“SHIPWRECK'S” GO-BY 2nd Edition 

 Copyright 1996

written by

FRANK CARVALHO 

LT MSC USN 

PHYSICIAN ASSISTANT 

[ FORMER-HMC (SW) DDG-40 ]

FOR USE BY MEDICAL PERSONNEL IN 

EXAMINATION PROCEDURES DURING

PATIENT EVALUATION.

WHILE NOT ALL INCLUSIVE, THIS GUIDE 

PROVIDES PERTINENT ASSESSMENT 

GUIDELINES. 

This Booklet is dedicated: 
To the Hospital Corpsman of past who served and gave 

their all for fellow shipmates in need of care. 

To the Hospital Corpsman of today to assist them in that 

task. 

To the Hospital Corpsman of the future to continue that 

fine tradition. 

******************************************** 

This booklet is can be downloaded at the following site: 

http://www-nshspts.med.navy.mil/nshs/sw/index.htm

Comments or Suggestions are greatly appreciated. 

 

Please Email Frank Carvalho 

at shpwrck@aol.com or shpwrck@juno.com

INDEX 

PAGES 

1-5.............History/Subjective/Objective 

6.................Skin/Nails/Hair 
7.................Head 

8-9.............Eyes 

10-11.........Ears 

12 ..............Nose 

13 ..............Throat 

14...............Neck 

15 ..............Chest and Lungs 

16-17..........Heart 

18...............Peripheral Vascular system 

19...............Gastrointestinal 

20...............Genitourinary- Male 

21...............Genitourinary- Female 

22-23..........Back (low) and Hip Exam with Neuro 

24-25..........Knee 

26...............Ankle and Foot 

27-28..........Shoulder (upper back) with Neuro

29...............Elbow and Hand 

30-34..........Mental/Neuro status exam with Cranial 

 Nerves/Cerebellar status 

35...............The ULTIMATE SOAP NOTE 

HISTORY 

Subjective

All important: Depending on the chief complaint 

consider everything, document the essential. 

Consider Abdominal, Genitourinary, Respiratory, 

Cardiovascular, Neurological, Musculoskeletal, and 

Psychiatric involvement. 
 2

Document presence or absence of fever, chills, nausea, 

vomiting, diarrhea, chest pain, shortness of breath and 

headaches. If you don't ask, they might not tell! 

Focus on History of Present Illness 

P- What Provokes discomfort? 

Q- What is the Quality of the discomfort? 

R- Where is the Region of the discomfort? 

S- What is the Severity of the discomfort? 

T- What is the Time sequence? 

What was the mechanism of injury? 

What was the pt doing prior to incident? 

Are there any associated symptoms? 

Are there any aggravating/relieving factors? 

Is this a recurrent illness or injury? 

Is the patient on any medications? 

Note pt's ETOH, caffeine and smoking habits. 

Allergies? ASK FOR YOURSELF!

REVIEW OF SYSTEMS: To help you focus your 

exam, consider a ROS.

General: First Impression. Nutritional status, weight gain/loss, 

weakness, fatigue, hydration status & overall condition? 

Skin: Changes in skin/nail/hair texture, appearance and color. 

Rashes, itching, lumps or infection? Cellulitis, Lymphangitis, 

lymphadenopathy? 
 3

Head: Loss of consciousness? Lightheaded, vertigo, headaches, 

symmetry, Hx of Injury, PMH, sinus pain? Visual disturbance? 

Ears: Acoustic trauma, hearing loss, tinnitus, drainage, pain, 

infection, discharge, vertigo. Hearing aids? Last Exam? 

Eyes: Visual changes, diplopia, epiphora, pain, discharge, 

injection, light halos, trauma, photophobia, glaucoma, cataracts, 

last eye exam? Iritis, visual acuity, and Glasses/contacts? 

Nose/Sinuses: Olfactory changes, stuffiness, drainage, itching, 

obstruction, hx of trauma, hay fever, nosebleeds, sinus problems. 

Throat/Mouth: Hoarseness, dysphagia, enlarged tonsils, bleeding 

gums, sores, leukoplakia, teeth condition, caries, tongue changes, 

dry mouth, hx of sore throat? 

