ProcrastiNotes: Medicine 1

Step (As stated in the manual)

Grand Practicals
Materials

Position

1
Script/Normal Findings

Preparation
Wash hands before and after the
examination

Alcohol/Alcogel

Introduce self to patient and explain

exactly what will be done to the patient.
Ask also if patient would lke to use the
restroom

Patient is seated

I am washing my hands

Patient is seated

Magandang umaga po, ako po si _______;

second year medical student sa ilalim ni Dr.
_________. Andito po ako ngayon para isailalim
kayo sa Physical Exam; Maaari lamang po na
sundin nyo ang aking mga sasabihin at kung
may gagawin man tayong hindi ninyo gusto, o
hindi kayo komportable o nasasaktan kayo,
sabihin nyo lang po agad sakin.
Ano po ang Pangalan niyo?
Gusto nyo po ba muna mag CR bago tayo mag
umpisa

Ensures privacy and Patient's comfort

throghout the examination as well as
ensure adequate lighting and exposure

Well equiped Physical

Patient is Seated
Exam Area: 2 Drapes, Bed,
Pillow, Amibent Lighting

Examiner speaks in a professional

manner. No jargon or inapproriate
language used.
General Sur vey
Makes an accurate general survey and
reports accordingly (level of
consciousness, habitus, level of comfort,
ambulatory status, mood, facies if any
ETC)

Questions for the Patient:

Nasaan po kayo ngayon?
Anong araw ngayon?
Ano po kinain nyo
kaninang umaga?
Sino ang presidente ng
Assesses patient's orientation as to time, Pilipinas?
place and person; memory,
Ilang oras na po kayo
attention/calculation ETC
nandito?

Patient is Seated
Patient is conscious, coherent, cooperative,
(You may opt to be comfortable
seated as well)
No characteristic facies
Sthenic
Oriented to time, place and person
Intact immediate, recent and remote memory
Patient is Seated
Can perform calculations

Notes for any evidence of respiratory

distress (altered sensorium, central
cyanosis, speaks in phrases, tripod
position, prominence of SCM,
retractions, abdominal paradox)

Patient is Seated

Absent signs of respiratory distress:

Patient is seated comfortably; No central
cyanosis; Speaks in sentences; SCM is not
prominent

Vital Signs
Measures palpatory BP correctly.
Reports findings

Measures auscultatory BP correctly. If

elevated, measures BP on the other arm
and leg. (Leg BP may just be stated).
Reports findings

Sphygmomanometer

Cuff should be: 40%

of the upper arm
circumference, 80%
length; 2.5 cm above
cubital fossa, 1
fingerbreadth
underneath cuff

Note when the

radial pulse
disappears as you
inflate the cuff

Patient is Seated:
Right arm on a
table a little above
the patient's waist

Sphygmomanometer

Patient is seated:
Right arm on a
table a little above
the patient's waist

*You may opt to place the thermometer on the

opposite (Left) arm now

Stay on the Right

side of the patient

The patient's Auscultatory BP is _(Systolic)_

over _(diastolic)_

Stethoscope (Bell)

Place on brachial
artery

Inflate +30 from

palpatory BP

Deflate 2-3
mmHg/sec

Note 1st and 4th

korotkoff sound

Stay on the right

side of the patient

NOTES:

Ask how and when the patient arrived at

the clinic. (If the patient is tired let
him/her rest for 5 minutes prior to
obtaining the BP)

Rest for 30 minutes if there is recent

intake of caffeinated drinks, smoking ,
alcohol, illicit drugs, anti-HPN, NSAIDS and
steroids
The patient's palpatory BP is_______

NOTE: Ask what the patient's usual BP is

ProcrastiNotes: Medicine 1

Grand Practicals

Palpates the Patient's radial pulse

correctly. States the rate, rhythm and
volume.

Watch

Determines respiratory rate in a subtle

way. Describes and reports the rate and
pattern of breathing.

