CHINMAYA INSTITUTE OF NURSING

PHYSICAL EXAMINATION

I. SKIN(through out the body from face to extrimities)

A. Colour - Pigmentation(browness) loss of pigmentation redness pallor

Cyanosis yellowing .
NOTE:- PALLOR:DUE TO DECREASED REDNESS IS SEEN IN ANEMIA & IN DECREASED BLOOD FLOW , AS IN FAINTING OR
ARTERIAL INSUFFICIENCY
CYANOSIS:SEEN BEST IN LIPS, ORAL MUCOSA & TONGUE BECAUSE OF VENOUS OBSTRUCTION
YELLOWING:IN SCLERA, CONJUNCTIVA,LIPS,HARD PALATE, UNDERSURFACE OF TONGUE & SKIN.
INDICATES-LIVER DISEASE OR EXCESSIVE HEMOLYSIS OF RBC
B. Moisture - dryness sweating oiliness
C. Temperature
D. Texture - rough smooth
NOTE;- ROUGHNESS-INDICATES HYPOTHYROIDISM
E. Mobility(lift fold of skin and note the ease)-
NOTE;-EDEMA AND SCLERODERMA
F. Turgor(speed of skin which returns into
NOTE; DEHYDRATION

G. Lesions- Primary or secondary(macules/papule/vesicles/acne/psoriasis)

Present Absent.
II. NAILS

A. Colour –
B. Shape –
C. Lesions-

III. HEAD AND NECK

HEAD

A. Hair
quantity distribution texture Pattern of loss
(if any)
 NOTE;-FINE HAIR HYPERTHYROIDISIM, COARSE HAIR-HYPOTHYROIDISIM, NITS-EGGS OF LICE
B. Scalp
Scaliness Lumps/lesions
NOTE;-SEBORRHEIC DERMATITIS-REDNESS AND SCALING, PSORIASIS
C. Skull
Size contour

NOTE;-HYDROCEPHALUS-ENLARGED SKULL, MICRO & MACROCEPHALY

D. Face
Facial Contour asymmetry Involuntary edema masses
expression movements
NOTE;-ACROMEGALY, MYXEDEMA, NEPHROTIC SYNDROME, CUSHINGS SYNDROME, PAROTID GLAND ENLARGEMENT,
PARKINSONS DIEASES.

IV. EYES

A. Visual acuity- by using snellen’s chart & sufficient light

TEST- position the patient 20 feet from the chart. Ask the patient to cover one eye with
Card and read the smallest line of print possible.
Repeat to the other eye.
ABNORMAL;-MYOPIA-IMPAIRED FAR VISION, PRESBYOPIA-IMPAIRED NEAR VISION
RESULT-

B. Visual fields by confrontation

TEST- start in temporal fields. Ask the patient look into examiners eyes, place the examiner hand 2feet apart,
lateral to patient ears, instruct the patient to point examiner fingers as soon they are seen. Slowly return the fingers
to line of gaze until patient identifies them, repeat to upper and lower temporal quadrants.
RESULT-

C. Position and alignment of eyes

TEST- stand behind the patient, patient is seated. Draw the upper lids gently upward and compare the position of
eye and note relationship of cornea to lower lids.
ABNORMAL;-EXOPHTHALMOS-ABNORMAL PROTRUSION OF EYE.
RESULT-

D. Eyebrows
Quantity Distribution&scaliness

ABNORMAL;-SEBORRHEIC DERMATITIS
E. Eyelids
Position of lids Width of Edema of lids Color of lids lesions Condition & Adequacy
 In relation to palpebral direction of with which
Eye balls fissures eye lashes eyelids close

ABNORMAL;- BLEPHARITIS- INFLAMMATION OF EYELIDS, FAILURE OF EYELIDS TO CLOSE-CORNEAL DAMAGE

F. Lacrimal apparatus
Observe for swelling Tearing or dryness

G. Conjunctiva and sclera

Look for discoloration Swelling/nodules
TEST;-ASK THE PATIENT TO LOOK UP AS YOU DEPRESS BOTH LIDS WITH THUMBS

H. Cornea and lens-observe for opacities with oblique lighting

RESULT-
I. Iris-
J. Pupils
Size shape symmetry
TEST- ASK THE PATIENT TO LOOK INTO DISTANCE, AND SHINE A BRIGHT LIGHT INTO EACH PUPIL OBLIQUELY. THEN LOOK
FOR (DARKEN THE ROOM BEFORE LIGHTING) PUPILLARY CONSTRICTION.
2nd TEST FOR PUPILLARY DILATATION IN DARKEN ROOM.

