Chief complaints: Pain: - Bone/ muscle/joints. Bone pain - Deep/ Dull/ and Throbbing. Muscle pain -- Cramping/ Soreness.

Rheumatoid arthritis -- Joint pain / Stiffness. Weakness -- Myopathy/ Neuropathy. Proximal weakness -Difficulty in lifting objects/ combing hair Upper extremities Lower extremities -- Difficulty in walking/ crossing the knees

Distal weakness

-- Difficulty in dressing/ turning a door knob

Upper extremities Myasthenia gravis -- Diplopia/ swallowing/ chewing/ Generalized muscle weakness. Stiffness --Worse at any particular time of the day(arising) Balance and co ordination -- Falling/ lossing balance ataxia/irregular Un co ordinate voluntary movements.

Other related symptoms -- Fever/ joint pain/ back pain / vaginal Discharge/weight loss/Bowel and Bladder dysfunction/ Numbness/ Tingling/ swelling.

PAST HEALTH HISTORY: Child hood illness -- Juvenile Rheumatoid arthritis/ cerebral Palsy/muscular dystrophy. Surgery -- Surgery involving bones/ muscles/ joints Other supporting structures.

Diagnostic procedures: Post menopausal women -- Dexa scan Serious injuries -- In joints/ muscles / bones. Chronic illness -- Medical problem/ SLE/Arthritis/ Synovitis Myositis/HIV/TB/ Diabetes/Charcots joints.

Immunization Allergies

-- TT/Polio. -- Diary products/ Lactose intolerance.

Medications Middle aged women -- Estrogen replacement therapy. (Menopausal) Recent travel -- Exposure to chemicals /Lyme disease.

PERSONAL HISTORY

-- Smoking/ alcohol/ drug abuse.

FAMILY HISTORY: Familial musculoskeletal problems Gout/ arthritis/osteoporosis. LIFE STYLE AND HEALTH PRACTICES Smoking - How many/ How often/ How for. Alcohol -quantity/ amount/How for/How often Exercise - Timing/Daily/ weekly. Stress - Kind of stress

PSYCHO SOCIAL HISTORY Occupation history -- Travel to foreign country Geographical location -- Recent travel. Environment - Living condition Nutrition -- Vegetarian/ non vegetarian Habit -- Life style

ALCOHOL CAGE QUESTIONNAIRE: C ---- Have you ever felt, you should cut down on your alcohol intake. A ------ Have people annoyed you by criticizing your alcohol intake. G ----- Have you ever felt guilty about your alcohol intake. E ------ Have you ever needed alcohol for an eye opener.

ASSESSING READINESS TO QUITE SMOKING 5 AS

Ask about tobacco use. Advise to quite through clear personalized

messages Assess willingness to quite Assess to quite Arrange follow up and support.

EXERCIZE -FITT F ------- Frequency of exercise I -------Intensity T --------Time/ duration T --------Type of exercise.

RATING SCALE FOR MUSCLE STRENGTH

RATING EXPLANATION CLASSIFICATION

5 4 3 2 1 0

Active motion against full resistance Active motion against some resistance Active motion against gravity Passive ROM (gravity removed and Assisted by examiner. Slight flicker of contraction No muscular contraction

Normal slight weakness Average weakness Poor ROM severe weakness Paralysis.

HEAD TO TOE PHYSICAL ASSESSMENT. General appearance Thin/ moderately built/ obese Height - Loss Weight - Gain / Loss Head Face - Symmetrical/ Asymmetrical Oedema - Present/ Absent

Eye Eye brow

Eye lashes

Conjunctiva Eye lids Pupils

- Dry red eyes - Equal distribution of hair/ sparingly distributed/ Absent - Equal distribution of hair/ sparingly distributed/ Absent -Pale/red yellow / pink. - Able to open and close/ ptosis - PERLA

Ear Position

Drainage Nostrils Septum Discharge

- Above the level of the outer cantus/at the level of The outer cantus /below the level of the outer Can thus. - Present/ Absent - Patent/ obstructed - Centre / deviated - Present / Absent.

Mouth Lips Gums Odour Throat

-Dry/moist - Healthy/Swollen - present/Absent - Normal / Inflamed/ulcer/ nodules /swelling Discoloration/ Inflammation. Neck - Swollen glands Trachea - Mid line/ deviated. Neck muscle retraction - Present/ Absent

Chest Inspection
Chest movement Symmetrical/Asymmetrical

- S1 S2 heard / lung sound heard Percussion - Hyper resonant/ resonant/ dull Palpation - Mass/ tenderness Abdomen -Nausea/ vomiting/ Diarrhoea Genitalia - STD /Menopause/HRT/Lesions External - Drainage/ edema/ inflammation/ odour.

