Davao Medical School Foundation, Inc. ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR CARDIOVASCULAR EXAMINATION (JVP) Name of Student Legend: 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE 4 point = Done INCORRECTLY and INCOMPLETE 0 point= NOT DONE zalas: Date:____ REMARKS: [A-ESTABLISHING RAPPORT [OT Greets the patient potely 2. Introduces self | tam 2” year medical student | of Davao Medical Schoo! Foundation. | am in charge of taking the cardiovascular examination. r 3. Asks the patient NAME, AGE, ADDRESS, CIVIL STATUS, RELIGION, OCUPATION | “a. Explains the procedure &. Asks the patient's consent and permission to do the procedure 6. Drapes the patient appropriately JUS PRESSURE 7. Makes the patient lie in supine position comfortably B. MEASUREMENT OF JUGULAR VENO! @. Raises the head slightly on a pillow to relax the stemocleidomastoid muscles 9. Raises the head of the ‘examining table to about 30 degrees 70. Tums the patient's head away from the side to be examined 17. Uses tangential lighting and examine both sides of the head 72. Identifies the external jugular vein on each side 13. Finds the internal jugular venous pulsations 74 Focuses on the right internal jugular vein 15. Looks for the pulsationsin the right internal jugular vein fe \o 4 Be 3| fe pewakes | 17. Extends a long rectangular ‘objects or card horizontally form this point and a centimeter ruler vertically from the sterna angle 18. Measures correctly the JVP 79. Reports the JVP of the patient 20. interprets the JVP of the patient and enumerates the normal JVP 21. Thanks the patientDavao Medical School Foundation, Inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR BREAST AND AXILLA EXAMINATION Date: _— Name of Student: Legend: 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE: Done INCORRECTLY and INCOMPLETE NOT DONE 3 REMARKS ‘A. MAINTAINS ASEPTIC TECHNIQUE WHILE EXAMINING |O | 1 | 2 THE PATIENT 7, Washes hands with soap and water or disinfects hands with 70% alcohol. Eesaaaeaeee ESTABLISHING RAPPORT 2. Greets the patient politely 3. Introduces self 2° year medical student ‘School Foundation. | the breast and lam | of Davao Medical am in charge of taking axilla examination 4. Asks for the identifying data NAME, AGE, MARITAL, STATUS, OCCUPATION. RELIGION, ADDRESS: 3 Explains procedure & directs patient to cubicle %. Asks for female companion to be with the patient. 7. Asks if patient is ready and ‘secures permission to enter |___cubicle. INSPECTION IN THE ‘SEATED POSITION ‘8. Lets the patient sit on table/bed with arms hanging by the sides 9. Asks patient where in the area of breast is painful or has 2 mass or discharge 70. Inspects both breasts for size, symmetry, skin color, contour 77. Inspects both breasts for texture, venous patterns, lesions 72. Inspects both areolae & nipples for color, Montgomery tubercles, nipple eversion/inversion NIPPLES AND A! 73. Inspects both areolae & nipples for nipple retraction/deviation & |______ supernumerary nipples 74, Arms over head or flexed behind back LAE IN VARIOUS POSITIONSOa Fores REMARKS: a 15. Hands against hips with shoulders forward (or palms _pushed together) 76. Leaning forward at the waist E. PALPATION IN THE SEATED. (ON 17. Performs chest wall sweep using fingers & palm 18. Performs bimanual digital palpation using finger pads with either vertical sweep, circular or wedge technique F. PERFORM LYMPH NODE PALPATION 79. Axilla (with right arm supporting ] T right upper extremity of patient & left hand palpating the axilla & vice versa 7 : PERFORM AXILLARY PALPATION IN FOUR DIRECTIONS 720. Anteriorly to the pectoralis ] 21. Posteriorly to the scapula ‘22. Medially to the chest wall 23. Laterally to the inner arm [24 Supraciavicular area | 25. Infraciavicular area 26. Perform nipple compression H. PALPATION IN THE SUPINE POSITION ‘27. Inserts pillow under shoulders 28. Arms raised over head 29, Repeais step 10 — 23 above 30. Palpates Tail of Spence 31. Depresses nipple into areolar well T. DECLARES END OF PROCEDURE 32. Tells patient that the procedure is done and helps her up 33. Thanks patient and tells her to wear her clothes. 34. Explains the result of ‘examination to the patient Date___— .¢ and Signature of Preceptor. m Ris... and Revised by: Dr. Gladys Ogatis-SermonEE Davao Medical School Foundation, Inc. ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR ABDOMINAL EXAMINATION (PART 1) Name of Student: Legend: 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE 1 point = Done INCORRECTLY and INCOMPLETE 0 point= NOT DONE One: REMARKS A.ESTABLISH PATIENT = o 1 2 3 RAPPORT 1. Washes / disinfects hands | before the examination Greets the patient politely 3. Introduces self lam 2” year medical student of Davao Medical Schoo! Foundation. | im in charge of taking the abdominal [examination 4. Asks for the identifying data: NAME, AGE, MARITAL STATUS, OCCUPATION, RELIGION, ADDRESS. Explains the procedure. f ‘Asks if patient is ready & ‘secures permission to do the examination. L Places pillow under head and under knees; drapes pelvis 8. Exposes abdomen from xiphisternal area to inguinal area B. INSPECTION ‘9. Sitting at the right side, inspecting the abdomen tangentially. 70. Inspecting abdomen by standing behind the patient's head 11. Asks patient to sit up halfway to detect abdominal wall mass C. AUSCULTATION 12. Using diaphragm, listen for & Count bowel sounds; 4) 13. Using the bell, listen for bruits ‘over aorta & femoral arteries D. PERCUSSION 74. Systematic route, starting from RUQ & ending at RLQ 15. LIVER, determine liver edge as transition from tympany to dulinessREMARKS 16 LIVER, determine liver dome as transition from resonance to. dullness 17. Splenic duliness at left, se midair tne py “gh me ‘ibs | a 18. Gastric air bubbie at the left subcostal & epigastric areas E. PALPATION 19. Perform light palpation 20. Perform moderate & deep palpation 21, Liver border at right costal margin | 22. Gallbladder below liver margin & lateral to border of right rectus muscle 23. Spleen at left costal margin 24, Right & left kidneys 25. Aortic pulsation at midline 26. Elicit abdominal