clerkship handbook - University of Hawaii – Department of Medicine

Palpate anal canal, rectal ampulla (and prostate in
men), after gently inserting gloved and lubricated
index finger.
PELVIC EXAM: Instruction by obstetrician-gynecologist.
C. BRANCH STEPS: (EXTENDED PHYSICAL EXAMINATION)
If an abnormality is detected, it must be fully described and additional examination
(branch steps) performed to clarify and delineate that finding.
Example: If decreased auditory acuity is noted, the Weber and Rinne tests must be
done.
Such branch steps, how ever, are not part of the BPES.
Branch steps are taught in separate laboratory sessions. They are useful in further
elucidating abnormalities uncovered in the history and BPES and are generally not
screening maneuvers (Refer to page 24).
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