Submitted by: Andrea Dora J. Ortaliz MD-3 Submitted to: Dr.

Apolto-Garcia

Review of Systems

General. Usual weight, recent weight change, any clothes that fit more
tightly or loosely than before. Weakness, fatigue, fever.

Skin. Rashes, lumps, sores, itching, dryness, color change, changes in

hair or nails.

Head, Eyes, Ears, Nose, Throat (HEENT). Head: Headache, head injury,
dizziness, lightheadedness. Eyes: Vision, glasses or contact lenses, last
examination, pain, redness, excessive tearing, double vision, blurred vision,
spots, specks, flashing lights, glaucoma, cataracts. Ears: Hearing, tinnitus, vertigo,
earaches, infection, discharge. If hearing is decreased, use or nonuse of
hearing aids. Nose and sinuses: Frequent colds, nasal stuffiness, discharge, or
itching, hay fever, nosebleeds, sinus trouble. Throat (or mouth and pharynx):
Condition of teeth, gums, bleeding gums, dentures, if any, and how they
fit, last dental examination, sore tongue, dry mouth, frequent sore throats,
hoarseness.

Neck. Lumps, “swollen glands,” goiter, pain, or stiffness in the neck.

Breasts. Lumps, pain or discomfort, nipple discharge, self-examination

practices.

Respiratory. Cough, sputum (color, quantity), hemoptysis, dyspnea,

wheezing, pleurisy, last chest x-ray. You may wish to include asthma, bronchitis,
emphysema, pneumonia, and tuberculosis.

Cardiovascular. Heart trouble, high blood pressure, rheumatic fever,

heart murmurs, chest pain or discomfort, palpitations, dyspnea, orthopnea,paroxysmal nocturnal dyspnea,
edema, past electrocardiographic or otherheart test results.

Gastrointestinal. Trouble swallowing, heartburn, appetite, nausea,

bowel movements, color and size of stools, change in bowel habits, rectal
bleeding or black or tarry stools, hemorrhoids, constipation, diarrhea. Abdominal
pain, food intolerance, excessive belching or passing of gas. Jaundice,
liver or gallbladder trouble, hepatitis.

Urinary. Frequency of urination, polyuria, nocturia, urgency, burning

or pain on urination, hematuria, urinary infections, kidney stones, incontinence;
in males, reduced caliber or force of the urinary stream, hesitancy,
dribbling.

Genital. Male: Hernias, discharge from or sores on the penis, testicular

pain or masses, history of sexually transmitted diseases and their treatments.
Sexual habits, interest, function, satisfaction, birth control methods,
condom use, and problems. Exposure to HIV infection. Female: Age at
menarche; regularity, frequency, and duration of periods; amount of bleeding,
bleeding between periods or after intercourse, last menstrual period;
dysmenorrhea, premenstrual tension; age at menopause, menopausal symptoms,
postmenopausal bleeding. If the patient was born before 1971, exposure
to diethylstilbestrol (DES) from maternal use during pregnancy. Vaginal
discharge, itching, sores, lumps, sexually transmitted diseases and
treatments. Number of pregnancies, number and type of deliveries, number
of abortions (spontaneous and induced); complications of pregnancy; birth
control methods. Sexual preference, interest, function, satisfaction, any problems,
including dyspareunia. Exposure to HIV infection.

Peripheral Vascular. Intermittent claudication, leg cramps, varicose

veins, past clots in the veins.

Musculoskeletal. Muscle or joint pains, stiffness, arthritis, gout, and

backache. If present, describe location of affected joints or muscles, presence
of any swelling, redness, pain, tenderness, stiffness, weakness, or limitation
of motion or activity; include timing of symptoms (for example, morning or
evening), duration, and any history of trauma.

Neurologic. Fainting, blackouts, seizures, weakness, paralysis, numbness

or loss of sensation, tingling or “pins and needles,” tremors or other involuntary
movements.

Hematologic. Anemia, easy bruising or bleeding, past transfusions

and/or transfusion reactions.

Endocrine. Thyroid trouble, heat or cold intolerance, excessive sweating,

excessive thirst or hunger, polyuria, change in glove or shoe size.

Psychiatric. Nervousness, tension, mood, including depression, memory

change, suicide attempts, if relevant.

No. Cranial Nerve Function

I Olfactory Sense of smell
II Optic Vision
III Oculomotor Pupillary constriction, opening the eye, and most
extraocular movements
IV Trochlear Downward, inward movement of the eye
VI Abducens Lateral deviation of the eye
V Trigeminal Motor—temporal and masseter muscles (jaw
clenching), also lateral movement of the jaw
Sensory—facial. The nerve has three divisions:
(1) ophthalmic, (2) maxillary, and (3) mandibular.
VII Facial Motor—facial movements, including those of facial
expression, closing the eye, and closing the mouth
Sensory—taste for salty, sweet, sour, and bitter
substances on the anterior two thirds of the tongue
VIII Acoustic Hearing (cochlear division) and balance (vestibular
division)
IX Glossopharyngeal Motor—pharynx
Sensory—posterior portions of the eardrum and ear
canal, the pharynx, and the posterior tongue,
including taste (salty, sweet, sour, bitter)
X Vagus Motor—palate, pharynx, and larynx
Sensory—pharynx and larynx
XI Spinal accessory Motor—the sternomastoid and upper portion of the trapezius
XII Hypoglossal Motor—tongue