reflexes L F. KIDNEY PUNCH SIGN 27. With patient sitting up, percuss right & left costovertebral angles for kidney tenderness 28. Summarizes the results to the patient © 29. Asks the patient for clarification and further questions 30. Thanks the patient Name and Signature of Preceptor_ Date. Updated and Revised by: Dr. Gladys Ogatis-Sermon‘Davao Medical Schoo! Foundation, i ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR ABDOMINAL EXAMINA’ n TION (PAI (MURPHY'S SIGN, ROVSING'S SIGN, PSOAS SION, OBTURATOR SIGN) Date: Name of Student Legend 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE 1 point = Done INCORRECTLY and INCOMPLETE 1 point= NOT DONE ‘4. Asks for the identifying data: NAME, AGE, MARITAL | STATUS, OCCUPATION, RELIGION, ADDRESS. ‘Obtains permission Explains each step of the examination in advance. Places pillow under head and under knees ‘Drapes the peivis and exposes the abdomen from the xiphisternal area to the inguinal area ZZ B. PERFORMS MURPHY’S SIGN ‘9. Hook your left thumb or the | fingers of your right hand under the costal margin at the point where the lateral border of the rectus muscle intersects with the costal margin. 70. Ask the patient to take a deep breath. 77. Watch the patient's breathing and note the degree of tenderness. 72. Knows what does it mean to have a (+)MURPHY'S SIGN a x) a al c. 73. Ask the patient to point to where the pain began and where it is now. 74. Ask the patient to cough Determine whether and where pain results.REMARKS. a - |. PERFORMS ROVSING'S SIGN 15. Presses deeply and evenly in the left lower quadrant. Then quickly withdraw the fingers. 16. Knows what does it mean to have a (+) Rovsing's Sign iz PERFORMS PSOAS SIGN 17. Place your hand just above the | Patient's right knee and ask the | Patient to raise that thigh against your hand. 18. Tums the patient onto his left side. Then extends the patient's right leg at the hip. i 19. Knows what does it mean to have a (+) PSOAS SIGN PERFORMS OBTURATOR SIGN 20. Flexes the patient's right thigh at the hip, with the knee bent, and rotate the leg internally at the hip. | | 21. Knows what does it mean to have a (+) OBTURATOR SIGN | 22. Summarizes the results to the patient 23. Asks the patient for clarification and further questions 24, Thanks the patient Name and Signature of Preceptor_ Date. Updated and Revised by: Dr. Gladys Ogatis-SermonDavao Medical School Foundation, Inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR EXAMINATION OF PERIPHERAL VASCULAR SYSTEM Name of Student Legend: 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE 1 point = Done INCORRECTLY and INCOMPLETE 0 point= NOT DONE RAPPORT of/si/2]3 [REMARKS ‘A. ESTAI 7. Greets the patient politely 2 Iniroduces self Lam 2 year medical student of Davao Medical School Foundation. | _am in charge of taking the peripheral | vascular system examination. Z_ Asks for the identifying data | NAME. AGE, MARITAL | STATUS, OCCUPATION, RELIGION. ADDRESS i ‘Explains the procedure. &._ Asks i patient is ready & ‘secures permission to do the ‘examination. | [B.EXAMINING THE ARMS. 6. Inspects both arms from the fingertips to the shoulders. [ % Notes for size and symmetry of | arms and any swelling; venous | pattem; color of skin and nail beds and texture of skin @. Assesses the skin temperature of the hands and arms using the back of the fingers | I} | 9. Palpates the radial artery and compare the pulses in both arms 10. if with suspected arterial insufficiency, palpates the brachial artery L 17, Feels for 1 or more epi-trochlear nodes C. EVALUATING THE ARTERIAL iv. 12. Performs the Allen test correctly and completely(aeaconeae | REMARKS 13. Inspects both legs from the {groin and buttocks to the feet. 14, Notes for size and symmetry the legs and any swelling: not for venous pattern, any pigmentation, rashes, scars or ulcers, 15. Assesses the skin temperature of both feet and legs using the back of the fingers 16. Palpates the superficial inguinal lymph nodes, including the horizontal and vertical groups. Notes for their size, consistency 7. and any tendemess. 18. Paipates the femoral pulse 79. Paipates the popliteal pulse 20. Palpates the dorsalis pedis pulse 21. Palpates the posterior tibial pulse 722, Looks for edema and compares the foot and leg to the other 23. Checks for pitting edema over the dorsum of each foot, behind each medial malleolus and over the shins 24. Palpates the calf muscles E. SPECIAL TECHNIQUES 4._ ASSESSING FOR CHRONIC ARTERIAL SUI IFFICIENCY 25. Raises both legs to about 60 degrees until maximal pallor of the feet develops, usually within ONE MINUTE, 26. Asks the patient to sit up with legs dangling down and compare both feet 27. Notes for the time required for return of pinkness of the skin (NORMAL 10 SECS OR LESS) 28. Notes for the filling of the veins of the feet (NORMAL 15, SECONDS)2. MAPPING VARICOSE VEINS EMAR’ | 28°Lets the patent be in standing ||} -2-+-% — position I a 30, Places the palpating fingers gently on a vein in the Side ofthe thigh eee! 31. Compresses the vein shar | with the other hand” 32, Feels for a pressure wave T transmitted to the fingers of the upper hand 3. EVALUATING THE COMPETENCY OF VENOUS VALVES: L FILLING (TREDELENBURG) TEST | 33 Instructs the patient politely to | be in supine position while | assisting the patient [34 Elevates one leg to 90 degrees to empty it of venous blood ‘Occludes the Great Saphenous Vein in the upper thigh by manual compression 35. ‘Asks the patient to stand while ‘occluding the vein ‘37. While you keep the vein occluded, watch for venous filing in the leg. (NORMAL: 35 | SECONDS) 38. Lets the patient stand for 20 seconds, releases the compression and watches for additional filling of the vein ‘SUMMARY 39. Summarizes the findings to the T T patient ‘40. Interprets the findings to the patient 1. Provides education to the patient on how to keep the peripheral vascular system normal and healthy 442. Asks the patient for further Clarification and questions. [ 43. Thanks the patient Name and Signature of Preceptor.Davao Medical Schoo! Foundation, Inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR MUSCULOSKELETAL SYSTEM (PART 1) (Head and Neck; Elbows; Wrists and Hands) Name of Student. Date: Legend. 