Watch

Takes the temperature and report

findings

Thermometer

Patient is seated

2
Pulse rate is (60-100); Regular; Volume of +2

Stay on the right

side of the patient
Patient is seated

Respiratory rate is (12-20); Normal Pattern

Keep your hand on the

Stay on the right
radial pulse and discretely side of the patient
observe the rise and fall
of the patients chest.
Patient is seated

Patients temperature is _______

Patient is seated

They usually make you do this at the end of the

practicals

It is suggested that you

place the thermometer
on the opposite (Left)
arm earlier so that you
save time.
Measures BMI (height and weight will be Calculator
provided by facilitator), show
computation
Pen and Paper

kg/m2

Normal: 18.5 22.9

1 inch = 0.0254 m
1 kg = 2.2 lbs
Inspects the entire skin surface using
penlight and ruler of necessary
States skin color, texture, moisture,
primary and secondary lesions

Usually no materials are

Patient is seated:
used however if you need Ask him to remove
to measure a lesion:
his shirt
Ruler
You are observing
the patient from
all sides

Note for PRIMARY LESIONS (macule, patch,

pustule), and SECONDARY LESIONS (scar,
erosion, keloid): measure with a ruler if needed
There are ______ primary and secondary skin
lesions; the skin has brown color; is warm to the
touch; and has appropriate skin turgor

If the patient
doesn't put his
shirt back on, you
may opt to drape
the patient
HEENT
Inspects and Palpate Head and Scalp
systemically and Report findings

Patient is seated

Head is normocephalic and has no

deformities

You are observing

the patient from
all sides
Inspects for position and alightment of
eyebrows, eyelids, eyes. Inspect for
abnormalities of conjunctivae and sclera

Hold the patients lower

eye lids down ask him
to look up
Hold the patients ypper
eye lids up ask him to
look down

Test visual acuity (central vision) using

snellen chart or pocket card and report
findings (CNII)

Jaegers Chart

Ask the patient to

cover one eye

Ask him to Place the

chart the level of his
umbilicus

Note at which
distance equivalent
he can read the
entire line

Do the same on the

other eye

Patient is seated
You are seating
opposite the
patient

Patient is seated
You are either
seated opposite of
or looking over the
patient to see
where he stopped

Symmetric aligntment of eyebrows, no

crusting of the eyelids and eyes; pink palpebral
conjunctiva and an anicteric sclerae

The patient can see at _(Numerator)_ feet

what normal people can see at
_(Denominator)_ feet

ProcrastiNotes: Medicine 1

Grand Practicals

Checks conjugate extraocular

movements (CN III, IV, VI) moving finger
slowly to 8 cardinal fields of gaze

Ask the patient to follow

your finger with only his
eyes. Try to keep his head
still

Make an asterisk (*)

in front of the
patient, moving your
finger back to the
center after making
one ray

Patient is seated

Extraocular movements are all normal

** Examines trigeminal nerve functions:

sensation to face and muscles of
mastication

Small brush from the

reflex hammer (perform
on both sides of the face)

Brush above the

eyebrows

Brush on the cheeks

Brush on the jaw

Patient is seated:
eyes closed

Nararamdaman nyo po ba ito? (while

brushing)

You are seated

opposite the
patient

Gigil po kayo (Clench teeth; do the same)

Patient is seated

Ngiti po kayo, simangot (ikunot ang noo),

lungkot po

You are seated

opposite the
patient

The patients trigeminal sensory and motor

components are intact

Ask the patient to

clench teeth (feel

the temporals)

Move the jaw side to

side
**Check for muscles of facial expression
(CN VII)

Ask the patient to SMILE,

FROWN, SAD FACE
(perform it as well)

You are seated

opposite the
patient

Facial nerve is intact, muscles move

symmetrically

** Ask patient to stick out tongue and

note whether it is midline during
protrusion (CN XII)

Ask the patient ti imitate

you

Stick out tongue

Move it side to side

Up and down

Patient is facing
you

The tongue is in midline during protrusion; has

sufficient CN 12 function

Test pupils for reactivity to light, both

direct and consensual as well as
accomodation (CN II and III)