Neck: Goiter, pain, masses, nodules, adenopathy, thyroid 

problems, stiffness, creptitus? Hx of Injury? 

Respiratory: Cough, dyspnea, pleurisy, sputum (amt, type, 

color), asthma, bronchitis, COPD, emphysema, effusion, TB, last 

CXR? Coccidiomycosis, Histoplasmosis and smoking history? 

Cardiac: HTN, hyperlipidemia, rheumatic fever, murmurs, chest 

pain/discomfort, orthopnea, dyspnea, edema, last ekg/stress test? 

CHF, pericarditis. Hx of surgeries/procedures/monitors. 

Peripheral vascular: Nocturnal pain, claudication, varicose 

veins, thrombophlebitis, leg cramps? CHF? Venous 

insuffieciency? DVT? 
 4

Gastrointestinal: Heartburn, dsyphagia, appetite, indigestion, 

belching, flatulence, hematemesis, stool changes, hemechezia, 

melena, diarrhea, constipation, nausea, regurgitation, vomiting? 

Hx of gallbladder, liver, pancreatic disease, PUD? 

Genital (male) Hernias, sores, lesions, penile discharge, pain , 

testicular/mass discomfort, scrotal mass/discomfort? hx of 

STD's. Sexual hx, function, problems? 

Genital (female): Birth control, sexual hx/function, STD's, 

itching, sores, discharge, dyspareunia, last pap/pelvic exam? 

Menarche, menopause, LMP, GPA, menstrual regularity, 

frequency, duration, amt? Dys/amenorrhea, metromenorrhea and 

PMS, 

Urinary: Dysuria, polyuria, frequency, stones, pattern change, 

incontinence, nocturia, STD, hesitancy, dribbling, hematuria, 

infections? Flank discomfort? 

Hematologic: Bleeding, bruising, anemias, petechia, hx of 

transfusions, sickle cell, thalassemias, G6PD? 

Endocrine: Thyroid, adrenal, hormonal. Heat/cold intolerance, 

edema, hirsutism, sweating, excessive thirst, hunger, polyuria, 

pigment changes? 

Psychiatric: Anxiety, mood swings, mania, depression, memory 

loss, insomnia, suicidal ideations, delusions, hallucinations? 

Musculoskeletal: Myalgia, stiffness, gout, arthritis, backache. Hx 

of swelling, pain, erythema, tenderness, decreased ROM? Hx of 

trauma, overuse. 
 5

Neurologic: Syncope, vertigo, seizures, blackouts, parasthesias, 

paralysis, tremors, weakness, involuntary movements, 

equilibrium, LOC. 

Other Problems and past medical history:

Consider any other problems which are currently active, 

comments should include functional impairment, childhood /adult 

illnesses, Hx of trauma, surgeries, hospitalizations. 

Document environmental exposures and Family History when 

appropriate. 

OBJECTIVE

Always start your objective with a opening 

statement concerning the patients general 

appearance and condition.

Example: Well developed, well nourished male in 

no acute distress. Pt is alert, orientated x3, 

cooperative, and shows no gross mental status 

changes. Pt appears hydrated. Vital signs noted. 

Consider listing a minimum of 3-4 Physical exam 

findings for each complaint. Check the system 
 6

above and below, and include the possibility of 

cutaneous, musculoskeletal and occult findings. 

Document the absence of critical findings. This 

Booklet will assist you in that task. 

Remember, its not what you find that gets you in 

trouble. IT’S WHAT YOU MISS!

SKIN/NAILS/HAIR

Inspect for color changes: brown, gray, bronze, blue 

reddish blue, red, yellow, hypo/hyperpigmentation. 

Palpate for skin changes: in moisture, temperature, 

texture, turgor. 

Inspect and palpate nails for changes in texture, 

color and shape. Look for infections 

Inspect and Palpate hair for changes in quantity, 

quality, texture and distribution. Look for infections. 

Primary Lesions include: macules, patch, papule, 

plaque, nodule, tumor, wheal, vesicle, bullae, pustule. 

Secondary Lesions include: Erosion, ulcer, fissure, 

crust, scale, lichenification, atrophy, scar, keloid. 