K. Extra-ocular movements- to test 6cardinal direction of gaze.

TEST-MAKE A WIDE H(WITH PENCIL OR FINGER) IN AIR, LEAD PATIENTS GAZE 1.TO PATIENTS EXTREME RIGHT 2. RIGHT
AND UPWARD 3. RIGHT ON DOWN 4. IN MIDDLE TO EXTREME LEFT 6.DOWN ON THE LEFT.
(PAUSE DURING UPWARD AND LATERAL GAZE TO DETECT NYSTAGMUS)

ABNORMAL-NYSTAGMUS-ABNORMAL RYTHMIC OSCILLATION OF EYES.

RESULT-
TO TEST CONVERGENCE- ASK PATIENT TO FOLLOW YOUR FINGER/PENCIL AS YOU MOVE IT IN TOWARDS THE BRIDGE OF
NOSE. HAPPEN WITHIN 5CM-8CM OF NOSE.
NOTE;- POOR CONVERGENCE-HYPERTHYROIDISIM.

OPTHALMOSCOPIC EXAMINATION-INSPECT FOR OPTIC DISC,RETINA,

ANTERIOR STRUCTURES.

V. THE EARS
A. The Auricle
Lumps/skin lesions Discharge/inflammation pain
 ABNORMALITIES;-CHONDRODERMATITIS HELICIS, CUTANEOUS CYST, SQUAMOUS CELL CARCINOMA, BASAL CELL
CARCINOMA,TOPHI, KELOID, RHEUMATOID NODULES, LEPROMATOUS LEPROSY.

B. Ear canal and drum- use an otoscope. Inspect the ear canal, eardrum.
ABNORMAL- PERFORATION OF EARDRUM, TYMPANO-SCLEROSIS, SEROUS EFFUSION, BULLOUS MYRINGITIS.
RESULT-
C. Auditory acuity
TEST- ASK THE PATIENT TO CLOSE ONE EAR WITH FINGER AND PROCEED THE TEST.
IF ACUITY ON TWO SIDES IS DIFFERENT , MOVE FINGERS RAPIDLY BUT GENTLY IN THE OCCLUDED CANAL(THIS WILL HELP
TO DO THE TEST). THEN
WHISPER TEST;-STAND 1-2FEET AWAY, EXHALE FULLY AND WHISPER SOFTLY TOWARD THE UNOCCLUDED EAR.
IN ORDER TO AVOID PATIENT READING LIPS, COVER LIPS OR OBSTRUCT PATIENT VISION.
RESULT-
TO TEST AIR AND BONE CONDUCTION;-WEBER TEST – SET THE FORK INTO LIGHT VIBRATION PLACE THE BASE
ON THE TOP OF PATIENTS HEAD OR ON MIDFOREHEAD. ASK WHETHER PATIENT HEARS ON ONE / BOTH SIDES. IF NOTHING
HEARD TRY THE TEST AGAIN BY PRESSING FORK FIRMLY ON HEAD.
RESULT-
TO COMPARE AIR CONDUCTION & BONE CONDUCTION;-RINNE TEST- PLACE THE VIBRATING TURNING
FORK ON THE MASTOID BONE, BEHIND THE EAR & LEVEL WITH THE CANAL.
WHEN PATIENT CAN NO LONGER HEAR SOUND, QUICKLY PLACE THE FORK CLOSE TO EAR CANAL & ASK WHETHER SOUND
CAN BE HEARD AGAIN. NORMALLY AC>BC.

ABNORMAL: EAR LOSS, OBSTRUCTION OF EAR CANAL BY CERUMEN.

RESULT-
VI. THE NOSE AND PARANASAL SINUSES

Inspect the anterior and inferior surfaces of nose by PENLIGHT OR OTOSCOPE to view
each nasal vestibule.
NOTE;- FOR ASYMMETRY/DEFORMITY.
ABNORMAL-DEVIATION OF SEPTUM

RESULT-
TEST FOR NASAL OBSTRUCTION- BY PRESSING EACH NOSTRIL AND ASKING THE PATIENT TO BREATHE IN.

