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 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
Hx is most likely to find diagnosis

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=wPzCA9k8GRQ ear exam

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 orientedx3---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 spinalAccessory - 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

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

23. 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