• Kidney stones, blood in urine, dysuria, voiding pattern changes, itching, cancer (e.g., prostate, cervix, ovarian), UTI.
• Sexual history: Sexual activity, use of protection against infection, method of birth control, multiple or same-sex partners, history of STD, ED (male Pts).

• Antibiotics, antifungals, antispasmodics, phosphodiesterase inhibitors (Viagra, Cialis, Levitra), analgesics.

• History of painful or burning urination?
• Female: Dysmenorrhea (abnormally severe cramping during menstruation).
• Male: Penis, testes, scrotum, and groin.

• Blisters, ulcers, sores, warts, or rashes.

• Symmetry, dimpling or edema, nipples (color, discharge, or inversion).
• Lumps or tenderness (palpate in a concentric circle, outward from nipple, including axillae), presence of implants.
• Breast self-exams?

• Lumps, masses, or swelling (palpate scrotum and groin area).
• Testicular self-exams?

• Female: Assess for vaginal discharge and note color, odor, amount, and any associated symptoms.
• Male: Inspect meatus for discharge and note color, amount, and any associated symptoms.

• Describe last period including date.
• Do periods occur regularly?
• Investigate bleeding other than normal period (frequency, quantity, symptoms).

• Topical creams, gels, or ointments such as antibiotic, antifungal, anti-inflammatory.
• Oral medications such as antibiotics, antifungal and antiviral agents, biologics, immunosuppressants, and corticosteroids.

• Color: Erythema, pallor, jaundice.
• Bruising, scars, tattoos.
• Cyanosis: Differentiation between central (lips, conjunctiva) and peripheral (nailbeds, extremities) cyanosis.
• Oral mucosa used for assessing color changes in darkskinned Pts.
• Sclera used for assessing jaundice in Pts of Asian descent.

• Texture and distribution.
• Condition of scalp.

• Cyanosis, fungal infections.
• Angle of attachment (normal, 160°; abnormal, >180°, indicating chronic pulmonary disease).

• Coolness.
• Warmth.

• Diaphoresis.
• Excessive dryness.

• Time it takes skin to flatten after pinching.
• Poor skin turgor is a sign of dehydration.
• Sternum or forehead skin used in older Pts.

• Presence and type of lesions or rashes.
• Determining whether rashes blanch.

• Pressure ulcers, surgical wounds.
• Inspection of legs and feet of diabetic Pts.

• Gait, balance, coordination, limitations.

• Posture, spinal curvature.
• Spinal deformities (scoliosis, kyphosis, lordosis).

• Limb length discrepancy.
• Grip strength.
• Push-pull strength of feet.

Muscle Strength Grading Scale

• 0..............No muscle movement.
• 1...............Visible muscle movement, but no joint movement.
• 2..............Joint movement, but not against gravity.
• 3...............Movement against gravity, but not against resistance.
• 4...............Movement against resistance, but less than normal.
• 5..............Normal strength.

• Limitations and pain during movement of neck, shoulders, elbows, wrists, spine, hips, knees, and ankles.
• Tests include: Flexion, extension, rotation, lateral bend, abduction, adduction, circumduction, supination, pronation, inversion, and eversion as applicable.

• Affect, mood, appearance, behavior, and grooming.
• Clarity of speech and coherence.
• Alertness, lethargy, confusion, obtundation, stupor.
• Orientation to person, place, time.

• Involuntary movements, muscle symmetry, atrophy.

Muscle Tone

• Flex and extend wrists, elbows, ankles, and knees; slight, continuous resistance to passive movement is normal.
• Note any decreased (flaccid) or increased (rigid or spastic) muscle tone.

Motor Strength

• Have Pt move against resistance. (See Muscle Strength Grading Scale in Musculoskeletal Assessment section.)

• Stroke lateral aspect of sole of each foot with reflex hammer.
• Normal response is flexion (withdrawal) of toes.
• Positive (abnormal) Babinski’s reflex is characterized by extension of big toe with fanning of other toes.

Clonus

• With knee supported in partially flexed position, quickly dorsiflex foot.
• Rhythmic oscillations are positive for clonus.

Deep Tendon Reflexes

• 0..........................................Absent.
• 1+........................................Diminished.
• 2+........................................Normal.
• 3+........................................Hyperactive without clonus.
• 4+........................................Hyperactive with clonus.

• Observe gait while Pt walks across room and back.
• Have Pt walk heel-to-toe or on heels in a straight line.
• Have Pt hop in place on each foot.
• Have Pt do shallow knee bend.

Rapid Alternating Movements

• Instruct Pt to tap tip of thumb with tip of index finger as fast as possible.

Point-to-Point Movements

• Instruct Pt to touch his or her nose and your finger alternately. Continually change position of your finger during test.

Romberg’s Test

Be prepared to catch Pt!

• Request that Pt stand with feet together, eyes closed for 10 sec. If Pt becomes unstable, test result is positive, indicating proprioceptive or vestibular problem.

Proprioception

• Instruct standing Pt to close eyes and alternate touching index fingers to nose.

• Using your finger and a toothpick, instruct Pt to distinguish between sharp and dull sensations.
• Compare left with right (Pt’s eyes closed).