System Return 3

Question 1

Initial

Answer 1

1. Appearance, dress, and behavior
2. Orientation to time, place, and person
3. Recent and remote memory
4. Speech
5. Gait. Posture getting in/out of chair or on the table

Question 2

Appearance, dress and behavior

Answer 2

1. Note appearance, dress, and patient behavior as they enter exam room.

Question 3

Orientation to time place and person

Answer 3

1. Ask patient to state name.
2. Ask person to state the date.
3. Ask person to state the place.

Question 4

Recent and remote memory

Answer 4

1. Recent memory: Ask what patient ate for breakfast.

2. Remote memory: Ask date of birth.

Question 5

Speech

Answer 5

1. Observed when patient answered previous questions.

Question 6

Gait. Posture, getting in/out of chair or on the table

Answer 6

1. Observe patient walking into room.

Question 7

Back and Extremities

Answer 7

1. Neck ROM-CN XI
2. Shoulder ROM-CN XI
3. Wrist ROM and grip
4. Hip ROM
5. Spine ROM and level of Iliac crests
6. Romberg tests
7. One fine motor test
8. One gross motor coordination
9. Assess radial pulses
10. Assess brachial pulses
11. Palpate tenderness of hands and fingers

Question 8

Neck ROM - CN XI

Answer 8

1. Test accessory nerve.
2. Place hand on side of face and have patient move neck against your hand.
3. Repeat on the opposite side.

Neck ROM

1. Tuck chin to chest (Flexion).
2. Look upwards to ceiling (Extension).
3. Rotate to right and left (Cervical rotation).
4. Place ear on shoulder (Lateral bending).

Question 9

Shoulder ROM - CN XI

Answer 9

1. Place hands on top of shoulders and have patient shrug shoulders against your hands.

Shoulder ROM:

1. Shoulder flexion (raise arms above head).
2. Shoulder extension (bring arm behind body).
3. Abduction: arm out to side.
4. Adduction: cross arm in front of body like you are stretching.
5. Internal Rotation: ask patient to scratch back of neck.
6. External Rotation: ask patient to reach back and scratch opposite scappula.

Question 10

Wrist ROM and grip

Answer 10

1. Place arms out with palms down.
2. Extend (raise to ceiling).
3. Flexion (pull wrist down).
4. Abduction (away from body).
5. Adduction (towards body).
6. Wrist grip: Ask patient to squeeze fingers.

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Question 11

Hip ROM

Answer 11

1. Have patient lie down.
2. Bring each leg up (flexion).
3. Lie on stomach and lift leg to sky (extension).
4. Place patient on side.
5. Abduct up away from body.
6. Adduct leg.
7. Place patient back on back.
8. Flex knee to check internal rotation.
9. Move leg in towards body (adduction).
10. Move leg outward (abduction).

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Question 12

Spine ROM and Level of Iliac Crests

Answer 12

1. Forward flexion to try to touch toes. NOte allignment of spine.
2. While patient is still bent over, place hands on iliac crests to make sure they are even (this is to check for even limb length).
3. Bend backwards slightly.
4. Twist to each side.
5. Lateral bending.

Question 13

One fine motor test

Answer 13

1. Find motor test: Have patient grab something.

Question 14

One gross motor coordination

Answer 14

1. Gross motor test: Heel to toe walking

Question 15

Assess Radial pulses

Answer 15

1. Palpate radial pulse bilaterally.

Question 16

Assess brachial pulses

Answer 16

1. Palpate brachial pulse bilaterally.

Question 17

Palpate tenderness of hands and fingers

Answer 17

1. Palpate fingers and joints. Could indicate arthritis if they experience tenderness.

Question 18

Skin and Nails

Answer 18

1. Personal hygiene
2. Skin color, temperature, turgor, moisture
3. Lesions, masses, edema, pigmentation
4. Color of nail beds, shape and contour
5. Assess capillary refill

Question 19

Personal Hygiene

Answer 19

Hopefully, the patient showered

Question 20

Skin Color, Temperature, Turgor, Moisture

Answer 20

1. Skin warm and dry.

Question 21

Lesions, Masses, Edema, Pigmentation

Answer 21

1. Observe for any noticeable masses or edema.

Question 22

Color of Nail-Beds, Shape, and Contour

Answer 22

1. Look at nail-beds to ensure they are pink in coloring. No clubbing.

Question 23

Assess Capillary Refill

Answer 23

1. Should be less than 3 seconds.

Question 24

Deep Tendon Reflexes

Answer 24

1. Biceps
2. Triceps
3. Brachiordialis
4. Knee
5. Ankle

Question 25

Biceps

Answer 25

1. Place thumb in bend of elbow.
2. Strike thumb.

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Question 26

Triceps

Answer 26

1. Lift arm up and have patient relax arm.
2. Strike behind the elbow.

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Question 27

Brachioradialis

Answer 27

1. Relax arm.
2. Place thumb on arm and strike with hammer.

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Question 28

Knee

Answer 28

1. Strike right below patella.

Question 29

Ankle

Answer 29

1. Aim hammer so that it hits Achilles.
2. Strike on outside part of ankle.

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