Comprehensive Skills Exam

Question 1

How to measure JVP? What to say?

Answer 1

Bed at 30º. Identify highest point of pulsation “meniscus” of Right Internal Jugular Vein. Use ruler at sternal angle/angle of louis and tangential lighting. Say, “Determining A and V waves. Elevated/abnormal findings are >4cm above sternal angle and >9cm above right atrium.”

Question 2

What is Kussmal’s Sign?

Answer 2

When JVP rises with inspiration due to impaired filling of Right Ventricle. Normally JVP decreases with inspiration.

Question 3

How to assess for Kussmal’s Sign? What to say?

Answer 3

Bed at 30º like testing for JVP. Use tangential lighting and ruler. Direct PT to inspire and observe for paradoxical rise of JVP with inspiration. Say, “When this sign is present this finding/sign suggests impaired filling of Right Ventricle.”

Question 4

When is assessing Hepatojugular Reflex indicated? (2 reaons)

Answer 4

1. Subacute right-sided heart failure

2. Passive hepatic congestion

Question 5

How to assess Hepatojugular Reflex? What to verbalize?

Answer 5

Bed at 30º. Use tangential lighting. Apply firm pressure over RUQ while observing JVP. Say, “Indicated in subacute right-sided heart failure or passive hepatic congestion.” If finding is positive say, “When present an increased JVP waveform is noted.”

Question 6

Listen to bruit with which part of stethoscope?

Answer 6

Bell

Question 7

Palpate for carotid pulse on which part of artery?

Answer 7

Lower 1/3

Question 8

How to assess carotid pulse? What to verbalize?

Answer 8

PT supine. Listen to bruit with bell. Palpate pulse on lower 1/3 of neck on both sides. Say, “The upstroke of the carotid pulse follows S1.”

Question 9

Where is Erb’s Point?

Answer 9

3rd or 4rd left ICS @ sternal border.

Question 10

Is murmur of Aortic Insufficiency/Regurg systolic or diastolic?

Answer 10

Diastolic

Question 11

How to assess for Aortic Insufficiency/Regurg? What to verbalize?

Answer 11

Diaphgram over 3rd or 4th left ICS @ sternal angle “Erb’s Point”. Sit upright, lean forward, exhale. Say, “High pitched diastolic murmur.”

Question 12

Where to listen for splitting of S2 heart sound?

Answer 12

2nd left ICS pulmonic area. With diaphragm.

Question 13

When does is normal splitting of S2 exentuated and disappears?

Answer 13

Exentuated with inhalation. Disappears with expiration.

Question 15

Assess splitting of S2 heart sound? Verbalize?

Answer 15

Diaphragm over 2nd Left ICS pulmonic area while PT quietly inhales and exhales. Say, “Normal splitting of S2 exentuated with inspiration and disappears with expiration.”

Question 16

Where to auscultate for murmur of HOCM?

Answer 16

Diaphragm over 3rd left ICS “Erb’s Point”.

Question 17

What happens to murmur of HOCM when PT squats, stands, or does valsalva?

Answer 17

Squat=murmur decreases
Stand=murmur increases
Valsalva=murmur increases

Question 18

How to assess for murmur of HOCM?

Answer 18

Diaphragm over 3 Left ICS “Erb’s Point”. PT squats then slowly stands while listening for charges of intensity.
Squating decreases murmur. Stand or valsalva increases murmur.

Question 19

What does Allen Test ensure?

Answer 19

Patency of ulnar artery before puncturing radial artery for blood.

Question 20

Allen Test? What to verbalize?

Answer 20

Tight fist with one hand, compress both ulnar and radial arteries with thumbs, tell PT to open hand and relax to slight flexed position. Release ulnar and say, “If ulnar artery is patent then palm flushes within 3-5 seconds. Indication for test is ulnar artery patency prior to radial artery puncture.”

Question 21

What 3 things to assess on Inspecting Abdomen?

Answer 21

1. Skin
2. Umbilicus
3. Contour

Question 22

What to check skin for in Inspecting Abdomen?

Answer 22

Scars, striae, dilated veins (capit medusa), rashes, lesions

Question 23

What to check umbilicus for in Inspecting Abdomen?

Answer 23

Contour, bulged, locations, inflammation, bleeding

Question 24

What to check contour for in Inspecting Abdomen?

