:

: : : :

.
.

MP3
history taking techniques tricks
( ) how to deal with

such cases .
( )
.
.
OSCE STATION

INNOVATION : FACEBOOK

facebook.com/groups/ INNOVATION.AZHARMED

Abo El Asrar Clinical Pediatrics

:

history taking History antenatal Natal neonatal period

( )
activites
75%
activity





activity


( )





research

research
research data show



end round exam


stations
stations
stations examiner

observe

history
examination
x-ray

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stations clinical sense

stations 2stations history

2stations examination
2 stations X-ray
History





X-ray


history

stop watch


within three minutes stations
examination

.... comment
examination
Paper

examiner finding
data

stations


stations examiner Switched off
observer
examiner
examination

Page |3

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examination examiner


....

examiner

....

diagnosis
history


examiner

history personal history

personal history
complaint
history of present illness
disease

history of present illness !!!!!

Past history

past history antenatal history Intra utrine
full sheet
antenatal history

Page |4

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antenatal history :
fever and rash
Infection STORCH infection
S for syphilis
T for toxoplasma
R for rubella
C for cytomegalo virus
H for herpes
epstein-barr virus others HIV and Hepatitis


teratogenesis
teratogenesis
drugs Irradiation
teratogenesis malformation baby

chronic disease
Maternal disease

antenatal history
antenatal history

antenatal history History
fever and rash .1
.2 teratogenesis
.3 maternal diseases
??



..
facial expression
X-ray

facial expression

( )
( )

Page |5

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: ( )
( ) ( ........ )

...



history

:


...
( )










(
)

stations


antenatal

(
)




: (
)

:

Page |6

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:
: ...

rash
:
.... .... STORCH infection
..... STORCH STORCH
:

: sore throat
sore throat
: ..
fever
:

fever fever


:

: ....
:


:




...
3rd
first trimester second
first trimester teratogenesis
last trimester Post natal defect
... malformation
... bleeding tendency

Malformation
teratogenesis 3

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...

:








: ... ...


irridation

...
...
:

:
no history of maternal disease during this stage

antenatal history

...

....
:
:
:

:

: rash
fever
:



:

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:
:
:

:
( )

:
:
: ...


:
Maternal disease

there is no history of fever and rash , there is history of exposure to teratogenesis

..... History of maternal disease


....

antenatal history
antenatal history

How to deal

( :::: ,
::: )
once ...

natal history

Natal history

Page |9

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site of delivery

( ) ..

Infection
Infection neonatal sepsis

vaginal delivery cesarean section

... vaginal
duration
Prolonged labor asphyxia cerebral anoxia
: .... method
: history of birth truma

: Onset of first cry ...
central hypoxia Neonatology
cyanosis
cesarean section Indication of cesarean section cesarean section

....
sever hypertension ... toxemia of pregnancy

cesarean section vaginal resuscitation

ventilator


full term Preterm




( )



:
:

:

:
:
....

P a g e | 10

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Infection premature rupture of membrane
sac aminonitic fluid
sac complelelty sterile
sac maximum 12
sac 18 18
Infection vagina a neuritis neonatal sepsis


:

: ...

12
Premature rupture of the membrane

( )

!!!!!


18 Infection premature rupture of the membrane

Once termination


Infection

:

12
, 12
utrine contraction separation of the placenta
Hypoxia
12
: ....

( )

P a g e | 11

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Abo El Asrar Clinical Pediatrics

: ...
( )








:



: 1,800 -1,900 2.5
birth weight

full term
pre term

Indication of cesarean section
full term
pre term
cesarean section !!!!
( )

delivered at hospital by doctor , there is no history of infection or

premature rupture of membrane , vaginal delivery and duration
No tools used vaginal delivery
No history of birth truma
Onset of first cry
cyanosis Resuscitation birth weight
full term preterm
comment
3-3.5 normal birth weight

P a g e | 12

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Abo El Asrar Clinical Pediatrics

neonatal history
( )


( )

( (
) ....
.... ( ....
) )

neonatal history
neonatal history
neonatal 28
Neonatal period
neonatal period

points Neonatal history

... History of jaundice neonatal jaundice

convulsion Neonatology
bleeding
respiratorydistress
admission to Neonatal intensive care unit NICU

History of jaundice or convulsion bleeding

respiratory distress admission to NICU




:
:
: ...
(
)


... ...

