SECTION1 (4) SECTION 4 SOCIAL HX -greet, supplies, wash (12) -age,race,dob,gender, PE-MOM-LaHaT-SHAVe identify? -CC SECTION 5 ROS (13) -OPQRST 3 points CEE H RGG MSN PEH

SECTION 2 PMH (10) SECTION 6 GENERAL Gen (4) Chron-when PHVV-snellen CN 2 optic PIA SII SECTION 7 SKIN HAIR gyn(pelvic exam, pap NAILS (3) smear date for female, INSPECT- testicular exam monthly S(color jaundice, for male) hydration skin turgor, SEX hx (pregnancy rashes, swelling) plans female) Hn (distribution, texture, turgor, edema) SECTION 3 FHX (15) N (scars, purpuric HEAD,HEART,BRAIN,LU lesions, tumors, nevi- NGS,GI,GU abcde eval) EMOC BMG SA SECTION 8 HEAD AND Sensation: Cheeks NECK forehead.(Ask if he can feel touching his face) HEAD Ask to Smile, raise Inspect- symmetry, eyebrows swelling, facial “Cranial nerve V expression, blonde and trigeminal and VII facial thick are intact” Palpate-look for lesions, hair loss, abnormalities EYES(4) “normocephalic, no Inspect- eyelids No inhabitants, no alopecia” drooping. *pull lower eyes, look up” SINUSES (sclera is white, Palpate 1) frontal and conjunctiva is pink and maxillary sinus (ask if not irritated, lens pupils there’s discomfort) iris are intact without any 2) temporal arteries abnormalities) (say its present) *Grab opthalmoscope* Touch Andys Jaws. Ask lights off him to open and close PERRLA- “look straight’ his mouth “No TMJ noted” We are going to do the six cardinal gazes. You will need to follow my opthalmoscope. L-R up (4) and down middle. Inspect- redness, III oculomotor IV deformities, or trochlear VI abducens obstructions in the canal “ill look into your eyes Palpate- tenderness and do ophthalmoscope “does that hurt” Palpating exam” the tragus. And there is “Ill look for red reflex first. no tenderness” And ill see more anatomy of the eye, test:

Red reflex is noted, I was -whisper test. Can you able to locate the optic cover one LEFT ear and disc. Disc to cup ratio 3:, repeat what you hear? vessels, macula, fovea Red-eleven-bird - (step are noted. away every word) Thats a PASS for the “repeat on other eye” whisper test I would complete this with the opposite ear as well. - I’m going to place it behind your ear, I need you to tell me when you stop hearing the vibration. I will move the • No injection or redness tuning fork (side of face) are noted. and again you’ll tell me • Repeat on other side when you stop hearing the vibration.1:2 ratio Which is a pass. NOSE (3) Repeat on. The other side INSPECT- midline no - put fork on abnormalities noted. top of head Cover nose one side of Make sure ythe pt hear the nostril and breathe in via ration on both ears. please? Good, and now ‘hearing is intact” the other side please. Good. That tells me that • These tests tell me it is patent. hearing and Cranial LOOK UP- (look nerve VIII which is with light) vestibulocochlear are -nasal mucosa intact. and turbinates are pink and moist, with no GRAB - abnormalities INSPECT EAR inside CLOSE YOUR • grey pearly tympanic EYES TELL ME WHAT U membrane SMELL (ALCOHOL • able to visualize the SWAB) cone of light Cranial which is hypoglossal are nerve I, olfactory, is all intact. intact. NECK (6) MOUTH (3) OPEN mouth- no INSPect- SYMMETRY, loose teeth, no EDEMA abnormalities mucosal membrane feel lymph nodes. is pink and moist. The PPOTSS anterior and posterior Preauricular, pillars are noted as well posterior auricular, as the hard and soft occipital, tonsillar, pallets. submandibular, tongue depressor and submental: light now moving down the say AHH cervical chain to feel for I can see that the tonsils the deep cervical chain, are about a 1+ grade. ANTERIOR (superficial stick tongue- and deep) AND move side to side POSTERIOR Cranial nerves IX which is FEEL TRACHEA- make glossopharyngeal, X sure it is no easily which is vagus, and XII displaced HOLD ANDYS NECK- Section 9: Thorax/ Feel for thryoid Lungs/Cardiovascular Ask pt to swallow I felt the thyroid drop, 1. Inspect thorax : there is no goiter, and no abnormalities including nodules on the thyroid. scars, hernias, rashes thorax for symmetry, any Shrug shoulders- obvious increased Cranial nerve XI, the respiratory effort, spinal accessory nerve, is intact. Palpate chest- Tenderness, skin NO JVD- NO turgor- assess for DISTENTION NOTED hydrated skin

