Sitting Up

1. Blood pressure (on both arms)

2. Pulse
3. Check head
4. Face movements
5. Check sensation in face (sharp, dull, light touch w/ cotton)
6. Check external ears
7. Check internal ears
8. Check hearing
a. Weber (placed on midline & ask if same on both sides)
b. Rinne (ask if can hear on mastoid process, then move to ear
once they stopped hearing it)
9. Check eyes
a. vision (with both eyes open, then with eyes covered)
b. have them follow finger with head still (ROMI)
c. wiggle fingers and ask them when they first see them
d. check pupils (light)
e. ask them to follow fingers (accommodation)
f. check fundus
10. Check nose
a. check for tenderness in sinus (external)
b. check inside the nose
11. Check mouth
a. examine inside mouth
b. have them stick tongue out and move it to the side
12. Check neck
a. check lymph nodes
b. check thyroid by having them swallow
c. neck movements (up, down, left right)
d. neck strength (have them push against your hand)
e. shrug shoulders
13. Check back/lungs
a. palpate for pain
b. costovertebral angle tenderness
c. have them say 99 when you touch them
d. percuss back (tap)
14. Listen to lungs
a. have them breathe through mouth when they feel you touch you
with the stethoscope

Lying down
 15. Check chest
a. while breathing
b. check for pain while pushing
c. have them say 99 when you touch them
16. look for JVD
17. check carotid pulses & listen over those areas
18. Listen to heart
19. Check abdomen
a. watch and look for any abnormal findings
b. auscultate 1st (listen)
c. percuss 4 quads
d. percuss over liver
e. percuss spleen
f. palpate and ask if they have any pain
g. try to feel liver, spleen and kidneys
20. check inguinal nodes & pulse

Sitting Up
21. Check arm & fingers and look for any abnormalities
a. Check for lymph nodes above the elbow
b. Check & compare pulses (radial, brachial)
c. Check sensations in arms (sharp vs dull; light touch with cotton)
d. Check vibrations in arms
e. Check arm strength
f. Check range of motion (ROM)
22. Examine Legs
a. look for anything abnormal (swelling)
b. check popliteal pulses
c. check ankle pulse
d. check dorsalis pedis pulse
e. check sensation in legs (sharp vs dull; light touch with cotton)
f. check vibration (on toe)
g. check proprioception by moving toe and asking them to say
direction
h. check leg strength
23. Check Reflexes
a. biceps, triceps, brachioradialis, patella, Achilles, plantar
24. Neuro
a. alternating hand movements
b. finger-to-nose
c. heel-to-shin

Standing
25. have them walk across the room
26. Romberg test
27. Check ROM of back

Headache History Taking

SOCRATES
Site unilateral (e.g. migraine) / frontal bilateral (e.g. tension headache)

Onset:

Was the onset acute or gradual? (sudden onset thunderclap headache is suggestive
of subarachnoid haemorrhage)

Character aching / throbbing / pounding / pulsating / pressure / pins and needles / stabbing

Radiation neck (meningitis) / face (e.g. trigeminal neuralgia) / eye (e.g. acute closed
angle glaucoma)

Associated symptoms:

Nausea / vomiting may suggest raised intracranial pressure (ICP)

Visual disturbance aura related / intracranial lesion / bleeding / stroke

Photophobia raised ICP / meningitis

Neck stiffness meningitis (may be related to infection or subarachnoid haemorrhage)

Fever suggestive of an infective process (e.g. bacterial meningitis / abscess)

Rash non-blanching purpuric rash may indicate meningococcal sepsis

Weight loss suggestive of malignancy consider cerebral metastases

Sleep disturbance headaches causing sleep disturbance are concerning (raised ICP)

Temporal region tenderness consider temporal arteritis

Neurological deficits weakness / sensory disturbance / impaired coordination /

cognitive symptoms / altered level of consciousness consider space occupying
lesions / intracranial bleeding / stroke

Timing:

Duration of headache?

Is it episodic?

Any clear pattern?

Diurnal variation?
 Chronic headaches in a month of 30 days, for how many of those days would the patient
have a headache?

Exacerbating / relieving factors:

Exacerbating factors are there any obvious triggers for the symptom? (e.g. caffeine /
codeine / stress / postural change)

Relieving factors does anything appear to improve the symptoms (e.g. improvement
upon lying flat suggestive of reduced ICP).

Severity:

Ask the patient to rate the pain on a scale of 1-10

Is the pain getting worse?

How is it impacting their daily life?