Global Checklist Flashcards
HEENT: head inspection
Observe hair for any loss or distribution changes
Inspect scalp for lacerations, scars, infection
Inspect skull for fractures
Inspect face for symmetry
Inspect skin for infection
When gathering information, what are you asking for?
HPI - history of present illness Past medical history Family history Medications (and potential allergies) Surgeries Lifestyle risk factors Review of Systems (focused questions of relevant systems to HPI)
HEENT: ear inspection
Inspection: observe outer ear; document any masses/lesions
Palpation: palpate outer ear & ask Pt about pain/discomfort
Otoscopy: gently pull auricle up & back. While holding otoscope, slowly insert speculum with a downward & forward movement into ear canal. Repeat with opposite ear
Hearing acuity: Pt blocks 1 ear w/ finger while Ex checks auditory acuity in opposite ear. Ex will then rub fingers together 3 ft. from the unobstructed ear & then move fingers until Pt can hear rubbing AND/OR Ex should whisper a word or number while standing approximatedly 3 ft from Pt’s side & ask him/her to repeat word
Special Tests: Weber Test - hit tuning fork, hold to middle of Pt’s forehead - normal hearing = same sound in both ears; Rinne Test - hit tuning fork, hold to Pt’s mastoid process until sound no longer heard, then place just outside external auditory meatus - if sound heard again, then test is normal
HEENT: eye - visual acuity
Ex should have Pt stand 20 ft from chart. Ex should ask Pt to cover 1 eye & use the other eye to read the lines until the Pt has read the smallest line of print possible (Pt has to read more than half the letters correctly). Ex should repeat procedure with other eye. Ex should record results.
HEENT: eye - visual fields
Ex should perform static finger wiggle test by standing in front of Pt; Pt looks into Ex eyes as Ex wiggles fingers & slowly brings them forward.
HEENT: eye - visual field defect testing
Ex tests 1 eye at a time & slowly moves fingers from defective area to the area of better vision OR Ex should perform the Kinetic Red Target Test
HEENT: eye - inspection
Check position & alignment of eyes
Inspect eyebrows for hair & scaliness
Ask Pt to look upward while gently moving lower lids of each eye downward; do reverse - testing CN II
Inspect conjunctiva, sclera, cornea, iris, pupils
HEENT: eye - pupil response
Lights off - shine penlight/ophthalmoscope light on each pupil
AVOID shining light into both pupils simultaneously; also, Pt should not focus on light
HEENT: eye - extraocular movement
Pt, without moving head, should follow Ex finger as it moves in pattern of “H”, then moves in toward the nose.
HEENT: eye - ophthalmoscopy
Lights off - Pt should pick distant point to focus on. Place hand on Pt head. Hold ophthalmoscope in right hand to view right eye, left hand to view left eye. Begin 10”-15” away from Pt, then slowly move in until foreheads almost touch. Pt should briefly look directly into light at some point.
HEENT - nose inspection
Inspect anterior and inferior surfaces of the nose, as well as the nasal septum and mucosa.
HEENT - nose patency
Ask Pt to inhale through each nostril separately while the opposite nostril is held shut. CN I is examined in special circumstances.
HEENT - nose: speculum
Standing in front of Pt, gently insert the short wide-tipped speculum into Pt’s nostril. Examine lower portions of nose and ask Pt to tilt head slightly backwards.
HEENT - nose palpation
Palpate frontal and maxillary sinuses.
HEENT - nose: special test
Transillumination - perform if infection is suspected. Turn off lights in room and shine a strong narrow light source under brow to examine the frontal sinuses and below the inner aspect of each eye to examine the maxillary sinus.
HEENT: mouth inspection
Inspect lips for lesions. Use a light to inspect the buccal mucosa and the back of the mouth and throat. Using a tongue depressor, depress more than halfway back on the tongue. Ex may have Pt phonate while inspecting the throat. Ask Pt to bite down. Inspect teeth and gums at the same time using a tongue depressor or gloved finger to move lips out of the way.
HEENT - mouth palpation
Ask Pt to extend tongue and move it from side to side. Use a cotton gauze or gloved finger when touching tongue. May inspect tongue at same time as inspecting the floor of the mouth. Palpate the floor of the mouth.
HEENT - trachea
Place thumb along each side of trachea in lower portion of the neck. Ask Pt to extend neck while placing index finger and thumb of one or both hands on each side of the trachea below the thyroid isthmus.
