Clinical Examination Skills

All information below was taken directly from Mosby. I need someone to help out and add critical info to the document like instruments used at what point, timing, erbage, or anything else that might facilitate a physical exam. !. "ermatology #Skin, $air, %ails, and &ymphatics'
a. Skin i. (erform o erall inspection of entire skin surface #p. !)*'. "uring e aluation of each organ system e aluate the o erlying skin for the following characteristics+ Color ,niformity -hickness Symmetry $ygiene &esions #record si.e, shape, location, configuration, color, blanching, texture, ele ation or depression, pedunculation, presence of exudates, pattern of distribution, configuration' #p. !/0' 1dors ii. (alpate skin surfaces for p. !/0'+ Moisture -emperature -exture -urgor Mobility b. Hair i. Inspect hair for the following #p. !*2'+ Color "istribution 3uantity ii. (alpate hair for texture #p. !*2' c. Nails i. Inspect for the following+ #p. !*2' (igmentation of nails and beds &ength Symmetry 4idging, beading, pitting, pealing ii. Measure nail base angle #p. !*5' iii. Inspect and palpate proximal and lateral nail folds for #p. !*5'+ 4edness Swelling (ain Exudate 6arts, cysts, tumors i . (alpate nail plate for the following #p. !*5' -exture 7irmness -hickness ,niformity Adherence to nail bed d. Lymphatics i. -he lymphatics system is examined region by region during the examination of the other body systems #head and neck, breast and axillary, genitalia, and extremities'. ii. Inspect the isible nodes for the following #p. 028'+ Edema Erythema 4ed streaks iii. (alpate the superficial lymph nodes and compare side to side for the following #pp. 0289 02/'+ Si.e Consistency Mobility "iscrete borders or matted -enderness 6armth

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E%The following steps should be performed with the patient sitting. e. Ears i. Inspect the auricles and mastoid area for the following #pp. 20!9200'+ Si.e Shape Symmetry &andmarks Color (osition "eformities or lesions ii. (alpate the auricles and mastoid area for the following #p. 202'+ -enderness Swelling %odules iii. Inspect the auditory canal with an otoscope, noting the following #p. 202'+ Cerumen Color &esions "ischarge, or foreign bodies i . Inspect the tympanic membrane for the following #p. 205'+ &andmarks Color Contour (erforations Mobility . Assess hearing through the following #pp. 20:9 20)'+ 4esponse to ;uestions during history 4esponse to a whispered oice 4esponse to tuning fork for air and bone conduction f. Nose and Sinuses i. Inspect the external nose for the following #p. 20/'+ Shape Si.e Color %ares ii. (alpate the ridge and soft tissues of the nose for the following #p. 20/'+ -enderness "isplacement of cartilage and bone Masses E aluate the patency of the nares #p. 20/'+ Inspect the nasal mucosa and nasal septum for the following #pp. 20/920*'+ Color Alignment "ischarge Swelling of turbinates (erforation Inspect the frontal and maxillary sinus area for swelling #p. 20<'. (alpate and percuss the frontal and maxillary sinuses for the following #p. 20<'+ -enderness or pain Swelling

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g. Mouth i. Inspect and palpate the lips for the following #p. 20<'+ Symmetry Color Edema Surface abnormalities ii. Inspect and palpate the gingi ae for the following #p. 220'+ Color &esions -enderness iii. Inspect the teeth for the following #p. 220'+ 1cclusion Caries &oose or missing teeth i . Inspect the tongue and buccal mucosa for the following #pp. 2289225'+ Color Symmetry Swelling ,lcerations Cranial ner e =II #hypoglossal' . (alpate the tongue #p. 225'. i. Inspect the palate and u ula #p. 225'. ii. Inspect the following oropharyngeal characteristics #pp. 22:922)'+ -onsils (osterior wall of pharynx iii. Elicit gag reflex #cranial ner es I= and =' #p. 22)'.