:
:
:
physiological jaundice
: ... ...

P a g e | 13

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: ... photo therapy

NICU

: Rh
Rh incompatibility


:
:
:
:
:
epilepsy
convulsion
:

convulsion

: :


( )Lol

:
:

Hemophilia
bleeding bleeding







: ... duration

neonatal history
history of physiological jaundice

P a g e | 14

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Abo El Asrar Clinical Pediatrics

No history of convulsion, no history of bleeding tendency , no history of respiratory distress

history of admission to NICU

NICU

NICU

cerebral palsy
sequelae
History of jaundice and admitted to NICU and received phototherapy

physiological jaundice
physiological
NICU NICU

direct hyperbilirubinemia
golden yellow in direct

.... Obstructive
indirect
dietic history




dietic history



:
:
:



:



one side or two sides

P a g e | 15

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Abo El Asrar Clinical Pediatrics

On need On need



On need

:
:
:



:
....




minimum




satisfied or not
:
:
:
:
:
:
:
:

Intake

polyurea diarrhea



sever dehydration


Obese

diarrhea

P a g e | 16

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:
:
:

:

:
:

oliguria under feeding constipation under feeding
poly uria diarrhea Over feeding

:


:
:
:
Under
:









:
:
:
: ( )



diluation
:

P a g e | 17

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:

Over diluation
:
concentrated formeula

100

:

:




sterilization


( )
sterilization
:

contamination


age

( ) 180
8 100 + 10 180

( )

powder milk

P a g e | 18

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Abo El Asrar Clinical Pediatrics

F 60
60



F 30





30


8 100 + 10 180
120
Mursmus


concentration

: 120
120

( )

120
diluted
diluted
180


:
frequency

P a g e | 19

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Abo El Asrar Clinical Pediatrics

:
:
:

Under feeding

complementary P
:


supplementary
supplementary

artificial milk
weaning
: ........
weaning
: .........

Developmental Milestones
Social & Language



vocalization vocal cords




Bubbling
( ... .....
)
DoubleBubbling

... :

P a g e | 20

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Abo El Asrar Clinical Pediatrics

....



...
...
...



( )


electronics

electronics
( ) :
: ....




...
...
..
:KG1


....

..
!!!!!



:

P a g e | 21

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Abo El Asrar Clinical Pediatrics

mental growth
( )
5
automatic bladder
automatic bladder evacuation of the bladder rectum

conditioned reflex
conditioned reflex

!! !! ( )
buttocks

control
control Order bladder









ascending fibers maturation
aware bladder full suppression
bladder

Oriented control
control




:

P a g e | 22

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Abo El Asrar Clinical Pediatrics

( )







developmental history






:

neck support
:


:

supported
:


:

:
.... !!!!!
:


( )

P a g e | 23

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( )

mental

social

Mental

sphincteric control
stool
developmental history

P a g e | 24

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Abo El Asrar Clinical Pediatrics

examination
cranial staff
examination

:

Abdominal Examination
abdomen
Inspection of the abdomen station
Inspection of the abdomen
contour of the abdomen
flat abdomen scaphoid abdomen bulge
acute obtuse sternal angle
Pulsation pulsation epigastrium
umblicus umblicus
mid way shifted side down ward
flat or bulge
umblicus discharge
umbilical nodule

skin
skin
dilated tortuous vein o
scars o
abnormal pigmentation o
Purpura bleeding under the skin o
abnormal rash o

divercation of recti
Umblicus Inguinal region
Hernia
genitalia

superficial palpation
Mass regedity tenderness superficial palpation
extra abdominal intra mass

palpation Inspection hernia

umblicus
kidney spleen Liver palpation

P a g e | 25

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Abo El Asrar Clinical Pediatrics

