1. NOVA SOUTHEASTERN UNIVERSITY
PHYSICIAN ASSISTANT PROGRAM
FORT LAUDERDALE
Course Syllabus
I. Course Title: PAC 5200, Physical Diagnosis III
II. Course Director: Steve Sager, MPAS, PA-C
Office: 954-262-1236
Email: ssager@nova.edu
III. Meeting Times: Please refer to the online WebEvent calendar.
Instructor’s Office Hours: By appointment, 2nd Floor, Room 1283, Terry Building
IV.
VI. Course Description: A combined lecture and laboratory format will be used to present the
concepts and skills required to elicit a medical history and perform a physical examination for
specific patient complaints. Small group and laboratory presentations will be used to refine the
medical history concepts and physical examination skills acquired in Physical Diagnosis I & II.
Instructional methods including supervised clinical experience and patient simulations will
facilitate the students’ integration of clinical information in order to diagnose disease and record
historical and physical findings in written format. The course will expand on the skills essential
for performing a thorough medical interview and physical examination and will enhance medical
documentation skills. This course also continues to develop medical problem solving skills. The
student will be taught the concepts and skills necessary to develop a differential diagnosis and
management plan for medical problems encountered in the primary care setting. Emphasis is on
correlation of historical information, physical findings, and pertinent laboratory results to
formulate a diagnosis. Through case presentations and medical simulations, the student will also
utilize knowledge acquired from previous and concurrent didactic courses to develop these skills.
VII. Course Goals:
A. Develop the skills necessary for correlation of historical information, physical exam
findings, and pertinent laboratory data to first formulate a differential diagnosis and then a
final diagnosis.
B. Provide the required knowledge to develop a differential diagnosis of common diseases
in primary care.
C. Develop and foster critical thinking as a tool to differentiate clinical scenarios of common
diseases encountered in primary care.
D. Refine communication skills central to obtaining and documenting a focused medical history.
E. Define and improve skills and techniques for performing a focused physical
examination.
F. Refine skills necessary for performing and interpreting a specialized physical
examination.
G. Demonstrate acquired skills by performance in simulated and actual patient contact and
examination settings.
H. Demonstrate an understanding of the importance of thoroughness and accuracy in physical
diagnosis skills in regards to reducing medical errors.

2. VIII. Subject Outline: Please refer to course schedule.
IX. Course Texts:
Required:
Seidel HM, Ball JW, Dains JE, Benedict GW. Mosby’s Guide to Physical Examination.
th
6 ed. St. Louis, MO: Mosby; 2006. (ISBN 13: 978-0-3230-2888-2)
Coulehan JL, Block MR. The Medical Interview: Mastering Skills for Clinical Practice.
th
5 ed. F.A. Davis; 2006 (ISBN 13: 978-0-8036-1246-4)
Recommended:
Seidel HM, Ball JW, Dains JE, Benedict GW. Student Laboratory Manual for Mosby’s Guide to
th
Physical Examination. 6 ed. St. Louis, MO: Mosby; 2006. (ISBN 13: 978-03230-3573-6)
LeBlond RF, DeGowin RL, Brown DD. DeGowin’s Diagnostic Examination. McGraw-Hill;
2008 (ISBN 13: 978-0-07-147898-4)
X. Course Format: Lectures and laboratory sessions will be scheduled weekly. Laboratory sessions
will be divided into two-hour blocks and attended by assigned student lab groups and faculty. In
addition to scheduled laboratory practice time, certain skills will require additional student
participation, which may include evenings and/or weekends. Advanced notice will be given for
those sessions as scheduled. These extra sessions will be mandatory.
XI: Learning Objectives: Individual instructors may provide you with additional objectives for their
lectures. You are responsible for objectives in this syllabus as well as those provided to you
throughout the semester. Given an adult patient and the necessary equipment, without assistance or
reference, students will be able to obtain a comprehensive medical history and perform a complete
head-to-toe physical examination utilizing a logical, systematic sequence of steps. Each section will
include the following:
1. Obtain a complete medical history and perform a physical examination, without assistance or
reference, utilizing a logical, systematic sequence of steps and necessary equipment on a
patient with a pathological condition.
2. Discuss common “difficult” encounter situations including the following:
a. interviewing a difficult patient
b. common patient behaviors that create difficult interviewing situations
c. strategies to overcome difficult interviews with patients that:
1) have impaired vision / hearing
2) have limited intelligence
3) are poor historians
4) have a language barrier
3. Describe adaptive behaviors the medical practitioner can employ to overcome a difficult
patient interview.
4. Discuss the different methods that can be used to interview the following special patient
populations:
a. pediatric patients
b. adolescents