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$ead and %eck

h. Head i. 1bser e head position #p. 0:0'. ii. Inspect skull and scalp for the following #p. 0:0'+ Si.e Shape Symmetry &esions iii. Inspect facial features, including the following #p. 0:0'+ Symmetry Shape ,nusual features -ics Characteristic facies i . (alpate head and scalp, noting the following #p. 0:0'+ Symmetry -enderness #particularly o er areas of frontal and maxillary sinuses' Scalp mo ement . (alpate the temporal arteries, noting the following #p. 0:2'+ -hickening $ardness -enderness i. Auscultate the temporal arteries for bruits #p. 0:2'. ii. Inspect and palpate the sali ary glands #p. 0:2'. i. Neck i. Inspect the neck for the following #p. 0:2'+ Symmetry Alignment of trachea 7ullness Masses, webbing, and skin folds >ugular ein distention Carotid artery prominence ii. (alpate the neck, noting the following #pp. 0:29 0:5'+ -racheal position -rachealtug Mo ement of hyoid bone and cartilages with swallowing iii. (alpate the thyroid gland for the following #p. 0::'+ Si.e Shape Configuration Consistency -enderness %odules #If gland is enlarged, auscultate for bruits.' i . E aluate range of motion of the neck #p. 0:5'.

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%eurology
. -est Cranial %er es ! through =II #pp. //09//*'. C% I #olfactory' -est ability to identify familiar aromatic odors, one naris at a time with eyes closed. C% II #optic' -est ision with Suellen chart and 4osenbaum near ision chart. (erform ophthalmoscopic examination of fundi. -est isual fields by confrontation and extinction of ision. C% III, I?, and ?I#oculomotor, Inspect eyelids for drooping. Inspect pupils@ si.e for e;uality and their direct trochlear, and abducens' and consensual response to light and accommodation. -est extraocular eye mo ements. C% ? #trigeminal' Inspect face for muscle atrophy and tremors. (alpate Aaw muscles for tone and strength when patient clenches teeth. -est superficial pain and touch sensation in each branch. #-est temperature sensation if there are unexpected findings to pain or touch.' -est corneal reflex. C% ?II #facial' Inspect symmetry of facial features with arious expressions #smile, frown, puffed cheeks, wrinkled forehead, etc.' -est ability to identify sweet and salty tastes on each side of tongue. C% ?III #acoustic' -est sense of hearing with whisper screening tests or by audiometry. Compare bone and air conduction of sound. -est for laterali.ation of sound. C% I= #glossopharyngeal' -est ability to identify sour and bitter tastes. -est gag reflex and ability to swallow. C% = # agus' Inspect palate and u ula for symmetry with speech sounds and gag reflex. 1bser e for swallowing difficulty. E aluate ;uality of guttural speech sounds #presence of nasal or hoarse ;uality to oice'. C% =I #spinal accessory' -est trape.ius muscle strength #shrug shoulders against resistance'. -est sternocleidomastoid muscle strength #turn head to each side against resistance'. C% =II #hypoglossal' Inspect tongue in mouth and while protruded for symmetry, tremors, and atrophy. Inspect tongue mo ement toward nose and chin. -est tongue strength winth index finger when tongue is pressed against cheek. E aluate ;uality of lingual speech sounds #l, t, d, n'. j. Cerebellar Function and roprioception i. E aluate coordination and fine motor skills by the following #pp. //*9//<'+ 4apid rhythmic alternating mo ements Accuracy of upper and lower extremity mo ements ii. E aluate balance using the 4omberg test #p. /*8'. iii. 1bser e the patient@s gait #pp. /*!9/*0'. (osture 4hythm and se;uence of stride and arm mo ements k. Sensory Function i. -est primary sensory responses to the following #pp. /*29/*5'+ Superficial touch Superficial pain -est ibratory response to tuning fork o er Aoints or bony prominences on upper and lower extremities #p. /*59/*:'. E aluate perception of position sense with mo ement of the great toe or a finger #p. /*:'. Assess ability to identify familiar obAect by touch and manipulation #p. /*:'. Assess two9point discrimination #p. /*:9/*)'. Assess ability to identify letter or number BdrawnB on palm of hand #p. /*:'. Assess ability to identify body area when touched #p. /*)'. Superficial and !eep "endon #efle$es (age : of !) &ast sa ed on + April 05, 08!5

ii. iii. i . . i. ii. l.

