Musculoskeletal exam: The patient has good s/l RAM.
Posted By: sh on 2008-01-24
In Reply to:
Subject: Musculoskeletal exam: The patient has good s/l RAM.
She says this twice. Clearly not sounding like range of motion. Thanks for any help!
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Musculoskeletal Exam
Subject: Musculoskeletal Exam
Does this make sense to anyone? Active range of motion of the left knee is approximately 0 to 100?
Musculoskeletal Exam
Subject: Musculoskeletal Exam
There are no [s/l dermaternal?] changes noted in upper and lower extremities.
Musculoskeletal exam
Subject: Musculoskeletal exam
Sensation is intact for the s/l fil-a-mon test.
s/l Fabray is positive on musculoskeletal exam.....(nm) TIA!
Subject: s/l Fabray is positive on musculoskeletal exam.....(nm) TIA!
x
Ear exam...good bony light
Subject: Ear exam...good bony light
The next word is what I don't understand. This is in the HEENT exam. The statement is: TM's are flat with good bony light ___. Is it - bony light reflects or maybe bony light reflex. Can anyone help with this. THX
Here is good lung exam site for you. sm
Subject: Here is good lung exam site for you. sm
http://medinfo.ufl.edu/year1/bcs/clist/chest.html
Here is a good all around PE link. Click on lower extremities exam. sm
Subject: Here is a good all around PE link. Click on lower extremities exam. sm
http://meded.ucsd.edu/clinicalmed/extremities.htm
The patient looks fairly good (or well)?
Subject: The patient looks fairly good (or well)?
x
Exam on patient with MS
Subject: Exam on patient with MS
Cranial nerve exam revealed left homonymous hemianopsia, as well as *slowsecots* to the left, ocular dysmetria.
Thank you so much for any ideas. This is backup account. Never heard this before.
would doc say skin with good s/l rigidity??? and turgor for elderly patient?
Subject: would doc say skin with good s/l rigidity??? and turgor for elderly patient?
Neuro exam - patient had cervicothoracic laminectomy - sm
Subject: Neuro exam - patient had cervicothoracic laminectomy - sm
Exam: Her wound is healed. She has got mild paraspinal tenderness with some evidence of spasm. No **rubo or corlora delora** noted. She is awake. She is oriented x3.
I have no idea what I am hearing or if my spaces are correct in my s/l. I'd love any help!! Thanks.
Patient has a history of s/l hyperpotassiumemia. I'm not finding any good hits on google and sm
Subject: Patient has a history of s/l hyperpotassiumemia. I'm not finding any good hits on google and sm
doc is known for making up his own words.
the patient is thin appearing on today’s exam, almost s/l morphonoid like.
Subject: the patient is thin appearing on today’s exam, almost s/l morphonoid like.
Are you in the hands? The back? Doing an exam or talking about a patient's test? nm
Subject: Are you in the hands? The back? Doing an exam or talking about a patient's test? nm
f
JUDE or JUTE exam. Patient has normal genitalia.
Subject: JUDE or JUTE exam. Patient has normal genitalia.
I've been listening and searching on this one - it's probably something simple.... Hope someone can help me - thanks in advance.
patient has shoulder pain. On exam no cerva-chromal crepitus. nm
Subject: patient has shoulder pain. On exam no cerva-chromal crepitus. nm
thanks.
physical exam under general: the patient appeared s/l kick ectic? nm
Subject: physical exam under general: the patient appeared s/l kick ectic? nm
Patient with below knee amputation. On exam, there is s/l communication to the drainage sites. TIA
Subject: Patient with below knee amputation. On exam, there is s/l communication to the drainage sites. TIA
Patient w/ dysesthesias in his hand, s/l [lamets] negative, and good range of motion of neck?-nm
Subject: Patient w/ dysesthesias in his hand, s/l [lamets] negative, and good range of motion of neck?-nm
Patient is oriented to time, person and place with good *respondent* memory. Does this make sense?
Subject: Patient is oriented to time, person and place with good *respondent* memory. Does this make sense?
musculoskeletal
Subject: musculoskeletal
Thanks for your advise, but...
Yes, that is what I would put, but dictators are very specific and do not want their verbiage changed, but cannot find a correct spelling of this anywhere!
Musculoskeletal help
Subject: Musculoskeletal help
I am doing a musculoskeletal exam. I cannot figure out what he is saying and cannot find a list of common tests done. Does anyone have a clue?
s/l Trendellenburg's test, (s/l bactruse) test, (s/l ulise) test, (s/lserial halls) test (s/l spurring) and straight leg raising negative.
Thanks in advance.
Figured out the musculoskeletal one... still looking for the other...
Subject: Figured out the musculoskeletal one... still looking for the other...
MUSCULOSKELETAL heading?
Subject: MUSCULOSKELETAL heading?
Newbie here. I'm typing an H&P and under instruction to supply appropriate headings & subheadings if they are not dictated, esp. in an H&P.