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE 1 point = Done INCORRECTLY and INCOMPLETE, 0 point= NOT DONE: REMARKS A. PREPARATION AND | ESTABLISHING RAPPORT 1. Washes both hands thoroughly or disinfects hand with alcohol thoroughly 2. Greets the patient politely 3. Introduces Seif | lam _ 2" year medical student | of Davao Medical Schoo! Foundation. | | Sui charge of ding pyc examination of your chest and lungs. ‘4. Asks the patient's NAME, AGE, MARITAL STATUS, OCCUPATION, RELIGION, ADDRESS ‘5. Explains the ‘examination/procedure [| € Asks if patient is ready & secures permission to do the examination HEAD AND NECK 7. Inspect the face and TMJ Tete ect @. To locate and palpate the joint, placed the tips of the index fingers just in front of the tragus of each ear and asks the patient fo open and close his or her L mouth 3. Palpate the muscles of mastication: = Masseters = Temporal Muscles = _Pterygoid Muscles 10. Range of Motion: Asks the patient to demonstrate opening and closing, protrusion and retraction (by jutting the mandible | forward), and lateral, and side-to-side motion 11. Inspects the neck 72. Palpates the spinous processes of the cervical spine, trapezius muscle, muscles between the scapulae_REMARKS __| [ Range of Motion: 13. Asks the patient to touch his/her chin to hissher chest 74. Asks the patient to tilt his/her head back I | T5"Asks the patient to turn hisher chin to his/her right and left _ 76 Asks to tit hisyher head towards |__ hiammer right and left shoulder ELBOWS ["A7. Inspects the elbow by ‘supporting the patient's forearm 0 that the elbow is flexed to L about 70 degrees. 78 Palpates the elbow, external ‘surface of the ulna, olecranon process and the epicondyles [Range of motion: 19. Asks the patient to bend the ‘elbow 20. Asks the patient to straighten | the elbow | Ziv Asks the patient to turn palms pas if carying a bow! of soup_| 22. Asks the patient fo turn the palms down | _WRIST AND HANDS 23. Inspects the wrist and hand 24. Palpates each wrist joint with your thumbs on the dorsum of the wrist and with your hands beneath it Palpates the radial styloid bone [35 | and the anatomical snuffbox. "Palpates the 8 carpal bones lying distal to the wrist joint, and then each of the 5 metacarpals and the proximal, middle, and distal phalanges. ~Compresses the MCP joints by squeezing the hand from each side between the thumb and fingers. Palpates the medial and the lateral aspects of each PIP joint between your thumb and index finger. As well as the DIP joints Range of Motion: 29. Asks the patient to point the fingers toward the floor with palms down. 30. Asks the patient fo point fingers toward the ceiling while palms down 31. Asks the patient to bring the fingers toward the midline with palms down| 12 Is REMARKS 32, Aaa the re atiot to Bring ai eras | 35 Ake ine ‘patent 10 Take @ fat d extend and spread tre | fingers ‘Maneuver ‘3a. Mand gnp strength i | ‘35. Finkelstein’s test | 36. Thumb abduction | ‘37. Tinel’s sign [ l o-SomanTas ke TITS | , | LE] Pry Ti | 40. Thanks the patientDavao Medical School Foundation, Inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR MUSCULOSKELETAL SYSTEM (PART 2) (SHOULDERS) e of Student Date:___ 3 points = Done COMPLETELY and CORRECTLY Done CORRECTLY but INCOMPLETE Done INCORRECTLY and INCOMPLETE —— oe : ‘A. PREPARATION AND REMARKS ESTABLISHING RAPPORT 1. Washes both hands thoroughly or disinfects hand with alcohol thoroughly 2. Greets the patient politely 3. Introduces Seif lam . 2° year medical student of Davao Medical School Foundation. | am in charge of doing physical | | examination of your chest and lungs. ‘4. Asks the patient's NAME, AGE, MARITAL STATUS, OCCUPATION, RELIGION, ADDRESS 5. Explains the examination/procedure | &. Asks if patient is ready & secures permission to do the examination is B. SHOULDERS 7. Inspects the clavicles, anterior | and posterior shoulders and scapulae @. Palpates the bony structures of the shoulder: Sternoclavicular joint to acromioclavicular joint to the subacromial area then to the bony spine of the scapula. 9. Passively extends the shoulder by lifting the elbow posteriorly then palpates the subacromial and sub deltoid bursae and SITS muscles. 10. Palpates the biceps tendon in the intertubercular groove. Range of Motion: 11. Asks the patient to raise his/her in front and overhead 12. Asks the patient to raise the ‘arms behind | 73. Asks the patient to Raise the | arm out to the side and overhead 74, Asks the patient to cross the arm in front of his/her body (crossover test)Jo [ata [so] newanns | rere oe pea pa a | hand behind the back and touch fe fap rena teach ates ee amar ake part ae [a eee ataea tre oes Geena ! a | 17. Asks the patient to touch the ‘opposite scapula using the two | motions (Apley scratch fest) __| 78. Tests Nees impingement sign. Press on the scapula to prevent | scapular motion with one hand, and raise the patient's arm with the other. 79. Tests Hawking’s impingement | | sign. Flexes the patient's shoulder and elbow to 90 | degrees with the palm facing down. Then, with one hand on the forearm and one on the arm, rotate the arm internally. 20. Tests supraspinatus " strengthempty can test). Elevate the arms to 90 degrees and internally rotate the arms with the thumbs pointing down, as if emptying a can. 21. Tests the infraspinatous strength. Asks the patient to place arms at the side and flex the elbows to 90 degrees with the thumbs turned up. provide resistance as the patient presses the forearms outward. 22. Tests forearm supination. Flexes the patient's forearm to 90 degrees at the elbow and pronate the patient's wrist. Provide resistance when the patient supinates the forearm. 23. Summarizes the findings 24, Thanks the patient T [Davao Medical School Foundation, inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR MUSCULOSKELETAL SYSTEM (PART 3) (SPINE AND HIPS) Name of Student: Date: Legend: 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE 4 point = Done INCORRECTLY and INCOMPLETE 0” point= NOT DONE 2/3 REMARKS. A. PREPARATION AND | ESTABLISHING RAPPORT |~ 1. Washes both hands thoroughly or disinfects hand with alcohol thoroughly 2. Greets the patient politely | 3. Introduces Self | 1am__. 