7/28/2019 IVMS ICM Physical Exam Checklist

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7/28/2019 IVMS ICM Physical Exam Checklist

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7/28/2019 IVMS ICM Physical Exam Checklist

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Cranial Nerve

___ 87. Test Nerve I: Sense of smell (not usually done). Ask patient if there hasbeen any change in smell or taste

Test Nerve II:a. Visual acuity Done with HEENT

b. visual fieldsc. ophthalmoscopic (disc, blood vessel, retina)

Test III, IV, VIIa. Pupillary reaction to lightb. Extraocular movements Done with HEENT

Test Nerve V: Sensory functions

___ 88. Test light touch on cornea and the three branches of the nerve bilaterally

Motor function V:___ 89. Test contraction of masseter muscles or forced opening of mouth against

resistance

Test Nerve VII: Motor function in musculature of face:___ 90. Raise eyebrows or forced eyelid closing

___ 91. Show teeth, puff out cheeks, or smile

Test Nerve VIII:Hearing (done with HEENT examination)

Test Nerves IX and Xa. observe elevation of palate vocalizing "ah" (done with HEENT)

Test Nerve XI:___ 92. Test rotation of patient's head against strong resistance

___ 93. In bounced Test shoulder shrug against strong resistance (elbows bent)

Test Nerve XII

___ 94. Observe midline protrusion of the tongue (This can be done withexamination of the mouth)

Cerebellar Function

Patient standing___ 95. observe gait___ 96. Have patient walk on toes

___ 97. Have patient walk on heels___ 98. Have patient hop on each foot___ 99. Observe tandem gait (heel-to-toe)

___100. Perform finger to nose and heel-to-shin test bilaterally

___101. Test fine rapid movements of fingers and feet

___102. Perform Romberg and pronator drift test

Reflexes

Deep tendon reflexes: (Test symmetrically)___101. Test biceps and brachloradialis reflex___102. Test triceps reflex

___103. Test patellar reflex Test achilles reflex___104. Test cremasteric, abdominal and plantar superficial reflexes

Motor: Done under Musculoskeletal Examination but will need to quantitatestrength on a 5/5 scale

Sensory

___105. Test light touch or pin prick on both sides of trunk___106.Test light touch and pin prick on 4 limbs

___107.Test position sense at least in feet

___108. Test vibration sense in at least both ankles

MALE GENITALIA AND RECTUM

___111. Inspect penis, foreskin, meatus, scrotum___112. Palpate penis, scrotum, testes, epididymes and other scrotal contents___113. Examine for hernia Inspect anus___114. Properly/comfortably insert index finger waiting for sphincter to relax___115. Palpate prostate and a 360'arc of rectum___116. Test stool sample on withdrawn examining finger for occult blood

IVMS ICM Physical Examination Checklist 3