1SCE 4e iew Sheet i. -est abdominal reflexes #pp. :52, /*)'. ii. -est the cremasteric reflex in male patients #p. /*/'. iii. -est the following deep tendon reflexes #pp. /**9/*<'+ Ciceps Crachioradial -riceps (atellar Achilles i . -est for ankle clonus #p. /*<'. . -est the plantar reflex #p. /*/'. m. Mental Status E$am i. 1bser e physical appearance and beha ior #p. *0'. ii. In estigate cogniti e abilities by assessing the following #pp. *29*/'+ State of consciousness 4esponse to ;uestions 4easoning Arithmetic ability Memory Attention span iii. E aluate emotional stability from the following #p. */'+ Signs of depression or anxiety "isturbance in thought content $allucinations i . 1bser e speech and language by the following #pp. */9**'+ ?oice ;uality Articulation Coherence Comprehension

n. %rief Neuro E$amination i. -he shorter screening examination is commonly used for health isits when no known neuro. logic problem is apparent. Cranial %er es Cranial ner es II through =II are routinely testedD howe er, taste and smell are not tested unl some aberration is found #pp. //09///'. (roprioception and 1ne test is administered for each of the following+ rapid rhythmic alternating Cerebellar 7unction mo ements,DD accuracy of mo ements, balance #4omberg test is gi en', and gait and heel9toe walking #ppDE //*9/*0'. Sensory 7unction Superficial pain and touch at a distal point in each extremity are testedD ibration and positionF senses are assessed by testing the great toe #pp. /*29/*)'. "eep -endon 4eflexes All deep tendon reflexes are tested, excluding the plantar reflex and the test for clone #pp. /**9/*<'.

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0. 1phthalmology
a. Eyes i. Measure isual acuity, noting the following #pp. 0/*90/<'+ %ear ision "istant ision (eripheral ision ii. Inspect the eyebrows for the following #p. 0*8'+ $air texture Si.e Extension iii. Inspect the orbital area for the following #p. 0*8'+ Edema Sagging tissues or puffiness &esions i . Inspect the eyelids for the following #pp. 0*89 0*0 '+ Ability to open wide and close completely Eyelash position (tosis 7asciculations or tremors 7lakiness 4edness Swelling . (alpate the eyelids for nodules. i. (alpate the eye for firmness. ii. Inspect the orbits. iii. (ull down the lower lids and inspect the conAuncti ae and sclerae for the following #pp. 0*090*2'+ Color "ischarge &acrimal gland punctate (terygium Inspect the external eyes for the following #pp. 0*590*:'+ Corneal clarity Corneal sensiti ity Corneal arcus Color of irides (upillary si.e and shape (upillary response to light and Accommodation "epth of anterior chamber (alpate the lacrimal gland in the superior temporal orbital rim #p. 0*:'. E aluate muscle balance and mo ement of eyes with the following #pp. 0*:90*/'+ Corneal light reflex Co er9unco er test Six cardinal fields of ga.e %ystagumus 1phthalmoscopic examination #pp. 0*/90<8'+ &ens clarity 4ed reflex 4etinal color and lesions Characteristics of blood essels "isc characteristics Macula characteristics

