Introduction to Clinical Skills

Limbs Examination

Universidad Iberoamericana UNIBE

Introduction to Clinical Skills

Teaching Staff Dra Elizabeth Peralta Dr Marcos Núñez Dra Cristina Páez C Dr Juan Carlos Mariñez Dra Wayna Greo Dra Yun Pey Lee

Introduction to Clinical Skills

Objectives Skin and Appendages Peripheral Vascular Neurological (Peripheral)

Sensory, Motor, Reflexes

Muscle-skeletal Muscle tone, Muscle strength

Introduction to Clinical Skills

Lower Extremities

Universidad Iberoamericana UNIBE

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology The Health History Health Promotion and Counseling

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

11 weeks

1.Periderm2. Basal layer3. Intermediate layer4. Migrating melanoblast5. Mesenchyme

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

Introduction to Clinical Skills

Skin and Appendages The Health History

Rash Moles (Nevus)

Health Promotion and Counseling Risk factors for skin cancers Avoidance of excessive sun exposrure Avoid skin dryness Nail cutting (pedicure) Shoes

Introduction to Clinical Skills

Skin and Appendages Forefoot Types

Introduction to Clinical Skills

Peripheral vascular exam Anatomy The Health History Health Promotion and Conseling

Introduction to Clinical Skills

Peripheral vascular exam Anatomy

Introduction to Clinical Skills

Peripheral vascular exam The Health History

Pain in the legs Intermittent claudication Cold, numbness, pallor in the legs, hair loss Swelling in calves, legs or feet Color change in toes in cold weather Swelling with redness or tenderness

Introduction to Clinical Skills

Peripheral vascular exam Health Promotion and Counseling

Screening for peripheral arterial disease Screening for renal artery disease Screening for abdominal aortic aneurysm

Introduction to Clinical Skills

Peripheral vascular exam Risk factors for Lower-Extremity arterial peripheral disease

Age younger than 50 years with diabetes or atherosclerosis risk factor of smoking, dyslipidemia, hypertension, or hyperhomocysteinemia

Age 50 to 60 years and history of smoking or diabetes Age 70 years or older Leg symptoms with exertion or ischemic rest pain Abnormal lower extremity pulses Known atherosclerotic coronary, carotid, or renal disease

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

The Legs Size, symmetry, skin color Femoral pulse and inguinal lymph nodes Popliteal, posterior tibialis and dorsalis pedis pulses Peripheral edema

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

Arterial system exam Anatomy Pallor, cyanosis Color and capillary refill Postural changes Extremity pulses ( 0 to 2+) Ankle Brachial Index

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

Arterial system exam

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

Arterial system exam

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

Venous system exam Anatomy Skin color, pigmentattion, ulcers Postural changes Venous pattern Competency of venous valves Soft edema

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

Venous system exam

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

Venous system exam

Introduction to Clinical Skills

Peripheral vascular exam Important Areas of Examination

Lymphatic system exam Anatomy Skin color Postural changes Edema (soft vs brawny) Palpable lymph nodes Painful lymh nodes Red striking tracts

Introduction to Clinical Skills

Peripheral vascular exam Recording your findings

“Extremities are warm and without edema. No varicosities or stasis changes. Calves are supple and nontender. No femoral or abdominal bruits. Femoral, popliteal, posterior tibialis and dorsalis pedis pulses are 2+ and symmetric”

Introduction to Clinical Skills

Peripheral neurological exam Sensory evaluation (sensory pathways) Motor exam (motor pathways) Reflexes (spinal reflexes: the deep tendon response)

Introduction to Clinical Skills

Peripheral neurological exam Sensory evaluation (sensory pathways)

Dermatomes Pinwheel

Digital nerves 2PD static

Introduction to Clinical Skills

Peripheral neurological exam Sensory evaluation (sensory pathways)

Introduction to Clinical Skills

Peripheral neurological exam Motor exam (motor pathways)

Body position Involuntary movements Muscle bulk Muscle tone Muscle strength

Introduction to Clinical Skills

Peripheral neurological exam Motor exam (motor pathways)

Introduction to Clinical Skills

Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response)

Patella Achilles tendon

Introduction to Clinical Skills

Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response)