AUSCULTate- take Stop for now deep breaths. 6 spots. Clear.

None of the lymph nodes AP DIAMETER IS 2:1 were swollen or hard. TEACH BSE for female- Did you have any also tell Andy if he tenderness as I was notices any nodules palpating? have an appointment (This should be done once a month 5-7days excursion. Can you after your period. You please take a deep should be feeling for breath in, let it out and any lumps in an up and hold it while it’s out? down pattern. Bring up Great now can you any abnormalities you please take a deep may find at an breath in and hold it in? appointment.) Thank you, so I assess approximately 4 cm 2. INSPECT BACK!!!!- which is a normal NODLUES SCARS diaphragmatic Palpate-tenderness excursion. Skin turgor AUSCULTATE LUNGS Ask pt to take deep AT THE BACK-TAKE breath x2 while DEEP BREATH holding pt’s back 23:46 • I will now auscultate Equal thoracic expansion your lung sounds in the back. Please take Assess tactile fremitus deep breaths as I listen Say 99 x 4 to your lung fields (4 pairs, same spots as Percuss lungs (study) tactile fremitus). Clear Should hear resonance lung sounds are heard throughout all posterior lung fields. • Next I will be assessing the diaphragmatic Tell Andy to deep breaths 2. INSPECT ANTERIOR • CLEAR LUNG THORAX!!!!- NODLUES FIEKLDS” SCARS Palpate-tenderness Cardiac Skin turgor Check for lung INSPECTION- heaves or expansion:Ask pt to lifts take deep breath x2 while holding pt’s back Palpate- for heaves and 23:46 thrills (chest and lower Equal thoracic expansion lateral chest) none noted

Palpate for tactile Palpate APICAL fremitues-99 x6 impulse. LOWER LEFT Percuss 3 pairs -2 lateral CHEST. Resonance is heard AUSCULTATE- AUCULTATE- carotid arteries for bruit> use diaphragm and bell. None are heard. • I will now auscultate Carotid feels your breath sounds normal in strength +2 (SAME PLACE I bilaterally. PERCUSS) auscultate. I will be listening to your Assess for jugular vein using the pulsation while pt is 45 mnemonic- diaphragm degree angle. first and bell Turn head to left- 29:57 “All Patients Enjoy Taking Meds” Can you turn your head Aortic, Pulmonic, Erb’s to the left please? I am Point, Tricuspid, and looking for the pulsation Mitral. so I can measure jugular vein pressure. I will put I have heard S1 and S2 my straight edge here at sounds without any the pulsation straight out murmurs or abnormal to touch my ruler at the heart sounds. sternal notch at a 90 degree angle. The LAY BACK normal measurement should be between 3-5 Listen to heart sounds cm, which yours is. while you’re laying study!!!!! down REPEAT THE SAME Lymphatic SEQUENCE. LYMPH NODES.”no DIAPHRAGM AND swelling” or tenderness BELL. Look for Palpate (PLSIS) murmurs and Pectoral abnormnalities. Lateral Sub scapular Infraclavicular femoral arteries.’no Supraclavicular bruits heard. DIAPHRAGM FIRST THEN. BELL