Ask the patient to focus

on a distant object

Place an object
(10cm) from his eyes

Ask him to abruptly

look at the near
object

Patient is seated

There is intact direct and consensual pupillary

light reflex and accomodation

DIM THE LIGHTS

Patient is Seated

Ask the patient to look at

a distant object

You are seated

opposite the
patient

You are seated

opposite the
patient

Penlight

Shine onto the eyes

of the patient
Does and opthalmic examination and
reports findings

DIM LIGHTS STILL

Patient is seated

Opthalmoscope

Look from a
distance, observe
ROR

Keep the ROR and

follow it closer until
you see the

Perform on both
eyes

You are seated

opposite the
patient

There is positive Red Orange Reflex, no

opacities
Absent papilledema
The optic disc is visible, with retinal vessels
branching from it. No haemorrhages
The disc margin is smooth, the AV ration is 2:3.
The Cup:Disk ratio is 0.75

ProcrastiNotes: Medicine 1
Checks hearing acquity in each ear (do
whisper test or watch ticking)

Grand Practicals
TURN ON LIGHTS

Patient is seated

4
Patient has good hearing acuity

Ask patient to cover 1 ear You are standing

near the patient

On the side of the

covered ear whisper
something

ask the patient to

repeat what you said

Repeat on the other

ear
Inspect and palpate external ear for
deformities, tenderness

Patient is seated
You are standing
near the patient

Ears are symmetrical and no deformities

noted; no mass on the auricle, no tragal
tenderness

Otoscope

Pull the ear lobe up,

back and laterally

Do both ears

Patient is seated

Tympanic membrane is visible,, pearl gray in

color, no hemorrhages, no perforations., cone
of light is at the anterior inferior portion.

Inspects nose structure, nostril patency,

septum position, inflammation of nasal
mucosa

Penlight

Patient is seated

Palpate for tenderness of the frontal,

ethmoid and maxillary sinuses. If tender
do trans-illumination.

Penlight only if tender

Inspects lips, gums, teeth, tongue, floor

of the mouth and posterior pharynx

Penlight

Patient is seated

Gloves

You are seated

opposite the
patient

Performs otoscopic exam properly and

report findings

** Test Gag reflex and note elevation of

palate

You are standing

near the patient

There is little cerumen but no blockage

You are seated

opposite the
patient
Patient is seated

Sinuses are non tender and not inflamed

Palpate between the eye You are seated

brows, on top of the nose opposite the
bridge and on the cheeks patient

Tongue depressor

Gag reflex: touch

the posterior
pharyngeal wall

Palpate at the back of the

head, behind the ear, in
front of the ear, beneath
the jaw, at each side of
the neck and above the
clavicle

Patient is seated

With patient swallowing, palpates

thyroid tissue correctly for size,
symmetry and consistency

Palpate the sides of the

area just beneath the
adams apple

Patient is seated

Ask the patient to

swallow
Place two fingers on
either side of the trachea

The lips are red, the gums are pinkish.

No dental caries, tongue in the midline, floor
of the mouth is clear
Uvula is in the midline
There is positive gag reflex with an elevation
of the palate during reflex

Examine for palpable lymph nodes at

occipital, pre and post auricular,
submandibular, submental, anterior and
posterior cervical and supraclavicular
areas.

Assesses whether trachea is midline

Patient has a hosrt bridged nose, has patent

nostrils, absent septal deviation and no
inflammation

There are no palpable lymph nodes

You are standing in

front of the
patient
The thyroid gland is palpable, no nodules,
symmetric and moves with deglutition

You may stand

either in front or
behind the patient
Patient is seated

Trachea is in the midline with equal spaces on

either side

You are in front of

the patient
Anterior Thorax and Lungs
Describe the configuration of the
anterior chest. Note for deformities of
the chest. Compare AP to lateral chest
diameter.

