ROS

9 Questions

ROS 9 Questions

Do you have any headaches? frequent or severe?

Have you had fainting spells (blackout)in the last 2yrs?

Is there a history of head injury or stroke?

Do you have dizziness or spinning sensation? (vertigo)

Have you had convulsions (seizures)

Do you have numbness or weakness of body parts, arms or legs?

Do you have trouble with balance or coordination?

Do you have trouble with memory or speaking ability?

Do you use alcohol or illicit drug?

Assessment of CN

CN I ___

Check nasal patency by ___

Ask pt to close eyes

Test and Occlude each ___ separately

Assessment of CN I Olfactory

Check nasal patency by having the patient sniff.

ask pt to close eyes 

test and occlude each nostril separately

CN II ______

(4)

CN II Optic 

Check visual acuity 

Perform visual field by confrontation

Inspect n. by opthalmoscope exam (focus on optic disc)

Report Findings 

CN 3/4/6

Name

Test _________

___ response to light

___response to light

___movements

CN 3 Oculomotor

CN 4 Trochlear

CN 6 Abducens

Test accommodation

Direct Pupillary response to light

Consensual pupillary response to light

Extraocular movement H Test

Report- All N. intact and functioning

CN 5 __

Request pt ___ ___

Motor Assessment:palpate __ and __ muscles

Sensory Assessment: 3

___ ___ assesement

___ assesment

___ assessment/Report technique

___ reflex/Report technique

CN 5 Trigeminal

Request pt clench teeth

Motor A:palpate temporal and masseter m.

Sensory A: Opthalmic/Maxilary/Mandibular Branches

Light Touch Assessement

Pain assessement

Temp Assessement/Corneal Reflex just report.

CN 7 __

Inspect and reports ___ asymmetry

MA: 6

SA: Explain ___ 2/3 ant. ___ salt/sweet/bitter

CN 7 Facial 

Inspects/reports facial asymmetry

MA: Raise Eyebrows

Frown

Close eyes against resistance

Show teeth

Smile

Puff out cheeks

SA: Explain Taste 2/3 ant. tongue salt sweet bitter

CN 8 __

Assess __ acuity by

Perform W/R

Report Finding

CN 8 Vestibulocochlear

Assess auditory acuity by whispered voice

Perform Webber/Rinne

Report Findings 

CN 9/10

SA: Report post. 1/3 of __ salt/sweet/bitter

MA: Say __

Inspect upward rise of 

Inward movement of __

Note __ reflex

Report __

CN 11

Assess __ __ against resistance

Reports ___ m. assessed by above

Assess __ m. by turning against resistance 

CN 11 Spinal Acessory

Assess raised shoulder against resistance

Report trapezius m. assesed from above

Assess sternoclydomastoid m. by turning against resistance

CN 12

Inspect 2

Report

CN 12 Hypoglossal

Inspect tongue/floor of mouth

Inspect tongue on protusion

Non-symmetrical=stroke

Motor System I/R 

Body __ / __ Movements /__ Bulk

__ and__ against resistance

Elbows

Wrist

Fingers 3

Motor System I/R

Body position/involuntary movements/m. bulk

Flexion/extension against resistance

Elbow/Wrist

Fingers

Grip/Abduction-Spread against resistance

Finger flexion w/ thumb opposition against resistance

Hips

4 types of Resistance 

Knees

2 types of Resistance 

Ankles 

2 types of flexion against resistance

Hips

Flexion/Abduction/Adduction/Extension

Knees 

Flexion/extension 

Ankles

Dorsiflexsion/plantar

Coordination

Rapid Alt Movements Upper and Lower Extremity

4

Point to Point -Upper/Lower Extremity 

5

Rap Alt Movements U/L Extremity 

Alt rotate dorsal/palmar hand on thigh

Fingers to thumb

Tap examiners hand with ball of foot/ alt and together

Report

Pt to pt U/L Extremity>give instructions or demo

finger to noes/eye open

finger to nose/eyes closed

Heel to shin

Report

Coordination cont..

Gait- Assess

6

Romberg/Explain/Report findings

Pronator Drift/Explain/Report findings

Gait Assess

Reg Gait/Walk on toes

Walk on heels/Tandem (heel to toe)

Hop on one foot/shallow knee bend

Romberg

Stand feet together arms at side/Close eyes

Cerebellar disfxn if rock forward

Pronator

Feet shoulder width/arms in front/close eyes/push one arm down and then bring up to starting position.

Sensory Assessment

Light Touch 4

Pain Sensation 5

Temp/explain

SA:

Light Touch 

Give instructions/close eyes

Cotton tip

Test Bilat/ arms/legs/trunk

Report

Pain Sensation 

Give instruction/close eyes

Alt blunt/sharp pain

Compare bilat

Arms/legs/trunk

Report

Temp/test if abnormality found

Vibratory Sensation 4

Position 2

Vib Sensation

Pt given instructions for responding

Upper extremity of bony prom of finger (dip) distal interphalangeal jt

Lower extremity bony prom of toe ip (interphalangeal) joint

Report

Postion

Great Toe/index finger

Grab sides lift up/down stop ask them to identify postion

Discrimination sensation assesment

Graphesthesia

Stereognosis

Pt Localization 3

Extinction 3

Discrimination Sensation 

Graphesthesia/eyes closed/number id/report

Sterognosis eyes closed/Object id

Point Localization

eyes closed point to exact location of touch

Arms/Trunk/Legs

Report

Extinction 

simultaneously touch both sides of body/diff 1vs 2 touches 

eyes closed point to exact location of touch

Arms/Trunk/Legs

Report

2pt discrimination 4

Reflexes

Deep Tendon 6

2pt Discrimination

paper clip/2ends/close eyes

id 1 vs 2 simultaneous touch on finger pad 

bilat

report min distance before discrimination

Reflexes

Deep Tendon Graded on 2 + scale

Biceps/Brachioradialis/Triceps/Patellar/Achilles

Hyperactivity Reflex Assessment ankle (clonus) 4

Superficial Reflexes 5

Hyperactivity Reflex Ankle

Support knee in flexed psition

Dorsiflex foot

Maintain dorsiflex

Reports normal response 

Superficial reflexes

Abdominal/Demo/Explain

Plantar/Babinski 

Stroke lat to med

Report norm toes curl

Report abnorm toes dorsiflex

Meningeal Signs Assessment

Brudzinski's Sign 2

Kernigs Sign 3

Levels of Consiciousness

Pt edu.

Brudzinski's Sign

Pt in supine psition/flex pt head /neck

Report presence flexion of hips and knees

Kernig's Sign

Flexes pt leg at hip and knee>discomfort behind knee norm for some

Slowly extends knee>Pain abnorm in both legs menengial irratation

Report pain/resistance 

Level of consciousness

Alert/Lathargic/Obtunded/Stuper/Comatose