PERTINENT POSITIVES AND NEGATIVES
 7

? Edema 

? Erythema/warmth 

? Pruritis/tenderness 

? Scaling/Flaking 

? Weeping/Discharge (color, amt, type) 

? Fluctuance 

? Mobile/fixed 

? Lymphadenitis/lymphangitis 

? Size, color, location, distribution 

? Asymmetry, borders, elevation 

? Auspwitz sign 

? Nikolsky’s sign 

? Telangiectasia 

HEAD/FACE

Inspect for symmetry, lesions, rashes, edema, 

erythema, twitching, involuntary movements, 

evidence of trauma/infection. 

Palpate for masses, nodules, lymph nodes, 

salivary glands, Sinus tenderness, temporal artery 

tenderness, step-off . 

PERTINENT POSITIVES AND NEGATIVES

? Edema, ecchymosis 

? Erythema, exudate, erosions 

? Obvious deformity 
 8

? Mastoid tenderness/ Battle sign 

? Cranial Nerve compromise (see page 34) 

? Cerebellar function (see page 31) 

? Periorbital edema/cellulitis 

? TMJ tenderness 

? Signs of infection 

? Sinus tenderness 

EYES

Visual Acuity: Gross exam at 14" tests only near vision! 

Snellen Chart is more reliable. 

Document as 20/_ OS, 20/_OD, 20/_OU with and 

without correction if applicable., 

Inspect the Eyebrows, eyelids, lacrimal apparatus, 

conjunctiva, sclera, cornea for edema, erythema, injection, 

abrasion, infection. Note pupils for dilation/constriction. 

 

Inspect for position and alignment of eyes. Orthophoric vs 

evidence of Strabismus. 

Hirschberg's test: Look for the light reflection on 

corneas. Are They Symmetrical? 

Cover/Uncover Test: Tests for Strabismus. 
 9

Exotropia, Esotropia, Hypertropia, Hypotropia?. 

Fields of Confrontation: Cranial nerve II

Tests for peripheral vision. Evaluate both eyes (8 fields) 

Are they equal to yours? 

Extra Ocular Movements: Check the 6 cardinal fields 

of gaze. Check for nystagmus, convergence, lidlag. 

Cranial Nerve III responsible for opening the eye, 

pupillary constriction, most extraocular movements. 

Cranial Nerve IV responsible for downward, inward 

movement of eye. (Superior oblique)- SO4. 

Cranial Nerve VI responsible for lateral deviation of eye. 

(Lateral rectus) LR6. 

Fundoscopic Exam: Note the Optic disc for sharp margins, 

2:1 cup to disc ratio. Is there any evidence of Retinal changes 

(AV nicking, copper wiring, exudates, wool spots, tapering, 

banking, neovascularzations.) 

Is there any papilledema, retinal detachment, drusen? 

PERRLA: 

Pupils, Equal, Reactive, Round to Light and Accommodation. Did 

you really check them all? 

PERTINENT POSITIVES AND NEGATIVES 
 10

? PERRLA/visual acuity 

? Injection/erythema/discharge (color, amt, type) 

? Ciliary/Limbic Flush, Limbic pallor, Hyphema, Dendrites 

? Foreign Body, abrasions, ulcers, invert eyelids 

? Anterior chamber depth, IOP 

? Preauricular Nodes 

? Fluorescent Stain 

? Keratoconjunctivitis 

EARS

Inspect Auricles and External canal for lesions, nodules, 

foreign bodies, deformities, erythema, edema , wax, 

ecchymosis, discharge. 

Palpate for tenderness and masses. Note preauricular 

and post auricular nodes. 

Auditory Acuity (conductive vs neuro loss) 

Whisper test: (gross exam) 

Weber test: lateralization to which ear? 

Rinne test: is AC>BC? 

 

 Suspected Hearing Loss 

 I 

 Weber Test 

 Lateralizes No lateralization Lateralizes 

 left I right 

 I I I 

 Rinne Rinne Rinne 

 / \ / \ / \ 

 AC> BC> AC> BC> AC> BC> 
 11

Neuro R Cond L Norm Bilat = Neuro L Cond R 

Norm L Norm R Cond Loss Norm R Norm L 

Tympanogram: Evaluate Eustachian tube function.

Conductive Loss: may be due to wax, foreign body, 

tympanosclerosis, otitis media, cholesteatoma. 

