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System Exams Promotion Exam

Musculoskeletal:Each joint involves inspection, palpation, active ROM, passive ROM and resisted muscle testing;

I can provide more detail if needed

Inspect and palpateStrength and ROM active, passive, resisted

TMJ

Cervical Spine

Thorasic andLumbar Spine

Shoulder

Elbos

!ands, rists,"ngers

!ips

#nees

$n%les

&eet'toes

Neurological:

Mental Status and Speech Exam

Cranial (erve E)am

Smell (! "earing (#!$isual acuit%, fields (&! S'allo'ing (,)!, rise of palate()!, gag reflex (,)!

*upillar% rxns (&,+! $oice ()!

EOM (+,,-! Speech (.,/,),&!0orneal reflex, ja' closing (.! Shoulder shrug (!

1acial movement (/! 2ongue movement (&!

2est Motor3Reflex3Sensor% (MRS! for upper and lo'er spinal levels

*pper E)tremit+a MRS-C./ MOTOR/ 0eltoid 1shoulder abduction2 and

3iceps 1elbo 4e)ion2 RE&LE5/ 3iceps

SE4SOR5: 6ateral arm

b MRS-C6/ MOTOR/ 3iceps 1elbo 4e)ion27rist extensors ('rist extension!

RE16E8: 9rachioradialis

SE4SOR5: 6ateral forearm, thum, index finger

c MRS-C7/ MOTOR/ Triceps 1elbo e)tension27rist flexors ('rist flexion!

1inger extensors (finger extension!RE16E8: 2riceps

SE4SOR5: Middle finger

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d MRS-C8/ MOTOR/ &inger 4e)ors 1"nger 4e)ion2

Interossei (finger aduction and adduction!RE16E8: 4one

SE4SOR5: Medial forearm, little finger, ring finger

e MRS-T9/ MOTOR/ Interossei 1"nger abduction and adduction2 RE16E8: none SE4SOR5: medial arm

Loer E)tremit+a MRS-L:/ MOTOR/ Tibialis anterior 1an%le dorsi4e)ion and

inversion2RE16E8: *atellar

SE4SOR5: Medial leg and footb MRS-L./ MOTOR/ E)tensor hallicuslongus1big toe e)tension2

luteus medius (hip aduction! Extensor digitorumlongus and revis

(toes &3. extension!

RE16E8: Medial hamstring SE4SOR5: 6ateral leg, dorsum of foot

c MRS-S9/ MOTOR/ ;eroneus longus and brevis1an%leplantar4e)ion and eversion2

RE16E8: eet

Test Cortical sensor+ >unctions-stereogenesis, graphesthesia, point location

*roprioception and 0ereellar function Coordination-rapid alternating movements-

=pper extremit%3alternated pronation and supination on thighs6o'er extremit%3tapping all of foot on floor or drs hand

Coordination and "ne motor s%ill-accurac+ o> movement

=pper extremit%3finger3to3finger or finger3to3nose

6o'er extremit%3heel3to3shin 3alance-e?uilibrium-Romberg >olloed b+ prontator dri>t

3alance-@ait-Observe normal gaitA Bal% heel-to-toe, al% on toes, al% onheels

HEENT: !ead

o Inspect face and s>in

o E)amine hair and scalp

o ;alpate s%ull and temporal arter+

E+es

o

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o Inspect e+e position and alignment, e+ebros and e+elashes, lacrimalducts, con=unctiva and sclera,cornea and lens, iris and pupil

o Test pupillar+ reaction to light and accommodation

o EOM

o Ophthalmoscopic e)am - lens, vessels,disc, ph+siologic cup, macula

Earso or deviation

o Th+roid - masses, enlargement

0$?*$:

Cardiovascular: 3lood ;ressure, ;ulse

Measure Jor hepato=ugular re4u)

;alpate carotid pulse and auscultate >or bruits

Inspect 'palpate chest heaves, li>ts, right ventricular impulse, apical impulse1;MI2or sie, s+mmetr+, selling 1measure i> necessar+2Avenous pattern, color, te)tureA hair pattern

;alpate >or temperature and edema in loer e)tremit+ D

;alpate >or peripheral pulses radial, brachialA >emoral, posterior tibial,dorsalis pedis

$uscultate >or bruits in abdomen

;alpate inguinal and epitrochlear nodes

Special tests

;atient LL0 listen at ape) 'bell 1murmur o> mitral stenosis2

;atient seated and leaning >orard, hold breathA Listen at ape) and LLS3'diaphragm 1murmur o> aortic regurgitation2

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9 lead E#@

!espiratory:

$ssess rate, rh+thm, depth and eFort o> respiration

Observe overall s%in color, "ngernails, respirator+ distress, use o>accessor+ muscles

*osterior 0hest Inspect - as+mmetr+

;alpate - masses, pain

Tactile >remitus

Respirator+ e)pansion

;ercuss - dullness, resonance

$uscultate - breath sounds, adventitious sounds

Special tests Transmitted voice sounds - as appropriate 1re?uired >orcompetenc+2/ 3ronchophon+, Egophon+, Bhispered pectorilo?u+

remitus

Respirator+ e)pansion

;ercuss - dullness, resonance

$usculate - breath sounds, adventitious sounds

Special tests same as posterior above

"#domen:

Observe - s%in, umbilicus, contour, peristalsis, pulsations

$uscultate - boel sounds, bruits, >riction rubs

;ercuss general, liver span, splenic percussion sign ;alpate

o Light general, cover all ?uadrantso 0eep general, liver, spleen, %idne+so $orta 1assessing sie o> pulsation2

Special tests - as appropriate 1re?uired >or competenc+2

Murph%As RovsingAs Oturator sign

Mc9urne%As *soas sign