And I will start with the bicep tendon. So I will support her arm on my arm, and then I'm placing my thumb on the medial aspect of the antecubital fossa, and I will strike my thumbnail with the pointy end of the hammer. And as you can see, she contracted her bicep tendon very well. Now I'm checking her patellar reflex with the flat end of the hammer. And she had a good response. And I'll come around and do her Achilles. I'll ask her to relax her foot, then I'll dorsiflex the foot a little bit, and tap with the flat end. And you notice she had a little bit of pronation there. [BLANK_AUDIO] Now I'll have the patient lie down for the abdominal exam. [BLANK_AUDIO] I will expose her abdomen. [BLANK_AUDIO] And I am observing the abdomen for its contours and symmetry, and there is no distortions. Now I will auscultate her bowel sounds in all four quadrants. [BLANK_AUDIO] Bowel sounds are present in all four quadrants. Now I will auscultate for any bruits. I will begin with the aortic area, which is right below the xiphoid process. [BLANK_AUDIO] Midline. [BLANK_AUDIO] Next I will do the left renal, which is above and lateral to the left, the umbilicus. The right renal is to the right and above the umbilicus. The iliac, to the left and below the umbilicus. [BLANK_AUDIO] And the right iliac, which is to the right and below the umbilicus. And I do not hear any bruits. Now I'm going to percuss in all four quadrants. I'm percussing for any tympany, dullness, or flatness. [BLANK_AUDIO] And it's normal. Next I'm gonna palpate in all four quadrants for tenderness and any masses. [BLANK_AUDIO] And that feels normal, I do not feel any masses. Now I'm going to palpate the liver and the spleen. Beginning with the liver. I'm gonna place my left hand underneath and I'm looking at the midclavicular line on the right. And I'm placing my palm upward right at the edge of the costovertebral angle, and I'm asking her to take a deep breath in. And as she does so, I'm pressing deeper and upward, and I might feel the lower edge of the liver. [BLANK_AUDIO] Now for her spleen I'd like her to adjust herself and come over towards me laterally. And I'm gonna put my left hand back here. And right below the costovertebral angle I'm gonna put my right hand. And as she breathes in, once again pushing upward and downward. And I do not feel the edge of the spleen which is actually normal. Now I'm gonna assess the Blumberg sign. I will take my hand vertically 90 degrees and I will press down into the abdomen. And when I release, if she feels any pain on the rebound, that would be a positive Blumberg sign. [BLANK_AUDIO] Any pain? [BLANK_AUDIO] Now I'm gonna assess the lower extremities. First I will inspect the skin for any lesions or any edema. I do not see any. Next I'm gonna do range of motion of her hip and I'm going to go ahead and flex her knee. And, in turn, flex her hip. And then I'm gonna go into abduction, taking the leg away. And adduction, crossing the midline. Next will be internal rotation.
- Fall '15