Comprehensive Skills Exam Flashcards
How to measure JVP? What to say?
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.”
What is Kussmal’s Sign?
When JVP rises with inspiration due to impaired filling of Right Ventricle. Normally JVP decreases with inspiration.
How to assess for Kussmal’s Sign? What to say?
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.”
When is assessing Hepatojugular Reflex indicated? (2 reaons)
- Subacute right-sided heart failure
2. Passive hepatic congestion
How to assess Hepatojugular Reflex? What to verbalize?
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.”
Listen to bruit with which part of stethoscope?
Bell
Palpate for carotid pulse on which part of artery?
Lower 1/3
How to assess carotid pulse? What to verbalize?
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.”
Where is Erb’s Point?
3rd or 4rd left ICS @ sternal border.
Is murmur of Aortic Insufficiency/Regurg systolic or diastolic?
Diastolic
How to assess for Aortic Insufficiency/Regurg? What to verbalize?
Diaphgram over 3rd or 4th left ICS @ sternal angle “Erb’s Point”. Sit upright, lean forward, exhale. Say, “High pitched diastolic murmur.”
Where to listen for splitting of S2 heart sound?
2nd left ICS pulmonic area. With diaphragm.
When does is normal splitting of S2 exentuated and disappears?
Exentuated with inhalation. Disappears with expiration.
Assess splitting of S2 heart sound? Verbalize?
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.”
Where to auscultate for murmur of HOCM?
Diaphragm over 3rd left ICS “Erb’s Point”.
What happens to murmur of HOCM when PT squats, stands, or does valsalva?
Squat=murmur decreases
Stand=murmur increases
Valsalva=murmur increases
How to assess for murmur of HOCM?
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.
What does Allen Test ensure?
Patency of ulnar artery before puncturing radial artery for blood.
Allen Test? What to verbalize?
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.”
What 3 things to assess on Inspecting Abdomen?
- Skin
- Umbilicus
- Contour
What to check skin for in Inspecting Abdomen?
Scars, striae, dilated veins (capit medusa), rashes, lesions
What to check umbilicus for in Inspecting Abdomen?
Contour, bulged, locations, inflammation, bleeding
What to check contour for in Inspecting Abdomen?
Scaphoid, flat, rounded, protuberant, or obese; bulding flanks, symmetry, visible organs, pulsations
How to auscultate abdomen? What to say?
Supine, knees flexes, arms at side. Use diapgragm. Say, “Normal amount of bowel sounds of 5-34 clicks or gurgles in one minute.”
How to palpate abdomen? What to say?
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.
How to asses for abdominal bruit? What to say?
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.”
How to percuss liver? What to say?
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.”
How to percuss spleen (general splenic percussion)? What to say?
Supine, knees flexed, arms at side. Identify left hypocondriac region “Traub’s Space”, percuss space, say, “Dullness over Traub’s Space may indicate splenomegaly.”
How to inspect elbow and what to say?
Check for swelling, positioning, skin changes, atrophy, deformity, guaridng, symmetry, fasiculations
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.”
Stand in anatomical position. Palpate landmarks, tenderness, crepitus, warmth, spasms, and bogginess.
Landmarks=lateral epicondyle, medial epicondyle, olecranon process, ulnar nerve in cubital tunnel
How to assess/palpate the TMJ? What to say and name?
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.
Assess elbow and what to say?
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).
Inspect spine and what to say?
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.”
Assess knee and what to say?
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.
Test for direct and indirect light reflex? What to say?
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.
How to test for coordination?
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”.
How to do Romberg Test? What to say?
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.
How to do Pronator Drift?
Arms up with shoulders flexed to 90º and palms up. Close eyes and assess for drift. Press down and see if can hold.
