Summary
This video captures a comprehensive clinical OSCE setup, demonstrating a complete head-to-toe physical examination on a healthy female patient. The clinician meticulously details visual inspection, palpation, percussion, and auscultation techniques across multiple body systems. The exam covers vital signs, HEENT, lymphatic, respiratory, cardiovascular, gastrointestinal, musculoskeletal, and extensive neurological testing including cranial nerves, deep tendon reflexes, tactile sensations, and coordination. Every assessment falls within healthy, physiological limits, showcasing a standard template for clinical providers on performing and documenting a physical examination.
Key Insights
Vitals and Cardiovascular Assessment Reveal Optimal Baseline Function
The patient exhibits excellent resting cardiovascular and systemic health indicators, starting with a blood pressure of 102/68 mmHg in the seated left arm. Sublingual temperature is completely normal at 36.6 degrees Celsius. Auscultation of the heart reveals normal S1 and S2 heart sounds with no murmurs, gallops, or extra beats such as S3 and S4. Additionally, there are no carotid bruits or thrills, the point of maximal impulse (PMI) is located properly in the fifth intercostal space at the midclavicular line, and the jugular venous pressure (JVP) measures minimally at 1.5 centimeters above the sternal angle.
HEENT Exam Shows Symmetrical Anatomy and Intact Cranial Nerves
The head, eyes, ears, nose, and throat exam confirms robust structural and neurological integrity. Visual acuity is 20/20 bilaterally without correction, visual fields are intact across all quadrants, and corneal reflections are symmetrical. Direct and consensual pupillary responses to light, proximity accommodation, and extraocular muscles (CN III, IV, and VI) are intact. Retinal exam reveals healthy bilateral red reflexes, clear optic disc borders, and no papilledema. Otoscopy shows intact, non-perforated tympanic membranes and a visual malleus bone. The nasal mucosa is pink and sinuses are non-tender, while the uvula rises symmetrically upon phonation (CN X) and the tongue moves normally (CN XII) without lesions.
Pulmonary Perfusion, Ventilation, and Chest Excursion are Fully Normal
Respiratory exams on both the posterior and anterior thorax show symmetric chest excursion with no accessory muscle use. Tactile fremitus is present and equal bilaterally across all fields. Percussion of the lung fields yields crisp resonance throughout, with diaphragmatic dullness appropriately mapped at the T10 level. Auscultation in all lung zones confirms clear, vesicular breath sounds without any wheezes, crackles, or other adventitious sounds, indicating healthy lung tissue and efficient oxygenation.
Highly Comprehensive Neuro-Screening Demonstrates Total Motor and Sensory Accuracy
The neurological exam highlights detailed sensory, motor, and cerebellar performance. Cranial nerves I, V, VII, XI, and XII are normal. Deep tendon reflexes (DTRs) measure a healthy 2+ bilaterally. Vibratory and tactile sensation tests, including discriminating sharp versus dull inputs and light cotton-swab touch, are symmetric across all dermatomes. Stereognosis and graphesthesia tests are completed without error. Motor coordination tests (rapid alternating movements, finger-to-nose-to-finger, and heel-to-shin) are steady and deliberate. Finally, the patient displays a negative Romberg sign and no pronator drift, alongside dynamic balance through heel, toe, and tandem gait walking.
Sections
Introduction and Vital Signs
Initial visual assessment shows a healthy, alert patient.
The clinician performs hand hygiene and begins with an inspection of the patient, Kourtney, noting that she appears mentally alert, exhibits a slender and well-nourished figure, and presents with no signs of immediate distress.
Seated blood pressure measured at 102/68 mmHg.
The patient is instructed to relax her arm, and her blood pressure is obtained using a manual cuff on the seated left arm, reading a normal value of 102/68 mmHg.
Body temperature, heart rate, and respiratory rate are stable.
Using a sublingual thermometer, the clinician measures the patient's temperature at 36.6 degrees Celsius. Simultaneously, she measures a resting heart rate of 68 beats per minute with a regular rhythm and a respiratory rate of 12 unlabored breaths per minute.
HEENT and Upper Extremity Inspection
Skin temperature and capillary refill are within normal limits.
The skin of the upper extremities is assessed as warm to the touch. Capillary refill is evaluated on the fingernails and is measured at less than two seconds bilaterally, confirming healthy peripheral perfusion.
Head and skull inspection shows no pathology.
The patient's head is characterized as normocephalic and atraumatic. The hair is thin but evenly distributed across the scalp, and the scalp itself is free of lesions, abnormalities, or pain upon physical palpation.
Snellen eye exam demonstrates bilateral 20/20 vision.
The patient covers her right eye and reads a text line from left to right, then switches to cover her left eye and reads the same line backwards without error. This establishes a visual acuity of 20/20 bilaterally without the use of corrective lenses.
