Comprehensive Skills Exam

Question 1

What needs to be verbalized when measuring the JVP?

Answer 1

That a normal range is 4-9cm and abnormal findings would indicate RA overload

Question 2

How do you measure the JVP

Answer 2

Raise bed to 30 degrees, use tangential lighting, use ruler to measure from sternal angle, identify highest point of pulsations (meniscus) and make an attempt to determine A and V waves

Question 3

What needs to be verbalized when inspecting the abdomen? (8 things)

Answer 3

Skin: scars, striae, dilated veins/capid Medusa, rashes/lesions
Umbilicus: contour, bulges, location, inflammation, bleeding, or discharge
Contour: scaphoid, flat, rounded, protuberant, obese
Assess for bulging of flank, pulsations and symmetry of visible organs

Question 4

How do you assess for aortic insufficiency?

Answer 4

Have pt sit upright, places diaphragm of stethoscope over either 3rd or 4th interspace, instruct patient to lean forward and exhale

Question 5

What needs to be verbalized when assessing for aortic insufficiency?

Answer 5

That it is a high-pitched diastolic murmur

Question 6

How do you do generalized splenic percussion?

Answer 6

Position patient supine with knees flexed, arms at side. Identify left hypochondriac region and percuss

Question 7

What needs to be verbalized when doing generalized splenic percussion?

Answer 7

Splenomegaly is when percussion goes from dullness to tympani, can indicated pleural effusion as well

Question 8

What is the left hypochondriac region?

Answer 8

Traube’s space

Question 9

What is the 3rd or 4th interspace called?

Answer 9

Erbs point

Question 10

How do you palpate the musculoskeletal system?

Answer 10

Elbow or Knee: Comment on: landmarks, tenderness, crepitus, warmth, spasm, or bogginess

Question 11

How do you test for Kusmault’s sign?

Answer 11

Set bed at 30 degrees, direct patient to breath in and use tangential lighting, observe for paradoxical rise of JVP with inspiration

Question 12

What needs to be verbalized when testing for Kusmault’s sign?

Answer 12

When it is present, this finding suggests impaired filling of the RV

Question 13

How do you assess for abdominal bruits?

Answer 13

Position patient supine, knees flexed and arms at side. Place stethoscope bell over: aorta, renal arteries, iliac arteries, femoral arteries. Listen for systolic or diastolic bruits

Question 14

What part of the stethoscope can be used over clothes to listen for abdominal bruits?

Answer 14

Diaphragm

Question 15

How do you assess the TMJ?

Answer 15

Verbalize general inspection, look at pts face, palpate for clicking and popping. Effective if pt is moving jaw. Have pt open and close mouth, protrude and retract mandible, slide from side to side

Question 16

What needs to be verbalized when assessing the TMJ?

Answer 16

Name atleast 2/3 of the muscles of mastication: Masseter, Temporalis, and Ptyergoid

Question 17

How do you assess for splitting of S2 heart sounds?

Answer 17

Can listen over 2nd and 3rd interspace, auscultate with diaphragm, listen while pt inhales and exhales quietly

Question 18

What needs to be verbalized when assessing for splitting of S2 heart sound?

Answer 18

Normal or physiologic splitting of S2 is accentuated by inspiration and usually disappears with expiration

Question 19

How do you assess the shoulder for active ROM?

Answer 19

Have pt flex to 180 degrees, extend to 50 degrees, ABduct to 180 degrees, and ADduct to 50 degrees, internal rotation can be limited or full, external rotation can be limited or full, also assess shoulder shrug

Question 20

How do you assess the carotid pulse?

Answer 20

Patient supine, listen for bruits, palpate for the pulse on the upper 1/3 of neck, do this on both sides

Question 21

What needs to be verbalized when assessing the carotid pulse?

Answer 21

The upstroke of carotid pulse follows S1

Question 22

How do you assess for hepatojugular reflex?

Answer 22

Set bed at 30 degrees, use tangential gifting, apply firm pressure over RUQ of abdomen while observing JVP in neck

Question 23

What needs to be verbalized when assessing for the hepatojugular reflex?

Answer 23

Used in pts with subacute right-sided HF or passive hepatic congestion. When the finding is present: an increased JVP waveform is noted

Question 24

How do you palpate the abdomen?