RESULT-

Observe for:-

Nasal Mucosa

colour swelling bleeding/exudate

ABNORMAL; VIRAL RHINITIS, ALLERGIC RHINITIS

Nasal septum

Deviation Inflammation Perforation

ABNORMAL; DNS , EPISTAXIS
 Observe for nasal polyps / ulcers:-
Palpate for sinus tenderness:-
TEST-PRESS UP ON THE FRONTAL SINUSES UNDER BONY BROWS, THEN PRESS MAXILLARY SINUSES
ABNORMAL- TENDERNESS, NASAL DISCHARGE, ACUTE SINUSITIS(FRONTAL & MAXILLARY)

RESULT-

VII . THE MOUTH AND PHARYNX

A. Lips
Color/moisture lumps ulcers Crack/scaliness
ABNORMAL: HERPEX SIMPLEX, ANGULAR CHELITIS, ACTINIC CHELITIS, CARCINOMA

B. Oral mucosa
Color Ulcers White patches Nodules
ABNORMAL: OPHTHOUS ULCER ON LABIAL MUCOSA

C. Gums and teeth

Color Gum Swelling/ulceration Teeth
margins Missing Discolored Abnormal Position loosened

ABNORMAL: GINGIVITIS
D. Roof of mouth
Color Structure OF Hard palate

E. Tongue and floor of mouth

TEST:- ASK THE PATIENT TO PUT OUT THE TONGUE, INSPECT FOR SYMMETRY(CN XII)

Color Texture Floor of tongue

F. Pharynx
TEST:-ASK THE PATIENT TO OPEN MOUTH & ASK THE PATIENT TO SAY “AH” OR YAWN (TO SEE PHARYNX).
OR
PRESS A TONGUE BLADE FIRMLY DOWN UPON MIDPOINT TO VISUALIZE PHARYNX NOT TO CAUSE GAG SAME TIME ASK FOR AN
“AH” OR YAWN & SEE RISE OF SOFT PALATE (CN X)

Soft palate Uvula Tonsils & pharynx

Color Symmetry Exudate Swelling Ulceration Enlargement

ABNORMAL- CARCINOMA OF TONGUE, CANDIDIASIS ETC. PARALYSIS OF X CRANIAL NERVE LEADS TO FAILURE IN RISE OF SOFT
PALATE & UVULA DEVIATES TO OPPOSITE SIDE.

VIII. THE NECK

 A. LYMPH NODES
Inspect
Symmetry Masses or scars Enlargement

Palpate
Size Shape Discrete/together Mobility Consistency Tenderness
SEQUENCE OF PALPATION- 1.PREAURICULAR-FRONT OF EAR 2.POSTERIOR AURICULAR-SUPERFICIAL TO MASTOID PROCESS.
3.OCCIPITAL-AT BASE POSTERIOR OF SKULL. 4.SUBMANDIBULAR-MIDWAY BETWEEN ANGLE AND THE TIP OF MANDIBLE.
5.TONSILLAR-AT THE ANGLE OF MANDIBLE. 6. SUBMENTAL- BEHIND TIP OF MANDIBLE.7. SUPERFICIAL CERVICAL-STERNOMASTOID.
8.POSTERIOR CERVICAL-ALONG THE ANTERIOR EDGE OF TRAPEZIUS. 9.DEEP CERVICAL CHAIN- DEEP TO STERNOMASTOID. 10.
SUPRACLAVICULAR- DEEP IN THE ANGLE FORMED BY CLAVICLE AND STERNOMASTOID.
B. TRACHEA & THYROID GLAND
Inspect trachea- For deviation
TEST:PLACE THE FINGERS ALONG ONE SIDE OF TRACHEA AND NOTE THE SPACE BETWEEN TRACHEA STERNOMASTOID. COMPARE IT
WITH OTHER SIDE SHOULD BE SYMMETRICAL.

NOTE : MASSES IN NECK MAY PUSH THE TRACHEA TO ONE SIDE

Result:

Inspect the neck for thyroid gland:

Observe the region- thyroid cartilage, cricoid cartilage, thyroid gland

For contour and symmetry while swallowing and still

ABNORMAL: GOITER IS GENERAL TERM FOR ENLARGED THYROID GLAND

Result:

Palpate the thyroid gland:

Anterior palpation- standing infront of patient apply pressure on one side of neck below cricoid and
palpate, repeat other side.