Neuro Loss: may be due to Cranial Nerve VIII 

dysfunction, cochlear damage, acoustic trauma. 

PERTINENT POSITIVES AND 

NEGATIVES 

? External ear &canal condition/ 

? Lymphadenopathy, hematoma, 

? Laceration with cartilage exposure 

? Edema, erythema, abrasions, cerumen 

? Drainage (color, amt, type) 

? Tenderness (where) 

? Foreign body, masses 

? TM condition (color, intact, mobile, landmarks) 

? Hearing acuity, Tympanogram 

? Air Fluid level 

? Anterior Cone of Light 

? Mastoid tenderness 
 12

NOSE/SINUSES

Inspect for masses, lesions, edema, erythema, 

deformity. Visualize the mucosa, note color, 

consistency, lesions, masses, discharge, exudate, 

abrasion, lacerations 

Palpate for tenderness, Percuss frontal and maxillary 

sinuses. Have patient bend forward. Note increase in 

discomfort to sinuses. 

Transilluminate with otoscope 

PERTINENT POSITIVES AND 

NEGATIVES

? Symmetry, Patency 

? Ecchymosis, edema, exudate 

? Bleeding (ant vs post) 

? Drainage (color, amt, type) 

? Septal hematoma (fracture) 

? Polyps 

? Foreign body 

? Mucous membrane color 
 13

THROAT

Inspect lips, gums, teeth, buccal mucosa, tongue, 

soft/hard palate, ant/post pillars, tonsils, uvula, 

posterior pharanyx, frenulum, salivary glands. 

Note any lesions, masses, edema, erythema, 

pustules, exudates, ecchymosis, nodules, masses, 

discharges, ulcerations, color variations. 

PERTINENT POSITIVES AND 

NEGATIVES 

? Uvula (midline?) Trismus , PTA 

? Erythema, edema, (where?) 

? Exudate (color, amt, type, where?) 

? Pustules, vesicles (where?) 

? Breath odor (fetid?) 

? Adenopathy (which ones?) 

? Tonsils (presence/absence) 

? Ulcerations, Leukoplakia? 

? Abscess (where?) 

? Oral Hygiene 

? Rash on face/truck 

? Heart Murmur, Hepatosplenomegaly 
 14

NECK

Inspect skin, trachea, thyroid, SCM, anterior/posterior 

triangles. 

Note symmetry, lesions, nodules, masses, edema, 

ecchymosis, erythema. 

Palpate all landmarks for tenderness, crepitus, spasm, 

nodules, masses, nodes. 

Lymph node examination: Preauricular, postauricular, 

occipital, tonsillar, submandibular, submental, 

anterior cervical, posterior cervical, supraclavicular. 

Assess Range of Motion: Flexion, extension, lateral rotation, 

lateral bending. (active and passive) 

PERTINENT POSITIVES AND NEGATIVES

? Masses, edema 

? Nodules 

? Meningeal signs (kernig, brudzinski) 

? Erythema, ecchymosis 

? Rigidity, Suppleness 

? Tenderness 

? Thyroid exam 

? Lymphadenopathy 

? Range of motion 

CHEST AND LUNG
 15

Inspect anterior/posterior/lateral. Observe rate, rhythm, 

depth symmetry of respirations, AP-LAT ratio. Look for 

retraction/bulging of intercostal spaces, masses, lesions, 

deformity. Palpate for tenderness. 

Auscultate all lobes, for pneumo/consolidation, consider 

AP/LAT CXR. If suspect effusion, include lateral 

decubitus view. 

Percussion: Listen for dull, tympanic, resonant, 

hyperresonant, flat sounds. 

