（4)肩[Shoulder]
•触诊双肩
•功能检查（三个过筛试验：一手越过头顶触摸对側耳朵；双臂上举，双手置于后枕；一手从背后触及对侧肩胛下角)
•检查上肢近端肌力
•检查触觉或痛觉（至少2/3部位)
•贝勒氏（Barre`s)上肢轻瘫试验（闭眼)
•Palpate both shoulders
•Functional examination (3 screening maneuvers: hand over head to opposite ear, hands behind head, touch lower border of opposite scapula)
•Check for proximal muscle strength
•Test sense of pain or touch:at least 2 of 3 positions (upper arm, forearm, & hand) on each upper extremity bilaterally and symmetrically
•Barre`s upper limb test (test for drift of outstretched arms with eyes closed)
（5)腱反射[Deep Tendon Reflexes(The reflexes should be checked bilaterally and both sides com-pared.)]
•肱二头肌反射
•肱三头肌反射
•桡骨骨膜反射
•Biceps reflex
•Triceps reflex
•Brachioradialis reflex
（6)共济运动[Coordination]
•快速轮替动作
•指鼻试验（睁眼)
•指鼻试验（闭眼)
•Rapid alternating movement
•Finger to nose test (with open eyes)
•Finger to nose test (with closed eyes)
4、背部[BACK]
•正确暴露背部
•逐个触诊脊柱棘突，检查有无畸形、压痛
•逐个叩击脊椎棘突（或用间接叩击法)检查有无叩痛
•检查肾区压痛和叩击痛
•检查胸廓活动度和对称性
•嘱受检者稍前倾，双上肢交叉，双手分别置于对侧肩部
•叩诊后胸部
•双侧对称地叩诊后胸部
•叩诊肺下界移动范围
•嘱受检者轻微张口作深呼吸
•听诊后胸部
•双侧对称地听诊后胸部
•听觉语音（耳语音)
•Expose the back correctly
•Palpate spinous processes one by one (check for scoliosis and tenderness)
•Test for percussion pain of spinal column one by one (or by indirect method)
•Test CVA for kidney tenderness by pressure and indirect fist percussion
•Palpate thoracic expansion and symmetry
•Have patient cross arms in front and touch opposite shoulder
•Percuss posterior lung fields
•Percuss posterior lung fields comparatively and symmetrically
•Measure diaphragmatic excursion
•Instruct the patient to breathe a little deeply with mouth open slightly
•Auscultate posterior lung fields
•Auscultate comparatively and symmetrically
•Vocal audible resonance
5、乳房（女性)[BREASTS (FEMALE)]
•充分暴露双侧乳房
•坐位（或站立位)观察乳房
•前倾位观察乳房
•双臂高举过头观察乳房
•用手指掌面以适当压力触诊右乳房
•按内上、外上、尾部、内下、外下顺序触诊右乳房，至少4/5部位
•触诊右乳晕及乳头，注意乳头溢液
•用手指掌面以适当压力触诊左乳房
•按内上、外上、尾部、内下、外下顺序触诊左乳房，至少4/5部位
•触诊左乳晕及乳头，注意乳头溢液
•教检者作乳房自我检查
•检查受检者右腋窝
•触诊右腋窝5群淋巴结
•检查受检者左腋窝
•触诊左腋窝5群淋巴结
•Expose both breasts completely
•Inspect both breasts symmetrically in sitting position
•Inspect both breasts symmetrically with patient leaning forward
•Inspect both breasts symmetrically with arms raised above head
•Inspect both breasts symmetrically with hands on hips and squeeze
•Palpate patient`s right breast with pads of fingers of right hand, applying gentle pressure
•Palpate right breast in the 5 following areas;superinternal, superlateral, tail, inferinternal, inferlateral (at least 4 of 5 parts of the breast should be palpated)
•Palpate nipples, areola, attempt to express discharge from nipple
•Palpate patient`s left breast with pad of fingers and palm, applying gentle pressure.
•Palpate left breast in the folloing areas:superinternal, superlateral, tail, inferinternal, inferlateral.
•Palpate nipples, areola, attempt to express discharge from nipple.
•Teach patient breast self-examination.
Axillary Examinaton
•Inspect the patient`s right axilla.
•Palpate chains of lymph nodes on right:top , medial, anterior, posterior, lateral
•Inspects patients left axilla
•Palpate chains of lymph nodes on left: tcp, medial, anterior, posterior, lateral.
