This document provides an introduction to examining the limbs and related systems in clinical skills. It discusses examining the skin, peripheral vascular, neurological and musculoskeletal systems of both the lower and upper extremities. Specific areas that will be covered include embryology, anatomy, health history taking, examination techniques, and health promotion counseling. The document is presented as a teaching guide for clinical skills related to limb examination.

1. Introduction to Clinical Skills Limbs Examination Universidad Iberoamericana UNIBE

2. Introduction to Clinical Skills Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee

3. Introduction to Clinical Skills Objectives Skin and Appendages Peripheral Vascular Neurological (Peripheral) Sensory, Motor, Reflexes Muscle-skeletal Muscle tone, Muscle strength

4. Introduction to Clinical Skills Lower Extremities Universidad Iberoamericana UNIBE

5. Introduction to Clinical Skills Skin and Appendages Embriology-Anatomy-Histology-Physiology The Health History Health Promotion and Counseling

6. Introduction to Clinical Skills Skin and Appendages Embriology -Anatomy-Histology-Physiology 11 weeks 1.Periderm 2. Basal layer 3. Intermediate layer 4. Migrating melanoblast 5. Mesenchyme

7. Introduction to Clinical Skills Skin and Appendages Embriology- Anatomy -Histology-Physiology

8. Introduction to Clinical Skills Skin and Appendages Embriology-Anatomy- Histology -Physiology

9. Introduction to Clinical Skills Skin and Appendages Embriology-Anatomy-Histology- Physiology

10. Introduction to Clinical Skills Skin and Appendages The Health History Rash Moles (Nevus) Health Promotion and Counseling Risk factors for skin cancers Avoidance of excessive sun exposrure Avoid skin dryness Nail cutting (pedicure) Shoes

11. Introduction to Clinical Skills Skin and Appendages Forefoot Types

12. Introduction to Clinical Skills Peripheral vascular exam Anatomy The Health History Health Promotion and Conseling

13. Introduction to Clinical Skills Peripheral vascular exam Anatomy

14. Introduction to Clinical Skills Peripheral vascular exam The Health History Pain in the legs Intermittent claudication Cold, numbness, pallor in the legs, hair loss Swelling in calves, legs or feet Color change in toes in cold weather Swelling with redness or tenderness

15. Introduction to Clinical Skills Peripheral vascular exam Health Promotion and Counseling Screening for peripheral arterial disease Screening for renal artery disease Screening for abdominal aortic aneurysm

16. Introduction to Clinical Skills Peripheral vascular exam Risk factors for Lower-Extremity arterial peripheral disease Age younger than 50 years with diabetes or atherosclerosis risk factor of smoking, dyslipidemia, hypertension, or hyperhomocysteinemia Age 50 to 60 years and history of smoking or diabetes Age 70 years or older Leg symptoms with exertion or ischemic rest pain Abnormal lower extremity pulses Known atherosclerotic coronary, carotid, or renal disease

17. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination The Legs Size, symmetry, skin color Femoral pulse and inguinal lymph nodes Popliteal, posterior tibialis and dorsalis pedis pulses Peripheral edema

18. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination Arterial system exam Anatomy Pallor, cyanosis Color and capillary refill Postural changes Extremity pulses ( 0 to 2+) Ankle Brachial Index

19. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination Arterial system exam

20. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination Arterial system exam

21. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination Venous system exam Anatomy Skin color, pigmentattion, ulcers Postural changes Venous pattern Competency of venous valves Soft edema

22. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination Venous system exam

23. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination Venous system exam

24. Introduction to Clinical Skills Peripheral vascular exam Important Areas of Examination Lymphatic system exam Anatomy Skin color Postural changes Edema (soft vs brawny) Palpable lymph nodes Painful lymh nodes Red striking tracts

25. Introduction to Clinical Skills Peripheral vascular exam Recording your findings “ Extremities are warm and without edema. No varicosities or stasis changes. Calves are supple and nontender. No femoral or abdominal bruits. Femoral, popliteal, posterior tibialis and dorsalis pedis pulses are 2+ and symmetric”

26. Introduction to Clinical Skills Peripheral neurological exam Sensory evaluation (sensory pathways) Motor exam (motor pathways) Reflexes (spinal reflexes: the deep tendon response)

27. Introduction to Clinical Skills Peripheral neurological exam Sensory evaluation (sensory pathways) Dermatomes Pinwheel Digital nerves 2PD static

28. Introduction to Clinical Skills Peripheral neurological exam Sensory evaluation (sensory pathways)

29. Introduction to Clinical Skills Peripheral neurological exam Motor exam (motor pathways) Body position Involuntary movements Muscle bulk Muscle tone Muscle strength