Ask patient to
remove his shirt

There is no pectus carinatum nor pectus

excavatum

Patient is seated

Lateral diameter is longer than the AP

diameter (2:1)

You are inspecting

near the patient

ProcrastiNotes: Medicine 1
Indentifies the Sternal Angle of Louis
and counts the spaces anteriorly

Assesses symmetry of lung expansion

(inspection and palpation)

Grand Practicals
Palpate the sternal angle
of Louis: 3 fingerbreadths
beneath the suprasternal
notch.

Laterally move to
palpate the 2nd rib

Below it count the

ICS, all the way
down to the
costochondral
junction

Patient is seated,
shirtless

Cup both sides of the

anterior chest wall at the
level of the subcostal
margin

Make your thumbs

meet at the xiphoid
process

Ask the patient to

inhale

Patient is seated,
shirtless

You are in front of

the patient

Patient is seated,
shirtless

Percusses anterior lung fields

Patient is seated,
shirtless

NOTE: Precordial area

Auscultates anterior lung fields

Stethoscope

Auscultate on the
same areas where
you performed
percussion

There is symmetrical chest expansion

You are in front of

the patient

Palpates any tenderness in the chest wall With the lateral side of
and perform tactile fremiti
your hand; comparing
one side to the other

Ladder-like and
systematic manner

Ask the patient to

say tres tres
Follow the formation of
the ribs to avoid
percussion bone

Absent tenderness and equal tactile fremiti on

both lung fields

You are in front of

the patient

The note is resonant on all lung fields

you are in front of

the patient

Dull on the area of the precordium

BORDERS: L 2nd ICS, L MCL, L 5th ICS, R Para
Sternal border

Patient is seated,
shirtless

There are no adventitious breath sounds;

mostly vesicular breath sounds

You are in front

Back, Posterior Thorax, Lungs

Inspects back, cervical and lumbar
spine.d Palpate each vertebral process
from cervical to sacral.

Palpate the vertebra from Patient is seated,

Vertebra is in midline. No obvious deviations
C7 all the way down to
shirtless
S2.
You are behind the
patient

Identifies the inferior angle of the

scapula and counts the interpaces
posteriorly

Ask the patient to rotate

his arm internally

Palpate the lower

border of the
scapula = Level of T7

Count the
interspaces down to
the 10th ICS

Patient is seated,
shirtless

Cup your hands on the

10th ICS and make your
thumbs meet at the
midline

make a crease

ask the patient to

inhale

Patient is seated,
shirtless

Palpates for any tenderness in the

posterior chest wall

You are behind the

patient

You are behind the

patient

Chest expansion posteriorly is symmetrical

ProcrastiNotes: Medicine 1
Tests tactile fremiti, compares one side
with another, tests top to bottom
(patient's arm crossed in front)

Grand Practicals
Use the lateral surface of
your hand; comparing
one side to the other

Ladder-like and
systematic manner

and ask the patient

to say tres tres

Patient is seated,
shirtless

Performs percussion properly. Compares Follow the formation of

the percussion notes of both hemithorax the ribs to avoid
from top to bottom. (patient's arms
percussion bone
crossed in front)

Ladder-like and
systematic manner

Patient is seated,
shirtless

6
Absent tenderness and equal tactile fremiti on
both lung fields

Ask the patient to

hug himself
You are behind the
patient
The note is resonant

Ask the patient to

hug himself
You are behind the
patient

Auscultates the posterior thorax and

Stethoscope
compares one side with another, tests

Ladder-like and
top to bottm. Checks voice transmission,
systematic manner
comparing one side with another.

