• 13. Heart:

  • a. Inspection. Point maximal impulse, chest contour.

  • b. Palpation. Point maximal impulse, thrills, lifts, thrusts.

  • c. Auscultation. Heart sounds, gallops, murmurs, rubs. Use diaphragm for high-pitched sounds of normal heart sounds (S1 and S2) and bell for abnormal sounds (S3 and S4).

  • 14. Abdomen:

  • a. Inspection. Scars (draw these), contour, masses, vein pattern.

  • b. Auscultation. Bowel sounds, rubs, bruits. Use diaphragm. Auscultate after inspection and before palpation and percussion. Listen to each quadrant for at least 1 min. If bowel sounds are present, they will be heard in lower right quadrant (area of ileocecal valve).

  • c. Percussion—organomegaly, hepatic dullness.

  • d. Palpation—tenderness, masses, rigidity, liver, spleen, kidneys.

  • e. Hernia—femoral, inguinal, ventral.

  • 15. Genitalia:

  • a. Male. Penile lesions, scrotum, testes. Circumcised?

  • b. Female. Labia, Bartholin’s and Skene’s glands, vagina, cervix. Bimanual examination of internal genitalia.

  • 16. Rectum—perianal lesions, sphincter tone, tenderness, masses, prostate, stool color, occult blood.

  • 17. Extremities—pulses (symmetry, bruits, perfusion). Joints (mobility, deformity). Cyanosis, edema. Varicosities. Muscle mass.

  • 18. Back—contour spine, tenderness. Sacral edema.

  • 19. Neurological:

  • a. Mental status. Alertness, memory, judgment, mood.

  • b. Cranial nerves (I—XII). See Figure 7-1.

  • c. Cerebellum. Gait, finger-nose, heel-shin, tremors.