STRATEGIES TO ASSESS CRANIAL NERVES IN NEWBORNS AND INFANTS

CRANIAL NERVES STRATEGY

I Olfactory Difficult to test
II Visual acuity Have baby regard your face and look for
facial response and tracking.
II, III Response to light Darken room, raise baby to sitting
position to
open eyes.
Use light and test for optic blink reflex
(blinking in response to light).
Use the otoscope (without a speculum)
to
assess papillary responses.
III, IV, VI Extraocular movements Observe tracking as the baby regards
your
smiling face move side-to-side.
Use light if needed.
V Motor Test rooting reflex.
Test sucking reflex (watch baby suck
 breast,
bottle, or possibly pacifier).
VII Facial Observe baby crying and smiling, note
symmetry of face and forehead.
VIII Acoustic Test acoustic blink reflex (blinking of
both
eyes in response to loud noise).
Observe tracking in response to sound.
IX, X Swallow Observe coordination during
Gag swallowing.
Test for gag reflex.
XI Spinal accessory Observe symmetry of shoulders.
XII Hypoglossal Observe coordination of swallowing,
sucking,
and tongue thrusting.
Pinch nostrils, observe reflex opening of
mouth with tip of tongue to midline.

Primitive Reflexes That Should Be Part of the Routine Neurologi

Primitive Reflexes Age
Palmar grasp reflex birth to 3-4months

Plantargrasp reflex birth to 6-8 months

Moro reflex birth to 4 months

Asymmetric tonic neck reflex birth to 2 months

Positive support reflex birth or 2 months until 6 months

Rooting reflex birth to 3-4 months

Trunk incurvation reflex birth to 2 months

Placing and stepping reflex birth and variable age to disappear

Landau reflex birth to 6 months

Parachute reflex 4-6 months and does not disappear

PRIMITIVE REFLEXES THAT SHOULD BE PART OF THE ROUTINE NEUROLOGIC EXAMINATION OF INFANTS

Primitive Reflex Maneuver Ages

Palmar Place your fingers into the Birth to Persistence beyond 4 mos
Grasp baby’s hands and press 3–4 mos suggests
Reflex against the palmar cerebral dysfunction.
surfaces. Persistence of clenched hand
The baby will flex all beyond 2
fingers to grasp your mos suggests central nervous
fingers system
damage, especially if fingers
overlap
thumb

Plantar Touch the sole at the base Birth to Persistence beyond 8 mos
Grasp of the toes. 6–8 mos suggests
Reflex The toes curl. cerebral dysfunction.

Moro Hold the baby supine, Birth to Persistence beyond 4 mos

Reflex supporting the head, 4–6 mos suggests
(Startle back, and legs. Abruptly neurologic disease; beyond 6
Reflex)
lower the entire body mos
about 2 feet. strongly suggests it.
The arms abduct and
extend, hands open, and
legs flex. Baby may cry.

Asymmetric With baby supine, turn Birth to Persistence beyond 2 mos

Tonic head to one side, holding 2 mos suggests
Neck jaw over shoulder.
Reflex The arms/legs on side to neurologic disease.
which head is turned
extend while the
opposite arm/leg flex.
Repeat on other side.

Positive Hold the baby around the Birth or Lack of reflex suggests
Support trunk and lower until the 2 mos hypotonia or
Reflex feet touch a flat surface. until flaccidity.
The hips, knees, and 6 mos Fixed extension and
ankles extend, the baby adduction of legs
stands up, partially (scissoring) suggests
bearing weight, sags after spasticity due to
20–30 seconds. neurologic disease.

ADDITIONAL PRMITIVE REFLEXES THAT SHOULD BE TESTED IF NEUROLOGIC

ABNORMALITY IS SUSPECTED

Primitive Reflex Maneuver Ages

Rooting Stroke the perioral skin Birth to Absence of rooting indicates
Reflex at the corners of the 3–4 mos severe generalized
mouth. or central nervous system
The mouth will open disease.
and baby will turn
the head toward the
stimulated side and
suck.
Trunk Support the baby Birth to Absence suggests a transverse
Incurvation prone with one hand, 2 mos spinal cord
(Galant’s) and stroke one side lesion or injury.
Reflex
of the back 1 cm Persistence may indicate
from midline, from delayed development
shoulder to buttocks.
The spine will curve
toward the
stimulated side.
Placing Hold baby upright Birth Absence of placing may
and from behind as in (best indicate paralysis.
Stepping positive support after 4 Babies born by breech
Reflexes
reflex. Have one sole days). delivery may not
touch the tabletop. Variable have placing reflex.
The hip and knee of age to
that foot will flex and disappear
the other foot will
step forward.
Alternate stepping will
occur.
Landau Suspend the baby Birth to Persistence may indicate
Reflex prone with one hand. 6 mos delayed development.
The head will lift up
and the spine will
straighten
Parachute Suspend the baby 4–6 mos Delay in appearance may
Reflex prone and slowly and does predict future
lower the head not delays in voluntary motor
toward a surface. disappear development
The arms and legs will
extend in a protective
fashion.