“Listen to your patient, he is telling you the diagnosis.

” — Sir William Osler

Telehealth Physical Exam Performing a physical exam via telehealth can seem challenging, especially if the patient is in their home where assessment tools,
such as a blood pressure cuff or digital stethoscope, may not be available. But with some thoughtfulness, cooperation of the
patient, and adequate lighting and camera, providers are able to examine several organ systems. And, as Osler reminds us, let’s
not forget our most keen diagnostic tool: a thorough patient history.

EYES NECK CHEST SKIN

• Appearance of conjunctiva • External appearance of the • Inspection of the breasts • Rashes, lesions, ulcers,
and lids (lid droop, neck (overall appearance, (symmetry, nipple cracking, fissures,
crusting/exudate, symmetry, tracheal discharge) mottling, petechiae
conjunctival injection) position, gross evidence of • Chest wall or costochondral • Cyanosis, diaphoresis
lymphadenopathy, jugular tenderness with self-
• Appearance of pupils venous distention)
(equal, round, extraocular palpation
eye movements) • Gross movement (degrees of
flexion anterior, posterior and
• Assessment of vision laterally) ABDOMEN NEUROLOGIC
(seeing double)
RESPIRATORY • Dermatomal distribution
• Examination of the
abdomen of numbness or pain
EARS, NOSE, MOUTH, • Assessment of respiratory • Tenderness on self- • Examination of
AND THROAT effort (intercostal retractions, sensation (by touch
palpation
use of accessory muscles, or pin)
diaphragmatic movement,
• External appearance of
pursed lip breathing,
the ears and nose (scars, MUSCULOSKELETAL PSYCHIATRIC
speaking in full sentences or
lesions, masses)
limited due to shortness of
• Assessment of hearing breath) • Examination of gait and • Orientation to time,
(able to hear, asks to station (stands with/without place, and person
• Audible wheezing use of arms to push off
repeat questions) • Recent and remote
• Presence and nature of chair; steady gait, broad/
• Inspection of lips, mouth, memory
cough (frequent, occasional, narrowed based)
teeth and gums (color,
wet, dry, coarse) • Inspection of digits and nails • Mood and affect
condition of mucosa)
(capillary refill, clubbing, • Pressured speech
• Gross inspection of throat
(tonsillar enlargement, CARDIOVASCULAR cyanosis, inflammatory • Mood lability (crying,
exudate) conditions, petechiae, laughing)
pallor)
• Appearance of face • Presence and nature of
(symmetric, appropriate edema in extremities (pitting, • Extremity exam may
movement of mouth, weeping) include:
no drooling or labial • Capillary refill • Alignment, symmetry,
flattening, ability to raise • Temperature of extremities defects, tenderness on
eyebrow, frown/smile, per patient/other measure self-palpation
close eyes, show upper
lower teeth, puff out • Range of motion, pain,
cheeks) contracture Suggested Citation:
CONSTITUTIONAL • Muscle strength and
• Pain or tenderness when Showalter, G. (2020, March 30).
patient palpates sinuses tone (flaccid, cogwheel,
Telehealth Physical Exam. Loengard,
or ears • Vital signs (heart rate and respiratory rate; spastic), atrophy,
if available, temperature, blood pressure, abnormal movements A., Findley, J. (Eds.).
weight) • Presence and nature of https://caravanhealth.com/
• General appearance (ill/well appearing, (un) edema, temperature
comfortable, fatigued, attentive, distracted,
disheveled/unkept)

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