renal splenomegaly hepatomegaly

percussion of the abdomen

( )


examination skull
rickets

P a g e | 26

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General Examination
EXAMINATION OF THE HEAD
SHAPE

brachycephaly antero posterior


plagiocephaly
abnormal shape abnormal shape

fontanelle examination of the head

fontanelle
anterior fontanelle
fontanelle
suture
sutures
skull sutures
skull
Metopic suture suture .1
anterior fontanelle Metopic suture
coronal suture
sagittal suture
lambdoid suture
frontal bone , parietal bone , occipital bone
anterior fontanelle and posterior fontanelle

.2
.3
.4
.5

sutures
sutures suture Hydrocephalus

craniotabes
rickets
craniotabes sutures hydrocephalus
bone of the skull craniotabes

craniotabes

P a g e | 27

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fontanelle torch transillumination test
( )) / )
Macewen's sign
Macewen's sign sign percussion bone hydrocephalus sutures
fontanelle resonant
percussion

hydrocephalus
hydrocepalus dilated untortous scalp veins
scalp dilated veins scalp



...
...
ear
nose
mouth

No No

abnormality
.1 eye brow
outer third of the eye borwLost
outer third of the eye brow
Hypo thyrodism
.2 eye lashes
chronic toxemia T.B.
very long eye lashes
general
.3 puffiness
renal edema massive edema
renal edema
bilateral puffiness
=> unilateral puffiness
unilateral puffiness
.4 sunken eye

P a g e | 28

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sunken eye dehydration
.5 sclera
Jaundice
Jaundice
sclera
congenital glaucoma
osteogenesis imperfecta X-ray
osteogenesis imperfecta blue sclera
sub conjunctival hemorrhage
hemorrhage
bleeding tendency

.6 Pupil cataract
galactosemia
rickets
congenital rubella cataract
Light Pupil pupillary reaction
directindirect

.7

.... nystagmus
squint

.8 upper part of the corneacovered by upper eyelid

lower part of the cornea covered by the lower eye lid sunset appearance

Negative



... nystagmus
divergent squint
divergent squint and no abnormal finding in the eye

ear

P a g e | 29

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Abo El Asrar Clinical Pediatrics

.1 position of the ear
Normal
lateral canthus of the eye Occiput
tragus
tragus tragus tragus
normal position of the ear
Occiput tragus

Low set ear

.2 shape of the ear

malformed
.3 size ear


.4 discharge
ear

.5

nose
.1 nasal obstruction
.2 snoring

... unilateral or bilateral
mentallyawared
Mentally not awared compression
compression
Unilateral or bilateral
.3 nasal discharge
.4 nasal bridge
depressed nasal bridge prominent nasal bridge Normal

Mouth
Mouth

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.1 pallor Pallor
cyanosis cyanosis
.2 anomaly hare lip
.3 maceration
Maceration angle lip
lip

.4 Mouth odor
Mouth odor aceton odor DKA

.5



anomaly

.6 tongue throat

monillia
Oral thrush white coated tongue
scarlet fever white strawberry tongue
thorat

hair
comment
.1 black
.2 texture coarse hair
.3 integrity
( ) Normal integrity
kwashiorkor easy pickable hair
.4 anterior hair line
posterior hair line
anterior hair line normal
posterior hair line Normal
abnormal
cretinism anterior hair line

turner
low posterior hair line

hair black in color , coarse hair , normal intergrity , normal anterior and posterior

P a g e | 31

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hair line

examine head

skull examination
.1


forehead eye brow anterior hair line

Occiput
59.5
skull circumference 59.5

.2 shape of the skull

Large skull no specific shape
.3 fontanelle fontanelle
closed depression anterior fontanelle

.4 sutures
depression
closure

Metopic suture depression

sagittal suture
coronal suture depression
sutures closed depression
.5 craniotabes
craniotabes
craniotabes :
.6 Hair
full comment on skull
:
trans illumination test
... fontanelle closed

