Now, I will auscultate her lung sounds in the interior lung fields, beginning at the intercostal spaces. Sarah, if you will take some normal breaths in and out through your mouth. And your breath sounds are nice and clear. Now, I'm gonna proceed to the posterior chest. And listen to her lungs. And Sarah, if you will, for our purposes here, turn around. Actually, there you go. Now I'm going to auscultate eight areas, beginning above the scapulas. Take some normal breaths, in and out through your mouth. And I'm gonna get the lateral. Middle right, middle low. OK, thank you. You can sit down. Now I'm gonna check Sarah's upper extremities. I'm gonna begin with inspecting the joints of her hands. If you'll extend your hands out. And I'm noting any redness or swelling or any deformities of her finger joints. Thank you. And next I am going to palpate for capillary refill. So I will do that one finger on each hand. I'm gonna press on a finger nail until it turns white and then I'll release, and I see that it turns pink, a healthy pink, within less than 3 seconds. Let me do the left side, pressing on the nail til it turns white, release, and it turns a healthy pink in less than 3 seconds. And that would be a normal capillary refill. Now I will check her radial pulses bilaterally, and if you will just face your palms in-- inward and I'm gonna palpate the radial pulses. And they are equal, about 2+ bilaterally. Next, I'm gonna assess her hand grips. So if you'll grip my hands together tight, tight, tight. Very good, very good, so her strength in her hands are five out of five. Now I'm going to assess Sarah's range of motion. Range of motion should normally be examined bilaterally. However, for purposes of this examination, in the emergent evaluation, it is only necessary to perform a range of motion unilaterally. And the same will apply when you perform deep tendon reflexes. Now I'm going to assess range of motion, passive range of motion of the elbow. Flexion and extension. And I would do so on the other side. And now, I would like to check her strength of her biceps and triceps. So if you will, flex your elbows and push against my hands. And now, pull back towards you, thank you. And her biceps and triceps strength was five out of five. Now I'm gonna assess the passive range of motion of the shoulder. Flexion, extension, internal rotation, external rotation. Then you have abduction and adduction. Now I'm going to assess cerebellar coordination with rapid alternating movements. And Sarah, if you will take your thumb and touch your index finger, middle finger, and fourth
finger, fifth finger. And just repeat that. She does that very well, and is well coordinated. Next I will do the rapid movements of her hands. So palms down on your thighs, and then up, and then down, and alternate, and increase the speed. Very good, nice and normal and coordinated. Now I will assess her deep tendon reflexes, only on one side for demonstration purposes. And I will start with the bicep tendon. So I will support her arm on my arm, and then I'm placing my thumb
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- Fall '18
- Sarah, gonna move