Introduction to Clinical Skills

Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response)

Reinforcement of Knee Reflex

Introduction to Clinical Skills

Peripheral neurological exam Reflexes (spinal reflexes: the deep tendon response)

Introduction to Clinical Skills

Peripheral neurological exam Reflexes (Cutaneous stimulation reflex)

Introduction to Clinical Skills

Muscleskeletal exam Joint structure and function The Health History Health Promotion and Counseling Examination of specific joints

Spine and Hip Joints of lower extremities

Introduction to Clinical Skills

Muscleskeletal exam Joint structure and function

Introduction to Clinical Skills

Muscleskeletal exam The Health History Common or concerning Symptoms

Low back pain Monoarticular or polyarticular joint pain Inflammatory or infectious joint pain Joint pain with systemic features such fever, chills, rash, anorexia,

weight loss, weakness Joint pain with symptoms from other organ system

Introduction to Clinical Skills

Muscleskeletal exam Health Promotion and Counseling. Important Topics

Nutrition Low back: lifting biomechanics Prevneting falls Osteoporosis: screening and prevention

Introduction to Clinical Skills

Muscleskeletal exam Examination of specific joints

Introduction to Clinical Skills

Muscleskeletal exam Joint structure and function

Introduction to Clinical Skills

Muscleskeletal exam Joint structure and function

Introduction to Clinical Skills

Introduction to Clinical Skills

Upper Extremities

Universidad Iberoamericana UNIBE

Introduction to Clinical Skills

Skin and Appendages

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

Introduction to Clinical Skills

Skin and Appendages Embriology-Anatomy-Histology-Physiology

Introduction to Clinical Skills

Skin and Appendages The Health History

Rash Moles (Nevus)

Health Promotion and Counseling Risk factors for skin cancers Avoidance of excessive sun exposrure Avoid skin dryness

Introduction to Clinical Skills

Peripheral vascular exam The Health History

Pain in the hands Intermittent claudication Cold, numbness, pallor in the hands, hair loss Swelling in arm, forearm and hand Color change in fingers in cold weather Swelling with redness or tenderness

Introduction to Clinical Skills

Peripheral vascular exam Arterial Venous Lymphatics

Introduction to Clinical Skills

Peripheral vascular exam Allen´s Test

Introduction to Clinical Skills

Peripheral vascular exam Allen´s Test

Introduction to Clinical Skills

Peripheral vascular exam Allen´s Test

Introduction to Clinical Skills

Peripheral vascular exam Allen´s Test

Introduction to Clinical Skills

Peripheral vascular exam Arterial Venous Lymphatics

Introduction to Clinical Skills

Peripheral vascular exam Arterial Venous Lymphatics

Introduction to Clinical Skills

Peripheral neurological exam Sensory

Pinwheel exam

Introduction to Clinical Skills

Peripheral neurological exam Sensory

2PD static or moving

Introduction to Clinical Skills

Peripheral neurological exam Sensory

Tinel´s sign

Introduction to Clinical Skills

Peripheral neurological exam Motor

Introduction to Clinical Skills

Peripheral neurological exam Flexion Extension Pronation Supination

Introduction to Clinical Skills

Peripheral neurological exam Ulnar deviation Radial deviation

Introduction to Clinical Skills

Peripheral neurological exam Fingers flexion Fingers extension

Introduction to Clinical Skills

Peripheral neurological exam Motor

Muscle Bulk Muscle Tone Muscle Strength

M0 –M5 Grip strength

Dynamometer

Introduction to Clinical Skills

Peripheral neurological exam Motor

Introduction to Clinical Skills

Peripheral neurological exam Motor

Introduction to Clinical Skills

Peripheral neurological exam Motor

Introduction to Clinical Skills

Peripheral neurological exam Motor

Introduction to Clinical Skills

Peripheral neurological exam Motor

Introduction to Clinical Skills

Peripheral neurological exam Reflexes

Introduction to Clinical Skills

Peripheral neurological exam Reflexes

Introduction to Clinical Skills

Muscleskeletal exam Muscles Bones Joints an ligaments

Introduction to Clinical Skills

Introduction to Clinical Skills