Result :

Posterior palpation- Stand behind. Place the fingers of both hands on patients neck so that index
fingers are just below the cricoids. Move fingers laterally as needed

Result :
NOTE : SEE FOR THE ENLARGEMENT OF THYROID GLAND AND SIZE, SHAPE AND CONSISTENCY.

Carotid arteries and jugular veins

See for jugular vein distension

Palpate the carotid pulse

Result :

IX. THE THORAX AND LUNGS

Rate Rhythm Depth Effort of breathing

ABNORMAL : TACHYPNEA, HYPERPNEA, BRADYPNEA, CHEYNE-STROKE,BIOTS BREATHING, SIGHING RESPIRATION, OBSTRUCTION
BREATHING.

Check patient for color for cyanosis:

Listen to patient breathing(abnormal sounds):

Examine shape of finger nails(clubbing):

Examine position of trachea(pleural effusion, pneumothorax):

Examine shape of chest(ant-post diameter may increase with aging or in COPD):

Examination of posterior chest

Inspection- stand behind the patient(note the shape and movement , deformities/asymmetry).
ABNORMAL / DEFORMITIES OF THORAX

BARREL CHEST-INCREASED ANT-POST DIAMETER(NORMAL DURING INFANCY & AGING) SEEN IN COPD.

TRAUMATIC FLAIL CHEST- PARADOXICAL MOVEMENT OF THORAX IN CASE OF MULTIPLE RIB FRACTURE;

DESCENT OF DIAPHRAGM WHICH DECREASE INTRATHORACIC PRESSURE ON INSPIRATION.

FUNNEL CHEST(PECTUS EXCAVATUM)- DEPRESSION IN LOWER PORTION OF STERNUM.

PIGEON CHEST(PECTUS CARINATUM)- STERNUM IS DISPLACED ANTERIORLY, INCREASING THE ANT-POST DIAMETER.

THORACIC KYPHOSIS- ABNORMAL SPINAL CURVATURE AND VERTEBRAL ROTATION DEFORM THE CHEST.

PALPATION

Identification of tender Assessment of observed Further assessment of Assessment of tactile

area(PALPATE AREA WHERE
PAIN IS REPORTED/LESIONS ARE
EVIDENT)
abnormalities(MASSES/SINUS) resp expansion(TEST-
PLACE THUMBS AT LEVEL AND
PARALLEL TO 10TH RIBS, SIDE
THEM MEDIALLY TO RAISE
LOOSE SKIN FOLDS B/W THUMBS
& SPINE. ASK PATIENT TO
INHALE DEEPLY- WATCH THE
DIVERGENCE OF THUMBS &
FEEL RANGE & SYMMETRY OF
RESP MOVEMENT )
fremitus(TEST-IT IS
PALPATING VIBRATIONS
TRANSMITTED THROUGH THE
BRONCHO PULMONARY TREE TO
CHEST WALL WHEN PATIENT
SPEAK. OR ASK PATIENT TO SAY
“99”/”ONE-ONE-ONE”. IF
FREMITUS IS FAINT ASK THE
PATIENT TO SPEAK LOUDLY/
DEEPER VOICE. )
LOCATION FOR FREMITUS-

PERCUSSION- By pleximeter- hyperextend middle finger and plexor-right middle finger.

To note sound characteristics like

Nature of sound Location heard

Flatness Thigh

Dullness Liver

Resonance Normal lung

Hyper resonance None(seen in

emphysema)
Tympany Gastric air
bubble/puffed out cheek

LACATION for percussion and auscultation-

AUSCULTATION-done along with percussion through the tracheobronchial tree

1.listening to sounds generated by breathing(vesicular,broncho vesicular,bronchial,tracheal)

2.listening for added sounds/abnormal sounds(crackels, wheezes, rhonchi , stridor , pleural rub,
mediastinal crunch)

RESULT-

Examination of Anterior Chest

Inspection : - Shape, deformities / asymmetry, movement

Palpation - tenderness, assessment of respiratory expansion

TEST - PLACE THUMBS ALONG COSTAL MARGIN ALONG LATERAL RIB CAGE, SLIDE THEM MEDIALLY TO RAISE LOOSE SKIN FOLDS BETWEEN
THUMBS. ASK PATIENT TO INHALE DEEPLY. WATCH FOR DIVERGENCE OF THUMBS AS THORAX EXPANDS AND FEEL SYMMETRY.

