Week 3: Neurologic, Musculoskeletal, and Cardiopulmonary Assessment
11 unread reply.6464 replies.
Using a friend, family member, or colleague, perform a neurovascular (include all cranial nerves),
musculoskeletal, and cardiopulmonary (includes the heart, lungs, and peripheral vasculature) exam.
Document the physical examination findings in the SOAP note format.
Even though your patient may have abnormal findings, you must document the expected normal exam
findings for the system. If you would like to include the abnormal findings they should be noted in
parenthesis next to the normal expected findings. The complete subjective and objective sections must
be included. You may include the assessment and plan portion of the SOAP note, but these sections will
not be graded.
You should devise a chief complaint so that you may document the OLDCART (HPI) data. You must use
the chief complaint of headache, back pain, and cough. You should also focus the ROS based on the
patient’s chief complaint and the body systems being examined. Refer to the SOAP Note Format
document in Course Resources as necessary. This will be the same format that faculty will follow during
the immersion weekend.
* There are videos of the exams to be performed at immersion in Modules → Introduction and
Resources→ Immersion section. Also the immersion evaluation forms are located in the Course
Resources section. They should be reviewed and practiced often.
This topic was locked Jul 23 at 11:59pm.
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Tiffany Lunsford
Tiffany Lunsford
Jul 16, 2017Jul 16 at 7:20pm
Manage Discussion Entry
Class, Welcome to week Three! This week, we are focusing on neurological, musculoskeletal and
cardiopulmonary exams. Please follow the discussion question and grading rubric closely, I have also
posted additional helpful guidance. Please remember what goes in the ROS (Subjective) vs. the Physical
Exam (Objective).
Here are the following course outcomes to assist in focusing this week:
,3: Demonstrate knowledge required to perform a focused health history and examination for
developmental, gender-related, age-specific, and special populations. (PO 1, 5)
6: Differentiate normal from abnormal findings. (PO 1, 4)
8: Adapt history and physical examination to the needs of the patient, i.e., pediatric versus geriatric
patient (PO 1,4,7)
Class, I wish to give some extra guidance to practicing, performing the assessments and posting your
assessment for Neurological, Musculoskeletal and Cardiopulmonary systems. These systems should
include detail of what all findings (normal or if your patient is with abnormal findings) would include for
each of the assigned systems.
When assessing the neurological system one area for example of detail would be cranial nerves which
should include listing each one of them with some identification that shows that you know the
assessment test for each cranial nerve. This detail should also be applied to other aspects of the
Neurological examination such as finger to nose, heel to shin test, reflexes, level of consciousness, motor
function etc…many more to include…please refer to both texts for other areas to be included.
Cranial Nerve example (not all inclusive): no deficit to sense of smell (Olfactory CN1) upon the patient
patent nares through ability of sniffing bilateral nares, able to identify odors such as coffee and
peppermint.
For Musculoskeletal, it goes beyond inclusion of range of motion and should include all maneuvers that
show no deficits/deficits (upper and lower extremities, cervical spine- as well as other aspects of the MS
exam).
MS example (not all inclusive): ballottement, bulge sign, phalen test, ROM all areas (with degrees),
McMurray, valgus, drawer, noted or not noted Genu varum etc…..please refer to both texts for other
areas to be included.
Cardiovascular example (not all inclusive): physical exam to the thorax, lungs, and vascular system. Many
of you will be more comfortable with these areas because you have been wielding a stethoscope for
some time. However, learning things like whispered pectoriloquy and broncophony (not all inclusive
items to include) take practice.
Please ensure to read assigned readings and watch the video for this week. Doing this assignment in
such detail will help at Immersion weekend when you have to show knowledge of these assessments
and how to perform each test!
Note about diagnosis/differential diagnoses: the primary diagnosis should be included in the assessment
while if there are any other differential diagnoses being considered; students should list them in the
treatment plan.
Dr. Lunsford
Collapse SubdiscussionSarah Gray
,Sarah Gray
Jul 17, 2017Jul 17 at 3:16pm
Manage Discussion Entry
Dr. Lunsford and Classmates
Patient Information:
JNG,38, Male, Caucasian, United Healthcare
S.
