GI/MS/Neuro PE Exam
Introduction: Your name, title, & you’re the examiner. Would you please tell me your full name &
DOB. Please have a seat. How are you today? Can you tell me where you are? What is today’s date?
Any pain or discomfort anywhere or recent trauma? Advise GI/MS/Neuro exam & get permission &
for video. State, “cranial nerves #1-12 were examined during your last visit, as such I will not be
testing them during today’s visit.” Before we begin, do you have to use the lavatory?
General appearance: A&O - good historian - pleasant mood - follows commands - maintains eye
contact - skin color appropriate for race
GI - Exam in this order: Inspect, auscultate, percussion, and palpation (always last as it can shift
organs & masses) - Stand on patient’s right side during the exam
Gastrointestinal
Abdomen - pt lay down - Inspect, auscultate, percussion, and palpation (always last as it can shift
organs & masses) - Stand on patient’s right side during the exam
● Inspect skin -symmetry, no mass, no discoloration, no protruding vessels, no indication of of
peristalsis - no distention notated, no abnormal pulsations
● Auscultate bowel sounds - bowel sounds are high-pitched, use diaphragm of scope & clockwise:
RLQ, RUQ, LUQ, LLQ - dx of hypo bowel sounds, 3-5 min continuous listening - bowel sounds
positive in all 4
● Auscultate vascular sounds:
○ Aortic - midline, 2 fingerbreadths above the umbilicus - no bruit heard
○ Renal - 3 cm superior & lateral to umbilicus R&L, no bruit heard
○ Iliac - 3 cm inferior & lateral to umbilicus R&L, no bruit heard
○ Femoral - along crease midway between pubic bone & anterior iliac crest, no bruit heard
● Percuss - two sounds heard, tympanic (organs containing air) or dull (fluid-filled or dense)
○ all quadrants - tympany
○ Percuss liver - dullness - begin below umbilicus, R MCL, percuss upward until dullness is
heard then at above nipple, between 5-7 ICS, R MCL, downward until dullness heard, 6
cm
○ Percuss spleen - supine, arms above head, percuss lowest ICS L AAL (anterior axillary
line) tympany
, ● Palpate: light (1 cm depth) one hand and deep (5-8 cm depth), use two hands, one overlapping
the other - look pt’s face for grimacing - ask if has any pain, do that area last
○ All 4 quad - non tender
○ abdominal aorta - 2 fingerbreadths above the umbilicus, it bifurcates at umbilicus,
continue to palpate, under 3 cm - no tenderness or enlargement
○ Palpate liver border - MCL, below umbilicus, move vertically use rolling technique, no
enlargement or tenderness or masses
○ Palpate “balloting” kidneys - L kidney, stand pt R side, place L hand behind pt left flank,
lift left flank w/ L hand & press down w/ R; not palpable, normal finding. R kidney, stay
R side, lift R flank w/ L hand, R to palpate deep. R palpable; feel firm, smooth, and solid.
No tenderness or boogie
○ Palpate spleen - start at umbilicus at a diagonal up to LUQ, non palpable on inspiration
○ Bladder is not palpable unless distended, which it is not
Musculoskeletal & Neurological
During PE, remember the 5 P’s: Pain, Paralysis, Paresthesia, Pallor, Pulselessness
Upper Extremities
● Inspect clavicles, scapula, shoulders - symmetrical, alignment good, no discoloration or
swelling,
● Palpate joints - Ask pt place arms at side, for the shoulder, start at sternum where the should joint
begins, move to clavicle, scapula, rotator cuff, deltoid, then to elbow: no deformities or
tenderness or spasms, no swelling to the bursa
● ROM and. Strength
○ Neck - ROM, touch chin to chest (flexion) then tilt head back & look to ceiling
(extension) backward; expected ROM - lateral bending, touch shoulders to ear - test
rotation, turn head from side to side - Strength, ask pt tilt head to one side & NP push
against for resistance 5 out of 5
○ Shoulder - combine Ab & abduction with In & external rotation - arms extend out to the
side, all the way up to ceiling & cross behind head to upper back then bring back down &
cross hands behind back & go right into Elbow - Strength shrug shoulders against
resistance
Introduction: Your name, title, & you’re the examiner. Would you please tell me your full name &
DOB. Please have a seat. How are you today? Can you tell me where you are? What is today’s date?