RESULT:

Assessment of tackle fremitus – location –

Percussion – Percuss anterior and lateral chest, compare both sides using plexor and pleximeter.

Location For Percuss / Auscultation

Auscultation – Listen to chest, anterior and laterally as the patient breathes.

Listen to breath sounds.

X. CARDIOVASCULAR SYSTEM

Arterial pulse – rate of the heart-

Rhythm-

contour of pulse-

Blood pressure-

Jugular venous pressure and pulses

(estimates the central venous pressure)

- Position the patient – bed / table elevated to 30 degree, then adjust the angle to see jugular
venous pulsation in lower half of neck.
- Use tangential lighting and examine both sides
- Identify external jugular vein on each side.
- Identify the highest point of pulsation in IJV
Venous pressure measured as greater than 3 cm or 4 cm above the sternal angle is
considered elevated.

Heart

Inspection and palpation

- Location of apical impulse-

- Enlargement of right ventricle-

The cardiac apex (left ventricular area) - at / or medial to the mid clavicular line in 5th / 4th ICS.

The left eternal border in 3rd, 4th & 5th ICS (Right ventricular area)-

to feel impulse of right ventricle.

The epigastric (Subxiphoid area) -with hand flattened, press your index finger just under the rib
cage and up towards the left shoulder and try to feel right ventricular pulsation.

The left 2nd ICS – pulmonary artery

Pulsation of pulmonary artery may sometimes be felt here especially after exercise / excitement.

Percussion – starting well to the left on chest, percuss in 3, 4, 5th & possibly 6th ICS.

Auscultation

Listen to heart with stethoscope in right 2nd ICS close to the sternum Along the left sternal border in
each ICS from 2nd through 5th & at the apex.

XI. THE BREAST AND AXILLAE

The female breast Inspection – Appearance which includes, and

Colour size symmetry contour of breast

ABNORMAL-REDNESS / LOCAL INFECTION ,FLATTENING OF NORMALLY CANCER BREAST – CANCER

Inspect nipple
Size shape areola rashes discharge.
direction

ABNORMAL-FLUID / FLATTENING / NIPPLE RETRACTION (OR) DIMPLING.

Palpation – Ask patient to lie down, palpate entire breast including periphery, tail and areola.

The male breast – Inspect the nipple and areola for nodules, swelling or ulceration, Pigmentation.
Palpate the areola for nodules, enlargement of lymp nodes
Pectoral nodes, lateral nodes, sub scapular nodes.

XII. THE ABDOMEN

Patient should empty the bladder.

Inspection
Skin
Scars striae dilated rashes and striae dilated
veins lesions veins

Umbilicus -
CONTOUR LOCATION INFLAMMATION/HERNIA
The contour of abdomen - flat, rounded, protuberant, scaphoid
RESULT-

Peristalsis – observe for several minutes.

Pulsation – normal aortic pulsation is visible in the epigastrium

Auscultation - to assess bowel motility.

4 quadrants of abdomen

Assess for bowel sounds at right lower quadrant and note their frequency and character.
Normal sounds – clicks and gurgles
Loud prolonged gurgles of hyper peristalsis

If patient has BP listen in epigastrium in each upper quadrant for bruits – vascular sounds
resembling heart murmurs.

Percussion

-Help to assess the amount and distribution of gas in the abdomen.

-to identify masses that are solid / fluid filled
-estimate size of liver and spleen

 Percuss all four quadrants lightly to assess the distribution of tympany and dullness.

Palpation

Light palpation – identifying abdominal tenderness, muscular resistance,

superficial organs and masses.

RESULT-

Deep palpation – as in obesity difficult, use 2 hands, one on top of the other.
To identify tenderness, enlargement.

RESULT-

XIII. MALE GENITALIA

Inspect for scars, edema, inflammation, size, shape, symmetry, scars, edema, inflammation,
discharge, lesions, hair distribution, warts.
RESULT-

Palpation – swelling, tenderness, masses, warmth.

RESULT-

Penis-
Circumcision –done or not
Scrotum -
Testis -Palpate / Nonpalpable-
ABNORMAL – HYDROCELE, VARICOCELE, SORES, DISCHARGE.

XIV. FEMALE GENITALIA

External genitalia – Menarchy – age-

Menstrual cycle-regular/irregular,how many days,nature of flow,any
dysmennorhea-
Vaginal discharge-
XV. ANUS – Anal reflex
ABNORMAL - FISSURE, FISTULA, HEMORRHOIDS, POLY RECTAL PROLAPSED ETC.