2° year medica student | of Davao Medical School Foundation. | | am in charge of doing physical | examination of your chest and lungs. | 4. Asks the patient's NAME, AGE, MARITAL STATUS, OCCUPATION, RELIGION, ADDRESS. 5. Explains the examination/procedure 6. Asks if patient is ready & secures permission to do the I | | L examination |B. SPINE 7. With the patient standing, inspects the vertebral profile, paravertebral muscles, iliac crests, posterior superior iliac spines and cervical, thoracic and lumbar cuy From sitting f standing position, palpates spinous process of each vertebra with his/her thumb |S Palpates “the paravertebral muscles and over the sacroiliac joint. | Range of Motion: 10. Asks the patient to bend forward | and touches toes 11. Asks the patient to bend the | back as far as possible 72 Asks the patient to rotate from side to side | E 13. Asks the patient to bend to the side from the waist. loins 14. Inspects and observes the patient's gaitiF 16. Inspects the anterior and 15. Observes the lumbar portion of the spine and assesses the Jength of the legs — posterior surfaces of the hip 17. Palpates the surface bony landmarks of the hip: Anterior and Posterior i erior aspect 18. With the patient supine, asks | the patient to place the heel of the leg being examined on the ‘opposite knee. Then palpates along the inguinal ligament, which extends from the anterior superior iliac spine to the pubic tubercle. | Range of Motion: 19. With the patient supine, places your hand under the patient’ lumbar spine. Asks the patient to bend each knee in turn up to the chest and pull it firmly against the abdomen 20. Asks the patient to lie face ‘down, then bend the knee and lift it up or lying flat, move the lower leg away from the midline and down over the side of the table 21. Stabilizes the pelvis by pressing down on the opposite anterior— superior iliac spine with one hand. With the other hand, grasp the ankle and abduct the ‘extended leg until you feel the iliac spine move. 22. With the patient supine, stabilizes the pelvis, hold one ankle, and move the leg medially across the body and ‘over the opposite extremity. 23. Flexes the leg 90 degrees at hip and knee, stabilizes the thigh with one hand, grasps the ankle with the other, and swings the lower leg medially and lateral) 24. Summarizes the findings 25. Thanks the patientDavao Medical School Foundation, Inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR MUSCULOSKELETAL SYSTEM (PART 4) (KNEE; ANKLE AND FOOT) Name of Student 1 point 0 point= NOT DONE Legend: 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE a A. PREPARATION AND FABLISHING RAPPORT REMARKS 7. Washes both hands thoroughly or disinfects hand with alcohol thoroughly 2. Greets the patient politely 3. Introduces Self Lam 2” year medical student of Davao Medical School Foundation. | ‘am in charge of doing physical examination of your chest and lungs. ‘4. Asks the patient's NAME, AGE, MARITAL STATUS, OCCUPATION, RELIGION, ADDRESS % Explains the examination/procedure Asks if patient is ready & secures permission to do the examination B. KNEE 7. With the patient supine and knees in flexion, inspects the knees. @ Straightens the leg then palpates the supra patellar pouch and palpates along each side of the patella. ‘9. Asks the patient to tighten the quadriceps, checks for a sliding motion of the _patella (patellofemoral grinding test) 10. With the patient's knee flexed, palpates along the medial and lateral joint lines, along the medial and collateral ligaments and along the 3 other bursae. 11.Palpates the gastrocnemius, soleus muscles and the Achilles tendon Palpation tests for effusion in the knee Joint: 12.The bulge sign (for minor effusions) 13. The Balloon sign (for major effusions) ”REMARKS 14, Balloting the patela | Range of motion: | 15. Asks the patient to bend or flex the knee or squat down tothe 76. Asks the patient to straighten the leg or after equating down to | the floor stand up. | 7 Rats pater wie ing Shing the lower lop toward e-|— midline [IG | | TECAsks the patient while siting to | swing the lower leg away from —! the midline [ Maneuvers: 1, Abduction (or Valgus) Stress 20. Adduction (or Varus) Stress test | L | 21. Anterior Drawer Sign 22. Lachman test + 23. Posterior Drawer Sign 24. McMurray Test | i oL I C. ANKLE AND FOOT 25 Inapects the patients ankle and ] [26 Parpates the anterior surface of each ankle joint, along the achilles tendon, heel and over the medial and lateral malleolus ‘27. Palpates the metatarsophalangeal _joints, | compresses the forefoot and palpates the heads of the 5 | metatarsals and grooves | between them. | 28. Asks the patient to point the foot L |_| Range of motion: toward the floor 29. Asks the patient to point the foot toward the ceiling 30. Asks the patient to bend the heel inwardfe Le Mee Dorsifex a nd Plantar flex the foot atthe ar |-33. Stabilizes the ankle with one | | & Sables te hea ee and aver and evert the | as Aste the patont to taxi too | at the metaphalangeal joints ‘36. Summarizes the findings c 37. Thanks the patient - | iDavao Medical School Foundation, Inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR NEUROLOGIC EXAMINATION: CEREBELLAR Date: ___—— Name of Student: Legend 3 points = Done COMPLETELY and CORRECTLY 2 points = Done CORRECTLY but INCOMPLETE 1 point = Done INCORRECTLY and INCOMPLETE 0 point= NOT DONE a A. ESTABLISHING RAPPORT 7. Greets the patient politely 2. Introduces self lam 2° year medical student bf Davao Medical School Foundation. | Sin charge of taking the neurologic examination. 