The same areas

(patient's arms crossed in front)
where you
percussed

Ask the person to

say tres-tres

Patient is seated,
shirtless

There are no adventitious breath sounds

Vocal transmission is equal on both lung fields

Ask the patient to

hug himself
You are behind the
patient

Jugular Venous Pulses and Carotid Pulsation

Inspects neck veins and identifies
highest undulation of the R internal
jugular vein and measures JVP at 30o or
40o angles

Penlight

Shine a tangential
light on the neck

Patient is supine,
shirtless

The JVP is 3 cm H2O at 30o

OR

Ask the patient to

look to the left

The JVP is 4.5 cm H2O at 45o

2 Rulers

Place one at the

sternal angle of louis You are on the
right of the patient

Align the second

one with the highest
undulation and a
measurement on the
first ruler
Palpates for carotid artery pulse (one at
a time) and describe

Palpate the thyroid

cartilage, below it palpate
the cricoid cartilage and
lateral to it is the carotid
artery pulsation.

Do one at a time

Ask the patient to

look towards the
direction where you
are palpating

Patient is supine,
shirtless

Auscultates for carotid artery bruit, one

at a time

Stethoscope

Use the bell

Patient is supine,
shirtless

++ Measure BP NOW for Orthostatic

Hypotension (measure again after 10
minutes)

<Bruit implies aortic

regurgutation or
atherosclerotic aortic
stenosis>

Ask the patient to

look towards you

The carotid artery has a rapid upstroke and

gradual downstroke

Ask the patient to

look towards you
You are on the
right of the patient

There are no bruit

You are on the

right of the patent

Cardiovascular
Inspects the precordium and reports it's
dynamicity (adynamic, dynamic,
hyperdynamic)

Warm the hands before

touching the patient

Patient is supine,
shirtless
You are on the
right of the patient

The patient has an adynamic precordium

ProcrastiNotes: Medicine 1
Palpates the precordium and describes
the apex beat (location, diameter,
aplitude and duration in relation to
systole)

Grand Practicals

Cup the area underneath

the patient's nipple

Patient is supine,
shirtless

Apex beat is Left Midclavicular Line, 5th ICS

2 fingerbreadths in diameter, non sustained,
normal amplitude

Feel the apex beat and

localize it

You are on the

right of the patient Occupies half of systole

Stethoscope

Listen if the apex

beat lies between S1
and S2
Palpates for LV or RV heaves, PA or LA
lifts and Thrills

Heave: use the heel of

the hand

Patient is supine,
shirtless

Lifts: Use fingertips

You are on the

Thrills (Valves):
right of the patient Mitral 5th Left ICS PSL
Tricuspid 4th Left PSL
Pulmonic 2nd Left PSL
Aortic 2nd Right PSL

Thrills: Use Ball of the

hand

There are no heaves, lifts or thrills

Lifts:
Pulmonary Artery: 2nd Left ICS PSL
Aorta: 2nd Right ICS PSL
Left Atrium: 2nd-3rd Right ICS PSL
Heaves (ventricle):
LV: 5th Left ICS PSL
RV: 4th Right PSL
Auscultate heart in the following areas,
mitral, tricuspid, pulmonic and aortic
auscultatory valve areas using the
diaphragm in an inching manner and
note character of S1 and S2 and high
pitch murmurs if any

Stethoscope: Use
diaphragm

Shifts to bell and note for S3 and S4 and

any low pitch murmurs

Stethoscope: Use bell

Patient is supine,
shirtless
You are on the
right of the patient
Patient is supine,
shirtless

Systole is shorter than diastole

S1 is low pitched, S2 is high pitched
S1 is louder in the apex, S2 is louder in the
base

There are no murmurs and there is absent S3

and S4

You are on the

right of the patient
++ Carvallo's Sign

++ Valsalva Maneuver

Stethoscope: Use
Diaphragm

Over the 4th ICS L

PSL

Ask the patient to

inhale deeply

Patient is supine,
shirtless,

Stethoscope: Use Bell

Over the 5th ICS

MCL

Ask the patient to

hold his breath,
cover his nostrils and
exhale against
resistance

Ire po kayo

Patient is supine,
shirtless

There is a negative Carvallo's sign

A (+) Carvallo's sign would increase any

You are on the
Tricuspid regurgitation sound. It is a high
right of the patient pitched sound, so use the Diaphragm
There is Absent Increase in murmur due to
valsalva maneuver (??)

