HD 202: Human Physical and Psychosocial Development EXAM 3

Adult Screening PE Script Trans 0

May 10, 2017
Department of Medicine and Department of Family and Community Medicine

INTRODUCTION
Action Script Notes/Reporting
Introduction Magandang araw po, ako po si ______ at andito ako para You may need to get general data (NARGOSH)
eksaminin kayo. Ano pala pangalan ninyo? (Patient says name). Name
Ang lahat po ng mapag-uusapan natin ay mananatiling atin-atin Age
lamang, Maliwanag po ba? Ang isasagawa natin ngayon ay ang Religion
eksaminasyon ng inyong buong katawan. Kung may parte sa Gender
eksaminasyon na hindi kayo komportabe sabihin niyo lang po. Occupation
May katagalan po ito, okay lang ba iyon sa inyo? Maari ko rin ba Status (Civil)
kayong hawakan Address and Province
Handedness (optional since its not the neurological exam)
While the intro is ongoing check for the following: The patient has normal gait, has good speech fluency and
Motor: Gait, speech, voice comprehension, is speaking spontaneously and is able to
Sensory: Vision, hearing achieve a conversational goal
Higher Cerebral Functions: Orientation, Intelligence, Mood and The patient has good vision and no hearing problems
Memory The patient is well oriented to place, has good mood and
memory.

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Adult Screening PE Script EXAM 3
HD 202: Human Physical and Psychosocial Development Trans 0

Reference Modules: OS 202 B (CN II and VIII) and OS 204
Action
Ask the patient to sit, with you directly in front Bago tayo magsimula, maari ba kayong
Get BP and Pulse Rate
General inspection of the head. Do Head Sweep
and palpate in the following order:
Forehead > temples > occipital area > posterior
triangle > supraclavicular area > anterior triangle
> submandibular & submental lymph nodes
General inspection of the neck. Check for,
tracheal deviation. Place finger on suprasternal
notch.
Perform ocular exam
Check for visual acuity
Check for direct and consensual light reflex
Perform ear exam, rub fingers near patients ears
Check the nose. Lift and check w/ penlight if
redder than the oral mucosa. Note for deviation.
Inspect the mouth. Sweep buccal mucusa with
tongue depressor. Inspect tonsils, palate and
uvula.
POSITION A
Script
umupo?
Kukunin ko lang ang BP ninyo. Ano ba ng
karaniwan ninyong BP? Kayo ba ay kumain,
nanigarilyo, uminom ng kape o may
isinagawang pisikal na aktibidad?
Hahawakan ko lang kayo Maam/Sir
Hahawakan ko lang ang inyong mga mata.
Tingin po sa taas, tingin po sa baba. Ngayon po
basahin niyo ang mga numero mula sa
pinakamataas hanggang sa pinakamababa.
Ngayon magpapasilaw lang ako ng ilaw sa
inyong mga mata, hindi naman ito masakit pero
hindi rin ito komportable.
Naririnig niyo ba ito? Eto naman po?
Titingnan ko lang po ang butas ng inyong mga
ilong. Maari ko ba itong hawakan?
Pakibukas ang inyong bibig at ilabas ang
inyong dila. Itatapat ko lang ang tongue
depressor sa loob ng inyong bibig.
Reporting
N/A
The patient has pulse rate of _ per minute,
auscultatory BP of _over _, with palpatory
BP of _mmHg.
Upon performing a head sweep, the patient
has no palpable masses or enlarged lymph
nodes.
Upon there is no visible or palpable
deviation of the thyroid and tracheae.
The patient has anicteric scelerae and pink
conjunctiva. The patients vision is 20/20
and both pupils are equally brisk and
reactive to light.
The patients gross hearing is normal. The
patient has unobstructed external meatus
and does not experience any tenderness.
No discharge or exudates were noted.
Gross hearing was tested via finger rubbing
test.
The patient has unobstructed and patent
nasal
cavity. No discharges are observed.
The oral mucusa is pink, the tonsils are not
deviated.
Notes
SIT IN FRONT OF THE PATIENT. Do not open
your legs, but sit with legs together at a 45 deg.
Angle with respect to the patient
Avoid getting BP if the patient presents with the
ff conditions (from Cardio PE trans):
Patient should not have eaten, smoked, taken
caffeine, or engaged in vigorous exercise within
the last 30 minutes
Room should be quiet
Patient should be comfortable
Allow patient to rest for at least 5 minutes
Patient should sit upright with feet flat on the
floor
Do not press too hard
Use alcohol
Finger should touch the crest, otherwise trachea
is deviated.
No need to pinhole, or other light reflexes.
No need to do otoscopy or tuning fork
No need to use nasal speculum or check for
sense of smell.