Visual fields and external structures are examined.
The clinical examiner tests the peripheral visual fields through confrontation, demonstrating intact vision across all four quadrants. Examination of the eyelids reveals no ptosis. The sclera is clear and white, and the conjunctiva displays a slightly pale pink color.
Assessments of pupils, accommodation, and eye movements.
The corneal light reflections are medial and symmetrical, and no crescentic shadows are noted on the iris. Direct and consensual pupillary reactions to light are tested and found fully functional. Convergence and accommodation tests show healthy near-to-far tracking. Testing of extraocular movements indicates that cranial nerves III, IV, and VI are intact with smooth, conjugate gaze.
Ophthalmoscopic exam of the fundus indicates healthy structures.
Viewing through an ophthalmoscope, the examiner visualizes a red reflex in both eyes. The optic discs are successfully visualized with clear, distinct borders. There is no evidence of papilledema or arteriovenous (AV) nicking.
Hearing, tug test, and otoscopic inspection.
Auditory acuity is tested using a whispered voice while the patient occludes the opposite ear, proving intact hearing bilaterally. A tug test of the external ear canal is negative for pain. An otoscopic exam reveals a small amount of cerumen, but the tympanic membranes are fully visualized, intact, free of perforations, and show clear anatomical landmarks including the malleus.
Nose, sinus, and mouth examinations.
The nose is structurally symmetrical. Internal inspection shows slightly pink mucosa with minor clear discharge, but otherwise healthy turbinates. Palpation over the maxillary and frontal sinuses is completely non-tender. The mouth displays symmetrical lips, healthy-looking pink oral mucosa, and gingiva. Upon phonation, a symmetrical rise and fall of the uvula represents an intact cranial nerve X. Symmetrical tongue movement side-to-side confirms cranial nerve XII is intact.
Neck and Lymphatic Examination
Cervical lymph nodes are verified non-palpable.
The clinician systematically palpates all superficial cervical lymph node chains, including the preauricular, postauricular, occipital, submental, submandibular, tonsillar, superficial cervical, deep cervical, and supraclavicular nodes, noting that they are completely non-palpable and non-tender.
Tracheal alignment and thyroid glands are properly positioned.
Visual inspection and palpation confirm that the trachea is directly midline without any deviations. The patient is asked to swallow, proving a symmetrical rise and fall of the thyroid gland.
Thorax and Lung Assessment
Lungs are assessed symmetrically on the posterior chest.
The patient turns on the examination table to expose her back. The posterior thorax shows symmetric respiration of the chest wall with no obvious structural abnormalities. Palpation reveals a very mild hypertonicity of the paraspinal muscles, which remain non-tender to touch.
Tactile fremitus and percussion of the back are clear.
Symmetric chest excursion is verified as normal. The clinician assesses tactile fremitus by having the patient repeat the phrase '99' while palpating the back, showing equal vibrations. Percussion over all posterior fields shows normal resonance, and diaphragmatic excursion is mapped with dullness at the T10 spinal level.
Auscultation of the lungs reveals clear breath sounds.
The posterior lung fields are auscultated while the patient breathes deeply in and out. Symmetrical, healthy vesicular breath sounds are heard in all lung zones without any adventitious sounds such as crackles, wheezes, or rhonchi.
Anterior lung assessment shows consistent respiratory findings.
The patient lies in a supine position to facilitate the anterior lung examination. Symmetrical tactile fremitus is noted on the chest wall when repeating '99.' Resonant percussive notes are heard over all anterior lung fields, and clear vesicular breathing is confirmed during auscultation.
Cardiovascular Assessment
Jugular venous pressure and carotid arteries are evaluated.
The examination head of the table is elevated slightly. Jugular venous pulsations are identified and measured at approximately 1.5 cm above the sternal angle. The carotid pulses are palpated to display brisk upward strokes with no thrills, and subsequent auscultation confirms there are no bruits present.
Precordial inspection, palpation, and PMI location.
The precordium is inspected with no visible abnormal pulsations. The patient rotates slightly to her left lateral decubitus position, allowing the provider to palpate the point of maximal impulse (PMI), which is located in the fifth intercostal space at the midclavicular line and is approximately the size of a quarter.
Heart auscultation yields normal S1 and S2 sounds.
The heart sounds are auscultated with both the diaphragm and bell of the stethoscope over the four main valve areas. S1 and S2 are crisp and normal. S3 and S4 sounds are absent, and there are no clinical signs of cardiac murmurs, rubs, or gallops.
Abdominal Examination
Visual inspection and auscultation of bowel sounds and bruits.
The abdomen is inspected, displaying a centrally located umbilicus and no visible vascular abnormalities or scars. Auscultation of all four quadrants confirms normal-active bowel sounds. Auscultation is performed over the major abdominal arteries, showing an absence of bruits.
