Guide to Physical Exams

General Notes

At the beginning of the physical, you will want to assess the general health of the patient. Look at their build (skinny/fat, tall/short, etc.) and determine if everything looks normally distributed and in proportion. Have them walk for you and look for any awkwardness in their gait. Look at their skin tone; note any yellowness, excess bruising or sweating. Assess any injuries or sources of pain before going on to other parts of the exam. In general, try to follow a pattern so you don't forget anything.

Head and Neck Exam

Run your hands over the skull and check for any swelling or indentations. Press over the forehead and cheeks, checking for tenderness in the sinuses. Check for any swelling or tenderness in the lymph nodes by running your hands in tiny circles, starting below the ears, working your way to the underside of the chin, then starting again and working your way down the throat. Feel for the thyroid gland just below the large thyroid cartilage on the front of the neck. Have the patient swallow, so that you can make sure it is mobile and not swollen.

Head Reflexes

Tap the forehead gently above each eye; uncontrolled blinking is a bad sign with this test.

Eye Exam

Look at the patient's eyes. Make sure the sclera (the white part) is reasonably clear and that there is no obvious infection. Have the patient follow your finger up and down and to the upper and lower corners of their range of vision on both sides. Test peripheral vision by standing behind them, separating your hands as far as you can to the sides of the patient's head and then slowly moving them inward while wiggling your fingers until the patient can see them. Make sure that both pupils constrict in response to light and that they do so evenly.

Ear Exam

Test the patient's hearing, making sure it is roughly equal on both sides, and that they can hear both high and low sounds. Some Healers use their firelizards to hum or alternatively click their fingers. Make sure there is no pain in the ears and ask about head colds.

Mouth Exam

Use a glow tube to examine the back of the throat and look for redness or drainage. Look at the tongue, teeth and gums, especially noting any bleeding, sores or discoloration. Check also for foul smelling breath as this can indicate other conditions.


Look at toes and fingers. Check for discoloration. Ask the patient to raise their legs in a straight leg lift to assess any hip and back problems. Determine if the have the full range of movements at all joints—shoulder, elbow, wrist, hip, knee and ankles. Get them to curl their toes and squeeze against your hands to determine a like pressure in each muscle group. Repeat similarly with the fingers. Look for symmetry, coordination, weakness and pain. As you go through the muscle groups also test the deep-muscle reflexes using the side of your hand or a wood hammer, whichever is available. The responses should neither be too vigorous nor too shallow, as both extremes are bad signs.

Arm Reflexes

To begin, take hold of one of the patient's arms, cradling the forearm half bent over your own. Place your thumb over the tendon on the inside of the elbow. Tap against your thumb and feel the biceps tense in response. Hold the arm out at an angle and let the forearm drop straight down. Tap the triceps just above the elbow, and watch for the arm to move slightly in response (this one is faint). Tap the forearm, about a third of the way up from the wrist on the thumb side, and watch for the forearm to twist, with the thumb rotating outwards.

Leg Reflexes

With the patient's knee dangling over the side of the table, strike the tendon below the kneecap, and watch for the leg to kick in response. Test the tendon on the back of the ankle, watch for the ankle to jerk in response. Run your thumbnail up the sole of the foot, aiming for the base of the big toe. A normal response is to curl the toes; spreading the toes is a response seen only in infants and brain damaged patients.

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Begin the exam with the patient lying on their back. Try to get the patient to relax, and if they're ticklish begin the exam with their hand below yours. Note the general shape of the abdomen, especially any asymmetrical bulges. Press gently but steadily on all four quarters of the belly in turn, feeling for any hard or immovable masses below. Press your fingers in perpendicular to the surface in a line parallel to and a few inches below the rib cage on the right side to feel for the edge of the liver (liver enlargement and yellow skin would imply hepatitis).

Have the patient turn on their right side and feel for the spleen on the left. Try to trap it between your hands, with one on the back and one on the front, both just below the rib cage. A normal spleen will not stick down very far and may not be palpable.
Have the patient sit up, and thump firmly with the side of your fist just below the ribs on each side in the back (if the kidneys are inflamed, this will cause extreme pain; normally there should be little, if any, discomfort). Pound lightly along the spine all the way up, noting any tenderness and also making sure the spine is straight.

Abdominal Reflexes

During the abdominal exam, stroke with the handle of the hammer from each quarter toward the navel or use a fingernail. Look for the muscles to tense toward the hammer/finger in response.


To begin, take the patient's pulse. With your index and middle fingers lightly press over the radial bone in the wrist, which is just below the thumb. Do not use your thumb as it has a strong pulse point of its own. It should be steady, strong and of a reasonable speed. Compare the strength of the pulses in the right and left wrist (they should be about the same).

Listen at four places on the left side of the chest for the heart sounds using your listening tube. The sounds should be clear and steady, without any trace of grinding, or any muffling of the beats, that would indicate a heart murmur.


First, simply observe the motion of the ribcage as the patient breathes deeply, making sure it is symmetrical and even. Use your listening tube to listen to their breathing, starting on the back, at the lower border of the ribcage, and alternating sides as you move the tube up. You should listen to at least ten points in total on the back and at least eight on the front. If you detect any whistling, gurgling or popping sounds these indicate inflammation and should be examined further. In these cases, a detailed history should be taken regarding coughing and difficulties in breathing. There are other ways to examine the lungs in more detail, but they are probably not necessary for a simple physical.

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