P a g e | 32

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Macewen's sign
percussion Index finger bone fontanelle
fontanelle
( )
divergent squint
abnormality
Nose snoring
bulbar affection
obstruction
One side
( ) I think
bulbar
snoring
bulbar

nasal discharge
nasal septum

ears
ear
lateral angle of the eye occiput
ear
low set ear
Low set ear
...
ear low set ear
ear discharge site
( )

Mouth
pallor
pallor cyanosis
dryness Lips
torch
abnormal

......
: shunt

P a g e | 33

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bypass CSF lateral ventricle Peritoneum
shunt scalp valves
shunt ventricluo peritoneum shunt hydro cephalus
Occiput most prominent part of the bone
15 chronic hemolytic anemia

head and examine it
examine face of the chronic hemolytic anemia

skull circumferences
( : )


skull circumference
15
fontanelle sutures


comment

jaundice
lower fornix jaundice
jaundice chronic hemolytic anemia
Liver affection biliary system affection
just Lower fornix compensation Liver
tinge of jaundice
Puffiness
no abnormal finding detected
Nose
depressed nasal bridge
nasal discharge snoring
bone zygomatic bone hyper active bone marrow Prominent
upper jaw
Hyper active bone marrow
upper jaw lower jaw
upper jaw prominent Lower jaw

Lips

P a g e | 34

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pallor
tongue

hemosidrosis
iron deposit skin
muddy coloration
Muddy collection pallor jaundice iron deposit
iron deposit
Iron deposit
inspection examination of the abdomen spleen
Hypersplenism spleen
scar splenoectomy
Liver abdominal examinatioin

examination of the head

skin examination
skin examination

LIMBS EXAMINATION
rickets
finding rickets rickets
rickets
bone medulla cortex
cortex and medulla
Medulla hematology
rickets cortex
cortex

protein part osteoid tissue
minerals parts Minerals parts calcium
protien part bone osteoporosis
mineral part bone osteomalacia rickets
rickets
minerals protein part
Mineral part

P a g e | 35

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rickets defective on mineralization
defect bone mineralization
Mineral part

rickets Mineral part


simple way

rickets
(
)
bone
bone bone

bone
bone

bone bone
bone


rickets bone deformity
bone deformities

rickets

( ) bowing bowing
trunk
bowing




gross motor development
....

genu valgum deformity
ankle ankle knee
2 knees

knock knee genu valgum deformity

P a g e | 36

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genu varum deformity
2 knees
genu varum deformity

tibia curvature
curve tibia
tibia curvature
lateral anterior curvature

ribs
bone ribs
diaphragm ribs
Lower part of the ribs all the time
sulcus groove .... ribs
Harrison's sulcus horizontal sulcus

ribs negative pressure of the thorax
longitudinal sulcus

Mineral part of the bone
Integrity of the bone

deformity

bone
osteoid tissue deposit suppression
excess protein deposit

Over protein
excess deposit soft tissue protien
Over deposition of protein
flat bone of the skull
pareital bossing frontal bossing
pareital bossing frontal bossing
Osteoid tissue deposit

box shaped skull

P a g e | 37

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Abo El Asrar Clinical Pediatrics

cartilage
cartilage
cartilage
Over growth of the cartilage cartilage proliferation
bone Over growth of the cartilage
Over growth of the cartilage
broadening
broadening ... cartilage
cupping X-ray
broadening cartilage proliferation cupping of the bone pressue

effect

broadening


tibia fibula
emberyology tibia medial malleolus
fibula lateral malleolus
malleoli 2 separate bones
cartilage
cartilage
proliferation of the cartilage tibia Medial malleolus
lateral malleolus fibula
broadening

groove groove
groove Marfan Marfan sign
Marfan sign
two points of growth in cartilage malleolus Lower shaft of the
tibiaLower shaft of the fibula


rickets



para thormone hormone
parathormone hormone compensation para thyroid hormone
para thyroid hormone serum calcium

rickets

P a g e | 38

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serum phosphate
adenosine triphosphate source of energy
ATP

