Physical exam
John Perkins
Facilitator notes
Facilitator, please ask the student/team what examination they want to perform, and provide ONLY the finding of the examination they request, i.e. only one line at a time. Ask the student/team to be specific!
Example vignette
Team – “Measure vital signs.”
Facilitator – “What vital signs would you like?”
Team – “Heart rate.”
General inspection
John appears confused, occasionally drowsy, and in pain. Despite his dark complexion, a moderate jaundice can be appreciated. Reduced body hair. Obese body habitus.
Vital signs
HR 98 bpm
RR 18
O2 Sa 98% RA
BP 160/95
Temp 37.0°
Regional exam
Hands: Palmar erythema. Dupuytren’s contracture.
Hands: Asterixis cannot be assessed as patient does not collaborate.
Limbs: Muscle wasting. Scratch marks and bruising noted. Moderate jaundice. Peripheral oedema lower limbs up to calves.
Eyes: Scleral icterus. Pupils equal, round, reactive to light and accommodation.
Chest: Mild gynecomastia. Heart sounds dual, no murmurs. Pulses strong, regular. Adequate air entry on all lung fields, despite limited patient collaboration.
Abdomen: Very distended. Evident prominent superficial veins.
Abdomen: Diffusely tender on palpation of left lower quadrant. Liver not palpable. Spleen not palpable.
Abdomen: Shifting dullness identified on abdominal percussion.
Abdomen: No apparent hernias. Rectal exam not performed (partner withheld consent).
Neurological: Disoriented, confused. Brisk peripheral reflexes. Positive Babinski sign.
