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this is my personal notes i generated from studying Textbook of Physical Diagnosis.
Physical exam<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
Aï¼Ž Mental Status
a) Assess the level of consciousness: Hello, Mr. blah, can you hear me? If you hear me, squeeze my hand.
b) Evaluate speech: please repeat â€œno ifs, ands or butsâ€
c) Orientation: which state are you in? what time is it? What is your name?
d) Knowledge of current events: who was the franchise player of Chicago Bulls in 90s?
e) Judgment: what do u do when you are in a crowded theatre and fire breaks out?
f) Abstraction: what is similar about a dog and a cat?
g) Vocabulary: used in the level of difficulty: car then voluntary then enigma
h) Emotional response
i) Memory: recent memory (car, pencil, book) ask again in 5 mins. Remote memory
j) Calculation: serial 7s
k) Object recognition (language): show the pencil to the patient and ask what color it is
l) Integration of motor activities: 3-steps command: give the paper to the patient and fold in half and place it on the floor
The simplified version contains only orientation, memory, calculation, object recognition, 3-step command
B. Cranial Nerves
I. Do not do it
II. visual acuity (donâ€™t do); use ophthalmoscope under (DM, HT, increase intracranial pressure, CVA), check field(fix each other at the nose and close the eyes-same side and move up/down)
III/IV/VI: use right index finger to make half H on the left side with left hand to hold the chin of the patient. Do the same for the reverse eye.
V: Sensation: eyes closed, piece of gauze on forehead, cheek, jaws
Motor: bite down while palpate masseter, temporalis muscles
VII: Motor: lower: show teetch, puff out the cheek
Upper: make wrinkles on the forehead, close eyes and donâ€™t let me open them (do them separately)
VIII: Do not do it, except Weber and Rinne
IX/X/XII: open mouth wide and say ah and see if there is bilateral elevation of soft palate and if uvula is in midline; then ask the patient to stick out the tongue.
XI: Motor: ask the patient to turn the head to the right.
flexion/extension of arm: push down/up/back/forward and then relax
abduction of arm: abduct the arm against resistance
forearm flexion/extension: pull-in and relax and push-out and relax
wrist extension/flexion: make a fist and extend while you pull it up/down
finger adduction: ask the patient to grasp your extended index/midder fingers
finger abduction: resist my attempt to bring fingers together.
Upper tone: relax your arms and passively flex/extend upper limbs
Hip adduction/abduction: close/open the legs against resistance
Knee flextion/extension: hold the foot down as you extent the leg; do the reverse for extension
Great toe dorsiflextion/plantarflex.
Lower tone: grasp foot and passively dorsiflex and plantarflex to check ankle clonus.
1. Deep tendon (stretch reflex)
Biceps: place thumb firmly on biceps tendon and use the hammer to struck on thumb
Brachioradialis: strike the styloid process of radius.
Triceps: hang the patienâ€™t arm over your arm and strike on triceps tendon
Patellar tendon reflex
Achilles tendon reflex: hold the feet and strike post aspect of calcanus.
2. superficial reflex
Abdominal reflex: use tongue blade to stroke horizontally laterally to medially
3. Abnormal reflex
Babinski: lateral aspect of sole stroke from heel to the ball of foot and curved medially across the heads of metatarsal bones.
E. Sensation (If the light touch, pain, vibration normal, rest not required)
1. Light touch: close eye and ask the patient to identify the touch. If normal, do 2nd. If abnormal, continue to work proximally until sensation level is identified.
2. pain: close the eyes, tell the patientwhich is sharp and dull and ask the patient to identify
3. vibration: ta
p the tuning fork and place on bony prominence distally and close eyes, ask patient when he no longer feels the vibration on fingers/big toe.
4. proprioception (balance): instruct the patient: this is up, down; then close the eyes and ask me patient what is the direction.
5. tactile localization: close eyes, touch two places (face, right arm) simultaneously and ask the patient to identify both places.