XVI. MUSCULOSKELETAL SYSTEM

-Limitation in normal range of motion (ROM) or any unusual mobility.

-Signs of inflammation – swelling, tenderness, redness, increased heat.

ABNORMAL – ANKYLOSIS, SYNOVITIS, ARTHRITIS, TENDINITIS, BURSITIS, OSTEOMYELITIS

-Crepitus – palpable / audible crunching / grating produced movement of a joint / tendon.

-Deformities – Restricted ROM
Mal alignment of bones
-Muscular strength
-Symmetry

Head and Neck – the temparomandibular joint –TEST- PLACE THE LIP OF INDEX FINGER IN FRONT OF TRAGUS OF EACH
EAR AND ASK PATIENT TO OPEN MOUTH.

The tips of finer should drop into the joint space as mouth opens.

- Note the ROM, swelling tenderness.

RESULT-

The cervical spine

 - Observe for neck deformities and abnormal posture.
- Palpate the cervical spine related to tissues , muscles for tenderness.
- ROM – flexion – ask patient to touch chin to chest
Rotation - chin to each shoulder
Extension – put head back
Lateral bending– touch each ear to corresponding
Shoulder without raising shoulder
RESULT-
ABNORMA-L SPONDYLITIS, KYPHOTIC THORAX.

Hands and Wrists

ROM – TEST-MAKE A FIST WITH EACH HAND AND THEN EXTEND AND SPREAD THE FINGERS SMOOTHLY AND EASILY.

- Flex and extend the wrists

- Move the hands laterally and medially

Inspection – swelling, redness, nodules, muscular atrophy

Palpation – feel medical and lateral aspects of each inter phalangeal joint between the thumb and
index.
RESULT-
ABNORMAL – OSTEOARTHRITIS, R.ARTHRITIS, GOUT.

Elbows

ROM –TEST- ASK THE PATIENT TO BEND AND STRAIGHTEN THE ELBOWS. PALMS UP AND DOWN.
Inspection – swelling, tenderness (or) thickening
RESULT-
ABNORMAL – BURSITIS, EPICONDYLITIS, RHEUMATOID NODULES.

Shoulders

ROM – TEST -ASK THE PATIENT TO RAISE BOTH ARMS TO A VERTICAL POSITION AT THE SIDES OF HEAD.
-PLACE BOTH HANDS BEHIND THE NECK WITH ELBOWS OUT TO THE SIDE
PLACE BOTH HANDS BEHIND THE SMALL OF THE BACK.
BY CUPPING NOTE – CREPITUS..
RESULT-
ABNORMAL-ROTATOR CUFF TENDINITIS, ROTATOR CUFF TEARS,CALCIFIC TENDINITIS

Ankles and feet :

Inspect and palpate for nodules, deformities, swellings (or) corns.

Inversion, Eversion,
RESULT-
ABNORMAL - HALLUX VALGUS, FLAT FEET, HAMMER TOE.

Knees and Hips

Observe and palpate for – alignment, deformity, atrophy, swelling.

RESULT-

ABNORMAL – BOW LEGS, KNOCK KNEES, SYNOVIAL THICKENING .

ROM of Hips and Knees

- Flexion of Knees and Hips -TEST- ASK PATIENT TO BEND EACH KNEE IN TURN UP TO CHEST AND PULL FIRMLY AGAINST
ABDOMEN. NOTE THE OPPOSITE THIGH REMAINS ON TABLE.

- Rotation of hips –TEST- FLEX THE LEG TO 90 AT TIP AND KNEE.

- Adduction of hips – TEST-STABILIZE PELVIS BY PRESSING DOWN ON OPPOSITE ANTERIOR SUPERIOR ILIAC SPINE WITH ONE
HAND WITH OTHER GRASP ANKLE AND ABDUCT THE EXTENDED LEG UNTIL YOU FELL THE ILIAC SPINE MOVE.

RESULT-

The Spine

- Observe spine from side noting cervical, thoracic and lumbar curves and from behind lateral
curves.
-
ROM – TEST-BEND FORWARD TO TOUCH THE TOES

RESULT-
ABNORMAL – FLATTENING OF THE LUMBAR CURVE
LUMBAR LORDOSIS
KYPHOSIS
SCOLIOSIS

XVII. NEUROLOGICAL EXAMINATION

Divided into five Components

1) Cerebral function
2) Cranial nerves
3) Motor system
 4) Sensory system
5) Reflexes

CEREBRAL FUNCTION

Mental Status :

 Observe patient’s appearance and behavior, noting dress, grooming and personal hygiene.
 Posture gestures, movements, facial expressions and motor activity.
 Manner of speech and level of consciousness is assessed
 Assessing orientation to time place and person
 Memory.