3. c. geriatric patients
5. Properly complete clinical and inpatient documentation to include the following:
a. Construct and organize a complete medical history and physical exam on an adult and
pediatric patient
b. Define the purpose and parts of a SOAP note
c. Construct and organize a detailed but focused SOAP note
d. Construct and organize detailed but focused admission note and orders
e. Construct and organize detailed but focused daily inpatient progress note and orders
f. Construct and organize detailed but focused discharge summary and discharge orders
g. Describe the purpose and components of preoperative, operative and postoperative
notes
6. Discuss the purpose of oral patient presentations and orally present patient cases in an
organized and concise fashion.
7. Discuss appropriate patient education in relation to:
a. medication compliance
b. screening tests
c. preventative care
d. developmental milestones
e. treatment plans
f. follow-up evaluation and care
8. Perform an abdominal examination.
a. Select appropriate questions to elicit from the patient with an abdominal complaint
during a patient interview.
b. Recall abdominal anatomy and identify by quadrants possible organs involved, given
the anatomic location of abdominal pain.
c. Define the acute abdomen.
d. Perform the appropriate physical examination on the patient presenting with an acute
abdomen.
e. Demonstrate the proper physical examination techniques and special tests required to
assist the clinician in diagnosing an acute abdomen.
f. Given a case study, perform the appropriate focused history and physical examination
and formulate a differential diagnosis.
9. Perform a musculoskeletal examination.
a. Select appropriate questions to elicit from the patient with an musculoskeletal
complaint during a patient interview.
b. Identify and demonstrate the special techniques of examination and various causes of
deformities of the:
1) temporomandibular joint
2) cervical, thoracic, and lumbar spines
3) upper extremity (including the shoulder, elbow, wrist, and fingers/thumb)
4) lower extremity (to include the hip, knee, ankle, and toes)
c. Given a case study, perform the appropriate focused history and physical examination
and formulate a differential diagnosis

4. 10. Perform a female genital examination.
a. Select appropriate questions to elicit from the patient with a gynecological complaint
during a patient interview.
b. Recall the anatomy of the internal and external female genitalia and relationship to
other pelvic organs
c. Compare and contrast Tanner’s Stages for female external genitalia development
d. Compare and contrast the steps in performing a physical exam of the external genitalia
e. Demonstrate proper technique for the physical exam of the female external genitalia
f. Compare and contrast the steps in performing a physical exam of the internal female
genitalia
g. Demonstrate proper technique for the physical exam of the female internal genitalia
h. Describe and demonstrate the proper technique of a Pap smear
i. Given a case study, perform the appropriate focused history and physical examination
and formulate a differential diagnosis
11. Perform a physical examination of the breast.
a. Select appropriate questions to elicit from the patient with a breast related complaint
during a patient interview.
b. Recall the anatomy of the female breast
c. Recall the relationship of the female breast with chest anatomy
d. Describe the arterial, venous, and lymphatic components of the chest and breast
e. Compare and contrast Tanner’s stages of breast development
f. Compare and contrast the steps of the normal physical exam of the female breast
g. Demonstrate proper technique for the physical examination of the female breast
h. Demonstrate proper patient education for monthly breast self examinations
i. Given a case study, perform the appropriate focused history and physical examination
and formulate a differential diagnosis
12. Perform a routine obstetric examination.
a. Select appropriate questions to elicit from an obstetric patient during a patient
interview
b. Identify the changes in the anatomy of the pregnant patient
c. Differentiate the lie, presentation, attitude, and position of the fetus to the maternal
anatomy
d. Compare and contrast the specific signs and symptoms of the pregnant patient
e. Define the risk factors for the pregnant patient
f. Differentiate the methods of determining the estimated date of confinement
g. Identify the key points in the physical examination of the pregnant patient
h. Correlate the stage of pregnancy with the uterine size
i. Identify the four elements of Leopold’s maneuver
13. Perform a neurological examination.
a. Select appropriate questions to elicit from the patient with a neurologic complaint
during a patient interview
b. Differentiate “normal” from “abnormal” findings on neurologic examination
c. Identify common causes of various cranial nerve palsies
d. Differentiate conductive hearing loss from sensorineural hearing loss