PERTINENT POSITIVES AND NEGATIVES

? Auscultation (all lobes) 

? Respiratory expansion 

? Diaphragmatic excursion 

? Tactile fremitus 

? Percussion 

? Egophony, bronchophony, whispered pectoriloquy 

? Spirometry (before and after) 

? FEV1, pulse oximeter 

? Pleural rubs 

? Wheeze, rhonchi, rales (inspiratory/expiratory) 

HEART

Inspect for heaves, thrusts, obvious deformity. Note PMI (LMCL 

at 5th ICS) location and activity. 
 16

Palpate valve areas: 

(A) AORTIC -- RUSB at the 2nd ICS 

(P) PULMONIC -- LUSB at the 2nd ICS 

(M) MITRAL -- LMCL at the 5th ICS 

(T) TRICUSPID -- LLSB at the 5th ICS 

ERB's Point LMSB at the 3rd ICS 

Point of Ectopy midway between P and M

Auscultate valves with: 

Diaphragm for High Pitched sounds. 

examples- S1, S2, regurgitant murmurs 

Bell for Low Pitched sounds: 

examples- S3, S4, stenotic murmurs 

Murmurs are graded 1-6, note location, pitch, intensity, shape, 

quality, timing. 

Systolic Murmurs vs Diastolic Murmurs 

(A) stenosis (A) regurgitant 

(P) stenosis (P) regurgitant 

(M) regurgitant (M) stenosis 

(T) regurgitant (T) stenosis 

HEART

PERTINENT POSITIVES AND NEGATIVES

? Rate, rhythm, regularity 
 17

? S1, S2, S3, S4 

? Splits, clicks 

? Murmurs 

? Friction rub 

? Thrills, heaves, thrusts 

EKG Pertinent Positives and Negatives 

? Rate 

? Rhythm 

? Regularity 

? Axis 

? PR/QRS interval 

? Q's (where), J point changes 

? BBB's, hypertrophy, hemiblock 

? ST changes 

? Sinus, AV, junctional, ventricular origin 

? WPW, early repolarization 

? Upright T’s in I, II, V2-6 

PERIPHERAL VASCULAR SYSTEM

Inspect, Palpate and Auscultate carotids, abdominal aorta, 

renal, iliac, femorals, popliteal, posterior tibial, dorsal 

pedis, radial, ulnar, brachial pulses. 
 18

Look for edema, symmetry, venous, patterns, varicosities, 

change in temperature, color, texture differences on all 

extremities. Include nailbed assessment. 

Palpate for sensory changes, varicosities, pulse 

differences, cord tenderness. 

PERTINENT POSITIVES AND NEGATIVES

? Jugular venous distension (CVP) 

? Hepatojugular reflux 

? Retrograde filling test (valvular competency) 

? Manual compression (saphenous) 

? Allen's test (radial/ulnar patency) 

? Adson's test (subclavian) 

? Thrombophelbitis/ DVT 

? Compartment Syndrome 

? Varicosities 

? Homan's Sign 

 

GASTROINTESTINAL

Inspect abdomen for lesion, masses, distension, 

erythema, edema, ecchymosis, color changes, striae. 

Auscultate all four quadrants for bowel sounds, 

listen to aorta, renals, iliac arteries. 

Palpate (light/deep) for guarding, rigidity, masses, 

tenderness. 
 19

Percuss entire abdomen, liver and spleen. 

PERTINENT POSITIVES AND NEGATIVES 

? Masses, aneurysms, bruits 

? Hepatosplenomegaly 

? Rigidity, guarding, rosvings 

? Rebound, referred rebound 

? Psoas, obturator, cough 

? Heelslap, pelvic shake 

? Ascites (fluid wave) 

? Murphy's, Cullen's, Grey-Turner's sign 

Rectal Exam

? sphincter tone, hemocult 

? fissure, fistula, hemorrhoids 

? ulceration, excoriation, infection, lesions 

? Prostate: size, shape, consistency, boggy, hard, 

 firm, enlarged, nodules, masses, tenderness. 

GENITOURINARY (MALE) 

Inspect entire pubic area. note lesions, masses, edema, 

erythema, ecchymosis, excoriation, lichenification, 

discharge, drainage. 

Palpate entire pubic area for tenderness, masses, nodules, 

cysts, lymphadenopathy. 
 20

PERTINENT POSITIVES AND 

NEGATIVES

? Lesions, rash, erythema (Where?) 

? Masses/ nodules/ cysts (where?) 

? Discharge/drainage (color, amt, type) 

? Scrotal vs testicular involvement 

? Epididymitis vs torsion 

? Phren's sign 

? Cremasteric Reflex 

? Hernias 

? Spermatic cord 

? Lymphadenopathy (where?) 

