rotate. To test muscle strength, repeat against
resistance.
D. Shoulders(Ball and socket joint)
 Inspect for symmetry, swelling, color and masses.
 Palpate for tenderness.
 Test ROM by having patient flex, extend, abduct and
adduct. Also have patient perform external and
internal rotation.
 Test muscle strength of shoulder by performing ROM
against resistance.
E. Upper arm and Elbow (hinge joint).
 Inspect for symmetry, swelling, color and masses.
 Palpate for tenderness.

 Test ROM by having patient flex, extend, supinate

and
Pronate.
 Test muscle strength of upper arm and elbow by
performing ROM against resistance.
F. Wrist (Condyloid Joint)
 Inspect and palpate for tenderness and nodules.
 Test ROM by having patient flex, extend,
hyperextend, perform ulnar and radial deviation.
 Test muscle strength by repeating against resistance.
G. Hands and fingers (hinge, saddle and Chondyloid Joints).
 Inspect for size, shape, symmetry, swelling and color.
 Palpate for nodules and tenderness.
 Test ROM by having patient extend, flex, abduct,
adduct, perform internal and external rotation,
hyperextend, and stand and swing extended leg
backward.
H. Knees (Hinge Joint)
 Inspect knees for size, shape, symmetry, deformities,
and swelling n both supine and sitting positions with
knees dangling.

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  Palpate for tenderness, warmth, consistency, and
nodules, beginning approximately 10 cm above knee
and moving downward over patella.
 Test ROM by having patient flex and extend.
 Test ROM by repeating ROM against resistance.
I. Ankles and Feet (Hinge, Gliding and Chondyloid)
 Inspect position, alignment, shape, and skin while
patient is sitting, standing and walking.
 Palpate for heat, swelling, tenderness or nodules.
 Test ROM by having patient dorsiflex, plantar flex,
evert, invert and adduct.
 Test muscle strength by repeating ROM against
resistance.
7. Perform Phalen’s Test. Have patient flex the hands back to back
at a 90 degree angle and hold this position for about 1 minute.
Note for numbness or tingling anywhere from the thumb to the
ring finger.
8. Perform Tinel’s test. Percuss lightly over the median nerve. Note
for numbness and tingling on the palmar aspect of the wrist that
extend from the thumb to the second finger.
9. Perform Pronator Drift. Have patient stand with arms extended,
hands supinated, and eyes open and then closed for at least 20-
30 seconds. Check for downward drift and pronation of the arms
and hands.
10. Assess for Homan’s Sign. Support patient’s leg while
dorsiflexing foot. Note pain with dorsiflexion.
11. Perform straight leg raising (Lasegue’s Test). Ask patient to lie
flat and raise the affected leg to the point of pain. Note for pain
and sciatica that intensify with dorsiflexion of the foot.

12. Test for Kernig’s Sign. Have patient lie supine with one leg
flexed. Ask patient to extend the leg while you apply pressure to
the knee. Note for contraction and pain of the hamstring muscles
and resistance to extension.
13. Perform Thomas test. Have patient lie supine with both legs
extended and then flex one leg to her/his chest. Note for rising of
the opposite leg off the table. Repeat the same maneuver on the
opposite side.
14. Perform Trendelenburg Test. Have patient stand erect and check
the iliac crest. Then have the patient stand on one foot and check
again. Note if the iliac crest remains level or drops on the side
opposite the weight –bearing leg.
15. Perform Bulge Test. Have patient lie supine, stroke the medial
side of the knees upward several times to displace the fluid.
Then, press the lateral side of the knee and inspect for the
appearance of the bulge on the medial side.
16. Perform Ballottement. Have patient lie supine; press firmly with
your left thumb and index finger on each side of the patella.
Then gently tap on the kneecap. Note if patella will bounce back
to your finger.
17. Perform Lachman Test. To test medial and lateral stability, have
patient extend the knee and attempt to abduct and adduct it. To
assess the anterior and posterior plane, have patient flex the knee
at least 30 degrees. Stabilize and grasp the leg below the patella
and attempt to move it forward and back. Note for movement of
the joint.

