..........................................

:


: : : :

J
.....



) ....

( .....


what ever ... Long ....
History
general examination
Local examination according to system
Local examination
.... Long .......

.. History general Local


...

...
...
JJJJJ
...

 ..........................................
... ...

...

History examination

variability
Long
long


...
... ..




...
.... ...
History taking Personal history
complaint .... history of present illness ....
... Past history family history
... ... general examination

Local examination
diagnosis Investigations proper treatment

...
general Local

system
system
cardiology Long

COPD long case
Long COPD complicated by
cor pulmonale
)
(

65 55
J

 ..........................................
Neurology Hemiplegia
capsular hemiplegia Hemiplegia
Neurology
system
J )
(


Long




)JJJ (
...
...
Long case
LLL




)
(



Patient name is ...
65 ... from shobra

Personal history

history of present illness

History ...
...
system Positive Negative
History History
system

 ..........................................
......... 4 years later .... Patient suffered from

L
history
History

History History
.... ...
...


examination
general examination Local examination

general
general examination

3
3 general examination 3

general examination
120/80 pulse 75

general examination
History 1/3

general examination

1/3 Local examination
Local examination
L apex
L pulsation
examination inspection , palpation , percussion and auscultation


1/3
diagnosis J

 ..........................................
History history .... !!!!
... present history
No symptoms of other system investigated treated
Past history , family history examination







History history History ...
History , history Local examination



History
History
personal history

name , age , sex , occupation , marital status , residence and habit
neurology Handedness right handed left
handed
In paragraph
for example
male pa ent, M..A33yrs old, driver, married

and have 2 daughters
the youngest is 2 years old born and live in Cairo, and he is mild smoker or moderate
smoker
neurology right handed Left handed
Personal history

complaint as short as possible
one complaint is enough ...
) ( complaint number 1,
complaint number 2
one complaint
He is complaining of shortness of breathing of 2 month dura on

 ..........................................
he is complaining of weakness of the left side of the body of 2 weeks dura on
He is suering from coughing of blood of 1 hour dura on

Multi complaints
One complaint is enough
Medical treatment

history of present illness
history of present illness
1-analysis of the complaint
2- analysis of symptoms of the related system
3-other systems
4- investigations and treatment


symptoms of the related system

cardiology chest abdomen

symptoms ... Positive
negative
L Negative , positive , negative , positive ..........

positive
...
No yes
analysis
Negative No No No



positive
... ... analysis
.... .... No expectoration
... chest wheezes
.... no

positive

 ..........................................
symptoms the same onset course duration

example J J

the condi on started 5 years ago, by cough, expectora on and wheezes of acute
sudden onset and intermittent course

in attacks

expectoration dyspnea
wheezes



symptoms of related system
Positive Negative
Positive


..... .... .... ....

.... ....


2 years later one year later Now he ...
is suffering form



system
cardiology respiratory neurology abdomen rheumatology
symptomatology
symptoms C.V.S
cardio vascular system
symptoms of cardiology
) (

1-pulmonary conges on. 2-Systemic venous conges on. 3- Low cardic output. 4Cyanosis
C

 ..........................................
5-Plapita on. 6-Pain. 7-pressure manifesta on. 8-Blood pressure changes.
P

9-Embolic manifesta on. 10-fever.
symptomatology



Pulmonary congestion
.... analysis low cardic output
... analysis

.... .... .. ..... ..
.... ... .... ... .... ....
.... Pulmonary congestion Low cardic output
manifestations
analysis
...
analysis No

No
No history
again No Yes Yes No

***** .... )
(
Negative
) J (..................
pulmonary congestion Low cardic output manifestation
Mitral stenosis pulmonary congestion low cardic output
...
... pulmonary hypertension
systemic venous congestion

Positive
No symptoms of systemic venous congestion
right ventricular failure

 ..........................................

