This document provides information about Baymax, who introduces himself as a personal healthcare provider. It then provides details on performing a physical exam, including preparing for the exam, establishing rapport with the patient, ensuring privacy and comfort, and explaining findings. Common symptoms that may warrant examination are listed. The physical exam components covered include vital signs, skin, head, eyes, ears, nose, mouth, neck, lungs, heart, abdomen, back, extremities, neurologic exam and mental status exam.

1. HI! I AM BAYMAX. YOUR
PERSONAL HEALTH CARE
PROVIDER

2. KRISTINE FAITH P. TABLIZO, RN
PRC LICENSE 0576117

3. Prepare equipment/materials ahead.
Universal precaution.
Establish rapport.
Explain the procedure.
Ensure privacy and comfort.
Comprehensive, ergonomic PE.
Explain result/findings.

4. Common or Concerning Symptoms
 Headache
 Dizziness or vertigo
 Generalized, proximal, or distal weakness
 Numbness, abnormal or loss of sensations
 Loss of consciousness, syncope, or near-syncope
 Seizures
 Tremors or involuntary movements

5. Sudden numbness or weakness of the face, arm, or leg
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, or loss of balance or
coordination
Sudden severe headache

6. Facial drooping: A section of the face, usually only on one
side, that is drooping and hard to move
Arm weakness: The inability to raise one's arm fully
Speech difficulties: An inability or difficulty to understand
or produce speech
Time: Time is of the essence when having a stroke, and an
immediate call to emergency services or trip to the
hospital is recommended.[

7. Ms. CM, Sexing-sexy, Rawr.
Mental Status—level of alertness, appropriateness of
responses, orientation to date and place
Cranial Nerves
Motor System-strength, coordination (cerebellar*)
Sensory System
Reflexes-hypo, hyper *with gradings

9.  Appearance and behavior
 LOC
 Posture and Motor behavior
 Dress, grooming, hygiene
 Facial Expression
 Manner, affect
 Speech and language
 Quantity, Rate, Volume, Articulation, Fluency
 Mood
 Thoughts and perceptions
 Cognition, including memory, attention,
 information and vocabulary, calculations, abstract thinking, and constructional
ability -higher cortical fx

10. patient’s capacity for arousal, or wakefulness.
determined by the level of activity that the patient can be
aroused to perform in response to escalating stimuli from
the examiner.

14. Mnemonics CN Sensory/Motor /Both
Oh I Olfactory Some
Oh II Optic Say
Oh III Occular Many
To IV Trochlear (“2”) Money
Touch V Trigeminal (“3”) But
And VI Abducens My
Feel VII Facial Brother
A/ Very VIII Acoustic/Vestibulocochlear Says
Good IX Glossopharyhngeal Big
Velvet X Vagus Brains
So XI Spinal Accessory Matter
Heavenly XII Hypoglossal Most

16. Sense of smell
 ** Loss of smell occurs in sinus conditions ,head trauma, smoking, aging, and the
use of cocaine and in Parkinson disease.

17. visual acuity
optic fundi
Confrontation (visual field)
**Visual acuity is expressed as two numbers
 first- indicates the distance of the patient from the chart, and the
 second, the distance at which a normal eye can read the line of letters.

19. PERRLA
Near response
Convergence
Eyelid elevation

20. EOM’s

21. CN III Oculomotor Pupillary constriction, opening the
eye (lid elevation), and most extraocular
movements
CN IV Trochlear Downward, internal rotation of the
eye
CN VI Abducens Lateral deviation of the eye

22.  S,S,M,M,B…
 Motor—temporal and masseter muscles
(jaw clenching), lateral pterygoids (lateral
jaw movement)
 Sensory—facial. The nerve has three
divisions:
(1) ophthalmic, (2) maxillary, (3)
mandibular.

23.  Corneal Reflex.
 Sensory- CN V
 Motor- CN VII

24.  Raise both eyebrows.
 Frown.
 Close both eyes tightly so that you cannot open them.
Test muscular strength by trying to open them.
 Show both upper and lower teeth.
 Smile.
 Puff out both cheeks.
 Taste-anterior 2/3 of tongue

25. Whispered voice test
Rinne Test- AC:BC
 conductive hearing loss  BC = AC or BC > AC
 sensorineural hearing loss AC > BC
Weber Test- Lateralization
 sensorineural hearing loss = sound heard in the good ear
 unilateral conductive hearing loss = lateralization to impaired ear
 **Caloric Stimulation- COWS, VOR test
 *Romberg’s Test

26. Gag reflex
Taste- posterior 1/3

27.  Voice?
 Dysphagia?
 Say “aaaahhh”
 Gag reflex
 *The palate fails to rise with a bilateral lesion of CN X. In unilateral paralysis, one side of
the palate fails to rise and, together with the uvula, is pulled toward the normal side.

28.  Observe Trapezius muscle
 * Trapezius muscle paralysis, the shoulder droops, and the scapula is displaced
downward and laterally.
 Sternocleidomastoid
 Trapezius weakness with atrophy and fasciculations- peripheral nerve disorder.
 A supine patient with bilateral weakness of the sternomastoids has difficulty
raising the head off the pillow.

29.  articulation of words- CN V, VII, and X, as well as XII
 Tongue- atrophy or fasciculations (relaxed)
 asymmetry, atrophy, or deviation from the midline (protruded)
 move from side to side- note the symmetry of the movement
 push against the inside of each cheek in turn as you palpate for strength
 **Tongue atrophy and fasciculations-ALS; polio
 **unilateral cortical lesion-protruded tongue deviates transiently
away from the side of the cortical lesion, toward the side of
weakness.