3, Asks for the identifying data: NAME, AGE, MARITAL STATUS, OCCUPATION, RELIGION, ADDRESS: 4 Explains the procedure. [-& Asks if patient is ready & secures permission to do the _examination. _| ___ CEREBELLAR TESTS: RAPID ALTERNATING MOVEMENTS: ARMS 6. Shows the patient how to strike T ] Ie ‘one hand on the thigh, raise the i hand and tum it over and then strikes back the hand down on thigh | 7. Instructs the patient to do the same. ‘Urges the patient to repeat these alternating movements as rapidly as possible ‘Observes the speed, rhythm and smoothness of movement 70. Instructs the patient to repeat the same in the other hand [POINT TO POINT MOVEMENT: FINGER TO NOSE 11. Asks the patient to touch his/her index finger (the one who performs the test) and his/her (patient's) nose alternately several time 72. Moves the finger about so that the patient has to alter directions and extend the arm fully to reach it. 13. Observes the accuracy, y smoothness of movements and tremors. "HEEL TO SHIN TEST 14. Asks the patient place one heel ‘on the opposite knee and run it down the shin to the big toe15. Telle the patient repeat same | lure in the other hand | 76. Notes forth accuracy of the movern 17, WALK ACROSS THE ROOM (Asks the patient to walk across the room, then turn and come. swinging of arms, and movements of legs. [78 WALK HEEL-TO TOE (Asks the | patient to walk heel to toe and |. a. Jew] vals, | observes) |-20. WALKS ON THE TOES, THEN ON THE HEELS |S HOPS IN PLACE (instructs the | patient to hop on each foot in | turn (right then left) DO A SHALLOW KNEE BEND (Instructs or demonstrate to | bend the knee of one leg then | ‘on the other leg) 23. RISING FORM SITTING POSITION (Instructs the patient ares with feet together and eyes to sit down and rise up from sitting position without arm |____support)_falwic ave ‘STANCE i_ROMBERG TEST Scop 7 cd Bay Cheney SeDIE 24. Instructs the patient to stand T | open | 25: Instructs the student to close both eyes while standing without support 26. Observes for 30 seconds 27. Knows what is a positive Rhomberg’s test ZB. Interprets the meaning of the itive Rhomberg’s test TEST FOR PRONATOR DRIFT 29. Instructs the patient to stand with both arms straight forward, palms up and eyes closed for 30 to 60 seconds without support 30. Determines an abnormal finding in this test 31. Interprets the abnormal findings SUMMARY ‘32. Summarizes the findings to the patient : 33. Thanks the patient Name and Signature of Preceptor DateDavao Medical School Foundation, Inc ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR NEUROLOGIC EXAMINATION: CRANIAL NERVES ame of Student Date:____—— Degend: 3 points = Done COMPLETELY and CORRECTLY 2 pointe“ Done CORRECTLY but INCOMPLETE Done RECTLY an Bait» Bone INCO ‘and INCOMPLETE [+ Semmaismireorr o}1a}2]3 |-+— Greets the patient poitely [2 introduces seit iam 2 year medical student | Davao Medical School Foundation. | | gm in charge of taking the neurologic | examination. 1-3. Asks for the identifying data: | NAME, AGE, MARITAL | STATUS, OCCUPATION, | RELIGION, ADDRESS | — @ Explains procedure. |S. Asks if patients ready & | secures permission to do the | examination B. CRANIAL NERVES 6. CN 1. SMELL. Let's the patient | | close eyes, then occlude one nostril and tests smell of other nostril using non irritating odors (coffee, mild soap). Do the same with other nostril 7. CN VISUAL ACUITY (position’s patient 6m or 20 feet from the chart, instructs patient to wear glasses if with glasses; the patient's one eye is occluded while the other eye is tested; points each of the letters from the top up to the level the patient can read or up to 20/20; interprets the Visual Acuity Nill, IV, V. EXTRAOCULAR MUSCLES |. CNV. CORNEAL REFLEX, FACIAL SENSATION, JAW MOVEMENTe. avi Asks patient to raise” both eyebrows, frown, cose | | beth eves vay show upper lower teeth, smile. putt out | both cheeks Gi. GN Vill. Assess hearing with the voice test (positions at the back of the patient, occiudes the other ear by | palpating the tragus in circular 12. CNIXAND X. swallowing, rise of palate, gag reflex 73. CN Xi, shoulder and neck movement 74. CN XII. Tongue symmetry and position ‘SUMMARY = 75. Summarizes the findings to the patient 16. interprets the findings to the patient | 7 Take the patient for further | darification and questions. 78. Thanks the patient/— Explains the procedure [—& Asks if patient is ready and RaV80 Medical School Foundation, ine ARTS AND. SCIENCE OF MEDICINE 2 RATING SCALE FoR NEUI ‘SEI ROLOGIC EXAMI q 'NSORY, MOTOR AND. ‘SPECIAL signs of Student: —___ Date: Name 3 points = Done COMPLETELY and CORREGT Hea ‘LETELY and CORRECTLY Legere point ed |. ESTABLISHING RAPPORT Or lar lari | Gree he paiot paly 13 intreduces self | 2° year medical student |1am | Davao Medical School Foundation. | | gm in charge of taking the neurologic | examination: +3. Asks for the identifying data: NAME, AGE, MARITAL | STATUS, OCCUPATION, | RELIGION, ADDRESS secure permission to do the examination, BL MOTOR SYSTEM 6 BODY POSITION. Observe Patient's body position during movement and at rest 7. INVOLUTARY MOVEMENTS. Watch for tremors, fasciculation, or ticks: @ MUSCLE BULK. Inspects for the size and contour of muscles 3 MUSCLE TONE. Takes one of the patient arm and while supporting the elbow, flexes and extends the patient's fingers, wrist and elbow 10. STRENGTH ‘Shoulder abduction 11. Elbow extension 12. Wrist extension 18 Finger abductionBoe |; Knee flexion 76 Ankle dorsifiexion ‘SYSTEM. CHEC! NON KS FOR THE FOLI | [- 76. TEMPERATURE |_GetenrToucr Colton | [-20. VIBRATION | [|- 21. PROPRIOCEPTION 2. DISCRIMINATIVE SENSTIONS (2a ABLE TO RECITE THE DERMATOMES ‘SPECIAL TECHNIQUES: set ‘BRUDJINSKI SIGN . out 7Y 26. BABINSKI SIGN | KERNIG'S SI [_ 2B GN. + L | 27. STRAIGHT LEG RAISE TEST 28. Summarizes the findings to the z SUMMARY | pen 28. Interprets the findings to the patient | 30. Asks the patient for further clarification and questions. |" 31. Thanks the patientDavao Medical Schoot Foundation, | ARTS AND SCIENCE OF MEDICINE 2 RATING SCALE FOR MALE GENITALIA EXAMINATION Date: __— name of baa Done ye COMPLETELY and CORRECTL’ on ene ere, oP moint= NOT DONE LY and INCOMPLETE |_-washes hands before and after the examination. | ar Greets the 3 Introduces Seif Item 2" year medical student {ava0 Medical School Foundation. | rin charge of taking the male (Sta examination the patient's NAME, AGE, Asks: | MARITAL STATUS, | OCCUPATION, RELIGION, | ADDRESS it politely 3. Explains the procedure thoroughly -—@ Asks if patient is ready & ‘secures permission to do the ‘examination INSPECTION "7 Exposes male genitalia |S Inspects the penis: SKIN, PREPUCE (FORESKIN) RETRACTS IF PRESENT, GLANS @. Retums the retracted foreskin to its normal position 70. Inspects the scrotum: Lifts up the scrotum to see the posterior surface. 