ATP
muscles
muscle power ATP
generalized muscle weakness and hypotonia
delayed motor development generalized muscle weakness and hypotonia

growth motor development

Hypotonia


Organs ptosis hernia

kyphosis
kyphosis
correctable kyphosis
rickets

Marfan sign
medial and lateral malleolus
genu valgum deformity two knee
Paraietal bossing frontal bossing
still opened fontanelle fontanelle


delayed closure of the fontanelle
first molar
first molar
delayed dentation


rachitic rosary Lateral chest wall
retraction
Harrison's sulcus

kyphosis
kyphosis
Pot belly abdomen Umblical hernia

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Abo El Asrar Clinical Pediatrics

examine the extremities

Positive findings
extermities
Upper limb broadening
trunkbone deformity
lower limb Marfansign
Genu valgum deformity

clubbing
clubbing
color pallor jaundice cyanosis
pallor jaundice cyanosis
edema dorsum of the hand and the dorsum of the foot

edema
edema level Unilateral bilateral pitting non pitting
abnormalmovement chorea
abnormal movement tremors
temors
Purpura Ulcers scars


examine the extremities

P a g e | 40

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neck examination
lymph node examination duchenne myopathy

neurological examination

frame

NECK EXAMINATION
examine the neck
examination of the neck
goals examination of the neck
.1 shapeof the neck

.2
webbing
webbing fold of the skin
webbing syndrome
.3
neck pulsation
Pulsation neck
.4
swelling
swelling Neck
swelling
swelling thyroid swelling butterfly shaped
thyroglossal cyst hyoid bonecyst in the middle line
lymph node

examination of the neck

P a g e | 41

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shape of the neck

neck Normal shape
Down
Down short neck
examine the neck Down shape of the necknormal

webbing
no webbing
by inspection
pulsation swellings

pulsation
Pulsation Pulsation
arterial pulsation venous pulsation
Pulsation ( ) 45
venous pulsation Normal level of the clavicle

45
Neck
pulsation
( )
neck sterno mastoid muscle
pulsation
above the sterno mastoid muscle
pulsation arterial venous
arterial pulsation venous pulsation neck

arterial pulsation medial to sternomastoid
venous pulsation lateral to sternomastoid

arterial pulsation
venous wave



root of the neck
Pulsation venous
Pulsation arterial pulsation
neck
pulsation

P a g e | 42

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compression root of the neck
venous pulsation
arterial pulsation pulsation
swelling
swelling
thyroid
thyroglossal cyst
lymph node

neutral position

neck Inspection

thyroid swelling thyroid swelling swelling
thyroid swelling


protrosion of the tongue swelling
thyroglossal cyst swelling
thyroglossal cyst
thyroid swelling
surgical

lymph node
Lymph node
Lymph node of the neck


upper part of the sternum percussion
Index finger
bone direct
retro sterna goiter

....

retro sterna goiter Upper part of the sternum
thyroid swelling
bruit thyroid
aortic stenosis along the carotid artery root of the neck
systolic murmur propagated to the neck
root of the neck propagation of the arotic stenosis

P a g e | 43

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Abo El Asrar Clinical Pediatrics

comment
venous pulsation arterial pulsation webbing Normal shape of the neck
thyroglossal cyst thyroid swelling
Lymph node swelling
surface site which lymph node

site Lymph node comment

preauricular jugulo digastrics submandibular submental which group site

post auricular mastoid process

occipital goup of lymph node occiput
Upper deep cervical sterno mastoid muscle
Lower deep cervical
clavicle supra claviclar lymph node

horizontal group
post auricular preauricular jugulo digastric submandibular submental .... horizontal group
occipital
longitudinal group
Lower deep cervical upper deep cervical
supra claviclar lymph node
group site Lymph node
size
lymph node

smooth surface lymph nodes

consistency
firm in consistency Lymph node
soft lymph node Hard lymph node
tenderness
not tenderness
) ( tender lymph node
relation
relation