? Rectal exam 

? Prostate exam 

GENITOURINARY (FEMALE) 

Inspect entire pubic area. note lesions, masses, 

edema, erythema, ecchymosis, excoriation, 

lichenification, discharge, drainage. 

Palpate entire pubic area for tenderness, masses, 

nodules, cysts, lymphadenopathy. 
 21

PERTINENT POSITIVES AND NEGATIVES

? HCG 

? Cervical Motion Tenderness (PID) 

? Chandelier's Sign 

? Discharge/drainage (color, amt, type) 

? KOH/NaCl Prep 

? Cervical os condition, bleeding 

? Rectal 

? Ectopic, ovarian cyst, endometriosis 

? Adnexal masses, tenderness 

? Uterine masses, tenderness 

? Vaginal/introitus condition 

? Lesion, rashes, erythema, edema 

? Abortion, miscarriage 

? Chadwick's sign 

? STD workup (TM, chlamydia, RPR, HIV, wet prep), herpes 

 titer and hepatitis screen. 

LOW BACK/HIP EXAM WITH 

NEURO

Be familiar with all landmarks: iliac crest, 

ant/posterior iliac spines, sacrum, lumbars, coccyx, 

paraspinals, latissimus dorsi, greater trochanter, 

Sacral-iliac junction, Sciatic notch. 

PERTINENT POSITIVES AND NEGATIVES 
 22

? Edema, ecchymosis, erythema 

? Deformity, spasms (where) 

? Step off (spondylolisthesis, bifida) 

? Lordosis, scoliosis 

? Tenderness (where?) 

? SLR/ crossover SLR 

? Flip, Patrick, Yeoman's test 

? Hoovers, Milgrams test 

? Rectal Exam 

? Valsalva, (intrathecal pressure) 

? Kernigs test 

? Gaenslen's sign (Sacroiliac) 

? Pelvic Rock (Sacroiliac) 

? Trendelenburg test (hip) 

? Ober's Test (ITB) 

? Range of Motion, Muscle strength 

? Babinski 

Distraction Maneuvers 

? Sitting SLR 

? Axial Compression 

? Pseudo trunk rotation 

? Light touch 

NEURO CHECK L4, L5, S1

L4

Motor- Inversion of foot 

Sensory- Medial aspect of foot/calf 

Reflex- Patellar 

L5 
 23

Motor- Dorsiflexion of big toe 

Sensory- Dorsum of foot and lateral calf 

Reflex- None 

S1

Motor- Eversion of foot 

Sensory- Lateral aspect foot and sole 

Reflex- Achilles 

S5- Sphincter tone 

If any discrepancies, consider doing sensory specific testing 

list on page 32. 

KNEE

Observe patient presentation, consider mechanism 

of injury. Palpate all landmarks. Consider hip, ankle 

involvement. Do neurovascular check (L3, L4, L5, 

S1, S2). Consider Sensory Specific testing. 

PERTINENT POSITIVES AND NEGATIVES 

? Edema, erythema, ecchymosis, effusion 

? Deformity, stability, masses, tenderness 

? Valgus (med collateral) 

? Varus (lat collateral) 

? Anterior drawer (anterior cruciate) 
 24

? Posterior drawer (posterior cruciate) 

? Lachman's (ACL) 

? Posterior Sag (PCL) 

? Apley's compression (meniscus) 

? Apley's distraction (collaterals) 

? Flick test, Duckwalk, Childress (meniscus) 

? McMurray's, Bounce home test (meniscus) 

? Ballotment, bulge sign (effusion) 

? Patellar grind (PFS, CMP) 

? Tinel sign (neuromata) 

? ROM, muscle Strength (active/passive) 

? Neurovascular check (L4, L5, S1), sensory specific. 

IF no history of direct trauma, consider OVERUSE 

conditions. 

? ITB tendonitis 

? PES tendonitis 

? Quadracep/ patellar tendonitis 

? Retinacular tendonitis 

? Shinsplints 

? Stress fracture 

? PFS/CMP 

? Osgood Schlatter's 

? Bursitis (inflammatory, septic) 
 25

ANKLE/FOOT

Observe patient presentation, consider mechanism 

of injury (MOI). Palpate all landmarks. Consider 

knee, hip, back involvement. Do neurovascular 

check ( L4, L5, S1). Consider Sensory Specific 

testing. 