POSITION B
Reference Module: OS 204 and OS 205 (Chest PE), some OS 203 (Derma) for the chest
Action Script Reporting Notes
Do bimanual palpation of the thyroid gland. Hahawakan ko lang kayo. Ngayon po, Upon palpation, the thyroid of the patient is not When the patient swallows, confirm that it is the
lumunok kayo parang umiinom ng tubig. enlarged and no palpable masses are present. thyroid. It should move with the thyroid
cartilage.
Inspect the chest from behind. Pakitanggal ang inyong suot para matingnan The posterior & anterior chest walls show no For the Chest, the guide given only requires
Auscultate zigzag 4 levels posterior, left and ko ang inyong likod. Ngayon po, humnga lang lesions or deformities. There is symmetrical you to check from behind. No need to check

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right kayo ng malalilm. chest expansion & front unless preceptor asks.
Lower lateral lung 1 level only Itatapat ko lang kamay ko sa inyong likod. breathing sounds. There are no visible or For Respi, the order is IPPA (Inspection,
Zigzag 3 levels anterior, beyond cardiac Tuloy tuloy niyo lang sabihin ang tres tres, tres palpable masses Percussion, Palpation, Auscultation)
boundaries tres present and the lungs are resonant upon
percussion. No
adventitious (such as crackles, rhonchi and
wheezes) or
transmitted sounds (tactile and vocal fremitus,
bronchophony,
egophony, and whispered pectoriloquy) are
present.

Reference Module: OS 202 B (Motor Exam), OS 203
Action Script
Ask patient to stand. Evaluate motor power, Maari ba kayong tumayo?
balance, habitus (asthenic,
hyperthenic, hypothenic, athletic)
Measure waist to hip ratio
Press infraspinatus for tenderness
Do the GALS test, as follows:
Inspect from behind and the side
Touch toes (check if spine is at the midline)
o With hands behind the head, extend and flex
the neck
o Put arms down at the sides
o Flex arms with knuckles forward (inspect
fingers and
nails) or lift and pronate forearms
o Clench fist
o Touch each finger with thumb
o Touch ear to ipsilateral shoulder
POSITION C
The patient is able to stand. The patient shows
Waist: Between lowest rib and iliac crest
Hip: At the iliac crest
Hawakan ninyo ang inyong paa. Ilagay ang
inyong mga kamay sa likod ng inyong ulo at
ibaba ang ulo niyo. Ngayon naman, itaas ninyo.
Itabi ang inyong mga kamay. Ngayon, gayahin
niyo ako (Demonstrate the rest of the actions)
Reporting Notes
Patient should be able to stand in 1 second.
adequate motor power, balance
and presents with a/an endo/ecto/mesomorphic
body habitus.
The patients waist is _______ inches, while his Standard is 0.9 for males (1.0 based on DOST-
hip has a measurement of _______ inches. FNRI) and 0.85 for females
The waist-hip ratio
is _____.
The patient has no visible lesions and doesnt Easier to demo for patient to make things faster
experience tenderness upon applying pressure
to the supraspinatus muscle. Joint mobility is
intact with the spine in midline position, no pain
nor tight muscles felt upon movement and
fingernails are pinkish and well-groomed.
Patient shows no muscle wasting and has
adequate muscle mass in the extremities. The
patient has adequate motor power, balance
and presents with a/an endo/ecto/mesomorphic
body habitus.