P a g e | 44

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skin
Lymph node
Lymph node
skin is not attached to the lymph node

lymph node is not attached to the overlying skin

underlying muscle
sternomastoid muscle ) (
horizontal and vertical Lymph node
Muscle contraction

not attached to the underlying muscle
muscle

relation to the underlying muscle and the overlying skin

muscle
not attached to the over lying freely mobile freely mobile Lymph node
skin or underlying muscle
) (

draining area Lymph node

jugulo digastric lymph node

axillary lymph node examination
epitrochlear lymph node examination
inguinal lymph node examination
lymph node examination

Neck examination lymph node of the neck

axillary inguinal epitrochlear lymph node neck examine the lymph node
lymph node
lymph node


:

P a g e | 45

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Abo El Asrar Clinical Pediatrics

( )

( )

Neck
shape of the neck Normal long short neck
webbing

swelling ... thyroid swelling
.... swelling
thyroglossal cyst thyroid swelling


Percussion manubrium sterni
Middle finger


sterno mastoid muscle
( ) pulsation
pulsation
venous pulsation
level venous pulsation

Lymph node
Lymph node

Lymph node

:

( tone
......... )

submental submandibular tip of the fingers against bone

Mandibule
jugulo digastric
preauricular Post auricular occipital
medial part of sterno mastoid rolling

P a g e | 46

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Upper deep cervical

Lower deep cervical
clavicle supra clavicular

rolling
muscle contraction Upper deep cervical
lymph node




submandibular
jugulo digastric
preauricular
Post auricular
occipital
upper deep cervical Upper deep cervical
lower deep cervical lower deep cervical
supra clavicular

jugulo digastric lymph node

freely mobile
not tender
firm in consistency


auscultation
murmur propagated to the neck neck

Inspection, palpation, percussion and auscultation

examine the axillary lymph node

axillary lymph node

axillary lymph node

abduction

P a g e | 47

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Left axilla

axilla exposure

anterior fold of the axilla rubbing lymph node

chest wall Medial group

apical group
palpation against upper end of the humerus lateral group
groups
anterior group medial group apical group
lateral group


anterior group medial group apical group
lateral group

Posterior group
Posterior group posterior fold of the axilla

epitrochlear




Posterior aspect of the arm
thumb
epitrochlear thumb rolling
elbowsemi flexed

rolling thumb

Inguinal
exposure

Inguinal lymph node semi flexion
Inguinal ligament
inguinal ligament

P a g e | 48

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examination of the lymph node
neck examination Lymph node examination

Skin examination
Purpura
.... skin examination
.1 color of the skin
Pallor jaundice cyanosis

.2 skin texture
goose skin
vitamin A deficiency

texture Normal texture

.3skin elasticity
skin elasticity
fold skin Normal skin elasticity

dehydrated

.4 skin rash

raised above the level of the skin
raised (macule primary
lesions secondary lesions )

( papule Papule palpable p p Papule )

macule Not raised above the surface of the skin .... discoloration
Papule
papule
serous fluid
vesicle

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Pustule Pus secondary bacterial infection vesicle
vesicle Pustule

crust

Inflammatory scar deep injury crust

rash
papule macule scarlet fever macula popular
roseloa infuntum
maculo popular rash
vesicular rash

Infectious rash
chicken pox

abnormal pigmentation .5
hyper pigmented abnormal pigmentation
hypo pigmented

scar .6
scar inflammatory scar
scar
scar

bleeding under skin .7

purpura ecchymosis petechiae
Insect bite petechiae
Insect bite bleech of the skin
Purpura petechiae

edema .8
edema
edema
Pitting edema dorsum of the hand
Pitting edema dorsum of the foot
20-30
chin of the tibia

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chin of the tibia
edema
thigh upper limb ( pinching edema
skin edema )
skin
edema
abdominal wall cone
edema abdominal wall
Puffiness

skin examination
positive data
color of the skin pallor Jaundice cyanosis
Normal color
normal texture, normal skin elasticity, no rash, no abnormal pigmentation , no scars



fallot tetralogy
squatting position
: fallot
: " "
... cyanosis
fallot cyanosis


Infundibulum Hypertrophy cyanosis

squatting position

central cyanosis
( )

heart
sub valvular stenosis

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thrill sub valvular pulmonary stenosis