Mitral stenosis atrial fibrillation no
palpitation atrial fibrillation
... Negative
negative

Negative
medicine


) } {
}({


cardiology personal history
analysis of complaint Positive
Negative
positive Analysis
analysis
analysis
8
onset, course, duration, association, what increase, what decrease, effect of
treatment and recurrent or not
analysis
dyspnea ... Palpitation ....
Lower limb edema
.... analysis
... analysis

....
symptoms

symptoms
example
Pulmonary congestion symptom ...
dyspnea, cough, hemoptysis, recurrent chest infection

dyspnea
analysis dyspnea J
symptom no cough, no hemoptysis and no
recurrent chest infection

 ..........................................
dyspnea
systemic venous congestion
lower limb edema ascites right hypochondrial pain dyspepsia
jaundice
edema ....... analysis
No .... No
No
No symptoms
J
low cardic out put
Low cardic output syncopal attack
cyanosis
chest pain
palpitation
Pressure manifestation

symptoms cardio GIT
symptoms symptom


present history analysis of complaint
History of present illness Positive analysis
Negative No No No

Other systems
)
L
(
chest ... ... ... toxic
... manifestations
neurology motor weakness, sensory affection ....


no symptoms suggest other systems affection

Other systems

 ..........................................

) Investigations and treatment history of present illness
(





patient sought medical advice,
admitted recommended



patient investigated by ECG, chest X-ray, ECHO cardiography

and treated by Beta blocker

J
Investigation and treatment


diabetes Hypertension
Present history analysis diabetes
clinical pictures investigations
controlled controlled complications
hypertension
Hypertension complications of hypertension
diabetes Hypertension present history

present history Past
history
.... .... peripheral neuropathy ......diabetic
Hypertensive encephalopathy
hypertension stroke diabetes Hyper tension
past history

 ..........................................
... Past history present
history
Past history
systems chronic illness operations out come

family history
3 consanguinity .... similar condition chronic illness chronic disease

no consanguinity no similar condition No chronic illness family

Irrelevant family history
Menstrual history
female significant
blood endocrinology


Personal history present history
significant
present history value
complaint menstrual history
Menarche at age of
cycle 25 period 5 ... excessive amount
general manifestations of
anemia
excessive blood loss

....
chest
symptomatology of the chest
10 CHEST+ 3Cs + 2 Ps

symptomatology
.... Long
Long
) ( chest
chest COPD
COPD complicated by corpulmonale

 ..........................................
History

history
) ( J

Long

abdomen
abdomen
chest chest

neurology
.... neurology
abdomen tense ascites dyspnea
.... mitral stenosis
tense ascites
).... L
(

system

....



acute
chronic )
L (

trick
chronic short acute Long
.... Long
system
system system Present
history symptomatology of the related system
symptoms of the related system
system

 ..........................................
) (
neurology neurology neurology
Neurology
.... neurology
neurology

neurology

neurology
) (

Neurology hemiplegia
Hemiplegia Paraplegia



MS ) multiple sclerosis ( Mitral stenosis


chest
symptoms of the chest
chest 3 Cs 2 Ps
chest cough, haemoptysis, expectoration, Shortness of breathing( ....
dyspnea ) and
T
3 Cs Cyanosis , constitutional manifestations and systemic venous
congestion
systemic venous congestion
cor pulmonale
2 Ps
pain and pressure manifestations
chest

cough and expectoration dyspnea continous
wheezes COPD
cough expectoration big in amount , .... expectoration

 ..........................................
purulent discharge, postural variation, and bad odour
suppurative lung syndrome
chest
lung abscess , bronchiectasis
COPD

any symptom of the chest
analysis symptom chest 8

onset, course, duration, association, what increase, what decrease, effect of
treatment, recurrent or not
chest 3
3 varia ons
diurenal variations
Postural variations
bronchiectasis abscess
seasonal variations ..

any excreta

haemoptysis or expectoration
analysis haemoptysis expectoration 11
11
8
onset, course, duration, association, what increase, what decrease, effect of
treatment, recurrent or not
3 varia ons
postural, diurenal and seasonal

amount color odour
for analysis of any symptoms chest expectoration
haemoptysis 14