Abdomen PERCUSS: PERCUSS TWO AREAS IN EACH Inspect - symmetrical QUADRANT. RLQ, RUQ, without distention. No LUQ, LLQ scars,r hernias WE HERE TYMPANY- WHICH IS NORMAL Ausculate- bowel sounds. Rlq-ruq-luq-llq PALPATE: same ‘listen to bowel sounds at sequence; two points in each Do you have any quadrant” tenderness? No masses • Now I am going to are felt. listen for bowel sounds And now I am going to at two points in each do deeper . quadrant. Bowel Same sequence sounds are present Any tenderness? I don’t and normoactive feel any masses with deep palpation either. Auscultate- arteries - for bruits. ARIF rlQ- mcburneys. abdominal aorta, renal palpate.”take a deep arteries, iliac, and breathe and let it out” Do DEEP BREATH. Using you notice any pain? duck bell method. (Use Murphys sign!!!!- RUQ- L hand to lift up from negative sign. Take a the back, and R hand to deep breath. Do you push into the RUQ). notice pain>? Kidneys are not felt Repeat on other kidney. Liver-percuss . Start below nipple.”liver Feel for femoral lymph span is noted" nodes. For inguinal Palpate- take a deep hernias breathe in. exhale/ I did No tenderness noted. not feel her liver drop which is a normal finding. Please sit up!!!! No . We are going to do the CVA TEST Spleen costovertebral angle Percuss. tenderness. Let me Palpate- I dont find a know if any tenderness spleen-normal is noted. Lower back each side Feel for aortic massess left hand fist and slap. or pulsations- none noted. TeAch TSE- once a month in the shower. If KIDNEYS- PALPATE KIDNEYS/ TAKE A you feel any nodules or Hands sideways and lumps follow up. down., forward. Bring them forward. down. SPINE!!!!! Palms up/ Inspect bend INSPECT- edema, elbow. No discomfort? lesions, inflammation Wrist twists. Up down Ill fell for tenderness Strength. ASK TO bend Resistance- FORWARD.- looking for 1arms on side. Abduct scoliosis and kyphosis. and adduct. palpate. Repeat test 2Bend elbow and when you are standing resistance. Push out and up. in 3Wrist up and down. Cerevical spine- bend head forward and back. Open hands. Joints are Side to side., ear to not swollen or red. shoulder. Separate fingers. Bring “no crepitus no them together tenderness” feel at the “iu have good strength” back of neck, ask Andy good range of motion for any discomfort” Feel arteries. Radial. Ulnar 2 plus present Shoulder-feel for edema Brachial artery pain crepitus. “repeat on other side’ LOWER BODY!

CLOSE YOUR EYES ROM AND STRENGTH Raise leg and my hands Sharp an dull. are on his thigh Ask Andy about where Bring it down-hands on he feels it x4 lower thigh Leg out-like kicking DEEP TENDON REFLEXES Close eyes

Tricep dtr intact Sharp or dull x4 Bicep dtr intact-seiko brachioradialis reflex Patellar DTR X2 intact

Look at fingers. Cap FLEX FOOT? refill. Less than 3 ILL FELL ASCHILLES second. HEEL X2

LYMPH NODES.”no swelling” or tenderness POPLITEALX2 Assess. Epitrochlear TAKE SHOES OFF Axillary DORSALIS PEDIS X2 POSTERIOR TIBIAL X2 THEY ARE PRESENT STAND UP. SIDE TO SIDE

LEAN FORWARD AND BACL ROM KNEES UP RAISE TURN ANKLES X2 CIRCULAR FEET TOGETHER ARMS OUT CLOSE EYES BRING THEM DOWN

LEAN FORWARD. Touch toes. Feel his spine. Asees for scoliosis and kyphosis. No curvature. No signs of scoliosis and kyphosis walk!!! His gait is steady. Coordination and balance/