Any pain or discomfort anywhere or recent trauma? Advise GI/MS/Neuro exam & get permission &
for video. State, “cranial nerves #1-12 were examined during your last visit, as such I will not be
testing them during today’s visit.” Before we begin, do you have to use the lavatory?
General appearance: A&O - good historian - pleasant mood - follows commands - maintains eye
contact - skin color appropriate for race
GI - Exam in this order: Inspect, auscultate, percussion, and palpation (always last as it can shift
organs & masses) - Stand on patient’s right side during the exam
Gastrointestinal
Abdomen - pt lay down - Inspect, auscultate, percussion, and palpation (always last as it can shift
organs & masses) - Stand on patient’s right side during the exam
● Inspect skin -symmetry, no mass, no discoloration, no protruding vessels, no indication of of
peristalsis - no distention notated, no abnormal pulsations
● Auscultate bowel sounds - bowel sounds are high-pitched, use diaphragm of scope & clockwise:
RLQ, RUQ, LUQ, LLQ - dx of hypo bowel sounds, 3-5 min continuous listening - bowel sounds
positive in all 4
● Auscultate vascular sounds:
○ Aortic - midline, 2 fingerbreadths above the umbilicus - no bruit heard
○ Renal - 3 cm superior & lateral to umbilicus R&L, no bruit heard
○ Iliac - 3 cm inferior & lateral to umbilicus R&L, no bruit heard
○ Femoral - along crease midway between pubic bone & anterior iliac crest, no bruit heard
● Percuss - two sounds heard, tympanic (organs containing air) or dull (fluid-filled or dense)
○ all quadrants - tympany
○ Percuss liver - dullness - begin below umbilicus, R MCL, percuss upward until dullness is
heard then at above nipple, between 5-7 ICS, R MCL, downward until dullness heard, 6
cm
○ Percuss spleen - supine, arms above head, percuss lowest ICS L AAL (anterior axillary
line) tympany
, ● Palpate: light (1 cm depth) one hand and deep (5-8 cm depth), use two hands, one overlapping
the other - look pt’s face for grimacing - ask if has any pain, do that area last
○ All 4 quad - non tender
○ abdominal aorta - 2 fingerbreadths above the umbilicus, it bifurcates at umbilicus,
continue to palpate, under 3 cm - no tenderness or enlargement
○ Palpate liver border - MCL, below umbilicus, move vertically use rolling technique, no
enlargement or tenderness or masses
○ Palpate “balloting” kidneys - L kidney, stand pt R side, place L hand behind pt left flank,
lift left flank w/ L hand & press down w/ R; not palpable, normal finding. R kidney, stay
R side, lift R flank w/ L hand, R to palpate deep. R palpable; feel firm, smooth, and solid.
No tenderness or boogie
○ Palpate spleen - start at umbilicus at a diagonal up to LUQ, non palpable on inspiration
○ Bladder is not palpable unless distended, which it is not
Musculoskeletal & Neurological
During PE, remember the 5 P’s: Pain, Paralysis, Paresthesia, Pallor, Pulselessness
Upper Extremities
● Inspect clavicles, scapula, shoulders - symmetrical, alignment good, no discoloration or
swelling,
● Palpate joints - Ask pt place arms at side, for the shoulder, start at sternum where the should joint
begins, move to clavicle, scapula, rotator cuff, deltoid, then to elbow: no deformities or
tenderness or spasms, no swelling to the bursa
● ROM and. Strength
○ Neck - ROM, touch chin to chest (flexion) then tilt head back & look to ceiling
(extension) backward; expected ROM - lateral bending, touch shoulders to ear - test
rotation, turn head from side to side - Strength, ask pt tilt head to one side & NP push
against for resistance 5 out of 5
○ Shoulder - combine Ab & abduction with In & external rotation - arms extend out to the
side, all the way up to ceiling & cross behind head to upper back then bring back down &
cross hands behind back & go right into Elbow - Strength shrug shoulders against
resistance