11
) (
system abdomen

 ..........................................
symptomatology of abdomen
(upper & lower ) GIT ) General ( toxic Gynecological
J female
3Gs
hepato biliary system
... Urinary system
2 Bs
swelling Lower limb
swelling abdomen
systemic review Other systems
3 Ss
Present history present history
symptoms of the related system
GIT symptoms symptom

GIT symptoms upper lower
upper GIT
anorexia , dysphagia or odynophagia
vomiting
haematemesis
bad odour Halitosis
Heart burn
water brush
eructation
) hiccough
( idiopathic / Chronic renal failure .... hiccough

upper GIT


lower GIT

flatulence , audible borborygmi , Bowel habit, Haematochazia and melena

changes in bowel habit diarrhea constipation tnizimus
flatulence
6 give an account on flatulence

 ..........................................


physiological flatulence irritable bowel syndrome
malabsorption syndrome

acute diarrhea, chronic diarrhea, constipation and
flatulence
L
lower GIT changes in bowel habit flatulence audible borborygmi

bleeding per rectum
melena
Lower GIT
Positive
diarrhea Haematesis vomiting
amount color odour




focus history
)general ( toxic fever anorexia
headache malaise
Gynecological females
Pain abdominal pain analysis
Pain analysis
11

site, radiation, character
chest pain condition is
associated with chest pain LLL


Post graduates typical chest pain
atypical chest pain
typical chest pain anginal pain

 ..........................................
associated with typical chest pain Post graduates
pain typical
atypical
) ( J ....
)
... (
physician

physician .
pain
site, radiation, character
biliary system symptom Hepato biliary jaundice , puritis
pain
bleeding tendency analysis color of urine and stool
jaundice
jaundice symptom sign
cyanosis
jaundice analysis color of urine
color of stool

...
obstructive jaundice
.... hemolytic
jaundice
biphasic hepatocellular jaundice
related to urinary system
urogenital system system Pain
during micturation dysuria frequency Precipitancy
genital system impotence
swelling lower limb
symptom
swelling abdomen

Other systems

 ..........................................
abdomen
short examine abdomen
short GIT GIT
GIT abdomen

GIT hepato
splenomegaly

hepatosplenomegaly GIT

system abdomen GIT )
( abdomen GIT system

neurology

Long neurology system
analysis complaint
symptoms of neurology filling in space application like

Neurology symptoms
T N M + 4 Ss
T increased intracranial tension
N cranial nerves
M motor system
4 Ss
sensory system
speech troubles
sphincteric troubles
systemic review

Increased intracranial tension ... bursting
headache projectile vomiting blurring of vision coma
convulsion
symptoms of increased intracranial tension
symptoms
no symptoms of increased intracranial
tension

 ..........................................
No bursting headache No projectile vomiting No blurring of
vision ....

symptoms Low cardic out put no symptoms of
low cardic out put and no syncope syncope
symptoms ... no symptoms of pulmonary congestions
no systemic venous congestion
no hepato biliary manifestations
no upper or lower GIT manifestations
syncope

cranial nerves
cranial nerves History cranial nerve history
examination
examination
... ........
free No olfactory affection No optic affection
No cranial nerve affection
cranial nerve affected

all cranial nerves are intact except
motor affection sensory affection
condition associated with accumulation of food in the right side, dribbling of sliva
from right side, deviation of mouth from the left side, and dropped right shoulder
with deviation of the tongue to the right side
Other cranial nerves are intact
Positive cranial nerves
cranial nerves
**
** .. .. )
(
** ptosis .. ... ...
** Motor and sensory motor muscles of mastication

sensory face C2 face ear
...

** facial Upper half lower half upper half
... .. .
** vestibulocochlear
** 11 bulbar ... ) J

 ..........................................
(... ... .. ....

spinal part of accessory

hypoglossal




Myopathy
myopathy Motor weakness

No Myopathy
myopathy
myopathy weakness analysis
Otherwise ) (
Motor system
neurology
analysis
analysis motor system
weakness involuntary movement coordination
present history of
complaint




) ( History examination



.... application ... ...

...
... ... ....


