NSG3160 / NSG 3160 Exam 2 2026 Update – Health Assessment | Galen College | Verified Questions & Answers with Detailed Rationales | Grade A | Physical Examination & NCLEX-RN® Prep PDF

INSTANT PDF DOWNLOAD — This is the comprehensive Exam 2 preparation guide for NSG3160 / NSG 3160 - Health Assessment at Galen College of Nursing, featuring verified questions and answers with detailed rationales. Designed for nursing students mastering physical examination and health assessment skills, this resource consolidates the critical assessment concepts required to master the NSG3160 Exam 2 and excel in Health Assessment. The guide is meticulously aligned with the Galen College curriculum, NCLEX-RN® test plan, and current evidence-based health assessment practice standards. This verified resource provides comprehensive coverage of key NSG3160 Health Assessment Exam 2 topics, including: General Survey and Vital Signs (general survey—physical appearance (age, gender, level of consciousness, skin color, facial features, overall appearance), body structure (stature, nutrition, symmetry, posture, position, body build, contour), mobility (gait, range of motion), behavior (facial expression, mood and affect, speech, dress, personal hygiene); vital signs measurement techniques—temperature (oral, rectal, axillary, tympanic, temporal artery; normal range 36°C-38°C (96.8°F-100.4°F); fever (pyrexia) patterns (intermittent, remittent, sustained, relapsing); hypothermia; pulse—rate (bradycardia 60, tachycardia 100), rhythm (regular vs irregular), amplitude (0 absent, +1 diminished/weak, +2 normal/brisk, +3 increased/full bounding), contour; peripheral pulses (radial, brachial, femoral, popliteal, posterior tibial, dorsalis pedis); apical pulse auscultation (PMI—5th intercostal space, left midclavicular line); pulse deficit; respirations—rate (eupnea 12-20, tachypnea 20, bradypnea 12), depth (deep, normal, shallow), rhythm (regular vs irregular), pattern (Cheyne-Stokes, Biot's, Kussmaul, apneustic); blood pressure—systolic/diastolic, Korotkoff sounds (Phase I first appearance of tapping sound, Phase II swishing, Phase III crisp tapping, Phase IV muffling, Phase V disappearance of sound); auscultatory gap; hypertension (SBP ≥130 or DBP ≥80 per ACC/AHA guidelines); hypotension (SBP 90 or DBP 60); orthostatic hypotension (drop in SBP ≥20 or DBP ≥10 upon standing); pulse oximetry (SpO₂)—normal range 95-100%; limitations (motion artifact, poor perfusion, dark nail polish, carbon monoxide poisoning); pain assessment—PQRST (Provocation/Palliation, Quality, Region/Radiation, Severity, Timing); pain scales (numeric 0-10, Wong-Baker FACES, FLACC for nonverbal, PAINAD for advanced dementia, CRIES for neonates); Integumentary System Assessment (skin—inspection (color—pallor, erythema, cyanosis, jaundice, bruising (ecchymosis), petechiae, purpura, vitiligo, pigmented nevi; uniformity, lesions), palpation (temperature, moisture, texture, turgor (skin elasticity—decreased in dehydration), mobility, thickness, edema (pitting vs non-pitting, grading 1+ to 4+); primary skin lesions (macule, papule, patch, plaque, nodule, tumor, wheal, vesicle, bulla, pustule, cyst); secondary skin lesions (scale, crust, excoriation, fissure, erosion, ulcer, scar, atrophy, lichenification); vascular lesions (cherry angioma, spider angioma, telangiectasia, venous lake); malignant skin lesions (ABCDE rule for melanoma—Asymmetry, Border irregularity, Color variation, Diameter 6mm, Evolution/changes); pressure injury staging (NPUAP—Stage 1 (non-blanchable erythema), Stage 2 (partial-thickness skin loss), Stage 3 (full-thickness skin loss), Stage 4 (full-thickness tissue loss), Unstageable (eschar/slough obscures depth), Deep Tissue Injury (persistent non-blanchable deep red/maroon); hair—inspection (distribution, texture, quantity, pattern of loss); palpation (texture); nail assessment—inspection (shape (clubbing—associated with chronic hypoxia, COPD, congenital heart disease), angle (Lovibond angle 160° in clubbing), color (pallor, cyanosis, splinter hemorrhages, pitting), thickness, cleanliness); palpation (capillary refill—normal 2-3 seconds); Head and Neck Assessment (head—inspection (size, shape (normocephalic, microcephaly, macrocephaly, hydrocephalus, acromegaly), symmetry, position, involuntary movements (tics, tremors)); palpation (skull for masses, tenderness, depressions); facial features—symmetry (CN VII—facial nerve); CN V (trigeminal)—motor (masseter/temporalis muscle strength, jaw clench), sensory (light touch to forehead, cheeks, jaw); CN VII—motor (smile, frown, raise eyebrows, show teeth, puff cheeks, close eyes tightly); eyes—external structures (eyebrows, eyelids (ptosis, ectropion, entropion), eyelashes, lacrimal apparatus (epiphora, dacryocystitis), conjunctiva (pale, injected, petechiae), sclera (icterus—yellow), cornea (arcus senilis, opacity, clarity), iris (shape, color), pupils (size, shape, equality); pupillary assessment—PERRLA (Pupils Equal, Round, Reactive to Light, Accommodation); direct and consensual light reflex; accommodation (convergence and pupillary constriction when focusing on near object); visual acuity—Snellen chart (distance), Jaeger card/Rosenbaum (near vision); visual fields by confrontation (CN II—optic nerve); extraocular movements (EOMs)—CN III (oculomotor), CN IV (trochlear), CN VI (abducens); six cardinal fields of gaze; nystagmus; strabismus; ophthalmoscopic examination (red reflex, optic disc (color, margins, cup-to-disc ratio), retinal vessels, macula, fovea); ears—external ear (pinna/auricle—shape, size, position (low-set ears associated with genetic syndromes), landmarks, lesions, nodules (tophi—gout), tenderness (otitis externa with tragus manipulation)); ear canal (cerumen, discharge, foreign bodies, lesions, redness, swelling); tympanic membrane (color (pearly gray, red (otitis media), amber (serous fluid), white (scarring)), landmarks (malleus, umbo, light reflex, annulus), position (neutral, retracted, bulging), perforation); hearing assessment—whispered voice test, Weber test (lateralization to affected ear in conductive loss, to unaffected ear in sensorineural loss), Rinne test (air conduction bone conduction (positive Rinne) normal; bone conduction air conduction (negative Rinne) indicates conductive loss); audiometry; nose and sinuses—external nose (symmetry, lesions, discharge, flaring); nasal cavity (turbinates (color, swelling), septum (deviation, perforation), mucosa (color, discharge, polyps)); sinus palpation (frontal, maxillary) for tenderness; transillumination (frontal, maxillary sinuses); CN I (olfactory)—not routinely tested; mouth and pharynx—lips (color, moisture, lesions, cracking); oral mucosa (color, moisture, lesions (leukoplakia—white patch, erythroplakia—red patch—higher malignancy risk), ulcers); teeth (number, presence, caries, loose/missing teeth, dentures); gums (color, swelling, bleeding, retraction); tongue (color, symmetry, papillae, lesions, movement—CN XII hypoglossal); floor of mouth (palpation for masses); hard and soft palate (color, integrity, lesions, cleft); tonsils (size grading 1+ to 4+, exudate, erythema); uvula (position, movement on phonation—CN X vagus); gag reflex (CN IX glossopharyngeal, CN X vagus); neck—inspection (symmetry, masses, webbing, tracheal position (midline vs deviation), thyroid gland (visible with swallowing), carotid artery pulsations (visible—observe, do not palpate bilaterally simultaneously), jugular venous distention (JVD)—assess at 45-degree angle, JVP measurement (normal 4 cm above sternal angle)); palpation (trachea (deviation), thyroid (isthmus and lobes—have patient swallow), cervical lymph nodes (preauricular, postauricular, occipital, tonsillar, submandibular, submental, anterior cervical chain, posterior cervical