71. Inspects and describes the scrotal contour. 72. Inspects and notes for swelling and lumps. 13. Inspecis the inguinal and femoral areas carefully for bulges|_—-- Raia the patient to aan ao and notes for inguinal and c orl bulges TION "85, Palpates the shaft of the pe between thumb and first two | fingers }-16-Aaks the paiont if there spain ‘upon palpating the shaft of | penis 77 Palpates each testis between thumb and first two fingers |g Notes size, shape and |" tendemess |-7. Palpates each epididymis between thumb and first two fingers 2 Palpates each spermatic cord including the vas deferens between thumb and fingers and | feels for any nodule |Z Palpates for inguinal hernia | |B Using right hand for patient's | Fight side; and left hand for patient's left side. ' 23 Follows the spermatic cord upward to above the inguinal ligament [24 Finds the triangular slike ‘opening of the external inguinal 25. With finger located either at the ‘external ring or within the canal, asks the patient to strain down ‘or cough. [26 Notes any palpable hemiating mass 27. Summarizes the result of | examination to the patient L 28. Advises and thanks the patient a a Name and Signature of Precepto Date and Revised by: Dr. Gladys Ogatis-SermonDavao Medical Son 20 Founda ARTS AND SCIENCE OF MeenokeS RATING SCALE FOR ANUS AND PROSTATE EXAMINATION name of Sen SS Done COME id: «3 Points = Done COMPLETELY and CORRECTLY ace 2 points = Done CORRECTLY b 2 pointe = Done C ut INCOMPLETE 0 point NOT BO GERECTLY and INCOMPLETE aoe Se ee oe |;, ESTABLISHING RAPPORT Ola) 2 |g REMARKS | reat the patient politely | 7 Introduces Seif | ne Haun 2™ year medical student | Davao Medical Schoo! Foundation. | /oirin charge of taking the anus and | prostate examination. 3 Asks the patient's NAME, AGE, MARITAL STATUS, OCCUPATION, RELIGION, ADDRESS | ‘7 Explains the procedure |” thoroughly. | [Asks if patient is ready & | secures permission to do the ‘examination, | [B.EXAMINATION OF THE ANUS AND RECTAL [6 Positions the patient correctly by letting the patient lie on the left side with buttocks close to the edge of examining table near you 7. Instructs the patient to flex the hips and knees especially in the upper leg I Drapes the patient appropriately (covering the abdomen above and knees) | & Gloves one’s hand 10. Spreads the buttocks apart I 11. Inspects the sacrococcygeal and perianal area for lumps, ulcers, inflammation, rashes and other lesions|g Explains again to the patent ('° that you will insert your ireeicrt | the anus | ik a Te patent Bear dow |: Pases the pad of the gloved and lubricated finger ‘over tna | anus |-76As_ sphincter relaxes, gently | inserts the fingertip into the anal canal in the direction toward the umbilicus |--77. Notes the sphincter tone of the anus, tendemess, nodules, irregularities aes yout ed he tectum “and rotate finger clockwise to palpate as much as rectal surface as possible | +79. Notes for abnormalities like nodules, irregularities. or | induration +30. Palpates the prostate gland by rotating your hand counterclockwise |—“fiTums you body slightly away | “from the patient so that you can | feelthe area more easily |—“go Tells your patient that he may | feel an urge to urinate while you are palpating the prostate | [23 Notes for size, shape, mobility and consistency of the prostate SUMMARY 724. Summarizes the result of examination to the patient | | 25. Advises and thanks the patient L Name and Signature of Precept tor. Date. Updated and Revised by: Dr. Gladys Ogatis-SermonDavao Medical Schoo! Foundation, ARTS AND SCIENCE OF MEDICINE 2 RA TING SCALE FOR OB-GYNE EXAMINATION Date: _— of Student: 3 points = Done COMPLETELY nome regen” points = Done CORRECTLY |. ESTABLISHING RAPPORT Sera 3 Greets the patient politely Introduces Self 2° year medical student Udavao Medical Schoo! Foundation. | oii charge of taking the OB-GYNE REMARKS is Asks the patient's NAME, AGE, CIVIL STATUS, OCCUPATION, a RELIGION, ADDRESS ‘Obtains permission and selects chaperone (or gets a female ‘companion if examiner is male) ‘Explains each step of the ‘examination in advance, 7. Drapes the patient from mid- abdomen to knees; Depresses the drape between the knees to provide eye contact with patient. &. Avoids unexpected or sudden movements. le EXTERNAL EXAMINATION 9. Seats self comfortably and informs patient about every procedure (touching her genital area) 10. Assesses Sexual Maturity: pubic hair characteristics and distribution (if examining an adolescent; Tanner staging) 11. Inspects: mons pubis, labie majora and perineum.2 maj inspects: labia minora, cite | Grethral meatus, introtus: (nie ‘iaanoe of ntammat, Ficeration, discharge, swe | ornodules.) rae, swelling "ar inserts index finger of one gloved hand into vagina near posterior introitus, palpates | bach side between finger and thumb (4 & 8 o'clock positions) 7 Checks swelling or tendemess ‘and/or discharges exuding from duct opening of gland. (eg Bartholins gland) [es pIMANUAL EXAMINATION BT Lubricates index and middle fingers of one of gloved hands; |-76. From a standing position, inserts lubricated fingers into | vagina, exerting pressure posteriorly with thumb abducted | and little fingers flexed into palm. 47, Notes any nodularity and _*" tenderness in vaginal wall including region of urethra and bladder anteriorly 78. Palpates cervix: Check ion, shape, consistency, Posi regularity, mobility and tenderness and feels fornices around cervix. 79. Palpates uterus with other hand on abdomen midway between umbilicus and symphysis pubis. 20. Elevates uterus and cervix with pelvic hand, pressing abdominal hand in and down trying to grasps uterus between hands. Ti. Notes size, shape, consistency, and mobility, identifying tenderness and masses. 