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2. (ulmonary
The following steps are performed with the patient sitting. a. Chest i. Inspect the chest, front and back, noting thoracic landmarks, for the following #pp. 2)292):'+ Si.e and shape #anteroposterior diameter compared with trans erse diameter' Symmetry Color Superficial enous patterns (rominence of ribs ii. E aluate respirations for the following #pp. 2))9 2)<'+ 4ate 4hythm or pattern iii. Inspect chest mo ement with breathing for the following #p. 2/8'+ Symmetry Culging ,se of accessory muscles i . %ote any audible sounds with respiration #i.e., stridor or whee.es' #p. 2/8'. . (alpate the chest for the following #pp. 2/!9 2/2'+ Symmetry -horacic expansion (ulsations Sensations such as crepitus, grating ibrations -actile fremitus i. (erform direct or indirect percussion on the chest, comparing sides, for the following #pp. 2/292//'+ "iaphragmatic excursion (ercussion tone intensity, pitch, duration, and ;uality ii. Auscultate the chest with the stethoscope diaphragm, from apex to base, comparing sides for the following #pp. 2//92*2'+ Intensity, pitch, duration, and ;uality of expected breath sounds ,nexpected breath sounds #crackles, rhonchi, whee.es, friction rubs' ?ocal resonance

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5. Cardio ascular
a. Heart The following steps are performed with the patient sitting and leaning forward, supine, and in the left lateral recumbent positions; these positions are all used to compare findings or enhance the assessment. i. Inspect the precordium for the following #p. 528'+ Apical impulse (ulsations $ea es or lifts ii. (alpate the precordium to detect the following #p. 52!'+ Apical impulse -hrills, hea es, or lifts iii. (ercussion to estimate the heart si.e #optional' #p. 522'. i . Systematically auscultate in each of the fi e areas while the patient is breathing regularly and holding breath for the following #pp. 522955!'+ 4ate 4hythm S, SG Splitting S2 andHor S5 Extra heart sounds #snaps, clicks, friction rubs, and murmurs' . Assess the following characteristics of murmurs #pp. 55!9555'+ -iming and duration (itch Intensity (attern 3uality &ocation 4adiation ?ariation with respiratory phase

b. %lood &essels i. (alpate the arterial pulses in distal extremities, comparing characteristics a bilaterally for the following #p. 555'+ 4ate 4hythm Contour Amplitude ii. Auscultate the carotid, temporal, abdominal aorta, renal, iliac, and femoral arteries for bruits #p. 55<'. iii. Measure the blood pressure in both first supine and then, in patients at ri:/ for orthostatic hypotension, standing #pp. 5:!95::'. i . 6ith the patient reclining at a 5:9degree angle ele ation, inspect for Augular enous pulsations and distentionD differentiate Augular and carotid pulse wa es, and measure Augular enous pressure #pp. 5::95:/'. . Inspect the extremities for sufficiency of arteries and eins through the following #pp. 5:/95:<'+ Color, skin texture, and nail changes@ (resence of hair Muscular atrophy Edema or swelling ?aricose eins i. (alpate the extremities for the following #pp. 55<, 5:*'+ 6armth (ulse ;uality -enderness along a superficial ein (itting edema

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:. Creasts and axilla

a. Females i. Inspect with patient seated and arms hanging loosely at the sides. Inspect both breasts and compare them for the following #p. 5<5'. Si.e Symmetry Contour 4etractions or dimpling Skin color and texture ?enous patterns &esions Supernumerary nipples ii. Inspect both areolae and nipples and compare them for the following #pp. 5<595<:'+ Shape Symmetry Color Smoothness Si.e %ipple in ersion, e ersion, or retraction iii. 4einspect breasts with the patient in the following positions #p. 5<*'+ Arms extended o er head $ands pressed on hips or hands pushed together in front of chest Seated and leaning o er In recumbent position i . 6ith patient seated, palpate breasts systematically in all four ;uadrants and the tail of Spence and o er areolae for lumps or nodules #pp. 5<*9:88'D if breasts are large, perform bimanual palpation #p. :88'. . (alpate nipplesD compress gently to obser e for discharge #p. :8!'. i. (alpate for lymph nodes in the apex, medial and lateral aspects, anterior and posterior walls of the axilla, and the supracla icular area #p. :80'. ii. Continue palpation of breast tissue with patient supine, one arm behind head and towel under shoulder #p. :8!'. b. Males i. Inspect breasts for the following #p. 5<5'+ Symmetry Enlargement Surface characteristics ii. Inspect both areolae and nipples and compare them for the following #pp. 5<59:88'+ Shape Symmetry Color Smoothness Si.e %ipple in ersion, e ersion, or retraction iii. (alpate breasts and o er areolae for lumps or nodules #pp. 5<*9:88'. i . (alpate nippleD compress to obser e for discharge #p. :8!'. . (alpate for lymph nodes in the apex, meI dial and lateral aspects, anterior and posterior walls of the axilla, and the supracla icular area #p. :80'.

