Physical Exam Maneuvers That Earn Points on Part IV

6 min read·Updated September 1, 2026

In the 14-minute encounter you have maybe four or five minutes to examine. The candidates who look competent don't run more tests — they run the right tests, correctly, and say what they're doing. Physical examination is its own graded domain, and it rewards focus over volume.

Select before you touch: the discriminating exam

Your door note already gave you a differential; your exam's job is to separate those diagnoses, not to perform a rote head-to-toe. Before you start, know which two or three findings would change your mind. A shotgun exam — every orthopedic test you remember, in no particular order — reads as uncertainty. A tight sequence of maneuvers chosen to confirm or exclude your top diagnoses reads as a clinician.

Narrate everything

Say what you're doing and what you find, out loud: “I'm testing a straight-leg raise on the right… positive at about 40 degrees, reproducing his leg pain.” Narration does three things: it lets the examiner score what you did, it keeps you organized, and it feeds straight into your Objective section. A finding you didn't voice is a finding that's hard to credit.

Match the exam to the complaint

Low back / radicular — neuro screen (motor, reflexes, sensory), straight-leg raise and its variants, and the red-flag checks (saddle sensation, gait).
Neck / upper extremity — cervical ROM, neuro screen of the arm, and provocative tests appropriate to the suspected level or structure.
Shoulder / peripheral joint — focused ROM and the specific special tests for the structure you suspect, not the whole battery.
“Doesn't fit mechanically” — pivot to a screening exam that addresses the visceral or systemic possibility (vitals, abdominal, vascular) rather than forcing an orthopedic frame.

Do it right, not just fast. Accuracy and appropriateness are both scored. A maneuver performed sloppily can read as worse than not doing it — practice the mechanics of your core tests until they're clean, then practice choosing among them.

Don't skip the red-flag exam

When the history raises a concern, the exam is where you confirm or clear it — checking for the neurological deficit, the pulsatile mass, the systemic sign. Building that habit is how you catch the case that isn't yours to treat (red flags & dispositions).

Train the selection, not just the tests

Anyone can memorize special tests; the exam rewards choosing the right ones under time pressure. Drill it by running full timed encounters where you have to pick your exam on the fly — see Part IV, Station by Station and the study plan.

Frequently asked

How much of the Part IV encounter should be the physical exam?

Roughly four to five minutes of the 14-minute interaction — enough for a focused, discriminating exam, not a full head-to-toe.

What's the biggest physical-exam mistake on Part IV?

Running a shotgun battery of every test you remember instead of selecting the few maneuvers that separate your top diagnoses — and not narrating what you find.

Rehearse it, don't just read it.

DoorZero runs full, timed Part IV encounters against an AI standardized patient — free to start.

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Keep reading

Part IV, Station by StationA minute-by-minute Part IV patient station walkthrough — how to use the 2-minute door note, structure the 14-minute encounter, and write the 6-minute SOAP note.Red Flags & Dispositions on Part IVPart IV is quietly a triage exam. Learn the three dispositions, the red flags worth memorizing by content area, and the referral language that earns points.A Worked Part IV Case: Low Back PainOne Part IV patient station played out end to end — door note to SOAP — on a low-back radiculopathy case, so you can watch the method connect into one clean chain.

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