Percussion to define liver span and identify fluid/air.
The abdominal wall is percussed across multiple quadrants showing general tympany. Percussion is used to define the upper and lower borders of the liver, resulting in an estimated liver span of 7 cm at the midclavicular line. The splenic percussion sign is negative.
Light and deep palpation reveals no masses or organomegaly.
Both light and deep palpations are conducted across the abdomen. Sensation is normal with no muscle guarding, rigidity, or deep tenderness. Deep palpation during inspiration tracks a smooth liver edge with no nodules, and the spleen, kidneys, and abdominal aorta are determined to be non-palpable.
Inguinal lymph nodes and femoral pulses are checked.
Palpation is performed superior to the pubis area to assess the inguinal region and major vasculature. The abdominal aorta pulsation is measured at an unremarkable 2 cm width. Both inguinal lymph nodes are non-palpable, and the femoral artery pulses demonstrate normal brisk strokes.
Musculoskeletal and Extremity Exams
Lower extremity inspection reveals healthy range of motion.
The legs are inspected, noting only a few minor, insignificant bruises. Palpation of the major lower joints confirms no tenderness or pre-tibial edema. The patient demonstrates normal active range of motion of the hips, knees, and ankles by pulling her knees to her chest, spreading her legs, crossing them over, pointing her toes, and lifting them.
Lower limb muscle strength is 5/5 bilaterally.
Motor strength of the lower extremities is tested by applying manual resistance against knee flexion, knee extension, hip abduction, hip adduction, ankle dorsiflexion, and ankle plantarflexion. The patient easily overcomes this pressure, indicating a maximum muscle strength score of 5/5.
Cervical spine and upper extremity range of motion is normal.
The patient sits on the side of the exam table. Cervical range of motion is assessed as normal in all planes (flexion, extension, lateral flexion, and rotation). Inspecting the arms shows symmetrical muscle mass. Palpation of the joints is completely non-tender, and the active range of motion of the shoulders, elbows, and wrists is unrestricted.
Upper extremity muscle strength also grades at 5/5.
Upper extremity motor strength is validated by testing resisted elbow flexion/extension, wrist movement, finger abduction/adduction, and hand grip strength. The patient successfully resists all counter-forces, demonstrating a robust score of 5/5 across all upper muscle groups.
Detailed Cranial Nerve, Reflex, and Sensory Testing
Cranial nerve tests for olfaction, facial sensory, and movement.
Cranial nerve I is verified as intact after the patient closes her eyes, plugs alternate nostrils, and correctly identifies coffee and lemon scents. Cranial nerve V sensory portion is confirmed intact through sharp/dull cutaneous tests and light cotton-wisp touch across facial dermatomes, while CN V motor is verified by jaw clenching. Symmetrical facial movements (smile, frown, puffed cheeks, raised eyebrows) confirm an intact Cranial nerve VII.
Cranial nerve XI is confirmed, and deep tendon reflexes are analyzed.
An intact cranberry nerve XI is verified by having the patient shrug her shoulders and rotate her head against manual resistance. Deep tendon reflexes (DTRs) are assessed on the biceps, triceps, brachioradialis, patellar, and Achilles tendons, all resulting in a normal and symmetric 2+ score.
Proprioceptive and sensory exams verify healthy tracts.
The physician assesses sensory systems by checking vibration sense with a 128Hz tuning fork at the distal fingers and toes, which the patient detects accurately. Stereognosis is proven intact when the patient identifies hand-held objects with closed eyes. Graphesthesia is intact as the patient correctly identifies the number '3' traced on her palm. Sharp-to-dull sensory mapping is successfully verified across all body dermatomes.
Coordination, Romberg, and Gait Analysis
Coordination and rapid alternating testing are performed successfully.
Cerebellar coordination is evaluated via rapid alternating hand movements on the thighs, rapid finger-to-thumb opposition, and fast-paced bilateral foot tapping. Symmetrical, fluid movements are observed. Point-to-point accuracy is confirmed via repeated finger-to-nose-to-finger exercises, and the heel-to-shin test is completed smoothly with eyes open and closed.
Lumbar range of motion and Romberg stability testing.
The lumbar spine range of motion (flexion, extension, lateral bending, rotation) is assessed and found to be within normal limits. Station stability is evaluated via a Romberg test, which is negative as the patient maintains upright stability with closed eyes. Pronator drift is also tested and is negative.
Gait and tandem walking are normal, completing the exam.
Gait dynamics are observed as the patient walks with a normal stride, performs heel-walking, toe-walking, and heel-to-toe tandem walking without losing her balance or displaying ataxia. The examination concludes with normal physical findings throughout.
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