Lower extremity Leg Inspect the exposed anterior superior iliac spine Observe for pelvic tilt or obliquity

y which may indicate scoliosis, anatomic leg-length discrepancy,

or hip disease.
Palpate greater trochanter, patient on side, flex and internally rotate, palpate laterally Tenderness in this area may indicate swelling of the trochanteric bursa. Check ROM - bilaterally flex knee towards chest Principle muscle iliopsoas muscle (psoas major and minor and ilacus muscle) assisted by the sartorius and the rectus femoris muscles extend the leg straight Principle muscle Gluteus maximus assisted by most of the hamstrings (long head of biceps femoris, semitendonosus & semimebranosus abduction: hold hand on ASIS and move leg outwards Principle muscle Gluteus Medius and minimus, assisted by Sartorius, Gracilis and tensor fascia lata adduction: hold hand on ASIS and move leg outwards Principle muscles are the 3 adductors (longus, brevis, and magnus) assisted by gracilis and pectineus. rotation: knee/leg to 90 degrees hold thigh with one hand, hold ankle with the other turn ankle outward and then inward (external and internal) Principle muscles for internal rotation are Gluteus minimus, Gluteus medius, and Tensor Fascia Lata, Semitendonosus, Semimembranosus Principle muscles for external rotation are Gluteus maximus, piriformis, gemellus superior, obturator internus, gemellus inferior,obturator externus, quadratus femoris, Sartorius, Obturator externus, biceps femorus Knee - while flexed: Inspect knee Palpate Patella Swelling over the patella suggest prepatellar bursitis Check ROM of knee Flexion and Extension Principle Muscles for flexion are the hamstrings (biceps femoris, semimembranosus, semitendonosus), assisted by sartorius, gracilis, popliteus, gastrocnemius Principle muscle for extension is the quadriceps femoris, Check internal and external rotation Principle muscle for external rotation is the biceps femoris Principle muscles for internal rotation are popliteus and semitendinosus Inspect feet and ankles Palpate feet and ankles ankles Anterior aspect of each ankle joint, heel, MTP joints Pain over the plantar fascia suggests plantar fascilitis. Tenderness of the MTP joins can be an early sign of rheumatoid arthritis. Acute inflammation of the first MTP joint is associated with Gout. Check for pedal edema push on dorsum of each foot, behind medial malleolus, over shins Check ROM Dorsiflex and plantar flex

Principle muscles of dorsiflexion are tibilalis anterior, extensor hallicus longus, extensor digitorum longus, Perneous tertius Principle muscles of plantar flexion gastrrocnemius and soleus, assisted by plantaris, tibialis posterior flexor digitorum longus, flexor hallicus longus, fibularus longus and brevis Invert and evert the forefoot Principle muscles of Inversion are tibialis posterior, flexor digitorum longus, flexor hallucis longus, and tibialis anterior Principle muscles of Eversion are extensor digitorum longus, peroneus tertius, fibularis longus and brevis,

Special Maneuvers Palpate the medial and lateral malleolus bony tenderness suggests ankle fracture Ottawa Rules - An ankle x-ray series is only required if there is pain in the medial or lateral malleolar zone or an inability to bear weight both immediately and in ED. A foot x-ray series is only required if there is pain in the midfoot zone between the Navicular and the base of the 5th metatarsal or an inability to bear weight both immediately and in ED Perform the Lachman test for Anterior Cruciate Ligament significant forward excursion indicates ACL tear The anterior cruciate ligament provides anteroposterior & rotatory stability of the knee joint http://www.sports-injury-info.com/hip-anatomy.html HEENT Head part hair in three places to examine scalp palpate skull Sinuses palpate maxillary and frontal sinuses bilaterally Neck Lymph nodes bilaterally preauricular (in front of ears) posterior auricular (behind ears) occipital (base of skull) anterior cervical (down front part of neck) posterior cervical (down posterior part of neck) supraclavicular tonsilar (angle of jaw) submandibular (middle of chin) submental (under tip of chin) Thyroid neck slightly forward hands below cricoid cartilage swallow and non-swallow Eyes inspect conjunctiva vision acuity using chart (CN II) cover eye, read lowest line, cover other eye, read lowest line backwards or new line visual fields bilaterally (CN II)

patient looks in your eyes, wiggle fingers on both sides and have them point when come into their periphery. repeat three times Convergence (CN III, IV, VI) finger to 5cm in front of nose assess pupillary light reflex (CN II, III) light in each eye twice, checking reflex for that eye and constriction of other eye accommodation finger 10 cm in front, have focus on paper towel, repeat extraocular movements (CN III, IV, VI) make big H in 6 cardinal directions of gaze start to patients extreme right, then down, then up left, upward, then down Ophthalmoscope exam hold ophthalmoscope in your right hand to your right eye to examine the patients right eye place yourself 15 in away and at 15 degree angle move in to examine optic disc and retina

Ears look into each ear with otoscope light direct down and forward auditory acuity (CN VIII) have patient cover an ear whisper ABC 123 on unoccluded side tuning fork to top of head (weber) ask if can hear equally on both sides tuning fork on mastoid bones (rinne) ask when it stops making noise, then hold next to ear and ask if can hear Nose use light on otoscope to inspect nose on each side Mouth/throat - use light! Inspect with blade: gums, tongue, teeth gag reflex (CN IX) elevation of palate: say ah (CN X) tongue midline deviation (CN XII) Palpate masseter and temporal muscles (CN V) ask patient to clench teeth Pain sensation using broken q.tip ask that they can tell difference between sharp/dull close eyes check forehead, cheeks, jaw asking them to report sharp or dull Light sensation use cotton ball ask that they can feel light touch close eyes does this feel same as this Facial muscles (CN VII) raise eyebrows clench eyes frown

 smile big puff cheeks neck muscles (CN XI) turn head against hand (sternocleidomastoid strength) ask to shrug against your hands (upper trapezius) NEUROLOGY EXAM Gait walk across the room, turn, and come back walk heel-to-toe walk on toes walk on heels Romberg Test patient should stand feet together and arms at side and close eyes for 10 secs without support Reflex Sensory Pain Sensation sharp and dull Bilaterally for: arms (inner and outer forearm), hands (top, thumb, pinky), legs (front of thigh, medial and lateral aspect of calf), feet (top, little toe) Light touch cotton ball or cotton-tipped applicator Bilaterally for: arms (inner and outer forearm), hands (top, thumb, pinky), legs (front of thigh, medial and lateral aspect of calf), feet (top, little toe) Vibration tuning fork Place over DIP on patient finger and toe bilaterally Joint Position Sense - bilterally Big toe Finger Strength: Upper Extremity Grip Finger Abduction Opposition of thumb Flexion/extension Shoulder (deltoid) strength Strength: Lower Extremity Flexion at hip (L2, L3) Extension at hip (L5, S1) Adduction at hip (L3, L4) Abduction at hip Extension at knee Flexion at knee Dorsiflexion and plantar flexion Cerebellar/Coordination point to point movements Biceps reflex (C5, C6) Brachioradialsi Reflex (C5, C6) Triceps reflex (C6, C7) Knee (patellar) reflex (L2, L3, L4) Ankle (Achilles) reflex (S1) Plantar (babinski) response (L5, S1)

 UE - index finger to nose to your finger; bilaterally LE place heel on opposite knee and run down the shin to the big toe; bilaterally