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Abdomen H JI
Patient is supine i. Inspect the abdomen for the following #pp. :059 :0<'+ Skin characteristics ?enous return patterns Contour Symmetry Surface motion ii. Inspect abdominal muscles as patient raises head to detect presence of the following #pp. :0*9 :0<'+ Masses $ernia Separation of muscles iii. Auscultate with stethoscope diaphragm for the following #p. :0<'+ Cowel sounds in all four ;uadrants 7riction rubs o er li er and spleen ix. Auscultate with bell of stethoscope for the following #p. :28'+ ?enous hums in epigastric area and around umbilicus Cruits o er aorta and renal and femoral arteries x. (ercuss the abdomen for the following #pp. :289 :25'+ -one in all four ;uadrants &i er borders to estimate span Splenic dullness in left midaxillary line Jastric air bubble &ightly palpate in all ;uadrants for the following #pp. :259:2)'+ Muscular resistance -enderness Masses "eeply palpate all ;uadrants for the following #pp. :2)9:52'+ Culges and masses around the umbilicus and umbilical ring &i er border in right costal margin Jallbladder below li er margin at lateral border of the rectus muscle Spleen in left costal margin 4ight and left kidneys Aortic pulsation in midline 1ther masses Elicit the abdominal reflexes #p. :52'. 6ith patient sitting, percuss the left and right costo ertebral angles for kidney tenderness #p. :5!'.

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7emale Jenitalia
The patient is in the lithotomy position for the following: c. E$ternal 'enitalia i. Inspect the pubic hair characteristics and distribution #p. :*<'. ii. Inspect and palpate the labia for the following #p. :*<9:<8'+ Symmetry color Caking of discharge Inflammation Irritation or excoriation Swelling iii. Inspect the urethral meatus and aginal opening for the following #pp. :<89:<!'+ "ischarge &esions or caruncles (olyps 7istulas i . Milk the Skene glands #p. :<!'. . (alpate the Cartholin glands #p. :<0'. i. Inspect and palpate the perineum for the following #p. :<2'+ Smoothness -enderness inflammation 7istulas &esions or growths ii. Inspect for bulging and urinary incontinence as the patient bears down #p. :<2'. iii. Inspect the perineal area and anus for the following #p. :<2'+ Skin characteristics &esions 7issures or excoriation Inflammation d. (nternal 'enitalia Speculum E$amination i. Insert the speculum along the path of least resistance #p. :<5'. ii. Inspect the cer ix for the following #pp. :<59 :<:'+ Color (osition Si.e Surface characteristics "ischarge Si.e and shape of os iii. Collect necessary specimens for culture and (ap smears #pp. :<)9:<<'. i . Inspect aginal walls for the following #p. :<<'+ Color Surface characteristics Secretions e. %imanual E$amination i. Insert the index and middle fingers of one hand into the agina and place the other hand on the abdominal midline #p. :<<' ii. (alpate the aginal walls for the following #p. :<<'+ Smoothness -enderness &esions #cysts, nodules, or masses' iii. (alpate the cer ix for the following #pp. :<<9 )88'+ Si.e shape and length (osition Mobility i . (alpate the uterus for the following #pp. )889 )80'+ &ocation (osition Si.e shape and contour Mobility -enderness . (alpate the o aries for the following #p. )80'+ Si.e Shape Consistency -enderness i. (alpate adnexal areas for masses and tenderness #p. )80'. f. #ecto&aginalE$amination i. Insert the index finger into the agina and the middle finger into the anus #p. )82'. ii. Assess sphincter tone #p. )82'. iii. (alpate the recto aginal septum for the following #p. )829)85'+ -hickness -one %odules i . (alpate the posterior aspect of the uterus #p. )85'. . (alpate the anterior and posterior rectal wall for the following #p. )85'+ Masses, polyps, or nodules Strictures, other irregularities, tenderness

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1SCE 4e iew Sheet i. %ote characteristics of feces when the glo ed finger is remo ed #p. )85'.