Once CNS T N M + 4 Ss
cranial nerve
motor weakness Hemianathesia
... speech sensations

 ..........................................
cranial nerves
...
) L : (
weakness
13 .... onset, course, duration
character distribution

character
1-degree. 2-tone. 3-was ng. 4-trophic changes. 5-fasciculation

degree
tone
wasting
trophic changes ..
fasciculation
distributions
1-upper limb or lower limb
2- right or left
3-proximal or distal
Upper limb
lower limb
4-adductor or abductor
upper limb
lower limb
5- flexor or extensor
Upper limb
lower limb
analysis weakness
for example


...
J
the condition started two years ago, by weakness of both lower limbs, with acute
onset and regressive course, this weakness is in the form of paresis, the muscle was
accid for 2 weeks then changed s un l now , there is no was ng, trophic
changes or fasciculation, this weakness affect both lower limbs bilaterally and
symmetrically, distal muscle affection than proximal, abductor more than
adductor, flexors more than extensors

 ..........................................

J

analysis weakness 13

Motor system system symptom weakness

co ordination
No involuntary movement with normal coordination
weakness


motor system yes No
Motor Motor system

character distribution
character passive .... kinetic
regular irregular
tone

distribution


distal or proximal


Hip and neck
No involuntary movement 95%
99.99% motor weakness


coordination
coordination .... cerebellum
deep sensation
upper and lower limbs

 ..........................................
upper limb .... cerebellum
Lower limb
deep sensations upper limb

Lower limbs

deep sensations
Motor system
sensory system
sensation .... .... superficial .... deep cortical
superficial sensation superficial sensation
.... irritation destruction
irritation
destruction ...

deep sensations

cortical sensations
...
sensation system
superficial sensation analysis deep
cortical

with intact deep sensation ...
Hypothesia deep sensations
system
speech
symptoms system
...
hemiplegia

speech troubles
sphincteric troubles
micturation sexual function

 ..........................................

Micturation interpretation
Precipitancy

practically Precipitancy
Neurology
exclude local causes of precipitancy
benign prostatic hyperplasia
after exclusion of local factors male or females
consider Precipitancy neurology
....
exclusion of serious diseases Precipitancy
precipitancy ...
History bilateral partial upper motor neuron lesion

systemic review
Hemiplegia
cardio vascular system risky
cardio vascular system Hemi plegia
cardiology neurology
chest
abdomen
history
examination

History cardiology chest
abdomen
general
general multi system
hepatitis C COPD dilated
cardiomyopathy neurological disease
two systems
two systems



....

 ..........................................
general
Locomotor system rheumatological system example general
rheumatology

History

History of present illness
analysis of the complaint symptoms of the related system

rheumatological system

general articular extra articular
general toxic manifestations fever , headache , malaise,
anorexia and weight loss.
articualr pain, swelling, stiffness, deformities and disability
rheumatoid SLE mixed connective tissue disease


articular manifestations analysis Pain swelling
deformities and disability ... stiffness
articular manifestions
extra articular manifestations
extra articualr systems
cardiology
chest
abdomen GIT Kidney
CNS
Lymph node examinations history
skin eye

rheumatology
History of present illness toxic manifestation ...
arthritis SLE nephritis toxic manifestations
joint manifestations .rheumatology rheumatology

swelling stiffness Morning stiffness
value

 ..........................................
deformity
disability articular manifestations
rheumatology
extra articular
check cardiology chest systems
symptoms
No cardic , No respiratory
articular, no extra articular manifestations
...
extra articular manifestations
palpitation dyspnea
chest cough wheezes
system

... rheumatology Long case



systems History


general and local examination

general examination
systems cardiology abdomen chest
neurology rheumatology
general general examination
general examination
...


..... general condition mentality decubitus
built



face examination
neck examination Upper limb examination Lower limb
examination Back examination other systems examination

face 30 -40 physical signs 40

 ..........................................
face
) pallor , jaundice and cyanosis ...
stations station complexion
(


....
No abnormalities detected

face
hair frontalis wasting of temporalis Loss of outer third of
eye brows buffy eye lid conjunctiva cataract

Mouth examination 15

example space pallor, cyanosis, jaundice and
temperature
On request
No abnormalities ...
detected
...



