Head-to-Toe

Well, tomorrow is the "big day"--my full head-to-toe motor exam. It has to be done in a half hour. I practiced on Mirza last night and I did it in 27 minutes. However, I really want to practice it one more time tonight because I know it'll be a lot more scary when someone else is watching and grading and I might easily forget something under pressure. I'm feeling pretty good about it at this point though because when I practice, the most I ever miss is 1 or 2 and I realize it before the exam is done and I do it, so they can't take away points, except for not in logical order. We need an 85%.

This is the exam (I rewrote it so it was in "logical sequence"):
Head-to-Toe Motor Exam


Sitting

· Introduce yourself and explain exam.

-Ask them to remember 3 words: Apple, Book, Cat (Cognitive ability-memory (0.5))

-Inspect skin 0.5

-Palpate skin (turgor, texture, temperature) 0.5

-Hair—Inspect 0.5

-Nails- Inspect and palpate (clubbing, capillary refill) 1.0

-Observe facial features for symmetry 0.5

-Assess CN V—Trigeminal (Motor and Sensory) 1.0
Ask them to clench their teeth
Rub cotton on face for them to feel

-Assess CN VII –Facial (Motor only) 0.5
Ask to smile, frown, squeeze eyes, raise eyebrows)

-Palpate head and scalp, including sinuses and TMJ 2.0

-Palpate and auscultate temporal arteries. Inspect neck and neck veins. 2.0

-Palpate neck: 1.5
-Trachea
-Thyroid
-Lymph nodes (state which ones)

-Assess CN XI-Spinal Accessory 0.5
-Ask them to shrug their shoulders

Before each ROM say inspecting joints/muscles 1.0

-Neck 2.0
-Flexion
-Extension
-Lateral bending
-Rotation

-Neck Strength 2.0

-Shoulder 2.0
-Adduction
-Abduction
-Internal rotation
-External rotation

-Shoulder strength 2.0

-Elbow 2.0
-Flexion
-Extension
-Supination
-Pronation

-Elbow Strength 2.0
-Reflexes –Upper 2.5
-Biceps
-Triceps
-Brachioradialis

-Wrist 2.0
-Flexion
-Extension
-Ulnar deviation
-Radial deviation

-Hand strength 2.0

-Fingers 2.0
-Flexion
-Extension
-Adduction
-Abduction

-Inspection of eyebrows, eyelids, orbital area, eyelashes, lacrimal gland 2.5

-Palpation of orbital area (sclera, conjunctiva) 0.5

-Pupil condition and response to light and accommodation 1.0
CN III (Oculomotor), CN IV (Trochlear), and CN VI (Abducens)

-Direct and consensual response 0.5

-Extraocular movement (six cardinal fields) CN III, IV, VI 0.5

-Fields of peripheral vision CN II Optic 0.5

-Functional vision (Rosenbaum) CN II Optic 0.5

-Ophthalmoscope examination (red reflex using RRR, LLL) 2.0
-Proper use of instrument=1 point

-Inspection and palpation of the ear 1.0

-Otoscope: ear canal and tympanic membrane 2.0
-Proper use of instrument=1 point

-Functional hearing (whisper test) CN VIII Acoustic 0.5

-Assess Rinne (side of head) and Weber (top of head) 1.0

-Inspect external nose 0.5

-Inspect internal nares with otoscope (use diff. Speculum cover) 0.5

-Inspect lips, teeth, buccal mucosa, tongue, floor of mouth 2.5

-Inspect tongue for movement CN XII Hypoglossal 0.5

-Observe movements of soft palate CN IX Glossopharyngeal and X Vagus 0.5

-Inspect anterior, posterior, lateral, chest wall. 0.5

-Respiratory rate, rhythm, and effort (retractions, use of a accessory muscles) 0.5

-Palpate for chest wall (for tenderness, lesions) 0.5

-Thoracic expansion (anterior/posterior) 1.0

-Percussion (anterior, posterior, lateral) from apex to base (note resonance, hyper resonance, dullness 1.5

-Tactile (or voice) fremitus 0.5

-Auscultation of breath sounds from apex to bases (posterior, anterior, lateral) 1.5
Voice sounds: egophony, whispered pectoriloquy, bronchophony

-CVA tenderness (ie-hit kidneys) 0.5

-Inspection of precordium. Describe 6 areas of assessment (aortic, pulmonic, Erb’s point, Tricuspid, Mitral, Epigastric) 3.5

-Palpation of precordium for any heave, thrill, PMI, pulsations 0.5

-**Auscultation of heart in the 6 areas of assessment (sitting) 1.5

-Inspection, palpation, and auscultation of carotids 1.5

- **Location of palpable pulses (2.5)
-Radial
-Brachial

Laying Down

-Inspection of abdomen (supine position, pillow under head, arms at side, empty bladder 0.5

-**Auscultation of heart while laying down (1.5)

-Auscultation of all quadrants: 3.0
-Bowel sounds
-Aortic
-Iliac
-Femoral
-Renal arteries

-Percussion of abdomen in 4 quadrants 0.5

-Percussion of liver span at MCL 0.5

-Percussion of splenic dullness 0.5

-Light palpation of 4 quadrants 0.5

-Deep palpation of 4 quadrants 0.5

-Palpate aortic pulsation/width 1.0

-Palpate abdominal organs :liver, spleen, kidneys 1.5


-Hip: 3.0
-Internal rotation
-External rotation
-Flexion
-Extension
-Adduction
-Abduction

-Hip Strength 2.0

-Knee 2.0
-Flexion
-Extension

-Knee strength 2.0

-Popliteal pulse (2.5)

Sit back up

-Patellar reflex (2.0)

-Ankle 1.0
-Plantarflexion
-Dorsiflexion
-Ankle strength 2.0

-Foot 2.0
-Invert
-Evert
(of both subtalar joint and transverse tarsal joint)

-Achilles reflex (2.0)

-Babinski reflex

-Clonus

-Dorsalis pulse

-Posterior tibia pulse

-Ask them to repeat the 3 words from the beginning of the exam (0.5)

-Ask them: 1.0
-What would you do if your house was on fire? (judgement)
-What does it mean to say, “Don’t put eggs all in one basket”? (abstraction)

-Sensation 1.5
-Touch
-Pain
-Vibration
(lower and upper extremities)

-Discrimination 1.5
-Stereognosis (key in hand)
-Graphesthesia ( Draw 8 in hand)
-Proprioception (Done along with romberg)

-Coordination (finger to nose, nose to finger, alternating, rapid hand patting) 1.0

-Sitting balance (sternal nudge) 0.5

Standing up

-Vertebral column 2.0
-Flexion
-Extension
-Rotation
-Lateral bending

-Standing balance (Romberg sign) 0.5

-Gait 2.0
-Regular
-Tandem
-Walk on heels
-Walk on toes

The end!!!