5. e. Determine location of neurological lesion, given a case scenario
f. Differentiate amongst the various movement disorders
g. Differentiate atrophy, hypertrophy, and pseudohypertrophy
h. Differentiate between spasticity, rigidity, and flaccidity, and identify common causes
of each
i. Differentiate upper motor neuron lesions from lower motor neuron lesions
j. Differentiate CNS disorders from PNS disorders, and identify location of the lesion
and common causes
k. Compare and contrast the five clinical levels of consciousness
l. Given a case study, perform the appropriate focused history and physical examination
and formulate a differential diagnosis
14. Describe the historical and examination differences involved in assessment of a geriatric
patient.
a. Describe the anatomic and physiologic changes attributed to aging
b. Discuss important principles of geriatric assessment such as:
1) altered presentation of disease
2) non-specific presentation of disease
3) assessment of activities of daily living
4) multiple pathologic conditions (co-morbidities)
5) recognizing polypharmacy
c. Describe different types of advanced directives and their impact on management of
patients
d. Discuss the following assessments in relation to geriatric patients:
1) abuse and neglect
2) decubitus ulcers
3) falling
4) incontinence
5) nutritional assessment
6) affective disorders
e. Given a case, study perform the appropriate focused history and physical examination
and formulate a differential diagnosis.
15. Describe the historical and examination differences involved in assessment of pediatrics
patients to include the newborn, infants, toddlers, school-age, and adolescents.
a. Discuss the techniques and contents of the pediatric history
b. Discuss and describe the importance of developmental milestones in obtaining a
pediatric history
c. Discuss and perform the techniques utilized during the pediatric physical exam
d. Compare and contrast the adult and the pediatric history and physical exam
e. Discuss the importance and application of growth curves in pediatric assessment
f. Describe the Apgar scoring system
g. Identify the normal and abnormal physical findings of the pediatric-aged patient
h. Given a case study, perform the appropriate focused history and physical examination
and formulate a differential diagnosis
16. Perform a male genital and rectal examination.
a. Select appropriate questions to elicit from the patient with a genitourinary complaint

6. during a patient interview
b. Recall the anatomy of the internal and external genitalia and its relationship to other
organs
c. Compare and contrast Tanner’s stages for male genitalia development
d. Compare and contrast the steps in performing a physical exam of the male genitalia
and rectum
e. Demonstrate the proper techniques of examination of the male genitalia and rectum
f. Identify the techniques involved in the evaluation of the male patient for hernias of the
inguinal and femoral regions
g. Given a case study, perform the appropriate focused history and physical examination
and formulate a differential diagnosis
17. Discuss the evaluation of the acutely ill patient.
a. Compare and contrast the symptoms and signs that are indicative of an acutely ill
patient
b. Differentiate between the primary and secondary surveys in the evaluation of an
acutely ill patient
c. Apply the primary and secondary survey evaluations to assess an acutely ill patient,
given a case scenario.
18. Discuss the techniques used to assess a patient with “fatigue” as their chief complaint.
a. Discuss components of gathering a medical history for a patient complaining of fatigue
b. Discuss components of performing a physical exam for a patient complaining of
fatigue
c. List a differential diagnosis for fatigue
d. Discuss what diagnostic tests should be ordered for a patient complaining of fatigue
XII. Evaluation Procedures:
Quizzes – will be administered online in WebCT and in the classroom using audience response devices
(“clickers”). Quizzes will be given prior to most lectures for each system discussed. Advanced reading
of the material prior to the lecture is required. (Responding to questions asked during the lectures will
be counted as part of the class participation grade.)
Written examinations for PAC 5200 will be held at the times designated on the Web Event calendar. The
comprehensive midterm written examination will cover lecture material from the first half of the course.
The comprehensive final written examination will cover lecture material presented in the second half of
the course. Written exam failures require remediation of that exam.
Practical Examinations – Faculty will use standardized checklists to evaluate each student’s physical
examination skills. A minimum score of 80% (B-) must be achieved to pass each practical exam.
Failure of a practical exam requires mandatory attendance and participation in a remedial
exercise (tutorial). Although the remedial exercise is mandatory, your original grade will not change
after the exercise is complete.