30. Introduction to Clinical Skills Peripheral neurological exam Motor exam (motor pathways)

31. Introduction to Clinical Skills Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response) Patella Achilles tendon

32. Introduction to Clinical Skills Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response)

33. Introduction to Clinical Skills Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response) Reinforcement of Knee Reflex

34. Introduction to Clinical Skills Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response)

35. Introduction to Clinical Skills Peripheral neurological exam Reflexes (Cutaneous stimulation reflex)

36. Introduction to Clinical Skills Muscleskeletal exam Joint structure and function The Health History Health Promotion and Counseling Examination of specific joints Spine and Hip Joints of lower extremities

37. Introduction to Clinical Skills Muscleskeletal exam Joint structure and function

38. Introduction to Clinical Skills Muscleskeletal exam The Health History Common or concerning Symptoms Low back pain Monoarticular or polyarticular joint pain Inflammatory or infectious joint pain Joint pain with systemic features such fever, chills, rash, anorexia, weight loss, weakness Joint pain with symptoms from other organ system

39. Introduction to Clinical Skills Muscleskeletal exam Health Promotion and Counseling. Important Topics Nutrition Low back: lifting biomechanics Prevneting falls Osteoporosis: screening and prevention

40. Introduction to Clinical Skills Muscleskeletal exam Examination of specific joints

41. Introduction to Clinical Skills Muscleskeletal exam Joint structure and function

42. Introduction to Clinical Skills Muscleskeletal exam Joint structure and function

43. Introduction to Clinical Skills

44. Introduction to Clinical Skills Upper Extremities Universidad Iberoamericana UNIBE

45. Introduction to Clinical Skills Skin and Appendages

46. Introduction to Clinical Skills Skin and Appendages Embriology -Anatomy-Histology-Physiology

47. Introduction to Clinical Skills Skin and Appendages Embriology- Anatomy -Histology-Physiology

48. Introduction to Clinical Skills Skin and Appendages Embriology-Anatomy- Histology -Physiology

49. Introduction to Clinical Skills Skin and Appendages Embriology-Anatomy-Histology- Physiology

50. Introduction to Clinical Skills Skin and Appendages The Health History Rash Moles (Nevus) Health Promotion and Counseling Risk factors for skin cancers Avoidance of excessive sun exposrure Avoid skin dryness

51. Introduction to Clinical Skills Peripheral vascular exam The Health History Pain in the hands Intermittent claudication Cold, numbness, pallor in the hands, hair loss Swelling in arm, forearm and hand Color change in fingers in cold weather Swelling with redness or tenderness

52. Introduction to Clinical Skills Peripheral vascular exam Arterial Venous Lymphatics

53. Introduction to Clinical Skills Peripheral vascular exam Allen´s Test

54. Introduction to Clinical Skills Peripheral vascular exam Allen´s Test

55. Introduction to Clinical Skills Peripheral vascular exam Allen´s Test

56. Introduction to Clinical Skills Peripheral vascular exam Allen´s Test

57. Introduction to Clinical Skills Peripheral vascular exam Arterial Venous Lymphatics

58. Introduction to Clinical Skills Peripheral vascular exam Arterial Venous Lymphatics

59. Introduction to Clinical Skills Peripheral neurological exam Sensory Pinwheel exam

60. Introduction to Clinical Skills Peripheral neurological exam Sensory 2PD static or moving

61. Introduction to Clinical Skills Peripheral neurological exam Sensory Tinel´s sign

62. Introduction to Clinical Skills Peripheral neurological exam Motor

63. Introduction to Clinical Skills Peripheral neurological exam Flexion Extension Pronation Supination

64. Introduction to Clinical Skills Peripheral neurological exam Ulnar deviation Radial deviation

65. Introduction to Clinical Skills Peripheral neurological exam Fingers flexion Fingers extension

66. Introduction to Clinical Skills Peripheral neurological exam Motor Muscle Bulk Muscle Tone Muscle Strength M0 –M5 Grip strength Dynamometer

67. Introduction to Clinical Skills Peripheral neurological exam Motor

68. Introduction to Clinical Skills Peripheral neurological exam Motor

69. Introduction to Clinical Skills Peripheral neurological exam Motor

70. Introduction to Clinical Skills Peripheral neurological exam Motor

71. Introduction to Clinical Skills Peripheral neurological exam Motor

72. Introduction to Clinical Skills Peripheral neurological exam Reflexes

73. Introduction to Clinical Skills Peripheral neurological exam Reflexes

74. Introduction to Clinical Skills Muscleskeletal exam Muscles Bones Joints an ligaments

75. Introduction to Clinical Skills

76. Introduction to Clinical Skills