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Male Jenitalia
The following steps are performed with the patient lying or standing. g. enis and Scrotum i. Inspect the pubic hair characteristics and distribution #p. ):8'. ii. 4etract the foreskin if the patient is uncircumcised #p. ):!'. iii. Inspect the glans of the penis with foreskin retracted, noting the following #p. ):!'+ Color Smegma External meatus of urethra ,rethral discharge i . (alpate the penis, noting the following #p. ):0'+ -enderness Induration . Strip the urethra for discharge #p. ):0'. i. Inspect the scrotum and entral surface of the penis for the following #p. ):0'+ Color -exture Asymmetry ,nusual thickening (resence of hernia ii. -ransilluminate any masses in the scrotum #p. ):/' iii. (alpate the inguinal canal for a direct or indirect hernia #p. ):2'. ix. (alpate the testes, epididymides, and asa deferentia for the following #p. ):5'+ Consistency Si.e -enderness Cleeding, lumpiness, or nodules x. (alpate for inguinal lymph nodes #pp. 00!, 02!, 02) '. xi. Elicit the cremasteric reflex bilaterally #p. ):)'. h. rostate and #ectum i. Inspect the sacrococcygeal and perianal area for the following #p. )/:'+ Skin characteristics &esions (ilonidal dimpling andHor tufts of hair ii. Inflammation Excoriation Inspect the anus for the following #p. )/:'+ Skin characteristics and tags &esions, fissures, hemorrhoids, or polyps 7istulas (rolapse Insert finger and assess sphincter tone #p. )/:'. (alpate the muscular ring for the following #p. )/)'+ Smoothness E enness (alpate the lateral, posterior, and anterior rectal walls for the following #p. )/)'+ %odules, masses, or polyps -enderness Irregularities In males, palpate the posterior surface of the prostate gland through the anterior rectal wall for the following #pp .)/)9)/*' Si.e Contour Consistency Mobility In females, palpate the cer ix and uterus through the anterior rectal wall for the following #p. )/*'+ Si.e Shape (osition Smoothness Mobility $a e the patient bear down and palpate deeper for the following #p. )/*'+ -enderness %odules 6ithdraw the finger and examine fecal material for the following #p. )/*'+ Color Consistency Clood or pus 1ccult blood by chemical test

