ORARL, 5-3-5-3-9 1. Orientation: Time (5 points – 1 for each correct): What is the: (year) (season) (date) (day) (month)? Place (5 points – 1 for each correct): Where are we: (state) (county) (town) (hospital) (floor)? 2. Registration: Name three objects, ask patient to repeat (3 points – 1 for each on first…
Tag: Clinical examination
Clinical Skills and Approaches 
Percussion of Spleen
Traube’s semilunar space Borders: Superiorly: Left 6th rib superiorly Laterally: Left midaxillary line or Left anterior axillary line Inferiorly: Left costal margin Method: Patient’s position: supine with left arm slightly abducted. Percuss: from medial to lateral Interpretation: Resonance (Normal) and Dullness (Splenomegaly) Also: Pleural effusion or mass in stomach may…
Clinical Skills and Approaches 
Milkmaid’s grip in Chorea
Milkmaid’s Grip Milk maids grip is appreciated as an alternating squeezing and releasing of the finger like a milking motion, when asked to maintain a constant, firm grip of examiner’s fingers. This may reflect a combination of Chorea and Motor impersistence. As a result of poor grip, patients often involuntarily…
Clinical Skills and Approaches 
Gower’s sign
Synonyms: Gower’s maneuver, Myopathic walking, Butt-first maneuver Identifying Gower’s sign To check for Gower’s sign, place the patient in the supine position and ask him to rise. A positive Gower’s sign – an inability to lift the trunk without using the hands and arms to brace and push – indicates…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Abnormalities of First and Second Heart Sound
In the chapter of cardiac cycle, we have discussed the mechanism of production of heart sounds and their physiologic splitting. First Heart Sound (S1) Mechanism Closure of atrioventricular valves. It is best appreciated in mitral and tricuspid area of chest for respective components. Loud S1 Slamming a door from a…
Clinical Skills and Approaches 
Lhermitte’s Sign
Synonym: Lhermitte’s phenomenon, Barber chair phenomenon Definition of Lhermitte’s Sign Lhermitte’s sign (pronounced Ler-meets) is an electric shock-like sensations, spreading along the spine in a cervico-caudal direction and into the arms and legs felt upon active or passive flexion of the neck. Reverse Lhermitte’s Sign is defined when symptoms are…
Clinical Skills and Approaches 
Pronator Drift (Barre’s sign) : Neurological Examination
Components of pronator drift Progress from distal to proximal: Downward arm drift Forearm pronation Flexion of the wrist and elbow Method of assessment for pronator drift When the patient extends both arms upright in the supinated position and hold them at shoulder height for atleast 10 seconds (Patients should be…
Clinical Skills and Approaches 
Clonus : Clinical Examination and Mechanism
Definition of clonus Clonus is a rhythmic sustained involuntary muscular contraction (generally 5-8 Hz) evoked by sudden passive stretch of the muscle and tendon. Eliciting Clonus Clonus is commonly elicited in gastrocnemius (ankle clonus). Other sites where clonus can be elicited are quadriceps (patellar clonus), finger flexors and jaw. 1….