Physical examination

Question 1

tremors/parkinson

Answer 1

Inspection tremors
Face mask, decreased eye blinking
essential - head nodding
eyes - decreased drooling
mouth - decreased facial expression, drooling

Hands
H- hyperthyroidism - fine tremors
L - liver - flapping
C- cerebellar - finger to nose test
Parkinson vs Anxiety - count 10 to 1 if increase parkinson

arms
cog wheel
lead pipe rigidity
clasp knife - stroke

Special test
speak - british constitution - monotonous
Dysdiadochokinesia - rapid alternating movement
writing - micrographia
draw spiral on paper

Gait
stand - diffuculty in standing
walk - stooped posture, shuffling, decreased arm swining, patient turns in blocks
pull test more than 2 steps

end with mini mental examination

Question 2

thyroid examination

Answer 2

vital signs

Head
1. eyes - exopthalmos, lid lag test,
H test proptosis, nyatagmus
2. hair - hair loss

thyroid
1. Inspection
- swallow with water no enlargements
- trachea centrality
2. auscultation
- bruit both lobes
3. percussion
-upper part of sternum - retrosternal extension
4. palpation
-go to the back
-palpate and swallow, mass, nodule, tenderness, symmetry

shoulder
- for weakness

Arms
1. tremors
2. nails
3. palm for sweating

Knees
reflex, joint effusion

Legs
Pre tibial edema

Question 3

neck exam

Answer 3

Inspection:
SEADS, cervical and throcacic spine
Cough - tenderness
Back: SEADS

Palpation
tenderness, Mass, temperature
spinous process, paravertebral, trapezius

ROM -> Resistance
up, down, turn left right, tilt left right

EXTREMITIES
Inspection: SEADS
Palpation: PT,MD mass, pain, temperature, pulse
biceps, triceps, forearm, thenar, hypothenar

Motor
C5 deltoild
C6 thumb
C7 middle finger
C8 pinky finger
T1 lateral elbow

Sensory
C5 deltoild
C6 thumb
C7 middle finger
C8 pinky finger
T1 lateral elbow

Reflex
c5-6 Biceps bradioradialis
C7 c8Triceps

Question 4

Neuro

Answer 4

GCS

CN
1- smell changes
2 - acquity, color, accomodation, PERLA, fields , fundoscopy
3,4,6 - symmetry, ptosis, nystagmus, movement
5- facial sensation opthalmic, maxillary, mandibular
7- temporal, zygomatic, bucal, mandibular, cervical
9, 10 - uvula
11- shrug shoulders
12 -tongue potrusion - faciculation, midline

extremity
M - motor -
C5 deltoid
C5-C6 forearm flexion
C7 forearm extension
C6c7 wrist up
C7 wrist down
C7finger extension
C8 claw hand
C8-t1 fanning
R - reflex - biceps, triceps, brachioradialis
T - tone
S - sensory
C5 deltoid
C6
C7
C8
T1 lateral finger

lower
clonus
M
L23 hip up
L34 knee up
L45 foot up
L5S1 foot down, knee back

R patellar, achilles, babinski
T
S
L2 hip
L3 upper leg
L4 lower leg
L5 toe
S1 little toe

Cerebellar - finger to nose
Meningeal - brudzinki, kernig
Gait - rhombergs, tandem gait

compelete DRE, perianal

pulses

Question 5

hand exam

Answer 5

inspection SEADS
palpation - tenderness, mass, temperature, tone
radius, ulna, styloid process, MCP, PIP, DIP,

M
R radial fan close
U fan open
M thumbs up

R

T

S - c6, c7,c8

biceps MRTS

Question 6

cardio

Answer 6

bp in lying position
BP in sitting position - for ortostatic hypotension
dec SBO 20 DBP 10 HR inc 20

Inspection
Eyes palor, fundoscopy - papilledema
mouth dehydration
hands - xanthomata, osler, janeway lesions, capillary refill, clubbing, pulses, edema
radioradial delay
collapsing pulse

neck
inspection: JVP, kaussmalls hold breath, hepatojugular reflex
Palpation: thrills
Auscultation bruit

Chest
Inspection PMI
Palpation: Apex, bruit, heaves
auscultation
diaphragm - Aortic, Pulmonic, Tricuspid, Mitral - s1,s2 murmur
mitral - murmur

lower limbs
inspection SEADS, nail hyperthrophy, skin changes
palpation: radio femoral delay
blood prssure on lower extremities

Question 7

Back

Answer 7

Stand
Inspection: SEADS, posture
Palpation: TTC tenderness, temprerature, crepitation, mass, MARK dimples of venus 10 up and 5 down
Motor cross left right
Front back
Left side
Occiput and wall distance test - normal 0 degrees
schober test - normal >6
Adams test - bend foward for scoliosis

special test
leg raise test - done on affected leg normal 30-70
brugada test
cross leg raise test - done on non affectd but pain on affected leg
fabers test

if still with time
walk pabalik on heels s45
walk toes l1l2

MSRP
motor
hip flexion l23
knee extension l3l4
dorsiflexion l4l5
plantar flexion s1s2

Sensory
hip l2
upper leg l3
lower leg l4
lateral toe l5
medial toe s1

reflexes knee ankle
DRE

Question 8

Ankle

Answer 8

Inspection SEADS
Palpation: TTCP
achilies tendon, lateral ligaments, medial ligaments, metacarpals, digits
ROM active with resistance

talar drawers test
talar tilt
squeeze test

check upper and lower joints and neurologic examinations