1. Physical assessment
HIPPIRONEL can be used
to find most diagnosis.
history--OPQRST
inspection---scars, redness,symetry,gait
palpation--nodule, pain, spasm
percussion--heart/abdomen
instrumentation--stethoscope,tuning fork
range of motion---spine and extremities
orthopedic test--many tests
neurologic test---dermatomes, reflex,motor
related test---xray, MRI,ect
lab tests----CBC,ect

2. History--OPQRST
• Onset--when?
• Palliative--makes it better?
• Provacative--irritates?
• Quality--stab,burn,numb?
• Radiation/Referral--shoot down
arm/leg?
• Severity---0-10 or mild/moderate/severe
• Timing--after dinner, 2am?

3. History
• Past history---happened before?
• Family history--stroke,MI, cancer
• medications/vitamins
• other clinics?
• Medical history--surgeries
• Social history---alcohol,drugs,STD
• Occupational history--hard job,work
comp

4. Vital signs
• BP
• pulse
• resp
• temp
• height/weight
• pain rating

5. ROM--range of motion
• neck--flexion,extension, lateral flexion,
rotation
• lumbar--flexion,extension, lateral
flexion, rotation
• elbow--flexion,extension
• forearm--supination,pronation
• wrist--flexion, extension, radial
deviation ulnar deviation
• fingers--flexion, extension
• shoulder--flexion,extension, abduction,
adduction, internal rotation, external
rotation, circumduction

6. Integumentary
skin---dehydrated(tugor),color,
temp,ulcer
nails--clubbing,spooning, cap refill
less 2 sec

7. ROM--range of motion
• knee--flexion, extension
• hip-flexion,extension,int
rotation, ext rotation, abduction,
adduction
• ankle--inversion,eversion,
• plantar flexion,dorsiflexion
• toes-flexion,extension

8. eye exam
• http://www.youtube.com/watch?v=
• ear exam
• http://www.youtube.com/watc
h?v=iIbaq15t1L0

9. Musculoskeletal
• motor stength--0 to 5
• 5--Full ROM with gravity & full
resistance
• 4--Full ROM with gravity & some
resistance
• 3--Full ROM with gravity & No
resistance
• 2-Full ROM with gravity eliminated
• 1--slight contractility; no joint motion
• 0--No evidence of contractility

10. Neurology
• oriented?---time, place, name
• cranial nerves--I to XII these can
be seen on the bottom of brain
• ‘On old Olympus towering top, a
Fin and German viewed some
hops’

11. Cranial nerves
I Olfactory - olfaction (smell) s
IIOptic - vision (Contain 38% of all the axons connecting
to the brain.) s
III Oculomotor - eyelid and eyeball muscles m
IV Trochlear - eyeball muscles m
V Trigeminal - facial and mouth sensation , chewing b
VI Abducens - eyeball movement m
VII Facial - taste, facial muscles and salivary glands b
VIII Auditory - hearing and balance s
IX Glossopharyngeal - taste, swallowing b
X Vagus - long nerve goes to heart, GI, lungs b
XI Accessory - moving head and shoulder m
XII Hypoglossal - tongue muscles m
Some cranial nerves give sensation, some give muscle
control, some do both.

12. test your nerves
I Olfactory - olfaction (smell) s
IIOptic - vision (Contain 38% of all the axons connecting to the brain.) s
III Oculomotor - eyelid and eyeball muscles m
IV Trochlear - eyeball muscles m
V Trigeminal - facial and mouth sensation , chewing b
VI Abducens - eyeball movement m
VII Facial - taste, facial muscles and salivary glands b
VIII Auditory - hearing and balance s
IX Glossopharyngeal - taste, swallowing b
X Vagus - long nerve goes to heart, GI, lungs---gag b
XI Accessory - moving head and shoulder m
XII Hypoglossal - tongue muscles m

13. Dermatomes

14. homunculus

15. neuro levels

16. Abdomen
• RUQ LUQ RLQ LLQ--any bruises, bulges, discoloration
• sounds of borborygmus-normal 3-30? sound/minute
• no sounds after 5 minutes----severe GI problem
• McBurneys point---for appendix. between navel and
ASIS
• Murphy sign--------press under liver then release.
severe pain=cholecystitis
• murphys punch-----fist tap over kidneys

17. Orthopedic tests
stressing a body part to determine cause of pain
• neck
• lumbar
• elbow
• knee
• ankle
• hip
• shoulder

18. dermatome, motor, reflex
• http://www.youtube.com/watch?
v=esEWwFq940g

19. check your own
borborygmus
• normal, hyperactive, hypoactive

20. Cardiac
• percussion to find heart size
• systole (S1 sound)--ventricles contract
and aortic/pulmunary valves
open.mitral/tricuspid close.= lub
• diastole (S2 sound)--ventricles relax,
mitral/tricuspid open to let in blood,
aortic/pulmunary valves close.= dub

21. Cardiac
• pulses---
• 0 absent
• 1 weak/thready
• 2 palpable
• 3 strong
• 4 bounding

22. Pulses
• radial
• brachial
• popliteal
• dorsalis pedis
• carotid
• femoral
• http://www.youtube.com/watch?
v=74v4mEWhOao

23. check your pulses

24. Lungs
14-20 bpm
labored breathing?
scalene muscles used?
finger,lips color, coughing, sputum
chest shape--barrel, excavatus
palpation--hands on back,symetric
movement with breathing
‘99’ hand on back---fremitis vibration
auscultation---crackles, rales, wheezes