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 What physical exam would you do?  

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Author6 Posts

I seem to always be running short on time whenever there's a neuro exam in the case. Would really appreciate guidance on how much to perform!

FA Case:
35yo lady with 2/52 severe, sharp intermittent R sided headache, most consistent with migraine. Assoc with nausea during pain.
Past Hx of sinusitis (but current pain is different).
No meds/OCPs.
FHx father died of brain tumor at 65

Physical exam:
what I did ->

- UL (elbow flex/ext, wrist flex/ext, finger add/abd, grip)
- LL (hip flex/ext, foot plantar/dorsi)
reflexes (biceps, knee, babinski)

cerebellar (finger-nose only)


Made it just within 15min on my pretend patient, including closure.

1 HEENT palpation (head, facial sinuses, TMJ), fundoscopy, nose, mouth, teeth and throat inspection

2 neck inspection, palpation

3 Neuro CNs, muscle strength, DTRs

4 CVS auscultation

5 pulmonary auscultation
So my question is... (I know that this is a long post... sorry)

do you guys agree with FA's range of expected physical examination manouvres in this case?

and what movements would you have done for muscle strength? (do you do all, or how do you do screening manouvres)?

I thought that it was important to do a fairly comprehensive neuro exam as one of the DDx was intracranial mass and good neuro signs would have helped justify doing a CT on this young lady.


i will do HEENT and some neuro. Remember is a focused history is what the USMLE wants. FA tries to combine a few other things. A few things tho. Can you check for muscle strength on both limbs at the same time. this is the line i intend to use..."i will be checking your muscle power at the same so i can compare if there is any weakness.....

then my question: how much do u expose a woman for a chest examination?


DRGBOLLS: thanks for your reply. I am planning to examine muscle power at the same time on the R and the L.

About the female cardiac exam - I would make sure that the patient is covered as much as possible with a sheet/gown. But the auscultation MUST be done on the skin (not through the gown). You can get the woman to lift her breast if you want to palpate for the maximal point of impulse for cardiomegaly. I think I read some of these things on FA.


thanks. y exam is on the 11th... i think i read a post where u said yours was on the 17th.... all the best! do u know what to do if u want to do a fundoscopy? do u turn the light off? is there an examination light or the room goes dark??


i'm not 100% sure that you have to turn off the lights in a fundoscopy exam, but if you do turn off the lights, a back up light automatically goes on so it will not be totally dark. i saw this on the orientation video from the site. this site has downloads for practice typing notes as well.

good luck to both of you!


thanks sleepy student. a few other Qs. examination of the shoulder in women. do u take the whole gown off or u just lower it to inspect and palpate and then put it back on to do ROM and do they have to walk to see the swing(prolly for the elbow) and for the hip examination in a patient with hip pain, what do we do???? and aussiedoc, your journal is not lonely. i read it... lol.

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