BASIC ANAMNESIS AND

PHYSICAL EXAMINATION
RSUD ABDUL AZIZ
SINGKAWANG
 Anamnesis
• Main complain
• Present complain
• Past history
• Family history
• Social & Working history
 Anamnesis
 Chronology !!!
• Onset
• Provoke
• Palliate
• Quality
• Region
• Radiate
• Severity
• Time (duration, frequency)
 Anamnesis
• Loss of consciousness
• Olfactory  anosmia
• Visual  decreasing of acuity, diplopia, visual
field
• Eye lid  ptosis, lagophthalmus
• Face  numbness, tingling, pain, weakness,
spasm
• Hearing  dumb, tinnitus
 Anamnesis
• Swallowing  dysphagia
• Articulation  dysarthria
• Motor  weakness / parese, involuntary
movement, spasm
• Sensory  numbness, tingling, pain
• Micturition & Defecation  retention,
incontinence
• Sexual function  erection dysfunction
 Anamnesis
• Balance  dizziness, dysequilibrium
• Headache
• Back pain
• Higher function  cognitive impairment,
aphasia
 Physical Examination
General examination
• Vital sign & Pain scale
• Head  eyes, ear, nose, throat
• Neck
• Thorax  cor, pulmo
• Abdomen
• Extremity & Skin
• Genitourinary system
 Physical Examination
Neurological examination
• Conscioussness
• Pupil
• Meningeal signs
• Cranial nerves
• Motor system
• Sensory system
• Autonom system
• Balance & Coordination
• Higher function
• Other provoking tests (eg. pain)
 Conscioussness
Qualitative
• Compos mentis, apathy, delirium, somnolen,
stupor, coma
Quantitative  GCS
• Eye (1-4)
• Motor (1-6)
• Verbal (1-5)
•  Beware in some special conditions it can not
be examined (x)
 Conscioussness
• Unconscioussness
• Blackout
 Pupils
• Shape
• Equality
– Some population have 1 mm difference
• Size
• Reaction to light
– Direct & indirect
• Reaction to accomodation
 Pupils
• 3rd nerve palsy
• Horner syndrome
 Meningeal Signs
• Nuchal rigidity  VS neck spasm
• Laseque
• Kernig
• Brudzinsky I
• Brudzinsky II
 Meningeal Signs
• Meningitis
• Subarachnoid haemorrhage
• Fossa posterior mass
 Olfactory Nerve
Sensory
• Each nostril
• Non irritant material
 Olfactory Nerve
• Anosmia
 Optic Nerve
Sensory
• Visual acuity
• Visual fields  confrontation test
• Pupil reflex  afferent
• Optic fundus
 Optic Nerve
• Visual acuity
• Visual field
• Funduscopy
 Oculomotor Nerve
Motor
• Eyes movement (medial rectus, superior
rectus, inferior rectus, inferior rectus)
• Eyelid  ptosis
• Pupil reflex  efferent
 Oculomotor Nerve
• Diplopia
• Midriasis
• Ptosis
 Trochlear Nerve
Motor
• Eyes movement (superior oblique)
 Trochlear Nerve
• Diplopia
 Trigeminal Nerve
Sensory
• Ophthalmic
• Maxillary
• Mandibular
• Corneal reflex  afferent
Motor
• Temporalis
• Masseter
 Trigeminal Nerve
• Face hipestesia
• Face neuralgia
 Abducens Nerve
Motor
• Eyes movement (lateral rectus)
 Abducens Nerve
• Diplopia
 Fascial Nerve
Motor
• Fascial muscles
– Upper  frontalis, orbicularis oculi
– Lower  buccinator, orbicularis oris
• Cornela reflex  efferent
Sensory
• Taste of 2/3 anteriorly tongue
 Fascial Nerve
• Mouth deviation
• Lagophthalmus
 Vestibulocohlear Nerve
Sensory
• Cochlear  hearing
• Vestibular  balance
 Vestibulocochlear Nerve
• Sensory hearing loss
• Tinnitus
• Vertigo
 Glossopharyngeal Nerve
Sensory
• Taste of 1/3 posteriorly tongue
• Gag reflex  afferent
 Vagus Nerve
Motor
• Palatal movements
 Glossopharyngeal & Vagus Nerve
• Dysphagia
• Dysphonia
 Accessory Nerve
Motor
• Sternomastoid
• Trapezius
 Accessory Nerve
• Sternomastoid and trapezius weakness
 Hypoglossal Nerve
Motor
• Position of tongue  deviation
• Trophy
• Fascicullation
 Hypoglossal Nerve
• Dysarthria
 Motor System
• Tone
• Trophy
• Power
– Scale 0 – 5
– Special conditions  in unconscioussness & in
slight parese
• Reflexes
– Physiological  biceps, tericeps, knee, achilles
– Pathological  Hoffmann-Tromner, Babinsky
 Motor System
• Weakness
• Atrophy
• Involuntary movement
 Sensory System
• Exteroceptive
• Proprioceptive
 Sensory System
• Hypestesia
• Hyperesthesia
 Autonom System
• Micturition
• Defecation
• Erection
• Sweating
 Autonom System
• Retention
• Incontinence
• Anhidrosis
• Sexual dysfunction
 Balance and Coordination
 Ensure there is no any pareses !!
• Finger to nose
• Finger to finger
• Past pointing
• Diadochokinesia
• Knee to heel
• Romberg and sharpened Romberg
• Tandem walking
• Fukuda
 Balance and Coordination
• Dizziness / vertigo
• Dysequilibrium
 Nystagmus
• It may be normal in more than 30 degree
• Direction
– Horizontal, vertical, oblique
– Bidirectional, unidirectional
 Higher Function
• Orientation
• Attention
• Memory
• Executive
• Visuospatial
• Language
 MMSE (30 questions)
 Higher Function
• Cognitive impairment
• Aphasia
 Provoking Tests
Low back pain
• Tender / trigger point(s)
• Laseque
• Kernig
• Patrick
• Anti Patrick
Cervical pain
• Tender / trigger point(s)
• Spurling
 Provoking Tests
Wrist pain
• Tinnel
• Phalen
• Finkelstein

• Etc….
THANK YOU