Hello. I was hoping someone could point me in the direction towards where I could find a resource that gives a comprehensive write up of normal findings. I'll be having a series of OSCEs in a few months and want to prepare beforehand in order to make sure I don't miss out on anything. For some reason, when I perform PE on patients in my previous rotations, I frequently entirely forget to do something (for example, checking for fremiti). Hopefully there's a guide somewhere where I can refresh my PE skills?
Something like:
Cardiac
Inspection: Chest is symmetric, no scars. No cardiac heaves or lifts. Symmetrical expansion with respiration, no other wall motions.
Palpation: No thrills appreciated. Point of maximal impulse (PMI) (apical impulse) noted at midclavicular line, in fifth intercostal space.
Auscultation: Normal S1 and S2, with regular rate and rhythm. S2 > S1 at the base, S1 > S2 at apex. No splitting of the heart sounds heard. No murmur. No S3 or S4, no friction rub.
Maneuvers: No murmur is heard while squatting or upon release of valsalva, standing or during valsalva strain.
Neck:
Inspection: No jugular venous distention or pulsations.
Auscultation: No carotid bruits, or transmitted murmur. Carotid pulses 2/4 bilaterally.
Peripheral vascular:
Extremities
Inspection: No rashes, swelling, color change, or cyanosis in arms or legs. No signs of venous stasis or arterial insufficiency in legs, with normal hair distribution, and no pigmentation around ankles. No spider veins on legs and thighs bilaterally. No clubbing in fingernails. Capillary refill is brink (<1 sec).
Palpation: Hands warm and pink. Feet are a bit cool to the touch and pale, but equal bilaterally. No pitting or non-pitting edema in feet.
Palpation of Pulses:
Carotid: 2/4 bilaterally
Radial: 2/4 bilaterally
Brachial: 2/4 bilaterally
Femoral: right 2/4, left 2/4
Popliteal: right 2/4, left 2/4
Posterior tibial: right 1/4, left 1/4
Dorsalis pedis: right 2/4, left 2/4
Something like:
Cardiac
Inspection: Chest is symmetric, no scars. No cardiac heaves or lifts. Symmetrical expansion with respiration, no other wall motions.
Palpation: No thrills appreciated. Point of maximal impulse (PMI) (apical impulse) noted at midclavicular line, in fifth intercostal space.
Auscultation: Normal S1 and S2, with regular rate and rhythm. S2 > S1 at the base, S1 > S2 at apex. No splitting of the heart sounds heard. No murmur. No S3 or S4, no friction rub.
Maneuvers: No murmur is heard while squatting or upon release of valsalva, standing or during valsalva strain.
Neck:
Inspection: No jugular venous distention or pulsations.
Auscultation: No carotid bruits, or transmitted murmur. Carotid pulses 2/4 bilaterally.
Peripheral vascular:
Extremities
Inspection: No rashes, swelling, color change, or cyanosis in arms or legs. No signs of venous stasis or arterial insufficiency in legs, with normal hair distribution, and no pigmentation around ankles. No spider veins on legs and thighs bilaterally. No clubbing in fingernails. Capillary refill is brink (<1 sec).
Palpation: Hands warm and pink. Feet are a bit cool to the touch and pale, but equal bilaterally. No pitting or non-pitting edema in feet.
Palpation of Pulses:
Carotid: 2/4 bilaterally
Radial: 2/4 bilaterally
Brachial: 2/4 bilaterally
Femoral: right 2/4, left 2/4
Popliteal: right 2/4, left 2/4
Posterior tibial: right 1/4, left 1/4
Dorsalis pedis: right 2/4, left 2/4