22, Slides fingers of pelvic hands into anterior fornix and palpate body of uterus between hands. ' 36r Palpates each ovary by piaci % Spdominal hand on right tower aigarant and pelvic hand on aunt lateral fornix ‘abdominal hand in and Ti Presees down pushing adnexal Structures toward pelvic hand: Identifies right ovary or any masses; __-36 Repeat procedure on left side. |} SS ions "LES FOR STRENGTH AND TENDERNESS 26 athdraws examining fingers from cervix and spreads them against vaginal walls, i SESSMENT OF PELVIC FL¢ [A8Seer bimanual examination oe Wee 77 Asks patient to squeeze around fingers; checks for strength, tendemess and appropriate relaxation after contraction and endurance in all 4 quadrants, 8. With fingers placed posteriorly, asks patient to cough several times or bear down, looking for any urinary leakage and watching for tightening of adductor or gluteal muscles. 2 Palpates external pelvic floor muscles in a clockwise rotation to identify trigger points (32. Summarizes examination to the patient | (tenderness). ‘30. Performs rectovaginal exam if | indicated. i 31. After the procedure: returns | drape back, covering patient's abdomen. [SUMMARY the result of 33. Advises and thanks the patient Name and Signature of Preceptor_ Date Updated and Revised by: Dr. Gladys Ogatis-SermonDavao Medi [Pavae Medical Scnoot Fo SAND SCIENCE OF MESON 2 points ne f Student ne points = Done COMPL Date: eer eT pu Done CORRECTLY Gand CORRECTLY INE [ HING [ESTABLISHING RAPPORT ae 2/3 REMARKS. / | | lashes hands betore and ater j the examination Greets the patient politely : L es Introd Self year medical student _| \apa0 Medical School Foundation | 1 ooscharge of taking the OB — GYNE Somination _ 227" Asks the patient's NAME, AGE, | MARITAL STATUS, ’ i | OCCUPATION, RELIGION, ADDRESS: |—F Obtains permission and selects | > chaperone (or gets a female | __companion if examiner is male) | & Explains each step of the “| examination in advance. |=—Drapes the patient from mid- abdomen to knees; Depresses the drape between the knees to j | provide eye contact with patient. _| 8. Avoids unexpected or sudden movements. 7 EXAMINATION OF A PREGNANT PATIENT. INSPECTION OF THE ABDOMEN ‘9. With the patient in a semisitting position with knees flexed, inspects abdomen for striae, |___scars, size, shape, and contour. [PALPATION OF THE ABDOMEN. 10. Palpates abdomen and notes _ | for organs and masses, fetal | movement and uterine contractions. 1 __ [MEASURING FUNDIC HEIGHT | 11. With a plastic or paper tape measure, locates pubic | symphysis, places the “zero” end of the tape measure where | |___ bone is felt; | 12. Then extends the tape measure to the very top of uterine fundus | | and notes the number of |___ centimeters measured; | 13.Correlates fundic height with age of gestation.ater th ‘he mother ie Comfortably aa sine postion wih her aa te womans i eae te ara Palpates the uppermost part ot Fed uterus genty, with the fngertips of both hands almost touching each other, determines ‘eer ota partis located at ie fundus (“upper fetal pole”). manane maneuver: cone hand on each side Fithe woman's abdomen, turing the fetal body between the hands, 6 the uterus with one hand and palpates the fetus with the other, looking for the back ‘on one side and extremities on the other. rind maneuver: '90. Faces the woman's head. F-Grasps the uterine contents just above the symphysis pubis; ie. the lower fetal pole with the thumb and fingers of one hand to assess the presenting part and the descent into pelvis. Fourth maneuver: 22. Faces the woman's feet; 23. With both hands positioned on either side of the gravid uterus, identifies the fetal front and back sides; 7. Uses one hand at a time, sliding fingers downward and inward on each side of the fetal body using gentle pressure until “cephalic prominence” is reached, that is, where the fetal brow or occiput juts out. 25. Afier the procedure: returns drape back, covering patient's abdomen. 26. Records findings. Explains findings to the patient.ARTS AND , TING SC) eo SCIENCE, Foundation, ine RA’ ALE FOR EXAMINA: OF MEDICINE > TION oF jent: oints = Done COMPLETE Sy one COMPLI Dor ETELY Done IGE RECTLY but NCoRREOTLY a oT DONE RRECTLY ang OMPLETE nd INCOMPLETE. | gwar a gros i: 0 ————_—— To : , hands bef : REMARKS nes fore and afters +}-—|-__| Wet xamination, ne fier, i [gene ie parent or guardian | r++ aroauces Self paral eeae g 2 year medical student #3 Medical School Foundation. | j08@%arge of doing physical sation of YOUT cardiovascular | | oe pars te | patient's NAME, AGE giains the §xamination/procedure geks the patient's consent and mission to do the procedure i {GENERAL ‘SURVEY AND VITAL SIGNS gonatic GU T [ength-place the child in supine ar sition on a measuring board or measuring tray from head to heel with hips and knees extended Weight- weigh infant directly with an infant scale; should be weighed naked or be clothed only in a diaper Head Circumference — place 2 measuring tape around the widest diameter of the head Vial Signs 10. Blood Pressure is challenging in | infants and nevertheless important for high risk infants 77. Pulse — from birth — 1mo average heart rate is 140 with a range of 90-190 For 1-6mo average 130 with a range of 80-180. For 6-12mo average 115, range of 75-155 12. Respiratory rate should be observed for at least 60 seconds to assess both the rate and the pattern. Sleeping _ fespiratory rate is most reliable. Ranges 30- 60 per minute—~ | to0l for infants, Plagg accurate Lh 'S. Place inf | ne, Separat . te fit the thumb ane toes fone hand and the other (Ger On gently insert aweiciaeseand | rectal thermometer with ated 2-3em for at les lepth of Inspection — careful both normal marki iy te iy | potentially abnormal yee ifthere is jaundice, cutie = N° | marmorata, acrocyanosis benign rashes, birthmanc: lanuge for newborns Papacy legree of Bel | mee ohyaraten on HEAD aa 5 Sutures and fontanelles ah | be palpated. Sutures feel ine? | ridges and fontanelle like won | concavities. Anterior fontancte 14 Bees = = feolforinfanta eet p pty 2 ts newaxs | +l | _and Posterior fontanelle. 