Answer 24

Position patient supine knees flexed and arms at side, perform light palpation, assess with one hand, assess for superficial lesions, assess for guarding. Deep palpation: asses with two hands, assess abdominal organs, deep lesions

Question 25

What must be verbalized when palpating the abdomen?

Answer 25

Comment on how the exam will be more effective if you make effort to warm hands and stethoscope, also must say 3/5: Size, shape, consistency, mobility, pulsations

Question 26

How do you assess the elbow?

Answer 26

General inspection, standing in anatomical position, assess for valgus carrying angle (normal), palpate bony landmarks and other structures, medial and lateral epicondyle, olecranon process, ulnar nerve in cubital tunnel

Question 27

What needs to be verbalized when assessing the elbow?

Answer 27

Assess for skin changes, swelling, deformity, symmetry. Also say palpating within the cubital tunnel for the ulnar nerve

Question 28

How do you assess for murmur of HOCM?

Answer 28

Use diaphragm of the stethoscope over 3rd or 4th interspace, have pt squat, direct patient to stand slowly while listening to a change in intensity

Question 29

What needs to be verbalized when assessing for HOCM murmur?

Answer 29

Murmur decreases with squatting and increases with standing or with valsalvas maneuver. Its a harsh crescendo-decrescendo murmur

Question 30

How do you percuss the liver?

Answer 30

Have patient lying supine with knees flexed, arms at side. Percuss mid clavicular line, percuss from point below umbilicus in RLQ upward toward the liver. Identify lower border of dullness and right clavicular line, mark the area. Starting at nipple line: within right midclavicular line, percuss inferiority from lung resonance to liver dullness, identify upper border of liver dullness and mark area

Question 31

What is the normal liver span?

Answer 31

6-12 cm

Question 32

How do you inspect the spine?

Answer 32

Comments n the spinal curves, state that there is lordosis or concavity at the C and L spine areas, and convexity or kyphosis at T spine area. C7 region is vertebral prominence and the iliac crest is at L4 vertebral body

Question 33

How do you perform Allen’s test?

Answer 33

Direct pt to might tight fist with one hand, compress both radial and ulnar arteries between thumb and fingers, direct patient to open hand into relaxed slightly flexed position. Release pressure from ulnar artery

Question 34

What needs to be verbalized when doing Allen’s test?

Answer 34

Expected result is if the ulnar artery is patent; flushes within 3-5 seconds, performed to ensure ulnar patency prior to puncture of radial artery for ABG

Question 35

How do you measure calf circumference?

Answer 35

Locate the inferior pole of patella, measure to a point 10cm or 4 inches below patellar inferior pole. Measure calf circumference at marked area. Repeat on other leg. Measure unaffected first.

Question 36

What needs to be verbalized when measuring calf circumference?

Answer 36

Comparison of measurement between circumferences of calf can facilitate detection of DVT or VTE

Question 37

How do you auscultate the abdomen?

Answer 37

Position the patient supine with knees flexed and arms at side, with diaphragm of stethoscope warm: auscultate abdomen

Question 38

What needs to be verbalized when auscultating the abdomen?

Answer 38

Normal amount of bowel sounds heard in one minute is 5-34 clicks or gurgles

Question 39

What things need to be mentioned when inspecting the musculoskeletal system?

Answer 39

Assess for swelling, positioning, skin changes, atrophy, deformity, guarding, symmetry, fasciculation

Question 40

How do you assess the knee active ROM and palpate joint lines?

Answer 40

Position patient supine, assess flexion 135 degrees, assess extension 0 degrees normal. Palpate medial and lateral joint lines, want patient knees at 90 degrees and flexed for this

Question 41

How do you test for coordination of pt?

Answer 41

Have pt perform RAMs rapid alternating movement. Index finger to thumb, bilaterally or slap hands palms to thighs, heel to shin, both sides.

Question 42

What is the Romberg test?

Answer 42

Pt stand with heels together, while standing next to patient, let them know they will not fall, have close eyes and assess for excess swaying or difficulty standing.

Question 43

What is Tandem gait?

Answer 43

Have patient walk heel to toe

Question 44

What is pronator drift?

Answer 44

Direct patient to hold arms up, shoulders flexed 90 degrees with palms up, have them close eyes, assess for drift. Press both arms to see if they can hold arms up