Neck
neck vein
carotid artery equal )
(
... trachea ... chest chest trachea
local examination
thyroid
Lymph nodes
Neck vein Not congested neck vein Palpable pulsation and equal
in both sides, central trachea, no thyroid or lymph node enlargement

neck veins ) the neck veins
are not congested with the upper level of the wave above 3 cm above the clavicle,
while the is pa ent is lying 45 degree of the bed showing normal wave with systolic
) collapse with inspiratory emptying

 ..........................................

thyroid L
swelling

chest trachea centre

Upper limb .... Pulse comment
blood pressure , Hand examination clubbing
No abnormalities detected
Hand flapping tremors plammer erythema
wasting capillary pulsation oslers sign

Upper limb Pulse
Long pulse blood pressure


tremors
Palmmer erythema
general general


upper limb lymph node axillary lymph node upper limb
examination
lower limb
edema peripheral pulsation Pulse
dorsalis pedis artery
back deformity swelling neurology
Other systems
chest respiratory rate general examination
general examination upper limb
respiratory rate
chest trachea respiratory rate general
examination local examination

 ..........................................

3


Local examinations


general examination
general examination
*****
Personal history complaint History of
present illness Past history family history
History of present illness
family history past history

present history



family history and past history

History system
general examination
3
general examination

local examination

Inspection, palpation, percussion and auscultation
cardiology Local examination in cardiology
Inspection, palpation, percussion and auscultation
Inspection Percordial bulge scars dilated
veins Pigmentation areas of pulsation
apex
)

(
aortic and pulmonary thrill
Percussion
auscultation

 ..........................................
cardiology
auscultation


local examination Paragraph History
points
history Paragraph history
story
Points Local
.... chest
No dilated veins No scars No percordial bulge inspection cardiology
there is visible epigastric pulsation, supra sternal pulsation and apical pulsation
and there is no other visible pulsation
cardiology Palpation
Pulsation
thrill
palpable heart sounds

cardiology Pulsation Pulsation
apex apex
site, character, area and thrill
in mid calvicular line localized , hyperdynamic apical pulsation
with systolic thrill


there is palpable supra sterna pulsation, palpable epigastric pulsation from right
ventricles and no other palpable pulsation
thrill
there is systolic thrill on apex No thrill
palpable pulmonary component of diastolic shock palpable S1
second heart sound
Percussion
sure examples Percussion
heart Percussion
1-hepa c dullness. 2- right border. 3-base of the heart . 4- outside the apex . 5sternal dullness.
th
hepa c dullness in the right 5 intercostals space, no dullness outside
dullness the right sterna border, no dullness on the base of the heart

 ..........................................
Pulmonary area dullness two fingers or three fingers
pulmonary area

no dullness outside the apex

no sternal dullness there is sternal dullness

1-2-3-4-5
Hepatic dullness ... dullness right border
dullness apex sternal dullness

auscultation

apex tricuspid Pulmonary A1 A2
Mitral tricuspid S1 murmur
base of the heart S2 murmur
apex S1 accentuated muffled variable
normal
accentuated mitral stenosis ) tachycardia
MCQ Nodal rhythm ( accentuated S1 inspit of brady cardia
muffled Mitral regurge
variable atrial fibrillation
normal
murmur
Murmur comment
Murmur ) SCRIPT
( cardiology
site, character, relation to respiration & position, intensity, propagation, timing

arotic and mitral Murmur
expiration
tricuspid pulmonary Murmur
inspiration
Left sided heart murmurs are louder on expiration
right sided heart murmurs are louder on inspiration
murmur cardic cycle
accentuated S1 Pansystolic soft murmur apex Propagated to