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Musculoskeletal
The following steps are performed with the patient standing, sitting, and walking. i. 'eneral i. Inspect the skeleton and extremities and compare sides for the following #p. /8:'+ Alignment Contour and symmetry of body parts Si.e Jross deformity ii. Inspect the skin and subcutaneous tissues o er muscles and Aoints for the following #p. /8:'+ Color %umber of skin folds Swelling Masses iii. Inspect muscles and compare contralateral sides for the following #p. /8:'+ Si.e Symmetry 7asciculations or spasms i . (alpate all bones, Aoints, and surrounding muscles for the following #p. /8)'+ Muscle tone $eat -enderness Swelling Crepitus . -est each maAor Aoint for acti e and passi e range of motion and compare contralateral sides #p. /8)'. i. -est maAor muscle groups for strength and compare contralateral sides #p. /8/'. )oints "hat !eser&e articular *ttention "emporomandibular )oint i. -est range of motion by ha ing the patient perform the following #pp. /8/9/8*'+ 1pening and closing mouth Mo ing Aaw laterally to each side (rotruding and retracting Aaw ii. (alpate the Aoint space for clicking, popping, and pain #p. /8/'. iii. -est strength of temporalis muscles with the patient@s teeth clenched #p. /8*'. k. Cer&ical Spine i. Inspect the neck for the following #p. /8*'+ Alignment Symmetry of skin folds and muscles j. ii. -est range of motion by the following maneu ers #pp. /8*9/8<'+ 7orward flexion #5:K' $yperextension #::K' &ateral bending #58K' 4otation #/8K' iii. -est strength of sternocleidomastoid and trape.ius muscles #cranial ner e =I, spinal accessory' #p. /8<'. l. "horacic and Lumbar Spine i. Inspect the spine for alignment #pp. /8<9/!8'. ii. (alpate the spinal processes and para ertebral muscles #p. /!8'. iii. (ercuss for spinal tenderness #p. /!8'. i . -est range of motion by the following maneu ers #pp. /!89/!0'+ 7orward flexion #/:K' $yperextension #28K' &ateral bending #2:K' 4otation m. Shoulders i. Inspect shoulders and shoulder girdle for contour #p. /!09/!2'. ii. (alpate the Aoint spaces and bones of the shoulders #p. /!2'. iii. -est range of motion by the following maneu ers #pp. /!29/!:'+ Shrugging the shoulders 7orward flexion #!*8K' and hyperextension #up to :8K' Abduction #!*8K' and adduction #:8K' Internal and external rotation #<8K' i . -est muscle strength by the following maneu ers #p. /!:'+ Shrugged shoulders 7orward flexion Abduction Medial and lateral rotation n. Elbo+s i. Inspect the elbows in flexed and extend position for the following #p. /!:'+ Contour Carrying angle #:9!:K' ii. (alpate the extensor surface of the ulna, olecranon process, and the medial and lateral epicondyles of the humerus #p. /!:'. iii. -est range of motion by the following maneu ers #pp. /!:9/!)'+ (age !: of !) &ast sa ed on + April 05, 08!5

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7lexion #!)8K' Extension #!*8K' (ronation and supination #<8K'

o. Hands and ,rists i. Inspect the dorsum and palm of hands for the following #pp. /!)9/!/'+ Contour (osition Shape %umber and completeness of digits ii. (alpate each Aoint in the hand and wrist #pp. /!/9/!*'. iii. Strike the median ner e to test for the -inel sign #p. /!*'+ i . -est range of motion by the following maneu ers #p. /08'+ Metacarpophalangeal flexion #<8K' and hyperextension #28K' -humb opposition 7orming a fist 7inger adduction and abduction 6rist extension, hyperextension #/8K', and flexion #<8K' 4adial #08K' and ulnar motion #::K' . -est muscle strength by the following maneu ers #p. /08'+ 6rist extension and hyperextension $and grip p. Hips i. Inspect the hips for symmetry and le el of gluteal folds #p. /08'. ii. (alpate hips and pel is for the following #p. /08'+ Instability -enderness Crepitus iii. -est range of motion by the following maneu ers #p. /08'+

7lexion #!08K', extension #<8K' and hyperextension #28K' Adduction #28K' and abduction #5:K' Internal rotation #58K' External rotation #5:K' i . -est muscle strength of hips with the following maneu ers #p. /08'+ Lnee in flexion and extension Abduction and adduction . Inspect for flexion contractures with the -homas test #p. /2!'. i. Inspect for weak hip abductor muscles with the -rendelenburg test #p. /20'. -. Legs and .nees i. Inspect the knees for natural conca ities #p. /00'. ii. (alpate the popliteal space and Aoint space #p. /00'. iii. -est range of motion by flexion #!28K' and extension #89!:K' #p. /00'. i . -est the strength of muscles in flexion and extension #p. /00'. r. Feet and *nkles i. Inspect the feet and ankles during weight bearing and non9weight bearing for the following #pp. /00, /05'+ Contour Alignment with tibias Si.e %umber of toes ii. (alpate the Achilles tendon and each metatarsal Aoint #p. /05'. iii. -est range of motion by the following maneu ers #pp. /059/0:'+ "orsiflexion #08K' and plantar flexion #5:K' In ersion #28K' and e ersion #08K' 7lexion and extension of the toes

i . -est strength of muscles in plantar flexion and dorsiflexion #p. /0:'.

(age !) of !) &ast sa ed on + April 05, 08!5