Reference Modules: OS 205 (Breast, Cardio) and OS 206 (Abdomen and Genitalia), some OS 203 (Lower Ex)
Action
Ask the patient to lie down
Clinical Breast exam
If sitting:
Ask patient to put hands behind head
o Ask patient to place hands on waist
o Ask patient to lean forward
o Look for masses, asymmetry, dimpling and
discharge
POSITION D
Script Reporting Notes
Ngayon po, humiga kayo.
Maari ko bang eksaminin ang mga suso Upon inspection, the patient has symmetrical Ask preceptor if necessary, refer to Breast PE
ninyo? breasts and does not present any visible trans for proper techniques
masses, dimpling or nipple discharge. Upon
palpation, the patient does not present any
palpable masses or nipple discharge.

If supine:
o Cover patient except one breast
o Ask patient to place hand, ipsilateral to breast

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being examined, behind head
o Spirally palpate from axilla to nipple (note
masses)
o Pinch nipple for discharge
o Deeply palpate axilla (note masses)
o Repeat on other side
Neck: Hawakan ko lang ang inyong leeg The blood vessels of the neck are not
Neck Veins engorged and rapidly pulsating, and upon
o Look for highest position of pulsation on right auscultation, does not present with thrills or
internal jugular vein bruits. No upstrokes, no abnormal pulsation
o JVP at 45 degree elevation
Auscultate Carotid Artery
o Can also palpate
o Use bell on carotid artery (listen for bruit
(narrowing) & murmurs
Inspection lesions, point of maximal impulse Pakitaas lang ng inyong damit. Papakinggan Patients heartbeat is rhythmic and steady with Refer to Cardiac PE for full details!
Palpate for PMI ko lang ang inyong puso no splitting or murmurs upon auscultation. The
Auscultate for heat sounds apical beat coincides with PMI.

Abdomen Papakinggan ko lang ang inyon tiyan. Ngayon Inspection - note for any lesions or visible
Inspect the abdomen po tatapikin ko lang kayo. Ngayon, tumalikod masses
AUSCULTATE FIRST naman kayo Auscultation
Percuss for Traubes space o Use diaphragm on 4 quadrants
Palpate (but avoid palpating the spleen) o May also auscultate 9 quadrants
If = 5-20/min (normoactive)
ileus= no peristaltic movements
Obstruction
If > 5-20/min (hypoactive)
If > 5-20/min (hyperactive)
o Listen for bruits in aorta, renal artery, iliac
artery, & femoral artery
o Clicks & gurgles occur at 5-34 per minute
o Borborygmi - prolonged hyperperistaltic
gurgles (stomach growling at right lower
quadrant)
o Since bowel sounds are transmitted through
the abdomen, listening to one spot, such as the
right lower quadrant, is usually sufficient
Percussion
o Traubes space
Should be tympanic or resonant on 6th-7th
ICS at left anterior axillary line
Dullness of the area indicates splenomegaly.
Lower Extermities Pakitapat ang inyong paa sa inyong tuhod. Patients hip joint is intact with no pain in Inspect
Cross one foot across other knee, applying Relax lang po. Ngayon sa kabila naman. applying pressure, there is absence of pitting Hip Joint Evaluation - cross one leg over the
posterior pressure on crossed knee, repeat Ngayon, hahawakan ko lang ang inyo paa. edema in the lower extremities, and the other and apply posterior pressure on bent
Evaluate for ankle edema dorsalis pedis pulse is palpable knee (do this for both legs)
Evaluate dorsalis pedis Pitting Edema - inspect pre-tibial area &
ankles
Dorsalis Pedis Pulse - between 1st & 2nd
metatarsals

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