Auscultation

Lower extremities ROM - Full/ Limited Changes in sensation - Numbness/ tingling SYSTEMIC ASSESSMENT CENTRAL NERVOUS SYSTEM Level of consciousness - Alert/ awake/ Lethargy/ obtunded/ stupor/coma Dress and grooming -Neat/ meticulous grooming

Facial expression -- Good eye contact/ poor eye contact Head ache -- Present/ absent. Loss of sensation - Numbness/ Tingling CARDIOVASCULAR SYSTEM Rheumatoid heart disease/ pericarditis/ Myocarditis/ Raynauds disease. RESPIRATORY SYSTEM -Interstitial fibrosis/ pleuritis / pneu monitis pleural effusion

Gastrointertinal system :

GI Pain / diarrhoea nausea /vomiting/ difficulty in swallowing Genito urinary system : Haematuria Reproductive system :Menstrual Irregularities back pain Neurological : Loss of sensation / numbness tingling Endocrine system: Muscle wasting /weakness muscle ache /pain

ASSESSING POSTURE, GAIT CEREBRAL FUNCTION posture : Lordosis / Pregnancy lordosis genile Kyphosis / deviation of knees. Genuvarum / Genuvalgum. Gait / Tandem walking Walking : Heel and toe / on toes deep knee bend / hoping in place /Romberg test Eyes open / Eyes closed

CO - ORDINATION Upper extremities: Pronate position / supinate positionFinger thumbopposition Lower Extremitties: Toe tapping / Running heel down / shin Accuracy of movement: Finger to finger / finger to nose Abnormal gaits : Propulsive gait / surrors gait / spastie gait (hemiplegil)

Length Arms Leg

: :

Measuring arm length Measuring leg length Apparent / True measuring midpoint of arm ( arm circumference) Thigh circumference Depression / Elevation Retraction / protraction, circumduction, Extension / FlexionAbduction / Adduction Internal rotation / External Rotation Pronation / Supination Eversion / Inversion

Circumference Arm : Leg : Body movement :

Assessing Joints and Muscles Upper and lower Extremities Inspect / palpate Tempromandibular joint Inspect / Palpate : Sterno clavicular Joint Inspect / Palpate :

: : Muscle mass / tone

ROM / Muscle strength

Location to midline / color swelling / pain / masses Cervical, thoracic and lumbar spine :Inspect / Palpate cervical spine Tenderness / Pain / test room muscle strength neck Cervical Spine ROM :Hyper extension / Hexion Rt lateral bending / Lt lateral Bending

Left Rotation / Rt rotation Thoracic and lumbarspine: Hyper extension / flexion RtLateral bending / Lt lateral Bending Left rotation / Rt rotation Shoulders Inspect : Symmetry / Swelling Palpate : color / masses ROM : tenderness / test ROMMuscle strengthForwardflexion / Backward extensionAbduction / Adduction External rotation Internal rotation

Upper Arm & elbow Inspect : Symmetry / Swelling / color and messes Palpate : Tenderness / Test ROM muscle strength Wrist Inspect / Palpate: Tenderness / Nodules / test ROM muscle strength ROM : Extension / Hyper extension flexion Radial deviation / ulnar deviation

Hands and Fingers Inspect : Size / Shape / Symmetry swelling and color Palpate : nodules and tenderness test ROM /Muscle strength ROM : Hyperextension / dorsiflexion flexionHerberdens nodes / Rheumatoid arthritis Hand and Fingers Inspect : Symmetry / Shape Palpate : Stability / tenderness / Creptitis test for ROM Extension / Flexion

Hips ROM

Muscle strength Flexion / Adduction and Abduction / Hyper extension Eaternal rotation / Internal Rotation size / Shape / Symmetry Deformities / swelling in bub tenderness Flexion

Knees Inspect Palpate ROM

: : :

Ankles and feet Inspect :Position / Alignment / Shape skin Palpate : Beat / Swelling / tenderness or nodules / ROM ROM : Hyper extension / dorsiflexion Additional Test : Phalens test / tinels test straights leg raising Thomas test / Pronatos drift / Bulge test patellar ballottement lachman test / memorys test / Apleys test