Comprehensive Head to Toe Exam iHuman case study due july aug 2024

aspects of appearance and behavior to comment on

-dress, posture, grooming, hygiene

-stature, build

-nutritional state

-degree of cooperativeness

-state of distress

-affect

-eye contact

-motor activity

aspects of mood to comment on

congruence with situation and aspect

aspects of the skull, scalp, and hair to comment on

-contour

-lesions

-hair

-tenderness

CN VII (Facial) test

instruct patient to:

-frown

-elevate forehead/raise eyebrows

-clench and show teeth

-smile

-puff and blow out cheeks

-close eyes firmly (try to open against resistance)

CN V (trigeminal) test - motor

-place hands on patient's cheek's and temples

-instructs patient to contract and relax masseter muscles by clenching teeth

-tests strength by pushing down on the mandible against resistance

CN V (trigeminal) test - sensory

-instructs patient to close eyes and say "now" when feeling cotton touch their face

-use a light wisp of cotton over 3 nerve distributions bilaterally

aspects of the eyebrows, orbital areas, and eyelids to comment on

-distribution of eyebrows

-orbital edema, sagging tissue, lesions, nodules

-ptosis

-completeness of lid closure

-erythema

-discharge/tearing

aspects of the bulbar and palpebral conjunctivae and sclerae to comment on

-color

-edema

aspects of the lacrimal glands/sac to comment on

-edema

-tenderness

CN II, III (optic, oculomotor) test

-instructs patient to focus on a far fixed point, then on a near fixed point; observes pupillary response

-inspects B/L eyes with pen light; observes pupillary response

-performs swinging light test; observes pupillary response

aspects to comment on after CN II, III test

-corneal clarity

-pupillary size and shape

-pupillary reflex, direct, consensual, and afferent accommodation

CN III, IV, VI (oculomotor, trochlear, abducens) test

-have patient follow pen with eyes without moving their head

-six cardinal fields of gaze

aspects to comment on when testing CN III, IV, and VI

-conjugate or convergent gaze

-nystagmus, plane of movement

aspects to comment on during ophthalmoscopic exam

-red reflex

-retinal color and lesions

-characteristics of blood vessels

-disc and physiologic cup characteristics

-macular characteristics

aspects to comment on regarding the pinna, tragus, and mastoid area of the ear

-position

-deformities / lesions

-tenderness

-swelling

aspects to comment on during inspection of the auditory canal with otoscope

-patentcy

-cerumen

-erythema

-discharge

aspects to comment on during inspection of the tympanic membranes with otoscope

-tympanic membrane color

-transparency

-contour

-light reflex

-perforations

CN VIII (acoustic/vestibulocochlear) test / Whisper Test

-instruct patient to occlude one ear

-stand behind patient and whisper a 2-syllable word

-have patient repeat whispered word

aspects of the Whisper Test to comment on

-interpretation

-significance

aspects to comment on regarding the external nose

-shape

-nare patency

aspects to comment on regarding the nasal mucosa and nasal septum

-color

-discharge

-swelling of turbinates

-perforation of septum

aspects to comment on regarding the lips, gingivae, teeth, tongue, and buccal mucosa

-color

-condition of teeth

-presence of dentures/piercings

-ulcerations or lesions

CN XII (hypoglossal) test

-have patient stick out tongue

-have patient move tongue toward nose and chin

aspects of the CN XII test to comment on

-symmetry / position of the tongue

-tremors

-ability to move

CN X (vagus) test

have patient say "ahh"

aspects of testing CN X to comment on

-rise of palatal arch

-uvula

-anteroposterior pillars

-upper palate

-tonsils

-posterior pharynx

aspects of the carotid arteries to comment on

-rhythm

-grade

-presence of bruit

aspects to comment on regarding the thyroid gland

-tenderness

-consistency

-size

-nodules

aspects of B/L lymph nodes to comment on

-size

-consistency

-mobility

CN XI (spinal accessory) test

-have patient push against hand by turning head

-have patient shrug shoulders while providing downward pressure

aspects to comment on during CN XI test

-B/L strength grade

aspects to comment on regarding the neck

-ecchymosis

-erythema

-edema

-contour

-pain

-ROM

Where is the AC joint located?

between the lateral end of the clavicle and the acromion process of the scapula

aspects to comment on in regard to B/L shoulders

-ecchymosis

-erythema

-edema

-contour

-pain

-ROM

aspects to comment on regarding B/L elbows

-ecchymosis

-erythema

-edema

-contour

-pain

-ROM

Where is the medial epicondyle?

medial distal end of humerus

Where is the lateral epicondyle?

lateral/distal end of humerus

Where is the olecranon process located?