You are on the

(+) would indicate Mitral Valve Prolapse (??)
right of the patient

Abdomen
Instructs the patient to relax, bend knees Drape
to relax abdomen if needed an expose

Cover the chest of

abdomen
the patient
Ask if the patient is
experiencing any pain in
the abdomen
Inspects abdomen: skin characteristic,
abdominal contour, symmetry,
pulsations, visible peristalsis, umbilicus,
and any hernias (umbilical, inguinal)

Patient is supine,
draped
You are on the
right of the patient

Patient is supine,
Abdomen is (Globular, flat or scaphoid)
draped
Absent pulsations/Peristalsis
You are on the
Umbilicus is (Everted, inverted, flat)
right of the patient

ProcrastiNotes: Medicine 1
Auscultates abdomen: Bowerl sounds,
bruit if any (abdominal aorta, renal
arteries, iliac arteris and friction rub)

Grand Practicals
Stethoscope: Use
diaphragm
Stethoscope: Use Bell for
Bruit at the Epigstric
Area, Renal rteries and
iliac arteris

Percusses abdomen systematically in all

quadrants

Patient is supine,
draped

8
Absent friction rub

Normoactive bowel sounds

You are on the
right of the patient There are no bruit

Patient is supine,
draped

All four quadrants are generally tympanitic

You are on the

right of the patient
Percusses for liver dullness (determine
upper and lower border) and measures
liver span along R MCL

Percuss from the

umbilicus up

Note dull area

Percuss from the 2nd ICS
down

Note dull area

Patient is supine,
draped

The liver span in the R Mid-Clavicular line is (68) cms

you are on the

right of the patient

Ruler
Percusses for splenic dullness over
Traube's space in the left

Palpate for the 9th ICS at

the anterior axillary line

Ask the patient to

inhale deeply

Percuss

Patient is supine,
draped

Systemically palpates the entire

abdomen first light then deep while
looking at the face of the patient. Note
any direct or rebound tenderness and
any masses and describe if present.

Warm hands first

Patient is spine,
draped

++ Fluid Wave

Ask the patient to put his

hand on his midline

Place both hands on

both sides of the
patient's waist

Tap one side

The traubes space isn't obliterated

You are on the

right of the patient
No palpable masses, no tenderness

Avoid the area where

patient noted pain (if any) You are on the
right side

Patient is supine,
draped
You are on the
right side

There is absent Fluid wave

A (+) fluid wave would mean ascites?

A constant non-diminishing wave of fluid

from the tapping hand to the other side of
the abdomen

Palpate and describe the liver edge

Hook the lower border of Patient is supine,

the Right Subcostal
draped
margin and ask the
patient to inhale
You are on the
right side

The liver edge is smooth, sharp and nontender

++ Murphy's Sign

Press onto the right

subcostal margin and ask
the patient to inhale

Absent murphy's sign

Patient is supine,
draped
You are on the
right side

Bimanual Palpation of the Spleen

Hook the left waist of

your patient with your
right hand
Press upward onto the
left subcostal margin and
ask the patient to inhale

Bimanual and bilateral palpation of the

kidneys

Hook the left waist of

your patient with your
right hand.
Press your left hand on
the area above your right
hand and ask the patient
to inhale

Patient is supine,
draped

A (+) murphys sign would mean cholecystitis

Sudden stop of inhalation due to pain

The spleen is non-palpable

You are on the

right side

Patient is supine,
draped
You are on the
right side

Both the kidneys are non-palpable

ProcrastiNotes: Medicine 1
++ Iliopsoas Sign

Grand Practicals

Press onto the right thigh

of the patient and ask
him to raise his leg
against your applied
pressure

Patient is supine,
draped

Look for a dull area on

the abdomen and percuss
it. Then turn the patient
to the Left lateral
Decubitus position and
percuss the same area
again.

Patient is supine,
draped.

