Comprehensive Exam
Slide 2
A Comprehensive Assessment is a multi-system history and examination.
Its often referred to as a “Head-to-toe” assessment. If you will make it a point to always start from the
top and work your way down, you will seldom miss anything important.
Slide 3
In your Comprehensive exam video
• First you need to perform a 360 degree scan of the room you are in, show your equipment table,
and blank SOAP note (if used).
• You must state out loud what you are examining and what your findings are.
Example: When you put your stethoscope on chest to listen to the heart state each area (Aortic,
pulmonic, etc.) then state rate, rhythm and presence of murmurs or not. So rate of 72, regular rhythm,
no murmurs or ectopy found.
• No referral to notes is allowed during exam until the end if have time remaining in your 45-
minute limit. Points will be deducted if it appears you are looking at something.
• Wear professional attire with white lab coat.
Slide 4
First introduce yourself, you should ask an open ended question to understand why they patient came in.
Wash your hands.
Remember that your exam starts when you first see the patient.
Then start with comprehensive subjective history and full review of systems.
"Always listen to the patient they might be telling you the diagnosis."
- Sir William Olser
Slide 5
Review the patient’s vital signs and repeat any that are unusual. For your video, you can assume that the
vital signs were already taken. Discuss their vital signs with the patient.
Your assessment will begin with Mental status evaluation which includes:
• General appearance
• Mood and affect
• Level of Consciousness
• Communication skills
State these out loud in your video.
Slide 6
Skin and nails:
You will inspect skin surface throughout your exam for color and integrity. But make sure to state
this during your video.
Describe lesions, rashes, tattoos according to characteristics (exudates, location, distribution)
Palpate skin for turgor
Inspect nails for base angle and for color, length, symmetry, and cyanosis
Palpate nails for capillary refill and verbalize this.
, Slide 7
Hair:
o Inspect for hair color, distribution, and quality of hair, hair loss, scarring or inflammation
o Palpate scalp and hair (texture)
Slide 8
Head, Neck and Lymph Nodes:
• Inspect head and facial features, size, shape & symmetry
• Inspect for thyromegaly by palpation and auscultation
• Evaluate trachea position
• Assess carotid pulses by palpation and auscultation
Palpate lymph nodes bilaterally and at the same time (and name them!):
1. Occipital
2. Pre-auricular
3. Post-auricular
4. Tonsillar
5. Submandibular
6. Submental
7. Anterior cervical
8. Posterior cervical
9. Supraclavicular
10. Axillary
11. Epitroclear
12. Inquinal will not be assessed in the video
Slide 9
Eyes:
Inspect eyelid, eyeball, conjunctiva, iris, pupil, lens, sclera and lacrimal apparatus
For your video, you should verbalize a type of eye chart and how each is correctly used
Perform ophthalmoscope evaluation and describe what you see
PERRLA
Direct and consensual
Corneal light (ocular alignment)
Cover-uncover
EOM (Six cardinal fields)
Make sure to state the cranial nerve that these tests evaluate so you will get credit at the same time!
Slide 10
Ears:
• Inspect position
• Palpate external ears and mastoid processes
• Perform otoscope evaluation: Inspect canals and TM’s while bracing otoscope with finger
Slide 2
A Comprehensive Assessment is a multi-system history and examination.
Its often referred to as a “Head-to-toe” assessment. If you will make it a point to always start from the
top and work your way down, you will seldom miss anything important.
Slide 3
In your Comprehensive exam video
• First you need to perform a 360 degree scan of the room you are in, show your equipment table,
and blank SOAP note (if used).
• You must state out loud what you are examining and what your findings are.
Example: When you put your stethoscope on chest to listen to the heart state each area (Aortic,
pulmonic, etc.) then state rate, rhythm and presence of murmurs or not. So rate of 72, regular rhythm,
no murmurs or ectopy found.
• No referral to notes is allowed during exam until the end if have time remaining in your 45-
minute limit. Points will be deducted if it appears you are looking at something.
• Wear professional attire with white lab coat.
Slide 4
First introduce yourself, you should ask an open ended question to understand why they patient came in.
Wash your hands.
Remember that your exam starts when you first see the patient.
Then start with comprehensive subjective history and full review of systems.
"Always listen to the patient they might be telling you the diagnosis."
- Sir William Olser
Slide 5
Review the patient’s vital signs and repeat any that are unusual. For your video, you can assume that the
vital signs were already taken. Discuss their vital signs with the patient.
Your assessment will begin with Mental status evaluation which includes:
• General appearance
• Mood and affect
• Level of Consciousness
• Communication skills
State these out loud in your video.
Slide 6
Skin and nails:
You will inspect skin surface throughout your exam for color and integrity. But make sure to state
this during your video.
Describe lesions, rashes, tattoos according to characteristics (exudates, location, distribution)
Palpate skin for turgor
Inspect nails for base angle and for color, length, symmetry, and cyanosis
Palpate nails for capillary refill and verbalize this.
, Slide 7
Hair:
o Inspect for hair color, distribution, and quality of hair, hair loss, scarring or inflammation
o Palpate scalp and hair (texture)
Slide 8
Head, Neck and Lymph Nodes:
• Inspect head and facial features, size, shape & symmetry
• Inspect for thyromegaly by palpation and auscultation
• Evaluate trachea position
• Assess carotid pulses by palpation and auscultation
Palpate lymph nodes bilaterally and at the same time (and name them!):
1. Occipital
2. Pre-auricular
3. Post-auricular
4. Tonsillar
5. Submandibular
6. Submental
7. Anterior cervical
8. Posterior cervical
9. Supraclavicular
10. Axillary
11. Epitroclear
12. Inquinal will not be assessed in the video
Slide 9
Eyes:
Inspect eyelid, eyeball, conjunctiva, iris, pupil, lens, sclera and lacrimal apparatus
For your video, you should verbalize a type of eye chart and how each is correctly used
Perform ophthalmoscope evaluation and describe what you see
PERRLA
Direct and consensual
Corneal light (ocular alignment)
Cover-uncover
EOM (Six cardinal fields)
Make sure to state the cranial nerve that these tests evaluate so you will get credit at the same time!
Slide 10
Ears:
• Inspect position
• Palpate external ears and mastoid processes
• Perform otoscope evaluation: Inspect canals and TM’s while bracing otoscope with finger