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18. Perform McMurray’s Test. Position patient supine with her or
his knee fully flexed. Place one hand on the heel and the other
on the knee and gently internally and externally rotate the foot as
you bring the leg to full extension. Note for audible or palpable
clicks or knee lock.
19. Perform Apley’s test. Position the patient supine with his or her
knee flexed at 90 degrees. Place one hand on the heel and the
other hand on the knee. Apply pressure with both hands and
gently rotate the foot. Note for audible or palpable clicks.
20. Assess the sensory function of upper and lower extremities.
a. Light touch. Brush a light stimulus such as cotton wisp over
patient’s skin in several locations, including torso and
extremities.
b. Pain. Stimulate skin lightly with sharp and dull ends of
toothpick. Apply stimuli randomly and ask patient to identify
whether sensation is sharp or dull.
c. Temperature. Touch patient’s skin with test tubes filled with
hot or cold water. Apply stimuli randomly, and ask patient to
identify whether sensation is hot or cold.
d. Vibration. Place a vibrating tuning fork over a finger joint,
and over a toe joint. Ask patient to tell you when vibration is
felt and when it stops. If patient is unable to detect vibration,
test proximal areas as well.
e. Kinesthetics (position sense). Determine patient’s ability to
perceive passive movement of extremities.
 Hold fingers on sides and move up and down, and
have patient identify direction of movement.
 Flex and extend patient’s big toe, and ask patient to
describe movement up or down.
f. Stereognosis. With patient’s eyes closed, place a familiar
object such as a coin or a button, in patient’s hand, and ask
patient to identify it. Test both hands using different objects.
g. Graphesthesia. With patient’s eyes closed, use point of a
closed pen to trace a number on patient’s hand, and ask
patient to identify the number.
h. Two-Point Discrimination. Ability to differentiate between
two points of simultaneous stimulation. Using ends of two
toothpicks stimulate two points on fingertips simultaneously.
Gradually move toothpicks together, and assess smallest
distance at which patient can still discriminate two points.
Document distance and location.
i. Point Localization. Ability to sense and locate area being
stimulated. With patient’s eyes closed, touch an area; then
have patient point to where he or she was touched. Test both
sides and upper and lower extremities.
j. Sensory Extinction. Simultaneously touch both sides of
patient’s body at same point. Ask patient to point to where
she or he was touched.
21. Assess Deep Tendon Reflexes.
a. Biceps Reflex. Rest patient’s elbow in your nondominant
hand, with your thumb over biceps tendon. Strike your
thumbnail.
b. Triceps Reflex. Abduct patient’s arm and flex it at the elbow.
Support the arm with your nondominant hand. Strike triceps
tendon about 1-2 inches above olecranon process,
approaching it from directly behind.

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 c. Brachioradialis Reflex. With your nondominant hand,
support patient’s hand and palpate Brachioradialis tendon 3-
5 cm above wrist. Simultaneously strike styloid process of
radius.
d. Patellar Reflex. Have patient sit with legs dangling. Strike
tendon directly below patella.
e. Achilles Reflex. Have patient lie supine or sit with one knee
flexed. Holding patient’s foot slightly dorsiflexed, strike
Achilles tendon.
22. Test for Superficial Reflex.
 Plantar reflex. Stroke sole of patient’s foot in an arc from
lateral heel to medial ball.
XVI. During/Aftercare
1. Position client comfortably during the whole process of physical
assessment.
2. Provides privacy and exposes only the area being examined.
3. Gives clear and concise instructions.
4. Uses a complete set of clean equipments that is in good working
order.
5. Arranges equipment in an accessible manner.
6. Does aftercare of equipment used.

Legend:
0 - did not perform the step
1 - did not perform the step correctly
2 - performed the step correctly but slow
3 - performed the step correctly at a normal speed

________________ ____________________________
Student’s Signature Clinical Instructor’s Signature

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