Checks for CVA tenderness

Kidney Punch on the

Costo-vertebral angle

Patient is in Left
Lateral Decubitus
Position

No pain on CVA

(Stimulated) Rectal Examination

Inspect external
Explain
Lubricate
Inhale
Insert

Examine 3 6 9 12
positions

Hemorhhoids,
tumors

Prostate

posterior Vaginal
canal
Remove

Inspect for blood

Wipe off lubricant

Patient is in Left
Lateral decubitus
Position

No hemorhhoids, no fissures

The right leg is

folded

No masses no tumors

++ Shifting Dullness

You are on the

right side

Absent Iliopsoas sign

A (+) iliopsoas sign would mean appendicitis

RLQ pain on exertion

The same area is still dull so there is absent
shifting dullness

Then Patient
would be in Left
Lateral Decubitus

Non-tender prostate

No blood on examining finger

Normal Sphincteric tone

Neurological and Musculoskeletal

Assessment of GCS (Scenario Given by
Facilitator)

Normal: 15

Patient is sitting
down

Lowest: 3
++ Measure BP NOW for Orthostatic
Hypotension

Motor Coordination: FInger to nose test

(full arm extension, or alternate
pronation/supination test

Ask the patient to

put his shirt back
on

Simply ask the patient to

imitate what you do

Point to your nose

and point to the
patients pointing
finger
or

Do the pronation/
supination test

Patient is sitting
down

GCS

EYE OPENING
Spontaneous 4
To speech 3
To pain 2
None 1

BEST VERBAL RESPONSE

Oriented/Normal 5
Confused speech 4
Inappropriate words 3
Incomprehensible (No recognizable
voice) 2
None 1

MOTOR RESPONSE
Obey's Commands 6
Hand localizes to pain 5
Withdraws 4
Arm flexion to pain 3
Arm extension to pain 2
None 1
The patient has intact cerebellar function

ProcrastiNotes: Medicine 1
** Check sensory function of upper and
lower extremities and compare L and R
sides

Grand Practicals
The sharp pointed end of
the reflex hammer

Ask the patient if he

feels any sensation
on his upper and
lower extremities

Patient is sitting
down

** Check for DTR: biceps, triceps patellar Reflex hammer

achilles
Biceps: hold the forearm
supine, let it rest on your
forearm, strike the biceps
tendon

Patient is sitting
down

10
patient has equal sensation on both right and
left upper and lower extremities

eyes closed

All deep tendon reflexes are intact

*For achilles the

patient is kneeling

Triceps: hold the arm in a

90o angle, strike behind
the olecranon process
Paterllar: underneath the
patella
Achilles: strike the heel of
the patient
Test for balance/equilibrium: Romberg
or tandem gait test

Ask the patient to close

his eyes

Be ready to catch
the patient
OR
Ask the patient to walk
with one foot in front of
the other. Arms open
wide

Be ready to catch
the patient

Patient is standing Patient has intact cerebellar function

up and performing
either the
Romberg or the
Tandem gait test

Can raise shoulder against resistance

Put pressure on the

patients shoulders and
ask him to raise them

Patient is standing
up

Patient has intact CN 11 function

Ask patient to stick out tongue and note

whether it is midline during protrusion

Ask the patient ti imitate

you

Stick out tongue

Move it side to side

Up and down

Patient is facing
you

The tongue is in midline during protrusion; has

sufficient CN 12 function

Checks Motor strength of upper and

lower extremities and compare L and R
side including ROM

Ask the patient to imitate Patient is standing

you and see whether he
up
can perform the same
movements against
resistance

Abduct UE

Adduct UE

Flex elbow joint

Extend elbow joint

Hand eversion

Hand inversion

Wrist flexion

Wrist extension

Hip extension

Hip flexion

Rotation

Foot inversion

Foot eversion

Say's thank you

Alcohol

Wash your hands

after
** Means a test for NEUROLOGICAL EXAM that was put earlier for convenience
++ Means a BONUS POINT test that was put earlier for convenience

The patient has sufficient motor strength, no

signs of malaise or weakness

Ok na po tayo kuya, Maraming Salamat po!