6. 2-point discrimination
7. sterognosis: identify the object placed in the hands
8. graphesthesia: write the number down the palm and ask the patient to say it
9. point localization. Ask â€˜where is touchedâ€™
1. finger-to-nose: eyes close
3. Rapid alternating movement
4. Rombergâ€™stest: heels close, arms extend with palms facing upward, close eyes, see if the patient can hold steady.
5. Gait: ask the patient to walk straight ahead and return on tiptoes; walk away in heels and back in tandem gait.
i went through first aid minicasaes once, when they ask u to do complete neuro. do u do every single step i listed above? can somenone tell me the short complete version? appreciate it very very much.!!!!!!!!!!!
Is there an essential edition?
okay let me try
Think 6 things MCMCRS
Hello , can u hear me?can u smile? where r we ?Wht is de day? Ur full name ? Times 3
Wht u do if u find self addresd envelepe? ( Judge)
table chair pen --brief den ask 4 dem at MMSE end
(memory) Spell world backwards
(Abstraction) 'or' 'early bird catches the worm" means wht?
close ur eyes (3 object command)
Optic =finger counting/finger wiggling for visual field Direct & consensual reflex e torch & dim room
Oculomotor= 'H" routine
Trigeminal= tell 2 Bite down den palpate + Sharp Dull sense @ 2 congruent face spots
Facial= SPF ...Smile/Puff/Frown
Vestibulocochlear= whisper words ..ask him 2 repeat .Weber- TF on top (laterlizes) Rinne- TF on Mastoid den bring 2 ear ( AC>BC)
Vagus= Say 'Ah" --Observe
Accessory= Shrug shoulders against resist
Hypoglossal= Stick out tongue
play e elbow wrist ankle knee den resisted movments at dese joints (limbs)
Plz lean over & touch toes (spine)
Rapid alternate moves (just flip ur hands quickly & mak pt rep)
Finger 2 nose (self explanatory) (if dese 2 done no need 2 do pronator drift & ankle shin whatever)
Gait - plz Get up & go
Biceps triceps knee Babinski (all can b done sitting)
Pain=sharp & Dull @shoulders + Forearms+ Thighs+ Leg ( total 8 spots) Position = play e big toe (up & down) Vibration= TF @ DIPJ ( tell wen u feel vib)
Just touch chin 2 sternum if no fever/vomiting/neck stiff CC dont do Brudzinski/ kernings etc .
Edited by Aashi on Jan 14, 2008 - 5:49 PM
WONDERFUL GUYS REALLY THANX CAUSE I HAVE ALWYSE HAD A BIG TIME DIFFICULTY WITH NEURO EXAM ...
what exams shoud we do for eye exam in HEENT,AND WHAT EXAMS FOR OPTICNERVE IN cRANIAL NERVE EXAM AMONG 4 EXAMS below:
MS C MR C'S
for MSSE: ORAL CR JR
Orientation: person, place, date, situation
Registration: say pen paper chair, remember these words
Attention/ calculation: 100-7 series
Language: what do u call this (pencil)
Command Following: hold this paper and fold it into half
Remote: when is your birthday?
Judgment: if u see a wallet on the street what will you do
Recall: what are the three words i ask u to remember earlier
Personally I am finding it hard to memorize which components of the full neurological exam must be done in any patient with neuro-related C/C and which other parts are to be reserved only to specific C/Cs.
For instance, Kaplan suggests to perform a complete Neurological examination if the C/C is one among: headache, dizziness, balance or vision problems, numbness, tingling, weakness, psychiatric problems or memory problems.
In these cases they suggest to start the evaluation with mental status, which include evaluating orientation to person, place and time; memory (3 words to be repeated immediately and after 1 minute), attention (spelling world backwords), language (pointing and asking to name a pen and a tie or watch), commands (asking to close patient's eyes)
Now, my question is how many of you agree with this? In other words the MMSE would be much longer and complex: it would include also having the patient repeating a sentence (as there's no ifs ands or buts), writing a meaningful sentence, drawing two intersected pentagons and so on. Do you think we should stick to kaplan suggestion? And if yes how are you planning to test patient's command obeying? In kaplan they say to order the patient to close his/her eyes, but ideally, according to the MMSE technique, this should be written on a piece of paper and the patient should do it after reading.
I am eager to know your point of view, it would be nice to find a sort of consensus on this. Thanks a lot!
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