HEENT - thyroid
Stand behind seated Pt. Ask Pt to bend head to neutral position or slightly forward. 2 fingers of each hand should be placed on either side of trachea. Ask Pt to swallow (or take sip of water) while feeling the isthmus, then displace trachea to the left and ask Pt to swallow while palpating trachea. Repeat on the left side.
How many lymph nodes are there for palpating? Where are they?
9 - preauricular, postauricular, occipital, posterior cervical, cervical/tonsillar, submandibular, submental, cervical chain, supraclavicular
Upper Extremity - cervical spine inspection
Inspect for surgical scars, asymmetry.
Upper Extremity - cervical spine palpation
Palpate sides and center of cervical spine for tenderness, pain.
Upper Extremity - range of motion
Move Pt cervical spine to assess passive range of motion. Ask Pt to flex and extend neck. Ask Pt to turn neck laterally (both directions) to assess active range of motion.
Upper Extremity - cervical spine: special test
Spurling’s Test: perform if foraminal compression is suspected. Extend Pt neck, rotate head to one side, and apply axial compression downward on head.
Upper Extremity - shoulder inspection
Assess symmetry, deformity, and discoloration. State what you are inspecting for.
Upper Extremity - shoulder palpation
Palpate scapular spine, acromion process, acromioclavicular joint, and bicipital groove.
Upper Extremity - shoulder range of motion
Ask Pt to flex, extend, abduct (full arc), internally rotate (elbow flexed, thumb at opposite scapula), and externally rotate (elbow flexed, hands out at sides or behind head) both shoulders. Ask Pt to actively abduct arms overhead while checking for any difference between the scapulae.
Upper Extremity - shoulder strength
Resist Pt while he/she shrugs shoulders, flexes shoulder forward, and abducts shoulder.
Upper Extremity - special test: suspected AC joint injury
Cross Arm Test - adduct Pt arm across chest wall with humerus parallel to the floor so that the hand of the examined arm rests on the opposite shoulder.
Upper Extremity - special tests: suspected rotator cuff injury
Empty Can Test - instruct Pt to abduct both arms to 90 degrees and turn thumbs downward toward the floor. Push downward on Pt arms.
Full Can Test - instruct patient to abduct both arms to 90 degrees and turn thumbs up toward the ceiling. Push downward on Pt arms.
Upper Extremity - special test: suspected impingement
Hawkin’s Test - passively rotate the humerus into internal rotation while abducting to 90 degrees.
Neer’s Test - stabilize Pt shoulder, then passively forward flex arm above shoulder level to a full forward flexed position
Upper Extremity - special test: suspected subscapularis injury
Liftoff Test - Pt puts hand (with arm in full internal rotation) behind the lumbar spine and attempts to lift the hand away from the back.
Napoleon Sign - Pt places hand on stomach and attempts to push against stomach.
Upper Extremity - elbow inspection
Assess symmetry, deformity, and discoloration.
Upper Extremity - elbow palpation
Palpate lateral epicondyle, medial epicondyle, and olecranon process (just one side is ok).
Upper Extremity - elbow range of motion
Pt flexes, extends, pronates (elbow at 90 degrees, palm down), and supinates (elbow at 90 degrees, palm up) both elbows.
Upper Extremity - elbow strength
Resist Pt while Pt flexes and extends elbow.
Upper Extremity - special test: suspected medial/lateral collateral ligament instability
Perform valgus/varus stress test (whichever is appropriate).
Upper Extremity - special test: suspected cubital tunnel syndrome
Tinel’s Sign - tap between the olecranon and the medial epicondyle in the ulnar groove.
Upper Extremity - wrist and hand inspection
Assess symmetry, deformity, and discoloration. Assess thenar and hypothenar eminence. State what you’re inspecting for.
Upper Extremity - wrist and hand palpation
Palpate wrist, CMC, MCP, and PIP joints.
Upper Extremity - wrist and hand range of motion
Pt flexes and extends wrist, then moves hand to ulnar and radial sides. Pt flexes and extends fingers at MCP joint with fingers straight and makes fist.
Upper Extremity - wrist and hand strength
Resist Pt while Pt flexes and extends wrist, asses grip strength, resists finger abduction, and resists opposition of thumb and small finger.
Upper Extremity - special test: suspected median nerve entrapment
Tinel’s Sign - tap over the transverse carpal ligament with either the tip of the examiner’s finger, or with a reflex hammer, with the Pt wrist held in extension.
Phalen’s Test - Pt places tops of hands together and forces hands into wrist flexion. Pt holds position 30-60 seconds.
