Detailed Physical Exams

Question 1

List the 5 steps of an ear exam

Answer 1

1) Look at auricles, behind ears, tops of ears
Auricles and external canals are without and deformity or masses. No signs of cancer present.
2) Move ear and push on mastoids
No pain with motion of the auricle or tragus; no mastoid tenderness
3) Gross hearing test
Hearing is intact
4) Use otoscope correctly
No erythema or FBs in the external canal, tympanic membrane is pearly gray with the cone of light anteriorly. Didn’t visualize handle of malleus but if I did it should be towards the superior part. No perforations or scarring
5) Special tests
Webber test shows no lateralization; Rinne shows that air conduction is greater than bone conduction

Question 2

List the 3 steps of a head exam

Answer 2

1) Look at skull (front and back) and face
Pt’s skull is symmetrical and of an appropriate size. Face is without involuntary movements, asymmetry, or lesions
2) Palpate skull and face and mastoid process
Mastoid process is without redness or pain. Skull is without deformities, hematoma, or inappropriate depressions. Face is without bony deformities, crepitus, or masses
3) Battle sign & raccoon sign are absent with no other signs of trauma

Question 3

List the 7 steps of an eye exam

Answer 3

1) Look at lids and palpate lacrimal apparatus
Lids have no discoloration, masses, edema, or ptosis. No evidence of swelling or tearing of lacrimal apparatus
2) Conjuntivae and sclerae- have them pull lower lid down, use pen light
Conjunctivae are of appropriate color with no apparent swelling or discharge
3) Visual field screening
No evidence of peripheral vision loss
4) Pen to test accommodation
Displays accommodation
5) Cornea and lenses using light (look from the side and front)
Pt’s corneas reflect light appropriately and symmetrically & the lens is clear
6) Pupils using light
Pupils are PERRLA; they react to light appropriately and are symmetrical
7) Visual acuity: Use chart; ask them to cover one eye and read the lowest line they can read with each eye, then do both eyes. Do color vision too.
a. Say whether 20/20, 20/30, etc for each one
b. Color vision is intact

Question 4

List the 2 steps of an ophthalmoscope exam

Answer 4

Darken lights, ask pt to focus on object far away
1) Come in at 15 degrees with ophthalmoscope
Red light reflex is present
2) Move closer to pt and focus scope
Retina and its veins are visualized and retina is without lesions or hemorrhages. Optic disc not visualized but if it were it would be lateral of the line of sight and without papilledema and with a clear border.
Fovea and macula not visualized but if they were they would be without exudates or cysts

Question 5

List the 4 steps of a nose exam

Answer 5

1) Look at external surface
Nose is symmetrical with no lesions or deformity
2) Palpate nose, frontal, and maxillary sinuses
Nose is without tenderness or masses, frontal and maxillary sinuses are without tenderness
3) CNI: Have pt occlude one nostril and smell, then again with other side
Sense of smell is intact; nares are patent
4) Otoscope: Internal nares are without rhinorrhea or cracking. Mucosa is of appropriate color with no edema. Septum is without deviation or perforation.

Question 6

List the 3 steps of a mouth and pharynx exam

Answer 6

1) Look at lips and ask pt to protrude tongue and push tongue against both cheeks
Lips are pink and moist.
2) Look at oral mucosa, tongue, gums, and floor of mouth with tongue depressor and pen light. Ask patient to move tongue to the side, stick tongue out, and lift tongue
Posterior pharynx has no edema or lesions; airway is patent.
Oral mucosa, tongue, gums, and floor of mouth are of appropriate color with no lesions or ulcers
3) Look at and palpate teeth, gums, and floor of mouth
Teeth are firmly implanted without caries; gums are pink with no retraction or bleeding; floor of mouth is pink and without masses

Question 7

List the 4 steps of a neck and TMJ exam

Answer 7

1) Look at neck, and thyroid with oblique lighting
Neck is symmetrical with no erythema
2) Look at and palpate TMJ (anterior to ear), have pt open and close mouth.
No edema or erythema of the TMJ and it has an appropriate smooth ROM
3) Palpate lymph nodes (including beneath jaw)
In front of tragus, postauricular 1 in into hair, base of skull in hairline, along inferior jaw from TMJ to mid chin, along SCM and in front of and behind it, superior and inferior to clavicle along length
Lymph nodes are without tenderness and are of appropriate size. Inferior aspect of mandible is without swelling, tenderness, or induration.
4) Palpate thyroid and trachea (move trachea), have pt swallow.
Thyroid is symmetric, of appropriate size and consistency and is without tenderness or nodules. Trachea is midline and without pain with movement