Under the Physical Examination, the Dr. dictated most headings, but under ABDOMEN, she continued with what I think is more of a musculoskeletal exam:
ABDOMEN: His abdomen is rotund, nontender, nondistended, and soft. He has no costovertebral angle (CVA) tenderness to percussion. He has no thoracic tenderness to palpation. His pain begins at approximately L2 down to his sacrum, with pain greater down his right gluteus versus his left, but does have pain. He has slow movement and grimaces with any movement. He is able to stand. Decreased range of motion secondary to pain. Straight-leg reflex painful in both legs. Reflexes are diminished bilaterally.
Here is my question: I cannot find a precedent for adding the MUSCULOSKELETAL subheading. Yet beginning from "His pain" and following is not really under an ABDOMEN exam, is it? At the very least, I feel I should start a new paragraph, but then my format is messed up b/c everything else has a subheading!
Needless to say, it stresses me out a bit. Any advice is definitely appreciated!
Musculoskeletal/Neurologic
Subject: Musculoskeletal/Neurologic
You need to head it the way I did in the subject above...
It is Amrix, a musculoskeletal relaxant- nm
Subject: It is Amrix, a musculoskeletal relaxant- nm
xx
Roxitan is correct....musculoskeletal and
Subject: Roxitan is correct....musculoskeletal and
xx
I'd say positive for musculoskeletal back pain.
Subject: I'd say positive for musculoskeletal back pain.
Patient with gangrene of foot. On exam, the entire foot is ulcerated with s/l us-i-nest debris.
Subject: Patient with gangrene of foot. On exam, the entire foot is ulcerated with s/l us-i-nest debris.
:-)
NWMNMT:Good grief, good grief, good grief..If this is the case, the doctor should also explain
Subject: NWMNMT:Good grief, good grief, good grief..If this is the case, the doctor should also explain
the meaning in an ADDENDUM.
How do you know what the doctor meant? GOOD GRIEF, are you the know-it-all (hyphens must be put here, as it is used as a noun!) on this board? Get over yourself!
Who understands what it means without an explanation?
The MOST obvious is apparently like I understood it:
5 packs in 1 year.
Maybe the doctor really meant this, 5 packs per year, so essentially a nonsmoker.
GOOD GRIEF, get over yourself!
Throat exam is normal, as were the rest of her neck, face, and skull exam.
Subject: Throat exam is normal, as were the rest of her neck, face, and skull exam.
Glad to help. You give good me a good S/L and info. nm
Subject: Glad to help. You give good me a good S/L and info. nm
Glad to help. You give good such good S/L and info. nm
Subject: Glad to help. You give good such good S/L and info. nm
Eye exam: s/l "sub-lamp" exam shows left side has multiple small punctations in the cornea.(t
Subject: Eye exam: s/l "sub-lamp" exam shows left side has multiple small punctations in the cornea.(thanks)
Physical exam on eye exam, s/l Cardinal Welk's space?? noted.NM
Subject: Physical exam on eye exam, s/l Cardinal Welk's space?? noted.NM
What kind of doc is doing the exam? And where in the exam is this test mentioned? nm
Subject: What kind of doc is doing the exam? And where in the exam is this test mentioned? nm
s
Question about eye exam...when everting lids on eye exam (sm)
Subject: Question about eye exam...when everting lids on eye exam (sm)
It is EVERT, not AVERT, right? I have always typed it with an E but I have a PA who keeps insisting it is A. I always thought Avert applied to gaze, as if to look away. Just want to make sure everting the eyelid is the right term. TIA.
Good save, Hay! I never heard of this. Have a good one! nm
Subject: Good save, Hay! I never heard of this. Have a good one! nm
s
doc dictates "the patient has 120 pack year smoking history", patient is 75...is that right???
Subject: doc dictates "the patient has 120 pack year smoking history", patient is 75...is that right???? NM
Patient is here for an s/l eflex injection. Patient previously had Orthovisc.
Subject: Patient is here for an s/l eflex injection. Patient previously had Orthovisc.
nm
OB patient - s/l The patient has a 'null' sign.
Subject: OB patient - s/l The patient has a 'null' sign.
Which is correct? self-breast exam or breast self-exam (nm)
Subject: Which is correct? self-breast exam or breast self-exam (nm)
xx
A1c; patient is to follow up in 2 weeks; patient has a followup in 2 weeks.
Subject: A1c; patient is to follow up in 2 weeks; patient has a followup in 2 weeks.
nm
Good for you
Subject: Good for you
:-)
good/well
Subject: good/well
According to Webster's, good as an adjective and standard after verbs like "feel" and "taste". It goes on to say that both "good" and "well" are used to express good health, but "I feel good" may connote good spirits in addition to good health. I was always taught in English class that one feels "good," not well. If you feel well, your fingers are working correctly. Since it says that good and well are both used to express health, perhaps you can take your choice. I would write that he looks good.
Looks good to me.
Subject: Looks good to me.
x
THX again-- your good!
Subject: THX again-- your good!
You are good, that is it !!!! Thank you...nm
Subject: You are good, that is it !!!! Thank you...nm
x
looks good to me, thanks!
Subject: looks good to me, thanks!
//
Yep, you did! Good for you! More fun that way. nm
Subject: Yep, you did! Good for you! More fun that way. nm
x
So far so good for you, then.
Subject: So far so good for you, then.
re hypertension
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