76 Skull and Facial Symmetry — See ae Saal Seno = 7 | swelting ike i | succedaneum (typically crosses suture lines) pov cephalhematoma (does not |___ cross suture lines) 77. Chvostek Sign’ percuss the | cheek to check this sign which is present in some metabolic disturbances. Percuss at the top of the cheek just below the | zygomatic bone in front of the ear, using the tip of your index or middle finger. Positive sign | produces facial grimacing | caused by _repeated { contractions of the facial muscle EYE | 18. Inspection — Hold baby upright | supporting the head, rotate yourseif with the baby slowly in | one direction. Examine the | sclerae, pupils, irises and | extraocular movements. Observe pupillary reaction to | __ tight [REARS relation to the eyes. Determine 19. Note position of the ear in shape and features to {abnormality Name and Signature of P' Edited and updated by: Dr- Mikhail Ness Date. receptor_—<$_$_—_—_—_ M. Buhay and Dr. Gladys Ogatis-SermonDavao ARTS Medical RATING SCALE Foy SAND Science foun, ne R EXAM NATION AMTOF INFANT (BIRTH TO 2 YEARS) of Student: PART ame 3 reine Done COMB = Done CO; [eve 2 points = Dong Connesreuy ‘and CORRECT: Date, b ty 4 point = poce® 0" point= NOT NGORRECTLY aniNCOMPLETE F MEDICINE 2 nd INCOMPLETE o tt2atsa REMARKS [ESTABLISHING RAPPORT Washes hands bef; a [tne examination, -"° 8" after | Greets the parent oF guardian | sa |g Introduces Seif | om 2” Year medical stud | fDava0 Medical Schoo! Foundation 1 (erp charge of doing physical | Zymination of your cardiovascula Sem PE ks the patient's NAME, AGE = Explains the | examination/procedure -—& Asks the patient's consent and | permission to do the procedure NOSE AND SINUSES 3 7. Test the patency of nasal T passages by gently occluding each nostril alternately while | holding the infant's mouth closed. Check if nasal septum is L midline i ‘¢. MOUTH AND PHARYNX 8. Use both inspection with a |” tongue depressor and flashlight | and palpation to inspect the | mouth and pharynx. Note the : | _ presence of cysts, pattern of | tooth eruption, gag reflex, and | listen to the quality of the infant’s cry [D.NECK “9” Palpate the lymph nodes of the |” neck and assess for any masses. Palpate the clavicles and look for evidence of jon —assess respi 10. Inspectio ira patterns. Observe for30.80 seconds. Note color. nasal component of Dresher, audible breath sounds 4 of breathing ede| rion fremitus By Placing your hang C7 i Snihe chest when th | Sgt make nice Fie’ |) Begetoon ees | fe of the chest and feel fey symmetry in the transmitteg) wbrations. Percussion is mat ; tis essential to comm’, each side. Note the presente | | mee | | | gerRasatltation- staring wi a dpper part of the thorax mete ( Ganosis, responsiveness I] | | Hg. Inspection — Observe for any | |x Patan and fatigue PLETE and INCOMPLETE 2 [Asks the patient's NAME-AGE 3 Explains the examination/procedure Asks the patient's consent and permission to do the procedure (B.NERVOUS SYSTEM (CRANIAL NERVES) 7. | Olfactory — very difficult to test Ti Visual Acuity — infant regard 8 your face and look facial response and tracking Ui, ill Response to Light — Use light and test for optic blink reflex (blink in response to light). Til, IV, VI Extraocular movements — observe how well infants tracks your smiling face or whether the eyes move 10. 11. 72. [Tai x | face : Vill Acoustic — test if there is \king of both eyes in emonse to a loud Noise 13. reflex 75. XI Spinal = a and Gag — Swaleraination during swallowing. Test for presence of = observe sy!reflex opening ¢ with tip of tongue to. mange | 78 Plantar Grasp Reflex ~toucn the sole at the base of the toes then the toes will curt 78. Rooting Reflex — stroke the perioral skin at the corners of the mouth; the mouth will open and the infant will turn the head toward the stimulated side and suck; 2. Moro (Startle) Reflex — Hold the infant supine, supporting the head, back and legs. Abruptly lower the entire body about 2 feet. The arms will abduct and extend, hands will open, and legs will flex; 21. Asymmetric Tonic Neck — Reflex — with the infant supine, turn head to one side, holding jaw over shoulder; the arms/legs on side to which head is turned will extend while the opposite arm/leg will flex then repeat on other side; present up to 2 months Noma and Ginnatiire of Precept1sm___~ 2 year medical st ‘pavao Medical Schoo} F | Gran charae of doing physica st! Zennation of your chest a ngs 3. Explains the examination/procedure 7 Asks consent and form the. focedure Neon To | SERIE te visi jon 3. ASKS: Do you have aiff doing daily activities ae 7 REMARKS | your eyesight? @ PERFORMS: visual acuity teat |____using Snelien’s chart [T. MENTIONS: positive scream>VA20/40 | [Hearing (8. ASKS: Do you have hearing problem? [~S. PERFORMS: whisper test or Weber's test or Rhine's test | ' 70" MENTIONS: positive screen abnormal to any tests ‘Mobility 1 RSS DO you have any history of fall? 12. PERFORMS: timed get up and go test 13. MENTIONS: abnormal >20sec. Incontinence | 14. ASKS: Do you have leaks or lost urine and got wet? ie at | 75. ASKS: Have you lost urine on least 6 separate dates? f = T ie: MENTIONS: —— een YES to any questi | Sawe asthe? ve YOU lO a Bi ag o aa ES ea _qq PERFORMS: waigp — 76 Pe MS: weigh Patient —— __-q@ MENTIONS: posi i 4.5kgS OF Weighs «agree? FORT] — -—fi. PERFORMS: draw a Clock test |-— _-@ MENTIONS: deme, unable to recall 1-2 teu unable to draw a correct time” © COCK with gopeession 23. ASKS: Do you feel sad or - items or depressed? 74, ASKS: Have you lost i doing pleasurable actimtecs 25. MENTIONS: positive screen f YES to any questions [Functional Status (KATZ INDEX of ADL) : $— full function 5-mild impairment 34- moderate impairment 0.2-severe impairment 26. ASKS: Are you able to do, 2 EATING or FEEDING without assistance BATHING without assistance GOING to the toilet without assistance TRANSFERRING without assistance DRESSING without assistance CONTROL bladder and bowel without accidents 27. MENTIONS: positive screen NO L to any question | 28. Gives Summary of findings to \__ patient