 ..........................................
expiration left lateral position axilla
there Murmur S1 normal S1 tricuspid
increased by inspiration is systolic murmur
second heart sound aortic Pulmonary

ejection systolic, harsh murmur, A1 aortic murmur
propagated to the carotid, increased on leaning forward
Murmur A2
early diastolic soft blowing murmur Mued S2
localized, increased on leaning forward and on expiration ....A2
Murmur
ejection click Opning snap S3 and S4
discussion
cardiology local examination general History
diagnosis
diagonsis
diagnosis diagnosis
diagnosis
etiological diagnosis, anatomical diagnosis, pathological diagnosis and functional
diagnosis
complicated compensated

acase of rheumatic valvular heart disease, most probably double mitral, patient is
compensated but complicated by atrial fibrillation

failure organ compensation
this patient is not compensated Heart failure
the patient is well compensated heart failure
J

general examination history chest

inspection
chest inspection
inflated Normal shape of the chest
bulg retraction Pectus carniatum pectus excavatum

 ..........................................

hyper inflated barrel shaped chest

Increased antro posterior diameter of

respiratory movement rate site
chest wall lesions No scars No dilated veins No
pigmentation

Pulsation
Pulsation heart chest
emphysema absent apical pulsation absent all
pulsation Pulsation epigastric pulsation
) (L
Inspection chest epigastric pulsation
.... right ventricular enlargement
sternomastoid tendon trachea central
Litten sign
Palpation chest
) T (
trachea central shifted
.... COPD COPD trachea
central
retraction dullness
shifted shifted

tenderness
TVF
palpable wheezes
chest expiation
) T (chesT

Palpation
TVF Increased diminished bilaterally equal on both

 ..........................................
sides
tenderness tenderness tenderness
tenderness in right supra mammary area
there is palpable rhonchi all over the chest
chest expantion
there is bilateral limitation of the chest expantion
Percussion
percussion chest
front , lateral and back
front Line
3 areas
emphysema
Hyper resonance chest with encroachment on hepatic dullness and encroachment
on bare area of the heart
..... conculsion
.... Percussion ...
Hyper resonance emphysema



emphysema
bare area dull resonance

system
auscultation auscultation chest

Percussion
auscultation
air entry diminished air entry bilaterally
No air entery of the right side
diminished air entry bilaterally and basally bronchiectasis
breath sounds
vesicular breathing with prolonged expiration harsh

 ..........................................
additional sound
bilaterally and generalized ronchi
changed by cough and poly phonic Main expiratory

decreased vocal resonance
COPD J
hemi plegia COPD ) (

COPD


abdomen
abdomen

auscultation Percussion Palpation Inspection
Points
front and back abdomen Inspection
mid line front
there is wide subcostal angle, there is visible epigastric pulsation, No .....
visible peristalsis, No divercuation of recti or (there is divercation of recti ) ,
umbilicus
umblicus
umbilicus is slightly shifted downward, everted, normal color, no hernia, no
discharge or nodule
comment

normal hair distribution, and no testicular atrophy

contour
symmetrical enlargement of the abdomen with full flanks counter
there is respiration mainly thoracic or abdomno thoracic

gynecomastia

no hernia, no scars , no dilated Hernia
veins
systemic Portal vein Milk test .... dilated veins

 ..........................................
vein
J back scars swelling renal angle
swelling
Palpation palpation
superficial and deep palpation
superficial palpation ) ( concuslion
No superficial swelling and no tenderness

superficial palpation
superficial swelling tenderness

no superficial swelling and no tenderness
deep palpation
Mainly organs Liver
Liver ..... there is impalpable liver
shrunked normal
liver normal
shrunken
Normal
rounded border and soft in consistency
Light percussion
sctrach technique
) lower costal margin
J
right iliac fossa scratch
Lower border of the liver
(
Liver
palpation

Left lobe of the liver
right Left
spleen splenic swelling in the le hypochondrium 4
finger ( finger of the patient ) below the left costal margin , has sharp edge , firm in
consistency, smooth surface, not tender, not pulsating
Notch with splenic notch
Kidney