proximal end of ulna

aspects to comment on regarding B/L wrists

-ecchymosis

-erythema

-edema

-contour

-pain

-ROM

B/L wrist ROM

-extension

-flexion

-radial deviation

-ulnar deviation

B/L elbow ROM

-flexion

-extension

-supination

-pronation

B/L shoulder ROM

-flexion

-extension

-abduction

-adduction

-internal rotation

-external rotation

neck ROM

-flexion

-extension

-rotation

-lateral bending

where is the "snuffbox" located?

when fingers are abducted, it's the space below the extensor pollicis longus tendon

aspects to comment on in regard to B/L hands and fingers ROM

-ecchymosis

-erythema

-edema

-contour

-pain

-ROM

-number, completeness, position, shape, symmetry of digits

upper extremity deep tendon reflexes

-biceps

-triceps

-brachioradialis

aspects of the deep tendon reflexes to comment on

-grade

-significance

aspects of the precordium to comment on

-heaves or lifts

where is the point of maximal impulse located?

5th ICS, left midclavicular line

what are the 5 areas of the heart to auscultate?

-aortic

-pulmonic

-Erb's point

-tricuspid

-mitral / apical

aspects of the heart sounds to comment on

-rate

-rhythm

-presence of murmur

aspects of thorax inspection to comment on

-skin characteristics

-respiratory rate, rhythm

-symmetric or paradoxical chest rise / retractions

-use of accessory muscles

-symmetry of shoulders, clavicles

-AP to transverse diameter ratio

aspects of anterior and posterior thorax auscultation to comment on

-clarity of lung sounds

-adventitious sounds

aspects of abdominal inspection to comment on

-skin and hair characteristics

-contour

-symmetry

-pulsations/movements

-umbilicus

aspects of bowel sound auscultation to comment on

-rate

-interpretation, significance

where are abdominal vascular sounds auscultated at?

-epigastric

-umbilicus

-aorta

-B/L renal arteries

-B/L iliac arteries

-B/L femoral arteries

What are you listening for when you auscultate abdominal vascular structures?

bruits

aspects of abdominal percussion to comment on

-tympany or dullness

-interpretation, significance

Percussion of the upper border of the liver

percuss intercostal spaces along the R midclavicular line starting at an area of lung resonance down, marking the first area of dullness

percussion of the lower border of the liver

percuss along the R midclavicular line from an area of intestinal tympany up, marking the first area of dullness

what is a normal liver span?

6-12 cm

What is Castell's Method?

method to percuss the spleen

steps of Castell's method

-follow anterior axillary line to last intercostal space

-have patient exhale completely and percuss for tympany

-have patient inhale and percuss for a change to dullness

aspects of light and deep abdominal palpation to comment on

-rigidity, guarding

-tenderness

-masses

steps of liver palpation

-place left hand under thorax parallel to 11-12th ribs

-place right fingertips lightly below costal margin at MCL

-instruct patient to take a deep breath and exhale completely

-on exhale, palpate with R fingertips and apply upward pressure with left

-hold position while patient inhales

Where is the iliac crest located?

L4-L5

where is the anterior superior iliac spine located?

where is the posterior superior iliac spine located?

B/L hip ROM

-flexion

-extension

-adduction

-abduction

-internal rotation

-external rotation

aspects of B/L hip ROM to comment on

-ecchymosis

-erythema

-edema

-contour

-presence or absence of crepitus

-pain

B/L knee ROM

-flexion

-extension

where is the suprapatellar pouch located?

where is the popliteal fossa located?

the hollow at the back of the knee

where is the MCL located?

medial side of the knee

Where is the LCL located?

External side of the knee

where is the tibial tubercle located?

aspects of B/L knee ROM to comment on

-ecchymosis

-edema

-erythema

-contour

-genu varum / genu valgum

-pain

-crepitus

genu varum

bow legged

genu valgum

knock knees

B/L ankle ROM

-dorsiflexion

-plantar flexion

-eversion

-inversion

aspects of B/L ankle ROM to comment on

-ecchymosis

-edema

-erythema

-contour

-pain

B/LLE deep tendon reflex locations

-patellar

-anchilles

aspects of B/LLE deep tendon reflexes to comment on

-grade

-significance

Spine ROM

-flexion

-extension

-lateral bending (R and L)

-rotation

aspects of spine ROM to comment on

-ecchymosis

-edema

-erythema

-contour

-pain

-posture

-alignment of hips, shoulders, feet

balance and gait tests

1. Romberg's test

2. Pronator drift

3. Natural gait

4. tandem walking

5. toes and heels

aspects of balance and gait to comment on

-smoothness of movement

-balance, guarding

-weakness

-stiffness

Romberg's test

standing up with feet together, arms out and eyes closed, see if they can maintain balance

Pronator drift

hold palms out upwards and look for movement of palms (rotation)

tandem walking

Assess balance by asking person to walk a straight line in a heel-to-toe fashion

toes and heels walking

have patient to walk across room on their toes and back on their heels

aspects to comment on regarding the thyroid gland