Inspect and Palpate all landmarks 

PERTINENT POSITIVES AND NEGATIVES

? Edema, ecchymosis, erythema, effusion 

? Lesions, rashes, masses, nodules. 

? Deformity, tenderness, crepitus (where?) 

? Neurovascular ( L4, L5, S1 ), sensory specific 

? Stability (ATFL, CFL, PTFL, deltoid ligament) 

? Talar rock, ant drawer 
 26

? Metatarsal squeeze (morton's neuroma) 

? Plantar fascia 

? Peroneus brevis 

? Fx (Jones, Pott's, Talar dome) 

? Squeeze test (Achilles) 

? Syndesmosis disruption 

? Homan's Test (DVT) 

? ROM, muscle Strength (active/passive) 

? Bursitis, (inflammatory, septic) 

SHOULDER EXAM WITH NEURO

Observe patient presentation, consider mechanism of injury 

(MOI). Palpate all landmarks. Consider neck, elbow involvement. 

Do neurovascular check ( C5, C6, C7, C8, T1, T2). Consider 

Sensory Specific testing. 

PERTINENT POSITIVES AND NEGATIVES 

? Edema, erythema, ecchymosis, effusion 

? Deformity, tenderness (where?) 

? Drop arm test (rotator cuff) 

? Yeargersons test (bicipital tendon) 

? Apprehension Test (shoulder stability) 

? Apley's Scratch test 

? Winging 

? ROM, muscle strength (active/passive) 

? Bursitis (inflammatory, septic, DJD) 

? Rhomboid vs trapezius spasm 

? Shoulder Girdle, axilla, clavicle status 

? AC separation 

? Shoulder dislocation 
 27

? Neurovascular check ( C5, C6, C7, C8, T1, T2). 

Do both active and passive ROM testing, Document 

findings. Note when you are able to reproduce discomfort. 

This is essential for accurate diagnosis. 

SHOULDER NEURO EXAM 

C5

Motor- Abduct Arm, Bicep flexion 

Sensory- Lateral Arm (Axillary nerve) 

Reflex- Bicep 

C6

Motor- Wrist extension, Bicep flexion 

Sensory- Lateral forearm/1st, 2nd digit 

 (musculocutaneous nerve) 

Reflex- Brachioradialis 

C7

Motor- Wrist flexors, finger extensors, tricep ext. 

Sensory- Middle finger 

Reflex- Tricep 

C8

Motor- Hand Intrinsics, finger flexors 

Sensory- Medial forearm/ 4th and 5th digits 

 (medial antebrachial cutaneous nerve) 

T1-2

Motor- Hand intrinsics, finger abd/adduction 
 28

Sensory- Medial Arm ( med.brach cutaneous nerve) 

If abnormal findings occur do Sensory Specific, on page 32. 

ELBOW/HAND

Observe patient presentation, consider mechanism of injury 

(MOI). Palpate all landmarks. Consider neck, Wrist involvement. 

Do neurovascular check ( C5, C6, C7, C8, T1, T2). Consider 

Sensory Specific testing. 

PERTINENT POSITIVES AND NEGATIVES

? Edema, erythema, ecchymosis, effusion 

? Deformity, nodules, tenderness (where?) 

? Crepitus 

? Bursitis (inflammatory, septic) 

? ROM, muscle strength (active/passive) 

? Bursitis (inflammatory, septic, DJD) 

? Snuff box tenderness 

? Tenosynovitis (inflammatory, infectious) 

? Fx, sprain, strain, overuse syndrome 

? Neurovascular check ( C5, C6, C7, C8, T1, T2). 

? Tendonitis 

? Flexor, extensor, collateral integrity 

? Fx (volar plate, boxer's, bennett's, colle's, nightstick) 

? Nodules ( DIP Hebeden's, PIP Bouchard's) 

? Cysts (ganglion) 
 29

Establish tendon, muscle, ligament, neurovascular 

integrity prior to any attempt at reducing or closing 

an injury. 