chain, supraclavicular)—assess size, shape, tenderness, mobility, consistency, matting); auscultation (carotid arteries for bruits (indicates turbulent flow, stenosis)—use bell of stethoscope, have patient hold breath); thyroid bruit (in hyperthyroidism); range of motion (neck flexion, extension, lateral bending, rotation); muscle strength (CN XI spinal accessory—shoulder shrug, head turn against resistance); Thorax and Lung Assessment (thoracic cavity landmarks—suprasternal notch, sternum (manubrium, body, xiphoid process), angle of Louis (sternal angle—location of tracheal bifurcation and 2nd rib attachment), costal angle (normal 90°, increased in COPD/barrel chest); ribs (12 pairs), intercostal spaces; vertebral landmarks (spinous processes (C7 prominent landmark), T4 (scapular level)); reference lines—midsternal, midclavicular, anterior axillary, midaxillary, posterior axillary, scapular, vertebral; lung lobes—right lung (3 lobes: upper, middle, lower); left lung (2 lobes: upper, lower); auscultation locations—posterior (apices to bases), lateral, anterior; breathing patterns—eupnea, tachypnea, bradypnea, hyperventilation, hypoventilation, Cheyne-Stokes, Biot's, Kussmaul, apneustic; inspection—shape and configuration (AP:transverse diameter (normal 1:2, barrel chest 1:1—COPD, emphysema)), symmetry (chest expansion), use of accessory muscles (sternocleidomastoid, scalene, trapezius—indicates respiratory distress), intercostal retractions (inspiratory pulling in of intercostal spaces—upper airway obstruction, respiratory distress), paradoxical breathing (inward movement of abdomen/chest with inspiration—diaphragmatic fatigue/flail chest), spinal deformities (kyphosis (hunchback), lordosis (swayback), scoliosis (lateral curvature)), clubbing of fingers (chronic hypoxia), pallor/cyanosis; palpation—tenderness (fractures, inflammation), masses, crepitus (subcutaneous emphysema—air in subcutaneous tissue), tactile (vocal) fremitus (palpable vibration of spoken "99"—increased with consolidation/pneumonia, decreased with pleural effusion/pneumothorax/COPD), chest expansion (symmetry—place hands on posterolateral chest with thumbs at T9/T10, ask patient to take deep breath, observe thumb separation); percussion—resonance (normal lung), hyperresonance (hyperinflation—COPD, pneumothorax), dullness (fluid/consolidation—pleural effusion, pneumonia, tumor), flatness (solid mass—bone, liver); diaphragmatic excursion (percuss liver/spleen dullness to estimate diaphragm position); auscultation—diaphragm of stethoscope for high-pitched sounds, bell for low-pitched; breath sounds—bronchial (trachea/thorax—loud, high-pitched, harsh, expiration inspiration—abnormal if heard over peripheral lung fields), bronchovesicular (mainstem bronchi—medium pitch, equal inspiration/expiration), vesicular (peripheral lung fields—soft, low-pitched, inspiration expiration); adventitious breath sounds—crackles/rales (fine (high-pitched, end-inspiration—pulmonary fibrosis, heart failure) vs coarse (low-pitched, early inspiration—bronchitis, pneumonia)), wheezes (continuous musical sounds—expiratory (asthma, COPD) vs inspiratory (upper airway obstruction—stridor)), rhonchi (low-pitched snoring/gurgling—large airway secretions—may clear with cough), pleural friction rub (dry, grating, leathery—pleuritis, inflammation); vocal resonance—bronchophony (spoken "99" sounds clear/transmitted—consolidation), egophony (spoken "E" sounds like "A"—consolidation), whispered pectoriloquy (whispered "1-2-3" heard clearly—consolidation); Cardiovascular System Assessment (precordium—inspection (visible pulsations (apical pulse PMI normally 5th ICS MCL—visible in thin patients), heaves/lifts (sustained forceful upward movement—ventricular hypertrophy), retractions); palpation—apical pulse (PMI—location (5th ICS, MCL), diameter (2-3cm normal), amplitude (gentle tap—normal), duration (brief—normal), sustained (hypertrophy)); thrills (palpable vibration/buzzing—turbulent blood flow—grade IV/VI murmur or beyond); heaves/lifts (palpable sustained upward movement—ventricular hypertrophy); palpate across precordium (aortic area (2nd ICS right sternal border), pulmonic area (2nd ICS left sternal border), Erb's point (3rd ICS left sternal border), tricuspid area (4th ICS left sternal border), mitral area (5th ICS MCL—PMI)); auscultation—use diaphragm for high-pitched sounds (S1, S2, murmurs, pericardial friction rub), bell for low-pitched sounds (S3, S4, mitral stenosis murmur); S1 (closure of mitral and tricuspid valves—beginning of systole—loudest at apex, coincides with carotid upstroke); S2 (closure of aortic and pulmonic valves—end of systole—loudest at base, splitting (physiologic—widens with inspiration, narrows with expiration), paradoxical splitting (narrows with inspiration—aortic stenosis, HCM), fixed splitting (ASD)); S3 (ventricular gallop—rapid filling—normal in children/young adults, pathological in older adults—heart failure, volume overload—"Kentucky"); S4 (atrial gallop—atrial contraction into non-compliant ventricle—hypertrophy, hypertension, aortic stenosis—"Tennessee"); murmurs—description (timing (systolic, diastolic, continuous), shape (crescendo, decrescendo, crescendo-decrescendo, plateau), location (point of maximal intensity—PMI), radiation, intensity (grade I-VI: I barely audible, II quiet but audible, III moderately loud, IV loud with palpable thrill, V very loud with thrill (stethoscope partly off chest), VI very loud with thrill (stethoscope off chest)), pitch (high, medium, low), quality (blowing, harsh, rumbling, musical); common murmurs—mitral regurgitation (holosystolic, apex, radiates to axilla), mitral stenosis (diastolic low-pitched rumbling, apex, opening snap), aortic stenosis (systolic ejection murmur, 2nd ICS right sternal border, radiates to carotids), aortic regurgitation (diastolic blowing decrescendo, 2nd ICS right sternal border or left sternal border), innocent/flow murmur (systolic, soft, no radiation, changes with position); pericardial friction rub (high-pitched scratchy/grating sound—pericarditis—triphasic (atrial systole, ventricular systole, early diastole), best heard with diaphragm at left sternal border while patient leaning forward); jugular venous pressure (JVP)—assess internal jugular vein (preferred over external), angle of Louis (sternal angle) reference point (normal 4 cm above sternal angle), elevated JVP (right heart failure, fluid overload, pulmonary hypertension, SVC syndrome, cardiac tamponade, constrictive pericarditis); hepatojugular reflux (apply firm pressure to RUQ for 30-60 seconds—sustained JVP elevation 4cm indicates right heart failure); carotid artery assessment—palpation (one at a time, avoid excessive pressure—vagal response/bradycardia, auscultate for bruits (carotid stenosis)); Peripheral Vascular Assessment (upper extremities—inspection (size, symmetry, edema (pitting vs non-pitting, grading), color (pallor, cyanosis, erythema), nail beds (capillary refill 2-3 seconds), venous patterns (varicose veins), scars, lesions); palpation—temperature (coolness—arterial insufficiency, warmth—inflammation/infection), capillary refill, turgor, edema; pulses—radial, ulnar, brachial (rate, rhythm, amplitude (0 absent, +1 diminished, +2 normal, +3 increased, +4 bounding), symmetry); Allen test (ulnar artery patency before radial artery puncture); lower extremities—inspection (size, symmetry, edema (pedal edema—right heart failure, venous insufficiency, liver disease, medications), color (pallor on elevation—arterial insufficiency, rubor/dependent rubor with dependency—reactive hyperemia), hair distribution (decreased in arterial insufficiency), skin (shiny, thin, dry—arterial), stasis changes (brown discoloration, hemosiderin deposition—chronic venous insufficiency), ulcerations (arterial ulcers—punched out, distal, painful; venous ulcers—shallow, irregular, medial malleolus, less painful), scars, lesions, varicose veins, spider veins); palpation—temperature (cool—arterial; normal/warm—venous), edema (grading 1+ (2mm trace) to 4+ (8mm severe)), pulses—femoral, popliteal, dorsalis pedis, posterior tibial (rate, rhythm, amplitude, symmetry); capillary refill (toes 2-3 seconds); venous assessment—homans sign (dorsiflex foot with knee extended—calf pain suggests DVT—low sensitivity/specificity, not recommended as sole diagnostic tool), calf circumference measurement (unilateral swelling—DVT), palpable cord (thrombosed superficial vein); peripheral arterial disease (PAD)—claudication (muscle pain/cramping with exercise, relieved by rest), critical limb ischemia (rest pain, nonhealing ulcers, gangrene); chronic venous insufficiency (CVI)—dependent edema, stasis dermatitis, venous stasis ulcers, lipodermatosclerosis); Breasts and Axillae Assessment (breast anatomy—tail of Spence (axillary tail), areola, nipple (supernumerary nipples, retraction, discharge, Paget's disease—eczematous changes), breast tissue (glandular/fibrous/fatty), Cooper's ligaments (suspensory ligaments—peau d'orange appearance when infiltrated by tumor), lymphatics (axillary nodes—pectoral (anterior), subscapular (posterior), lateral (brachial), central, infraclavicular, supraclavicular); inspection—size, symmetry, contour (mass, dimpling, retraction, peau d'orange), skin (color, texture, lesions, venous patterns, edema); nipple (direction (retracted, inverted, deviated), discharge (color, consistency, spontaneous vs expressed), crusting, rash (Paget's)); arm movement (raise arms overhead, push hands on hips, press hands together—assess for dimpling/retraction); positioning (supine with arm above head for examination, sitting for upper outer quadrant and tail of Spence); palpation—using finger pads, small circular motions, three levels of pressure (light, medium, deep), systematic pattern (vertical strip pattern recommended, or concentric circles, or radial spokes); breast tissue (nodularity, masses—characterize: location, size, shape (oval, round, irregular), consistency (soft, firm, hard, rubbery, cystic), delineation (discrete vs ill-defined), mobility (mobile vs fixed to skin or chest wall), tenderness); nipple—palpate for discharge (apply gentle pressure), retraction; axillae—palpate for lymph nodes (pectoral, subscapular, lateral, central) (size, consistency, mobility, tenderness); male breast examination (gynecomastia—smooth, firm, mobile disc of tissue under areola, usually bilateral; differentiate from breast cancer (unilateral, hard, fixed, irregular)); Abdomen Assessment (abdominal quadrants (RUQ, LUQ, RLQ, LLQ) and nine regions (right/left hypochondriac, epigastric, right/left lumbar, umbilical, right/left iliac/inguinal, hypogastric/suprapubic); surface landmarks—xiphoid process, costal margins, iliac crests, anterior superior iliac spines (ASIS), symphysis pubis, umbilicus; abdominal organs—RUQ (liver, gallbladder, duodenum, head of pancreas, right kidney, colon (hepatic flexure)); LUQ (stomach, spleen, left kidney, pancreas (body/tail), colon (splenic flexure)); RLQ (appendix, cecum, right ovary/tube (female), right ureter); LLQ (sigmoid colon, left ovary/tube (female), left ureter); epigastric (stomach, pancreas, duodenum, liver); periumbilical (small intestine, transverse colon, aorta, lymph nodes); hypogastric (bladder, uterus (pregnant), sigmoid colon, rectum); inspection—contour (flat, rounded/scaphoid (sunken—malnutrition, dehydration), protuberant/distended—gas, fluid (ascites), mass, obesity, pregnancy); symmetry (bulges, masses); skin (color, striae (stretch marks), scars (location, characteristics), lesions, veins (caput medusae—portal hypertension), rashes); umbilicus (inverted vs everted, position, discharge, hernia); pulsations (aortic—visible in thin patients); peristalsis (visible waves—intestinal obstruction); auscultation (perform before palpation/percussion to avoid altering bowel sounds)—bowel sounds (frequency (normal 5-30 per minute, hypoactive (5/min), absent (none after 2-3 minutes listening in each quadrant), hyperactive/hyperperistalsis (high-pitched tinkling/rushing—diarrhea, early obstruction)); vascular sounds (aortic bruit (AAA, stenosis), renal artery bruit (renovascular hypertension), iliac/femoral bruits, venous hum (portal hypertension), friction rub (liver/spleen—tumor, infarction)); percussion—general tympany (air/gas—normal), dullness (solid organs—liver, spleen, masses, fluid—ascites); liver span (percuss liver dullness from lung resonance to liver dullness (upper border) to liver dullness to tympany (lower border)—normal 6-12cm midclavicular line); splenic dullness (6th-10th rib posterior axillary line); shifting dullness (test for ascites—patient supine, percuss midline tympany to flank dullness, patient rolls onto side, previously dull area becomes tympanic if ascites present); fluid wave (test for ascites—patient or assistant presses hand midline, tap one flank, palpate wave on opposite flank—positive wave indicates ascites); bladder percussion (dullness above symphysis pubis indicates distended bladder); palpation—light palpation (1-2 cm depth, assess tenderness, guarding, masses, pulsations); deep palpation (4-5 cm depth, assess organ size, deep masses, aortic pulsation (normal 2.5-3cm width—3cm suggests AAA)); rebound tenderness (Blumberg sign—pain upon release of palpating hand—peritoneal inflammation, peritonitis, appendicitis); Murphy sign (palpate RUQ during inspiration—pain and inspiratory arrest—cholecystitis); Rovsing sign (palpate LLQ causes pain in RLQ—appendicitis); psoas sign (pain with right hip extension or flex patient against resistance—appendicitis (psoas muscle irritation)); obturator sign (pain with internal rotation of flexed right hip—appendicitis (obturator muscle irritation)); liver palpation (place right hand below costal margin, left hand behind patient lifting upward, ask patient to take deep breath, feel for liver edge (normal—smooth, firm, non-tender, 1-2cm below costal margin)); spleen palpation (approach from lower left abdomen toward LUQ, patient supine or right side-lying with left knee flexed, ask patient to take deep breath—spleen not normally palpable (if palpable, splenomegaly)); kidney palpation (bimanual—capture kidney between anterior and posterior hands, ask patient to take deep breath—right kidney may be palpable (lower pole) in thin patients, left kidney rarely palpable); bladder palpation (dome-shaped suprapubic mass—urinary retention); abdominal masses (location, size, shape, consistency, tenderness, pulsation, mobility); Male Genitourinary Assessment (penis—inspection (skin (color, lesions, hygiene), glans (erythema, discharge, lesions—condylomata, chancre—syphilis, carcinoma), meatus (location, discharge, stenosis), shaft (palpate for nodules, plaques (Peyronie's disease—curvature with erection)); foreskin (uncircumcised—retract to assess glans, phimosis (inability to retract), paraphimosis (inability to reduce retracted foreskin—emergency)); scrotum—inspection (size, symmetry, shape, skin (color, lesions, swelling, transillumination (hydrocele—transilluminates, hernia/ tumor—does not transilluminate)), normal left testicle hangs lower); palpation—testes (normal oval, smooth, firm, rubbery, uniform consistency, 3-5cm length), epididymis (posterolateral, soft, comma-shaped), spermatic cord (smooth, nontender), inguinal canal (palpate for hernia (ask patient to bear down/Valsalva) — indirect inguinal hernia (protrudes through internal ring, may descend into scrotum) vs direct inguinal hernia (through Hesselbach's triangle, does not descend into scrotum)); cremasteric reflex (stroke inner thigh—testicle elevates—L1-L2); testicular self-examination education; Female Genitourinary Assessment (external genitalia—inspection (mons pubis (hair distribution, lesions), labia majora/minora (symmetry, color, lesions, masses, Bartholin cysts/abscesses), clitoris (size, lesions), urethral meatus (location, discharge, caruncle (benign polypoid growth in postmenopausal women)), vaginal introitus (discharge, lesions, cystocele (anterior vaginal wall bulge—bladder prolapse), rectocele (posterior vaginal wall bulge—rectal prolapse)); bimanual examination (sterile gloves, lubricant)—vaginal walls (masses, tenderness), cervix (position, size, shape, os (opening—nulliparous small round, parous slit-like), discharge, lesions, cervical motion tenderness (chandelier sign—pelvic inflammatory disease, ectopic pregnancy)), uterine palpation (size (normal 6-10cm, pear-shaped), position (anteverted/retroverted/anteflexed/retroflexed), shape, consistency (firm), mobility, tenderness); adnexal palpation (ovaries (normal 3x2x1cm, almond-shaped, slightly tender), fallopian tubes (normally not palpable), masses (size, location, consistency, tenderness); speculum examination (select appropriate size speculum)—cervical visualization (Pap smear collection (ectocervix, endocervix—cytology), HPV testing), cervical cultures; Musculoskeletal Assessment (temporomandibular joint (TMJ)—inspection (swelling, asymmetry, deviation with opening), palpation (tenderness, crepitus), ROM (opening, protrusion, lateral deviation); cervical spine—ROM (flexion (chin to chest—45°), extension (look up—45°), lateral bending (ear to shoulder—45°), rotation (chin to shoulder—70°)); muscle strength testing (CN XI); shoulder—inspection (symmetry, swelling, atrophy, scapular winging), ROM (flexion (180°), extension (50°), abduction (180°), adduction (50°), internal rotation (90°), external rotation (90°)), special tests (rotator cuff—empty can test (supraspinatus), Neer impingement sign, Hawkins-Kennedy test, apprehension test (anterior instability)); elbow—inspection (carrying angle (5-15° valgus), swelling, nodules (rheumatoid—rheumatoid nodules, gouty tophi)), ROM (flexion (160°), extension (0°), supination (90°), pronation (90°)); wrist and hand—inspection (swelling, deformity (boutonnière, swan neck—RA), ganglion cysts, Heberden nodes (DIP—OA), Bouchard nodes (PIP—OA)), ROM (flexion (90°), extension (70°), radial deviation (20°), ulnar deviation (55°)), special tests (Phalen test (flex wrists for 60 seconds—numbness/tingling—carpal tunnel syndrome), Tinel sign (tap median nerve at wrist—tingling into hand—carpal tunnel syndrome), Finkelstein test (pain with ulnar deviation of flexed thumb—De Quervain tenosynovitis)); hip—inspection (gait (antalgic, Trendelenburg), symmetry, leg length discrepancy), ROM (flexion (120° knee bent, 90° straight leg), extension (30°), abduction (40°), adduction (25°), internal rotation (45°), external rotation (45°)), special tests (Trendelenburg test (stand on one leg—pelvis drops on unsupported side—gluteus medius weakness), Thomas test (flex opposite hip to flatten lumbar spine—fixed flexion contracture if thigh rises off table)); knee—inspection (swelling (effusion—ballottement, bulge sign), alignment (genu varum (bowlegged), genu valgum (knock-kneed)), atrophy (quadriceps), scars), ROM (flexion (135°), extension (0° hyperextension 5-10°)), special tests (anterior drawer (ACL), posterior drawer (PCL), Lachman (ACL), McMurray (meniscal tear—pain/click with rotation), valgus stress (MCL), varus stress (LCL), patellar apprehension (patellar instability), ballottement of patella (effusion—fluid wave displaces patella away from femur)); ankle and foot—inspection (alignment (hindfoot varus/valgus, midfoot arch—pes planus (flatfoot), pes cavus (high arch)), swelling, deformities (hallux valgus (bunion), hammertoe, claw toe, mallet toe), skin (calluses, ulcers, nail changes)), ROM (dorsiflexion (20°), plantarflexion (50°), inversion (35°), eversion (25°)), special tests (anterior drawer (ATFL—ankle instability), Thompson test (squeeze calf—foot plantarflexes—if absent, Achilles tendon rupture)); spine—inspection (curvature (kyphosis, lordosis, scoliosis—forward bend test for rib hump), symmetry (shoulder/scapula/iliac crest heights), gait); ROM (lumbar flexion (80°), extension (30°), lateral bending (35°)); Neurological Assessment (mental status (already covered in general survey/psychiatric—level of consciousness (alert, lethargic, obtunded, stupor, coma), orientation (person, place, time, situation), attention/concentration (serial 7s, spell "WORLD" backward), memory (immediate (repeat 3 words), short-term (recall 3 words at 5 minutes), long-term (past events)), language (aphasia—Broca's (expressive), Wernicke's (receptive), global, anomic), speech (dysarthria—motor speech disorder), constructional ability (draw a clock, copy intersecting pentagons), executive function (similarities, proverbs)); cranial nerves—CN I (olfactory)—not routinely tested; CN II (optic)—visual acuity (Snellen), visual fields by confrontation, fundoscopic exam; CN III, IV, VI (oculomotor, trochlear, abducens)—PERRLA, EOMs (six cardinal fields of gaze), nystagmus, ptosis (CN III); CN V (trigeminal)—motor (masseter/temporalis strength—jaw clench, lateral jaw movement), sensory (light touch to forehead (V1—ophthalmic), cheek (V2—maxillary), jaw (V3—mandibular)), corneal reflex (afferent CN V, efferent CN VII—blink); CN VII (facial)—motor (smile, frown, raise eyebrows, show teeth, puff cheeks, close eyes tightly), taste (anterior 2/3 of tongue—rarely tested); CN VIII (vestibulocochlear/acoustic)—hearing (whisper test, Weber, Rinne), balance (Romberg, gait); CN IX (glossopharyngeal) and CN X (vagus)—gag reflex (afferent CN IX, efferent CN X), swallow, voice quality (hoarseness—CN X), palate elevation (say "ah"—uvula midline); CN XI (spinal accessory)—shoulder shrug (trapezius), head turn against resistance (SCM); CN XII (hypoglossal)—tongue movement (protrusion (midline deviation indicates CN XII lesion), side-to-side); motor system—inspection (muscle bulk (atrophy, hypertrophy, fasciculations), tone (normal, spasticity (increased—UMN lesion), rigidity (cogwheel/lead pipe—Parkinson's), flaccidity (decreased—LMN lesion)), strength grading (0/5 no contraction, 1/5 flicker, 2/5 movement without gravity, 3/5 movement against gravity only, 4/5 movement against some resistance (weak), 5/5 normal strength); test major muscle groups (upper extremity—deltoid (shoulder abduction—C5, axillary), biceps (elbow flexion—C5-C6, musculocutaneous), triceps (elbow extension—C6-C8, radial), wrist extensors/flexors (C6-C8, radial/median/ulnar), grip strength, finger abductors/adductors; lower extremity—iliopsoas (hip flexion—L2-L3, femoral), quadriceps (knee extension—L3-L4, femoral), hamstrings (knee flexion—L5-S2, sciatic), dorsiflexors (ankle dorsiflexion—L4-L5, deep peroneal), plantarflexors (ankle plantarflexion—S1-S2, tibial)); coordination—cerebellar function (finger-to-nose, rapid alternating movements (RAMs—pronation/supination of hands), heel-to-shin, gait (tandem gait—heel-to-toe), Romberg test (stand feet together, eyes closed—swaying indicates positive Romberg—proprioception/vestibular/cerebellar dysfunction)); sensory system—light touch (cotton wisp), pain (sharp/dull—pin prick), temperature (cool/warm—test tube), vibration (tuning fork (128Hz)—over bony prominence (great toe, malleolus, tibia, patella, ASIS, finger, wrist, elbow, clavicle, sternum)), proprioception (position sense—move patient's toe up/down, patient identifies direction), discrimination (stereognosis (identify object in hand), graphesthesia (identify number traced on palm), two-point discrimination); reflexes—deep tendon reflexes (DTRs)—scale (0 absent