System Exams Promotion Exam

Musculoskeletal:
Each joint involves inspection, palpation, active ROM, passive ROM and resisted muscle testing;
I can provide more detail if needed
Inspect and palpate
Strength and ROM active, passive, resisted
TMJ
Cervical Spine
Thorasic and
Lumbar Spine
Shoulder
Elbows
Hands, wrists,
fingers

Hips
Knees
Ankles
Feet/toes

Neurological:
Mental Status and Speech Exam
Cranial Nerve Exam

Smell (1)
Visual acuity, fields (2)
Pupillary rxns (2,3)
EOM (3,4,6)
Corneal reflex, jaw closing (5)
Facial movement (7)

Hearing (8)
Swallowing (9,10), rise of palate(10), gag reflex (9,10)
Voice (10)
Speech (5,7,10,12)
Shoulder shrug (11)
Tongue movement (12)

Test Motor-Reflex-Sensory (MRS) for upper and lower spinal levels

Upper Extremity
a. MRS-C5:
MOTOR: Deltoid (shoulder abduction) and
Biceps (elbow flexion)
REFLEX: Biceps

SENSORY: Lateral arm

b. MRS-C6:

MOTOR: Biceps (elbow flexion)

Wrist extensors (wrist extension)

REFLEX: Brachioradialis
SENSORY: Lateral forearm, thumb, index finger
c. MRS-C7:

MOTOR: Triceps (elbow extension)

Wrist flexors (wrist flexion)

Finger extensors (finger extension)
REFLEX: Triceps
SENSORY: Middle finger

d. MRS-C8:

MOTOR: Finger flexors (finger flexion)

Interossei (finger abduction and adduction)

REFLEX: None
SENSORY: Medial forearm, little finger, ring finger
e. MRS-T1:

MOTOR: Interossei (finger abduction and adduction)

REFLEX: none
SENSORY: medial arm
Lower Extremity
a. MRS-L4:
inversion)

MOTOR: Tibialis anterior (ankle dorsiflexion and

REFLEX: Patellar
SENSORY: Medial leg and foot
b. MRS-L5:

c. MRS-S1:

MOTOR: Extensor hallicuslongus(big toe extension)

Gluteus medius (hip abduction)

Extensor digitorumlongus and brevis
(toes 2-5 extension)
REFLEX: Medial hamstring
SENSORY: Lateral leg, dorsum of foot

MOTOR: Peroneus longus and brevis

(ankleplantarflexion and eversion)

REFLEX: Achilles
SENSORY: Lateral malleolus, lateral foot
Test Vibration and joint position sense (posterior column)-start at dips of
hands and feet
Test Cortical sensory functions-stereogenesis, graphesthesia, point location

Proprioception and Cerebellar function

Coordination-rapid alternating movements-

Upper extremity-alternated pronation and supination on thighs

Lower extremity-tapping ball of foot on floor or drs hand
Coordination and fine motor skill-accuracy of movement

Upper extremity-finger-to-finger or finger-to-nose

Lower extremity-heel-to-shin
Balance-equilibrium-Romberg followed by prontator drift
Balance-Gait-Observe normal gait; Walk heel-to-toe, walk on toes, walk on
heels

HEENT:

Head

o Inspect face and skin

o Examine hair and scalp
o Palpate skull and temporal artery

Eyes

o Acuity
o Visual fields-peripheral/central

o Inspect eye position and alignment, eyebrows and eyelashes, lacrimal

ducts, conjunctiva and sclera,cornea and lens, iris and pupil

o Test pupillary reaction to light and accommodation

o EOM
o Ophthalmoscopic exam - lens, vessels,disc, physiologic cup, macula

Ears

o
o
o
o

Acuity - gross, Weber/Rinne

Inspect auricle lesions
Palpate - auricle, tragus and mastoid
Otoscopic exam - external canal, TM

Nose

o Inspect external and internal nose - lesions, mucosa condition

o Sinus palpation, trans-illumination as needed

Mouth/Pharynx

o Inspect Mouth: Lips, buccal mucosa, gums and teeth, roof of mouth, tongue, floor
of mouth
o InspectPost Pharynx, Tonsils
o Palpate - tongue

Neck

o Inspect
o PalpateNodes - auricular, occipital, tonsillar, submandibular,

submental, anterior cervical, posterior cervical, deep cervical,

supraclavicular
o Trachea symmetry/alignment; palpate for deviation
o Thyroid - masses, enlargement

CV/PV:
Cardiovascular:
Blood Pressure, Pulse
Measure JVP and check for hepatojugular reflux
Palpate carotid pulse and auscultate for bruits
Inspect /palpate chest heaves, lifts, right ventricular impulse, apical impulse
(PMI)

Auscultate - rate, rhythm, extra sounds, murmurs (diaphragm and bell)

Peripheral Vascular:
Inspect extremities for size, symmetry, swelling (measure if necessary);
venous pattern, color, texture; hair pattern
Palpate for temperature and edema in lower extremity
`
Palpate for peripheral pulses radial, brachial; femoral, posterior tibial,
dorsalis pedis
Auscultate for bruits in abdomen
Palpate inguinal and epitrochlear nodes

Special tests
Patient LLD listen at apex w/bell (murmur of mitral stenosis)
Patient seated and leaning forward, hold breath; Listen at apex and LLSB
w/diaphragm (murmur of aortic regurgitation)

12 lead EKG

Respiratory:
Assess rate, rhythm, depth and effort of respiration
Observe overall skin color, fingernails, respiratory distress, use of
accessory muscles

Posterior Chest
Inspect - asymmetry
Palpate - masses, pain
Tactile fremitus
Respiratory expansion
Percuss - dullness, resonance
Auscultate - breath sounds, adventitious sounds
Special tests Transmitted voice sounds - as appropriate (required for
competency): Bronchophony, Egophony, Whispered pectoriloquy

Anterior Chest
Inspect - asymmetry
Palpate - masses, pain
Tactile fremitus
Respiratory expansion
Percuss - dullness, resonance
Ausculate - breath sounds, adventitious sounds
Special tests same as posterior above

Abdomen:
Observe - skin, umbilicus, contour, peristalsis, pulsations
Auscultate - bowel sounds, bruits, friction rubs
Percuss general, liver span, splenic percussion sign
Palpate
o Light general, cover all quadrants
o Deep general, liver, spleen, kidneys
o Aorta (assessing size of pulsation)
Special tests - as appropriate (required for competency)

Murphys
McBurneys

Rovsings
Psoas sign

Obturator sign
Ascites fluid wave and shifting dullness