Answer 24

Scaphoid, flat, rounded, protuberant, or obese; bulding flanks, symmetry, visible organs, pulsations

Question 25

How to auscultate abdomen? What to say?

Answer 25

Supine, knees flexes, arms at side. Use diapgragm. Say, “Normal amount of bowel sounds of 5-34 clicks or gurgles in one minute.”

Question 26

How to palpate abdomen? What to say?

Answer 26

Supine, knees flexes, arms at side. Say, “Use warm hands and warm stethoscope.” First do light palpation with one hand to assess for superficial lesions and guarding. Then deep palpation with two hands to assess abd organs and deep lesions. Say, “Size, shape, consistency, moblity, pulsations” of lesions.

Question 27

How to asses for abdominal bruit? What to say?

Answer 27

Supine, knees flexed, arms at side. Use bell for low-pitch bruit. Listen over aorta, bilateral rental arts, bilateral iliac arts, bilateral femoral arts. Say, “Listening for systolic or diastolic bruit.”

Question 28

How to percuss liver? What to say?

Answer 28

Supine, knees flexed, arms at side. Percuss midclavicular line from point below umbilicus in RUQ upward toward liver, identify dullness and mark line. Then percussat nipple line in right midclavicular line inferiorally from lung’s resonance to liver’s dullness and mark line. Measure between the two marks and say, “Normal liver span should be between 6-12cm.”

Question 29

How to percuss spleen (general splenic percussion)? What to say?

Answer 29

Supine, knees flexed, arms at side. Identify left hypocondriac region “Traub’s Space”, percuss space, say, “Dullness over Traub’s Space may indicate splenomegaly.”

Question 30

How to inspect elbow and what to say?

Answer 30

Check for swelling, positioning, skin changes, atrophy, deformity, guaridng, symmetry, fasiculations

Question 31

``` Assess elbow (MSK) and what to say? (can be any joint, I picked elbow. there is another specific elbow assessment from this, basically the same.” ```

Answer 31

Stand in anatomical position. Palpate landmarks, tenderness, crepitus, warmth, spasms, and bogginess. Landmarks=lateral epicondyle, medial epicondyle, olecranon process, ulnar nerve in cubital tunnel

Question 32

How to assess/palpate the TMJ? What to say and name?

Answer 32

Say, “General inspection of TMJ and name 3 muscles of mastication=masseter, temporalis, pterygoid.” Palpate for clicking and popping by opening and clocking jaw. Direct PT to perform range of motion of mandible by open and close, protrude and retract, slide from side to side.

Question 33

Assess elbow and what to say?

Answer 33

Stand in anatomical psoition. Assess for normal valgus carrying angle, skin changed, swelling, deformity, symmetry. Palpate boney landmarks (medial and lateral epicondyle, olecrenon process), and other structures (ulnar nerve in cubital tunnel).

Question 34

Inspect spine and what to say?

Answer 34

Assess posture, spinous process, and paravetebral muscles. Comment on spinal curves, “Lordosis at cervical and lumbar spin areas. C7 is vetebral prominence. Convexity at thoracic spine. Iliac crest at L4 vetebral body.”

Question 35

Assess knee and what to say?

Answer 35

Supine. Testing active range of motions. Actively flex to 135º and say “this is normal”. Extension to 0º is normal. Palpate medial and lateral joint lines at 90º flexion.

Question 36

Test for direct and indirect light reflex? What to say?

Answer 36

Look straight ahead. Shine light in one eye and comment on pupil constriction. Shine again in same eye and say, “Direct constriction and other eye consensual constriction response.” Then do other eye.

Question 37

How to test for coordination?

Answer 37

PT performs rapid alternating movements (RAMs). Index finger to nose both sides, heel to shin both sides, hand-thigh slap, tap tip of index finger to distal thumb joint. Cerebellar disease, “dysdiadochokinesis”.

Question 38

How to do Romberg Test? What to say?

Answer 38

Stand with heels together, eyes closed, and stand next to PT telling them you won’t let them fall. Check for excess swaying or difficulty standing.

Question 39

How to do Pronator Drift?

Answer 39

Arms up with shoulders flexed to 90º and palms up. Close eyes and assess for drift. Press down and see if can hold.