Murmur
ejection systolic
ejection systolic
murmur
systole murmur
Murmur heart sounds

Pulmonary area murmur of Fallot of maximum intensity

Pulmonary area
2nd left inter costal space
left para sterna area
propagated
murmur

NEUROLOGICAL EXAMINATION

duchenne myopathy

X-linked
common X-linked
female male
common in male
duchenne myopathy
energy supply of the muscle ATP


mitochondrium glucose ATP muscle
ATP glycolysis .....
Metabolism muscle ATP

Mitochondrium
endoplasmic reticulum
Muscle generator endoplasmic reticulum
generator
ATP mitochondrium
muscle ATP
endoplasmic reticulum

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endoplasmic reticulum
creatine creatinine
creatinecreatinine
ATP

...... creatine phosphokinase

CPK creatine phosphokinase

creatine phosphokinase endoplasmic reticulum creatinecreatinine
membrane endoplasmic reticulum
membrane carrier protein
dystrophin
duchenne dystrophin
dystrophin creatine phosphokinase
creatinecreatinine

ATP


mitochondrium
mitochondrium endoplasmic reticulum

muscle ATP ATP
degeneration muscle fibers

:






proximal muscles

proximal muscle
18 20

cardiomyopathy heart failure
renal affection renal failure
duchenne
duchenne
degeneration Muscle fibers

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deposit of fibrofatty tissue functionally impaired
pseudo hypertrophy

muscle disease
Upper motor neuron lesion lower motor neuron lesion
Lower motor neuron lesion
Muscle weakness
hypo tonia
Hypo reflexia

pseudo hypertrophy

sensation Intact

Motor system examination

examination of the motor system
examination of the motor system
examination of the motor system

inspection
percussion


( )motor and reflexesMotor 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

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





coordination ............
coordination on the left side is intact and on the right ........ hemiplegia

side not examined

!!!!! examine
paralysed examination

reflexes
by inspection, by palpation, by percussion, Patient
power
coordination
............. coordination
superficial and deep reflexes

reflexes

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

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superficial reflexes
positive babiniski on right side
planter response on the left side ) ( negative negative on left side
abdominal reflex is lost on the right side
superficial reflexes
deep reflexes
hyper reflexia on the right side
Lower limb Upper limb hyper reflexia
triceps , brachio radialis and biceps Upper limb reflexes
centres
triceps centre brachio radialis centre biceps
centre
centres ankle knee Lower limb
) ( Normo reflexia

Pathological reflexes and clonus on the right side

adductor Patellar supra spinatus finger flexion
centres

reflexes

examination of the motor system
pseudo hypertrophy atrophy muscle state

pseudo hypertrophy calf muscles
function

muscle tone
muscle tone examination
Upper and lower limbs
lower limb
) D: (
wrist shaking Upper limb

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tone
tone upper limb
hands shaking

forearm flexion extension elbow joint

shoulder extension flexion

shoulder circumduction tone shoulder

wrist shoulder
gower method
gower sign

lower limb tone

shaking side to side
knee extension flexion
circumduction hip joint
tone

hypo tonia
examination
generalized hypo tonia ... muslce tone bilateral
Proximal more than distal

Muscle tone muscle power

(
against resistence )

wrist


adductor
trunk muscle
gowersign

winging of the scapula

serratus anterior scapula Prominent

sensations
superficialdeep
pathological reflexes embryological

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superficial refelexes
abdominal reflex
planter Upper motor lower motor
deep tendon reflexes
upper limb
triceps , brachio radialis and biceps
triceps elbow
120 reflex brachio radialis and biceps
tendon tricepis and brachio radialis
index of your finger bicepis
brachio radialis reflex supination

wrist
(
)

Lower limb ankle Knee reflex

reflex
ankle eversion

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