 ..........................................
Impalpable both kidneys
abdomen No other swellings
Percussion
ascites
ascites there is ascites detected by shifting dullness
sever ascites tense ascites there is tense ascites detected by
transmitted thrill

auscultation
Intestinal sounds Normal intestinal sounds right
and left ilica fossa
abnormal paralytic ilues obstruction
auscultation no vascular found
dilated vein
Hepatic tumor
no splenic rub splenic rub

no abnormalities
abdomen


abdomen
abdomen PR examination
it refused by patient

PR
....

any abdominal examination should be ended by per rectal
examination

 ..........................................
neurology

general general
mentality general Neurology

speech Normal speech slurred speech staccato
speech
cranial nerves examination
all cranial nerves are intact
) (

olfactory
all cranial nerves are intact


fatal mistake




cranial nerves
diabetic patient Optic occulomotor abducent facial

facial
all cranial nerves are intact except facial on the right side
upper motor Lower motor

cranial nerves )

( NO1 NO2
NO3

all cranial nerves by
examination are intact except

 ..........................................
upper motor Lower motor Unilateral bilateral

motor system
refelexes

) (motor and reflexes Motor system

reflexes motor system
station station examine
motor system in both lower limbs
examine the motor system of the right side of the body
examine the motor system
Motor system Motor
reflexs
reflexes Motor system

examine the motor system
Motor system reflexes Motor system reflexes


reflexes motor system
Motor system Inspection ...
Palpation, percussion , power, coordination .... motor system


reflexes
Motor system reflexes
motor system inspection, palpation,
percussion, power, coordination
Inspection muscle status spastic hemi plegia
flexed right upper limb and hyper extended right lower limb, no wasting, no
trophic changes or deformity
comment Inspection
palpation clasp knife spasticity on the right side with normo tonia on the
left side

 ..........................................
percussion No fasciculation, no myotonia
power
complete paralysis of the right side of the body with normal power on the left side
of the body
Motor system
coordination
Motor system
coordination





............ coordination
hemiplegia ........ coordination on the left side is
intact and on the right side not examined
examine!!!!!
examination
paralysed
reflexes
Patient by inspection, by
palpation, by percussion, power
coordination
coordination .............
reflexes superficial and deep

reflexes
A B
A superficial deep reflexes B
superficial reflexes corneal cranial nerves
abdominal and planter
cremastric

superficial reflexes
positive babiniski on right side
negative on left side ) negative ( planter response
on the left side

 ..........................................
abdominal reflex is lost on the right side
superficial reflexes
deep reflexes
hyper reflexia on the right side
hyper reflexia Upper limb Lower limb
reflexes Upper limb triceps , brachio radialis and biceps
centres
biceps centre brachio radialis centre
triceps centre
Lower limb knee ankle centres
) Normo reflexia
(
Pathological reflexes and clonus on the right side
finger flexion supra spinatus Patellar
adductor centres

reflexes






sensation
superficial deep sensations
superficial sensations conculsion
.as regard superficial sensation there is hypothesia on the right side of the body
and pain
deep sensation
this sensation are lost in the right side
position, movement, muscle vibration
sensation
cortical sensation
is intact on the left side but not examined on the right
not examined cortical superficial deep

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Back
general examination
gait


gait
there is right sided circumduction gait
para plegia
Peripheral neurpathy High stamping gait
sensory ataxia waddling gait
cerebllar ataxia zig zag or drunken gait
myopathy waddling )
(

other systems
hemiplegia
heart by inspection, palpation, percussion and auscultation
inspection
palpation
hemiplegia diabetic Hyper
tensive
hemiplegia comment
chest abdomen rheumatology no abnormalities were detected

diagnosis
rheumatology
rheumatology rheumatology examination

in general
articular and extra articualr
general ....
articular and extra articular
extra articular

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extra articular extra articular
chest abdomen Lymph nodes
skin
extra articular
Joint Joint
Joint examination
stations joint examination
) joint examination of the upper limb
( Lower limb Peripheral joints axial
joint special joints


Peripheral joints

Peripheral joints upper limb hand and left
CD TT


shape, muscle, swelling, movement , contour, deformity, tenderness and special
tests
joint
Peripheral joints axial joints





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