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Upper Limb Neurological Examination

- Inspection skin scarring, swelling, deformity, muscle wasting / bulk, tremor, posture- Tone shake hand, supinate, pronate, flex, extend (shoulder and elbow), abduct, adduct, internal, external

rotate

- Power elbows out, arms out, wrist flex up (both direction, hold wrist), fingers straight (hold hand), fingers out-

Reflexes bicep, tricep, brachioradialis, fingers- Coordination hand clap, nose to finger, eyes closed, follow finger, arm drift- Sensation c4 deltoid, t1 bicep, c5 tricep, c6 inner arm, c8 outer arm, outer posterior hand, c6 inner posterior

hand, c7 palm, dermatomes soft and sharp, vibration, proprioception

Lower Limb Neurological Examination tap quads / hamstring, squatting

- Inspection skin scarring, swelling, deformity, tremor, muscle bulk / wasting, posture, walking normally,tipitoes, heals, heal toe, rhomberg

- Tone roll leg, flex knee, patella and ankle clonus- Power hip (push down, bring up), hip abduction and adduction, knee (straighten leg, bring leg in), ankle flex,

extend, invert, evert

- Reflexes knee, ankle, babinski- Coordination heel shin, toe to finger, foot tap- Sensation l3 inner thigh, l4 inner leg, l5 outer leg, s1 top of foot, vibration (start stop), proprioceptionShoulder examination

- Look - skin scarring, swelling, deformity, muscle bulk, symmetry- Feel collar bone, shoulder joint, spine of shoulder blade, temperature, tenderness- Move follow me, arms up, extend shoulder, arms out, painful arc, arms in, internal, external rotate, passive

flex, extend, adduct, abduct, internal, external rotate

- Special tests bend elbows (push in and out), thumbs down, apprehension testElbow examination

- Look skin, scarring, swelling, deformity, muscle bulk, symmetry, nodules- Feel medial and lateral epicondyle, olecranon, bursa, swelling tenderness, temperature- Move flexion, extension, supination, pronation- Special tests clench fist and extend / flex against resistanceWrist and Hand examination

- Look both sides: skin, scarring, swelling, deformity (swan, boutonniere, z-deformity), cysts, muscle wasting,fingernails (no pitting),

- Feel swelling, tenderness, temperature, styloids, anatomical snuffbox, pisiform, scaphoid, all metacarpal,phalangeal joints, feel palm while flexing.

- Move form a fist. Wrist - flex, extend, side to side. Fingersflex all phalanges, extend, abduction, adductionof fingers. Thumb flex, extend, abduct, adduct, opposition with all fingers. PASSIVE.

- Special tests Grip fingers, oppose pinky and thumb, write something, phalens, tinels testHip examination

- Look skin, scarring, swelling, deformity, muscle bulk, symmetry, walking, trendelenburg, squat- Feel hip bone, hip joint, swelling, tenderness, warmth, pain?- Move leg up, bring knee to chest, flex knee and bring ankle in and out, abduct, adduct, extension- Special teststhomass test- Measure asis to medial malleolus, belly button to medial malleolus

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Knee examination

- Look skin, scarring, swelling, deformity, alignment (vagus or varus), cyst, walk, squat- Feel temperature, swelling, quads, hamstrings, border of knee bones, patella, patella tap, patella bulge- Move flexion, extension (feel for crepitus)- Special tests medial and collateral ligaments anterior and posterior draw, lachmans, medial and lateral

mcmurrays, appleys grind (pain or clicking), (patellar apprehension if patellar dislocation suspected)

Ankle and foot examination

- Look skin, scarring, swelling, deformity, muscle, nails, clawing, protrusions- Feel Achilles, medial and lateral malleolus, heal, mp,- Move flex, extend, inversion, eversion- Special tests squeeze calf for Achilles tendonCranial Nerve examination

- 1 olfactory any change in smell?-

2,3,4,6 optic, occulomotor, trochlear, abducens snellens, visual field, blind spot, pupillary reflex, swingingreflex, accommodation, H, fundoscopy

- 5 trigeminal soft and sharp touch, masseter, temporalis, pteregoids, jaw jerk, corneal reflex.- 7 facial furrow eyebrows (resist), close eyes shut (resist), puff out cheeks, smile, frown, show teeth- 8 vestibulocochlear otoscope, 66,100, 67, 100, rinne (both), webers (centre),- 9, 10, 12 glossopharangeal, vagus, hypoglossal inspection, depress and ahh, speak, cough, swallow, stick

out tongue

- 11 accessory shrug, turn headEye examination drooping, colour of sclera, ulceration, cranial nerve, ishihara, corneal reflex, fundoscopy

Ear examination outer ear (shape, swelling, protrusions), palpate, otoscope (external canal, tympanic membrane),

cranial nerve

Neck examination

- Look Skin, scarring, swelling, deformities, wasting, posture- Feel occipital process, spinous processes, c7, facet joints, paraspinous muscles- Move flex, extend, lateral flex, extend, rotate (feeling for crepitus)- Special tests - neurological and vascular examination of upper limbsBeck examination

- Look gait, posture, skin, swelling, scarring, deformity, muscle wasting- Feel spinous processes, paraspinous muscles- Move flex, extend, lateral flexion, rotation- Special tests - Schobers test, straight leg raise, press asis, venus dimples, neurological examinationCPR

- Danger surroundings, gloves- Response can you hear me? Shake, knuckles to sternum- Send for help call triple zero, location, gender age, incident, consciousness- Airways tilt head back, move jaw forward, remove contents, hand on chest, ear near mouth and look at chest- Compressions 30 compressions, 2 breaths, until help arrives- Defibrillation 8 y/o, follow prompts

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Injections

Pain History

Neurological History

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