CC “Headache, back pain and cough”
HPI:
Headache:
Onset: 1 week ago
Location: temporal area
Duration: on and of
Characteristics: throbbing and pressure feeling behind eyes
Aggravating Factors: reading and too much screen time
Relieving Factors: dark and quit room
Treatment: ibuprofen
Back pain:
Onset: 3 weeks ago
Location: Lumbar area both side of spine
Duration: present most of the time, worse in the morning
Characteristics: ache tight feeling, difficult to bend over at times, non-radiating
Aggravating Factors: sedentary time
Relieving Factors: going for a walk and stretching
Treatment: ibuprofen
Cough:
Onset: 3 days ago
Location: chest
Duration: on and of throughout day
, Characteristics: dry nonproductive, self-limiting
Aggravating Factors: talking too much
Reliving Factors: rest and hydration
Treatment: none
Current Medications:
Nexium 2o mg daily for acid reflux
Chantix 0.5 mg per day for smoking cessation with 2 weeks left
o Ibuprofen 400 mg every 6 hours as needed for back pain and headache
Allergies: no known allergies to food or drugs and no know allergy to a specific environmental allergy.
PMHx:
o questionable GERD with no official diagnosis
o appendectomy 30 years ago
o wisdom teeth removed approx. 20 years ago
o positive history of chicken pox, no other hospitalizations,
o hepatitis B vaccine up to date, unknown last DTap
o refused flu vaccine
o high school graduate
o every 6 month dental cleanings
o
Soc Hx: JNG is a waiter at a restaurant and a culinary arts student, playing guitar and writing music are
JNG hobbies, rescued a puppy one year ago, he is a recovering alcoholic for 4 years and is working
toward quitting smoking with Chantix, no other elicit drugs, JNG is married with no children, JNG states
dinking an adequate amount of water and eats a healthy diet including fruits and vegetables, JNG used
to run 3 miles 4 days a week but is no longer able to. He wears his seatbelt all the time, He lives in an
apartment and smoke detectors and co2 detectors are in working order. JNG is red headed, fair
complexion and has many freckles and regular use of sunscreen encouraged.
Fam Hx:
o paternal grandfather: Barrett’s esophagus, PVD with amputation
11 unread reply.6464 replies.
Using a friend, family member, or colleague, perform a neurovascular (include all cranial nerves),
musculoskeletal, and cardiopulmonary (includes the heart, lungs, and peripheral vasculature) exam.
Document the physical examination findings in the SOAP note format.
Even though your patient may have abnormal findings, you must document the expected normal exam
findings for the system. If you would like to include the abnormal findings they should be noted in
parenthesis next to the normal expected findings. The complete subjective and objective sections must
be included. You may include the assessment and plan portion of the SOAP note, but these sections will
not be graded.
You should devise a chief complaint so that you may document the OLDCART (HPI) data. You must use
the chief complaint of headache, back pain, and cough. You should also focus the ROS based on the
patient’s chief complaint and the body systems being examined. Refer to the SOAP Note Format
document in Course Resources as necessary. This will be the same format that faculty will follow during
the immersion weekend.
* There are videos of the exams to be performed at immersion in Modules → Introduction and
Resources→ Immersion section. Also the immersion evaluation forms are located in the Course
Resources section. They should be reviewed and practiced often.
This topic was locked Jul 23 at 11:59pm.
Search entries or author Filter replies by unread Unread Collapse replies Expand replies
Subscribed
Tiffany Lunsford
Tiffany Lunsford
Jul 16, 2017Jul 16 at 7:20pm
Manage Discussion Entry
Class, Welcome to week Three! This week, we are focusing on neurological, musculoskeletal and
cardiopulmonary exams. Please follow the discussion question and grading rubric closely, I have also
posted additional helpful guidance. Please remember what goes in the ROS (Subjective) vs. the Physical
Exam (Objective).
Here are the following course outcomes to assist in focusing this week:
,3: Demonstrate knowledge required to perform a focused health history and examination for
developmental, gender-related, age-specific, and special populations. (PO 1, 5)
6: Differentiate normal from abnormal findings. (PO 1, 4)
8: Adapt history and physical examination to the needs of the patient, i.e., pediatric versus geriatric
patient (PO 1,4,7)
Class, I wish to give some extra guidance to practicing, performing the assessments and posting your
assessment for Neurological, Musculoskeletal and Cardiopulmonary systems. These systems should
include detail of what all findings (normal or if your patient is with abnormal findings) would include for
each of the assigned systems.