31.  body position -during movement and at rest.
 involuntary movements- tremors, tics, or fasciculations.
 Note location, quality, rate, rhythm, and amplitude and relation
to posture, activity, fatigue, emotion, and other factors.
 characteristics of the muscles (bulk, tone, and strength)
 coordination
 If you see an abnormality, identify the muscle(s) involved.
 Determine whether the abnormality is central or peripheral in origin, and begin to learn which nerves
innervate the affected muscles.

33. ELBOW
 FLEXION and EXTENSION @
by having the patient pull and
push against your hand
 Flexion (C5, C6—biceps)
 extension (C6, C7, C8—triceps)

34.  extension (C6, C7, C8,
radial nerve—
extensor carpi radialis
longus and brevis)
 make a fist and resist
your pulling it down.

37.  (C7, C8, T1)
 squeeze two of your fingers as hard
as possible and not let them go
Weak grip
 cervical radiculopathy,
 de Quervain’s tenosynovitis,
 carpal tunnel syndrome,
 arthritis,
 epicondylitis.

38.  (C8, T1, ulnar nerve).
 palm down and fingers spread
 not not to let you examiner
move
 the fingers as he forces them
together

39. (C8, T1, median nerve)
against resistance

40.  Strength, tremors, movement
 Flexion, extension, and lateral bending of the spine, and
 Thoracic expansion and diaphragmatic excursion during respiration.

41.  extension (S1—gluteus maximus) Have the patient
push the posterior thigh down against your hand.
 Flexion-(L2, L3, L4— iliopsoas)
 your hand on the patient’s thigh
 Ask patient to raise the leg against
 adduction (L2, L3, L4—adductors).
 Ask the patient to bring both legs together
 Again, with resistance
 Abduction (L4, L5, S1—gluteus medius and
minimus).
 patient to spread both legs against your hands
*Symmetric weakness of the proximal muscles -myopathy;
*symmetric weakness of distal muscles -a polyneuropathy, or
disorder of peripheral nerves.

43.  Extension (L2, L3, L4—quadriceps).
 knee in flexion; ask to straighten the leg against
your hand
 quadriceps - strongest muscle in the body
 Flexion (L4, L5, S1, S2—hamstrings)
 knee flexed with the foot resting on the bed.
 Tell patient to keep the foot down as you try to
straighten the leg.

44.  Dorsiflexion
 (mainly L4, L5—tibialis anterior)
 Plantar flexion
 (mainly S1—gastrocnemius, soleus)

45.  for rhythmic movement and steady posture
 Rapid alternating movements
 Upper, Lower Ext.
 Point-to-point movements
 Arms—Finger-to-Nose Test
 Legs—Heel-to-Shin Test
 Gait and stance, other related body movements
 Heel-to-toe, heel, toe
 Hopping in place
 Romberg’s
 Pronator Drift

47.  In cerebellar disease one movement cannot be followed quickly by its
opposite and movements are slow, irregular, and clumsy.

48.  Gait that lacks coordination, with reeling and instability –ATAXIC
 May be due to cerebellar disease, loss of position sense, or
intoxication.
 **Inability to heel-walk is a sensitive test for corticospinal tract
damage.

49. Dorsal column disease ataxia, vision compensates for the
sensory loss.
(+) if loses balance when eyes are closed, a positive
Cerebellar ataxia- difficulty standing with feet together –
with yes open or closed.

50. Pronation of one forearm.
Sensitive and specific for a corticospinal tract lesion
originating in the contralateral hemisphere.

54.  Pain and temperature (spinothalamic tracts)
 Position and vibration (posterior columns)
 Light touch (both of these pathways)
 Discriminative sensations, which depend on some of the above sensations but also
involve the cortex
 Stereognosis
 Graphestesia
 2-point-discrimination
 Point localization

55.  Compare symmetric areas on the two sides of the body.
 When testing pain, temperature, and touch sensation, also compare the distal with the proximal areas.
 Scatter the stimuli to sample most of the dermatomes and major peripheral nerves
 both shoulders (C4)
 inner and outer aspects of the forearms (C6 and T1)
 thumbs and little fingers (C6 and C8),
 fronts of both thighs (L2),
 medial and lateral aspects of both calves (L4 and L5)
 little toes (S1)
 medial aspect of each buttock (S3).
 When testing vibration and position sensation, first test the fingers and toes. If these are normal, you may
safely assume that more proximal areas will also be normal.
 ●● Vary the pace of your testing. This is important so that the patient does not merely respond to your
repetitive rhythm.
 ●● When you detect an area of sensory loss or hypersensitivity, map out its boundaries in detail. Stimulate
first at a point of reduced sensation, and move by progressive steps until the patient detects the change.

57.  pointed end- small areas (i.e finger ), broad-end- larger areas
 Encourage the patient to relax; position the limbs properly and symmetrically.
 Hold reflex hammer loosely between your thumb and index finger so that it
swings freely in an arc within the limits set by your palm and other fingers.
 With wrist relaxed, strike tendon briskly using a rapid wrist movement.
 Strike should be quick and direct, not glancing.
 Note the speed, force, and amplitude of the reflex response and grade the response
using the scale below.
 Always compare the response of one side with the other. Reflexes are usually
graded on a 0 to 4+ scale.

58. Hyperactive reflexes
(hyperreflexia) - seen in
CNS lesions along the
descending corticospinal
tract.
Look for associated
upper motor neuron
findings of
 weakness, spasticity, or a
positive Babinski sign.
Hypoactive or absent reflexes
(hyporeflexia)
- seen in diseases of spinal nerve
roots, spinal nerves, plexuses, or
peripheral nerves.
-Look for associated findings of
lower motor unit disease, namely
weakness, atrophy, and fasciculations.
**MgSO4- decreases DTR

70.  Neck Mobility/Nuchal Rigidity
 Brudzinski
 Kernig

74.  Doll’s eye

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