Required Tools

• Monofilament (10 mmHg)
• Measuring tape 
• Scale
• Fundoscope
• 128 Hz tuning fork
• Reflex Hammer

Introduction

• Knock, enter the room, wash/sanitize hands and introduce yourself
• Greet the patient, ask the patient’s name, explain the exam and ask for consent 
• Always take vitals
  • Note: ask for orthostatic vitals as well

Inspection 

• Patient can stand for the first portion of the physical examination

Body measurements	Using measuring tape, measure waist circumference, hip circumference and height.  Using scale, measure weight.  Calculate waist-height ratio, waist-hip ratio and BMI.
Fundoscopy	Have patient look at a point in the far distance, fixing eye on object on the wall. Shine light from the ophthalmoscope in patient’s eye, should see the Red Reflex.  Find an artery and follow towards the centre of the eye until optic disk is seen as a confluence of retinal nerve fibers exiting the globe.  Look for signs of optic disc swelling, loss of venous pulsations. Look for signs of hemorrhages and neovascularizations (small branches vessels).
Skin Changes	Inspect for skin changes around the forehead, neck, armpits, navel and lower legs – specifically looking for: Anthracosis nigricans (hyperpigmentation of skin), impaired wound healing (long-lasting cuts and/or bruises) Look at shoes for any openings (cuts or nails) and inspect feet.
Mouth	Inspect for oral thrush and/or ulcerations.

Palpations

Peripheral Vascular Exam

Please see Peripheral Vascular Script

Auscultation 

Cardiac Examination	Please see cardiac exam script
Respiratory Examination	Please see respiratory examination script
Abdominal Examination	Please see abdominal examination script
Peripheral Vascular Examination	Please see peripheral vascular script