NEURO/MENTAL STATUS EXAM

Do all 6 components: 

1st- Mental Status Exam

Always check this on all patients: Observation is 

your best tool, These can be assessed without 

provoking the pt. Observe the following: 

Level of consciousness 

Posture and motor activity 

Dress, grooming and personal hygiene 

Facial Expression, Speech and Language 

Manner and affect Mood 

Insight and judgement: 

Thought content: Perceptions, interpretation of 

external stimulus. 

Thought Process: Sequence, logic, 

coherence, relevance of thought. 
 30

If anything does not seem right in the routine MS 

exam then check these cognitive Functions:

Test for memory (recent, remote) 

Test for calculation ability 

Test for orientation x3 (person, place, time) 

Test for abstract thinking (proverbs,similarities) 

Test for judgement 

Test for general knowledge 

Test constructional abilities 

Test for new learning ability 

2nd CEREBELLAR FUNCTIONS

1. Station 

2. Romberg 

3. Pronator sign 

4. Heel to toe walk 

5. Heel to shin drag 

6. Rapid alternating movements (RAM's) 

 - flipping hands on thighs 

 - index finger to thumb DIP 
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3rd MOTOR TESTING

Bilaterally check: 

 Cranial nerves III, IV, V, VI, VII, IX, X, XI, XII 

 C5 - T1 

 L4 - S1 

 Dermatomes 

4th SENSORY TESTING

Bilaterally check: 

 Cranial nerves I, II V, VII, IX, X, 

 C5 - T1 

 L4 - S1 

 Dermatomes 

Sensory specific tests 

Sharp/dull 

2 point discrimination 

Temperature 

Vibratory 

Pain 

Light touch 

Proprioception 

Stereognosis 

Graphesthesia 

5th REFLEX TESTING
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Bilaterally check: 

 Cranial nerves V, IX, X, 

 

Deep Tendon Reflexes:

C5 - Biceps 

 C6 - Brachioradialis 

 C7 - Triceps 

 L4 - Patellar 

 S1 - Achilles 

Superficial reflexes: 

Abdominal reflex - upper T7 - T10 

 - lower T10 - L1 

Cremasteric reflex - L1, L2 

Superficial Anal reflex - S2, S3, S4 

Bulbocavernosus reflex - sacral sparring 

Babinski sign- upper motor neuron lesion 

6th CRANIAL NERVE EXAM
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I- Olfactory

 Sensory - smell 

II- Optic

 Sensory - Visual Acuity, Peripheral 

 vision by confrontation.-- Fundoscopic 

III- Oculomotor

 Motor - EOM, accommodation.(lateral rectus, 

 superior oblique) 

IV- Trochlear

 Motor - EOM (superior oblique) 

V- Trigeminal

 Motor- clench teeth (palpate) 

 Sensory- bilateral 3 sections of face 

 Reflex- corneal 

VI- Abducens

 Motor- EOM (lateral rectus) 

VII Facial

 Motor- raise eyebrow, frown, smile, puff 

 cheeks, show teeth, shut eyes tightly. 

 Sensory: taste to anterior of tongue 

VIII Vestibulocochlear

 Sensory- watch tick, rub fingers, weber, rinne. 

IX/X Vagus/Glossopharyngeal

 Motor- Listen to voice, say "AH" 

 Sensory- Taste to Posterior tongue 

 Reflex- gag 

XI Spinal accessory

 Motor- Turn head, Shrug shoulders 

XII Hypoglossal

 Motor- stick out tongue 

 

The ULTIMATE SOAP note: 

Be sure to include something in each 

section and you've just about covered all bases! 

Subjective:
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Pt's name and biographical data 

Chief complaint 

Prior self care/ means of arrival 

History of present illness (concise) 

Review of systems/ associated problems 

Past medical history/ pertinent recent history 

Family/ social history/ other complaints 

Objective: 

Physical Exam/ vital signs 

Impression: Justify ancillary services 

Obtain consent for: 

Procedures, IV's, Labs, X-rays (time) 

Ancillary service interpretation 

Pt condition during/after procedure 

Assessment: 

Found worst to least critical 

Plan:

Meds, Labs, X-rays 

Follow-up date/ where? 

Pt education sheets 

Pt condition on discharge 
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Special thanks to HM2 Eddie Robirds 

for providing the Shipwreck logo.