Health Questions and Answers

Question: How can I perform a brief, directed physical examination on a patient with altered consciousness?

Answer:

The goal of the physical examination is to differentiate structural focal CNS problems from diffuse metabolic processes. Pay special attention to vital signs, general appearance, mental status, eye findings, and the motor examination.

The general appearance should be noted before examining the patient. Are there signs of trauma? Is there symmetry of spontaneous movements?

Mental status should be assessed quickly. Ask four sets of progressively more difficult questions:
(1) orientation to person, place, and time
(2) name the President of the United States/Philippines
(3) count backward from 20 (if done correctly ask for serial 3s or 7s)
(4) recent recall of three unrelated objects.
Motor examination is done to determine the symmetry of motor tone or strength and response of deep tendon reflexes.

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