Intellectual Function :

 IQ (Repeats 7 digits without faltering and can recite five digits backward)
 Proverbs test

Thought Content :

 Thought – spontaneous, natural, clear, relevant and coherent

 Any fixed ideas or illusions

Emotional Status

 Emotions are assessed – natural, even, irritable and angry, anxious

 Mood fluctuations
 Does patient unpredictably swing from joy to sadness during interview
Perception

* Agnosia – inability to interpret or recognize objects seen through special

senses.
Ex : Patients sees pencils but do not know what to do with it ?

Motor Ability

 Ask patient to perform a skilled act (throw ball, move chair)

Successful Performance – ability to understand activity and normal
motor strength.

Language Ability :
  Understand and communicate in spoken and written language
 Aphasia – deficiency in language function

Impact on Life Style :

 Assess life style, patient role in society including family & community roles.

Documentation of findings :

 Appropriate terms are used to document and report the abnormalities.

RESULT-

CRANIAL NERVES

1) OlFactory : with eyes closed the patient identifies adours (each nostril
Separately.

2) Optic : Smeller eye chart visual fields and ophthalmic examination

3) Occulomotor : Test for ocular rotations, movements, nystagmus. Test for

4) Trochlear Papillary reflexes and eye lids for ptosis.
6) Abducens
5) Trigeminal : ask the Patient close eyes. Touch cotton on forehead cheeks and jaw
Sensitivity to superficial pain is tested by sharp and dull ends of
broken tongue blade.
Test for temperature – hot and cold water

7) Facial : Observe for symmetry while patient performs facial movements

(smile, whistle, eye browns) for paralysis.

8) Acoustic : Whisper or watch tick test (Webers and Rinne Test)

9) Glossopharyngeal : Ability to discriminate between sugar and salt on posterior

Third of tongue.

10) Vagus : elicit gag reflex by depressing a tongue blade on post tongue
(hoarseness invoice).

11) Spinal Accessory : Muscle strength (trapezius muscle)

Sternocleidomastoid muscle

12) Hypoglossal : Tongue any deviations strength of tongue is assessed by

 tongue depressor.

MOTOR SYSTEM

-Assessment of muscle size tone and strength, co-ordination and balance.

-Observe posture gait
-Abnormalities – Spasticity (increased tone), rigidity in flaccidity

RESULT-

Muscle Strength :

 Ability to flex or extend extremities

 5 point scale to rate muscle strength

5 – full power 2 – just movable

4 – fair strength 1 – minimal contraction
3 – sufficient strength 0 – no contraction at all
RESULT-

Balance and Co-ordination :

 Coordination (point to point testing) (nose to finger eyes closed)

 Alternate pronate and supinate hand as rapidly as possible
 Ask to touch each finger with thumb
 Rombergs test – patient stands feet together first eyes open and eyes closed for 20 to 30
seconds. (loss of balance is noted).
 Hopping, heel to toe walking forward and backward.

RESULT-

REFLEXES

Reflexes are tested

1) Reflex hammer is used

2) Grading the reflexes - 4+
- 3+
- 2+
- 1+

1) Biceps reflex
2) Triceps reflex
3) Brachioradialis reflex
4) Patellar reflex
5) Ankle reflex (Achilles reflex)
6) Babinski reflexes
Superficial reflexes – (corneal, gag, plantar and babinski response)

SENSORY EXAMINATION

 Tactile sensation (cotton wisp)

 Pain and temperature
 Taste and sense.

RESULT-

XVIII. GLASGOW COMA SCALE : (15 Normal) (3 deep coma)

1. Eye Opening Response : Spontaneous 4

To Voice 3
To Pain 2
None 1

2. Best Verbal Response : Oriented 5

Confused 4
In appropriate words 3
Incomprehensible sounds 2
None 1

3. Best Motor Response : Obeys command 6

Localizes pain 5
Withdraws 4
Flexion 3
Extension 2
None 1

RESULT(TOTAL SCORE)-