Final Check Out

Question 1

Order of Exam

Answer 1

Hand Hygiene

Introduce Yourself

Head/Face

Eyes

Ears

Nose/Throat

Neck

Chest (Posterior and Anterior)

Heart

Abdomen

Peripheral Vascular

MSK

Question 2

Head

Answer 2

Inspect and Palpate Face and Head (Scalp and Hair) - for any scaliness, inhabitants, and texture - Appears normal

Palpate Temporal Arteries

Palpate TMJ

Motor function CNV trigeminal (clench teeth)

Sensory function CNV (light touch w eyes closed)

Motor function CN VII facial (smile, frown, puff cheeks, raise eyebrows)

Question 3

Eyes

Answer 3

Inspect eyes (conjuctiva and sclera)

Visual Field through confrontation

Test 6 cardinal fields of gaze (EOM) -> Accommodation -> Convergence Test for strabismus using corneal light reflex (checking for any asymmetry in your eyes)

Direct and Consensual pupillary light reflex

State EOM and PERRLA

Question 4

Ears

Answer 4

Gross Hearing (finger rubbing)

Inspect Outer ear P

alpate mastoid process and tragus for tenderness/swelling

Look inside ears - inspect canal and TM (cone of light right 5, left 7)

Question 5

Nose

Answer 5

Inspect nose symmetry Patency

Palpate frontal and maxillary sinuses

“Look inside at the middle and inferior turbinates”

Question 6

Neck

Answer 6

Inspect symmetry

Inspect thyroid as pt swallows

Palpate trachea

Palpate carotids 1 at a time, equal BL 2+, auscultate with bell for bruits

Palpate LN

Test CN XI (accessory) head against resistance, shrug shoulders

Palpate thyroid from posterior position

Question 7

Posterior Thorax

Answer 7

Inspect rate and rhythm of respirations, deviations of spine

Palpate spine for tenderness and deviation

Palpate respiratory expansion

Palpate for tactile fremitius (99 - vibration of sound through lung tissue)

Auscultate w diaphragm

Percuss for costovertebral angle tenderness (one hand flat on skin, bang with fist)

Question 8

Anterior Thorax (including Breast and Axilla)

Answer 8

Note AP diameter

Inspect rate and rhythm

Palpate for respiratory expansion

Palpate for tactile fremitus (c shapes again, say 99)

Auscultate w diaphragm for lung sounds - don’t forget RML*

Palpate axillary and epitrochlear LN

Question 9

Cardiovascular

Answer 9

Inspect Precordium

State jugular venous pressure technique (We’re going to skip this step but usually i would take a ruler to measure the vertical peak of the vein’s pulsation)

Palpate for thrills using palmar surface

Auscultate w diaphragm (state S1 is loudest at apex, S2 at the base) then Auscultate w Bell for murmurs

Palpate apical pulse (PMI) in left decubitus position then auscultate PMI with bell for murmurs

Question 10

Abdomen

Answer 10

Bend Knees

Inspect abdomen for bulges, pulsations, scars

Auscultate w diaphragm for bowel sounds (RLQ, RUQ, LUQ, LLQ)

Auscultate w bell for bruits at aortic, renal, iliac, femoral (checks for turbulent blood flow)

Percuss for tympany and scattered dullness

Percuss liver span (midclavicular percuss from under umbilicus up, then down from nipple line/ from typany to dullness)

Percuss for splenic enlargement (from border of heart down left axillary line -> towards costal margin- ask pt to take deep breath and tap a few more times)

Light palpation to note guarding or tenderness -> Deep palpation noting organ structures or masses

Palpate liver (should be smooth left hand under right back, deep breath and feel for liver) then spleen (should be nonpalpable-left hand under posterior rib cage, palpate for spleen as pt takes deep breaths)

Question 11

Peripheral Vascular

Answer 11

Palpate aortic wdith (should be less than 3)

Peripheral pulses 2+ equal BL - brachial, radial, ulnar, popliteal, post tibial, dorsalis pedis

Inspect leg hair distribution, color, lesions

Palpate legs for temp changes, edema

Cap refill 2-3 sec

Question 12

MSK/Neuro

Answer 12

Assess ROM Lower limbs (note poppig and crepitus) Hip ab/add, knee flexion, hip int and ext rot, ankle

Babinski

Muscle strength in multiple positions

Reflexes brachioradialis, bicep, tricep, patellar, achilles

Pain sensation, Light touch, Graphesthesia

Vibratory sense (tuning fork on pointer then arm)

Proprioception with big toe (up, left, down etc)

Rapid alternating movements (flap hands, fingers to thumb)

Finger to nose (use your finger and move positions), heel to shin (assesses cerebellar function) eyes open then close

ROM of neck and spine (chin to chest, tilt back, look left right, ears to shoulders), bend over, stretch flex, lateral movement, rotation

Romberg test (feet together eyes open then closed)

Pronator drift (arms parallel, palms up, eyes closed, then tap both arms)

Gait (normal, heel to toe, on toes then heels)