When assessing the neurological system one area for example of detail would be cranial nerves which
should include listing each one of them with some identification that shows that you know the
assessment test for each cranial nerve. This detail should also be applied to other aspects of the
Neurological examination such as finger to nose, heel to shin test, reflexes, level of consciousness, motor
function etc…many more to include…please refer to both texts for other areas to be included.
Cranial Nerve example (not all inclusive): no deficit to sense of smell (Olfactory CN1) upon the patient
patent nares through ability of sniffing bilateral nares, able to identify odors such as coffee and
peppermint.
For Musculoskeletal, it goes beyond inclusion of range of motion and should include all maneuvers that
show no deficits/deficits (upper and lower extremities, cervical spine- as well as other aspects of the MS
exam).
MS example (not all inclusive): ballottement, bulge sign, phalen test, ROM all areas (with degrees),
McMurray, valgus, drawer, noted or not noted Genu varum etc…..please refer to both texts for other
areas to be included.
Cardiovascular example (not all inclusive): physical exam to the thorax, lungs, and vascular system. Many
of you will be more comfortable with these areas because you have been wielding a stethoscope for
some time. However, learning things like whispered pectoriloquy and broncophony (not all inclusive
items to include) take practice.
Please ensure to read assigned readings and watch the video for this week. Doing this assignment in
such detail will help at Immersion weekend when you have to show knowledge of these assessments
and how to perform each test!
Note about diagnosis/differential diagnoses: the primary diagnosis should be included in the assessment
while if there are any other differential diagnoses being considered; students should list them in the
treatment plan.
Dr. Lunsford
Collapse SubdiscussionSarah Gray
,Sarah Gray
Jul 17, 2017Jul 17 at 3:16pm
Manage Discussion Entry
Dr. Lunsford and Classmates
Patient Information:
JNG,38, Male, Caucasian, United Healthcare
S.
CC “Headache, back pain and cough”
HPI:
Headache:
Onset: 1 week ago
Location: temporal area
Duration: on and of
Characteristics: throbbing and pressure feeling behind eyes
Aggravating Factors: reading and too much screen time
Relieving Factors: dark and quit room
Treatment: ibuprofen
Back pain:
Onset: 3 weeks ago
Location: Lumbar area both side of spine
Duration: present most of the time, worse in the morning
Characteristics: ache tight feeling, difficult to bend over at times, non-radiating
Aggravating Factors: sedentary time
Relieving Factors: going for a walk and stretching
Treatment: ibuprofen
Cough:
Onset: 3 days ago
Location: chest
Duration: on and of throughout day
, Characteristics: dry nonproductive, self-limiting
Aggravating Factors: talking too much
Reliving Factors: rest and hydration
Treatment: none
Current Medications:
Nexium 2o mg daily for acid reflux
Chantix 0.5 mg per day for smoking cessation with 2 weeks left
o Ibuprofen 400 mg every 6 hours as needed for back pain and headache
Allergies: no known allergies to food or drugs and no know allergy to a specific environmental allergy.
PMHx:
o questionable GERD with no official diagnosis
o appendectomy 30 years ago
o wisdom teeth removed approx. 20 years ago
o positive history of chicken pox, no other hospitalizations,
o hepatitis B vaccine up to date, unknown last DTap
o refused flu vaccine
o high school graduate
o every 6 month dental cleanings
o
Soc Hx: JNG is a waiter at a restaurant and a culinary arts student, playing guitar and writing music are
JNG hobbies, rescued a puppy one year ago, he is a recovering alcoholic for 4 years and is working
toward quitting smoking with Chantix, no other elicit drugs, JNG is married with no children, JNG states
dinking an adequate amount of water and eats a healthy diet including fruits and vegetables, JNG used
to run 3 miles 4 days a week but is no longer able to. He wears his seatbelt all the time, He lives in an
apartment and smoke detectors and co2 detectors are in working order. JNG is red headed, fair
complexion and has many freckles and regular use of sunscreen encouraged.
Fam Hx:
o paternal grandfather: Barrett’s esophagus, PVD with amputation