7. Classroom and laboratory preparation and performance will be evaluated based on student’s
attendance and participation. This includes:
a. punctuality
b. preparation and successful completion of assignments
c. classroom responses using the audience response device (“clicker”)
d. proper lab attire
e. functional diagnostic equipment
f. familiarity with material
The final course grade will be calculated based on the following distribution:
Written examinations 30%
Midterm = 15%
Final = 15%
Practical examinations 40%
Two (2) exams = 10% each
Final OSCE exam with standardized patient = 20%
Written assignments 20%
Five (5) assignments; see course schedule for details
Laboratory participation and quizzes 10%
In order to pass this course, all students must achieve a cumulative average of C (75%) or greater
on the written exams, a cumulative average of 80% (B-) or better on the practical examinations,
and a score of 80% (B-) or better on the final practical exam.
NOTE: all evaluation components of this course must be passed to pass the course. The student will
be offered one remedial exam for each component that is not passed. Failure to pass any of the
remedial exams will result in course failure without the option of additional remediation and the
student will be referred to the Committee on Student Progress.
XIII. Course Policies:
Participation is essential to learning physical examination techniques and will be expected of every
student throughout the course. Attendance is mandatory in this program. Absences and tardiness will
not be excused. Tardy students will not be permitted to enter the classroom until the second half of class.
Lab participation is mandatory. These are skills you will be using the rest of your clinical career. You are
expected to make full use of your time in lab to learn, improve your skills and help others in class where
appropriate.
Mandatory lab attire:
Women: sports bra, PA program t-shirt and PA program shorts
Men: PA program T- shirt and PA program shorts
All: monogrammed student lab coat with PA program logo

8. Diagnostic equipment is required for all laboratory sessions. Your equipment needs to be in working
order at all times. Students are also required to bring the required textbook to both lecture and lab sessions
throughout the semester.
Failure to dress appropriately will result in dismissal from the lab. Failure to actively participate in
lab activities or have working equipment will result in a deduction from your total laboratory grade.
Dismissal will be counted as an unexcused absence.
In addition, students will be evaluated on their participation in Clinical Problem Solving Lab Sessions.
Faculty will be grading students on their knowledge, level of participation and critical thinking skills.
Failure to attend the CPS lab or inadequate preparation will result in a “0” for that particular lab.
All written assignments must be in MS Word document format (.doc or .docx) and they must be
submitted electronically as an e-mail attachment. All written assignments must also be formatted
using the following parameters:
Margins: 1” on all sides
Font: Times New Roman 12-pitch
Spacing: single-space
Title: LastnameFirstinitial_Assignment (SmithA_SOAP)
Assigned reading must be completed prior to lecture or laboratory practicum. The required textbooks will
serve as the authoritative answer to a clinical problem if not addressed in lecture or written handout.
Students will be randomly called upon to answer questions in class and lab. They are also expected to
critique their own and fellow students’ thinking.
Please refer to the Academic Year Handbook concerning the policies and procedures for missed exams
and the procedure for documenting and reporting all absences. In the event of an absence, immediately
notify the course director of any missed lectures, exams or labs, via email or phone.
XIV. Classroom Behavior and Conduct
Professional behavior and decorum is a requirement for successful completion of this course. This
will be evaluated in the classroom, labs, and all associated encounters with the instructor and/or
staff. Failure to adhere to this standard, regardless of academic achievement in the course, will
subject the individual to referral to the Committee on Student Progress for possible disciplinary
action and/or dismissal.
THE COURSE DIRECTOR RESERVES THE RIGHT TO MAKE REVISIONS TO THIS
SYLLABUS AT ANY TIME.