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Clinical Skills I > Green Sheet > Flashcards

Green Sheet Flashcards

1
Q

Vital Signs

A
  1. ASSESS: Height, weight, temperature, pulse oximetry
  2. ASSESS: Respiratory rate, rhythm and depth of respirations [Assess one minute]
  3. PALPATE: Radial pulse for rate, rhythm, amplitude [Palpate one minute]
  4. PALPATE: Systolic blood pressure in right arm, sitting [Wait 1-2 minutes]
  5. AUSCULTATE: Blood pressure in right arm, sitting [Wait 2-5 minutes]
  6. AUSCULTATE: Blood pressure in right arm, standing
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2
Q

General Survey and Assessment

A
  1. INSPECT & ASSESS: Age, gender, race, developmental and nutritional state, distress, level of consciousness, cleanliness, ability to cooperate, affect, posture.
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3
Q

Skin, Hair, and Nails

A

Perform #1 and #2 simultaneously

  1. INSPECT and PALPATE: all skin areas for color, moisture, temperature, turgor, and lesions in the following order: hands, arms, axillae, shoulders, neck, face, back, chest, abdomen, legs, and feet.
  2. INSPECT and PALPATE: any lesions for location, number, size, shape, color, and elevation.
  3. INSPECT and PALPATE: hair for distribution, quantity, texture, and areas of hair loss.
  4. INSPECT: finger and toe nails for color, thickness, and surface conditions.
  5. INSPECT: nail base angle for clubbing on all nails, upper and lower.
  6. PERFORM: capillary refill test, bilaterally, on all digits of the upper and lower extremities noting time elapse of return to full nail color [normal is less than two seconds]
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4
Q

Head

A
  1. INSPECT and PALPATE: head for size, shape, symmetry, tenderness.
  2. INSPECT: facial features for symmetry, parotid gland enlargement.
  3. PALPATE: TM joints for tenderness & swelling, while patient opens and closes jaw.
  4. PALPATE: parotid glands for size and tenderness, note if enlarged.

5. PALPATE: temporal arteries for tenderness and thickness.

  1. AUSCULTATE: temporal arteries with bell for bruits.
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5
Q

Eyes (Visual Testing)

A
  1. TEST: distant vision with Snellen chart at 20 feet - both eyes, then each eye with and without glasses (CN II).
  2. TEST: near vision with Rosenbaum chart at about 14 inches - both eyes, then each eye with and without glasses (CN II).
  3. TEST: peripheral visual fields by confrontation. (CN II)
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6
Q

Eyes (External Eye)

A
  1. INSPECT: eyebrows and lids for ptosis, lesions, and edema.
  2. INSPECT: conjunctiva for color and exudate.
  3. INSPECT: iris and pupils for size, shape, and equality.
  4. INSPECT: sclera for color.
  5. INSPECT: cornea for clarity using tangential lighting
  6. TEST: depth of anterior chamber using tangential lighting.
  7. PERFORM: upper lid eversion for foreign body.
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7
Q

Eyes (Neurological)

A
  1. TEST: corneal sensitivity with wisp of cotton (Sensory CN V and Motor CN VII).
  2. TEST: accommodation by having patient focus on distant object then on examiner’s finger positioned 10 cm from patient’s nose.
  3. TEST: extraocular muscles in six cardinal fields and vertical movement (CN III, IV, and VI)
  4. TEST: corneal light reflex for balance of extraocular muscles.
  5. PERFORM: cover/uncover test if corneal light reflex is not symmetrical in both eyes. (See example Appendix A)
  6. DIM THE ROOM LIGHTS
  7. TEST: pupillary light reflex both directly and consensually
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8
Q

Eyes (Opthalmoscopic Examination)

A

(DIM ROOM LIGHTS)

  1. INSPECT: ocular media (cornea, anterior chamber, lens, vitreous) for red reflex and opacities.
  2. INSPECT: ocular fundus to include disc, vessels, general background
  3. INSPECT: macula have patient look at the light.

(TURN ROOM LIGHTS BACK ON)

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9
Q

Ears

A
  1. INSPECT and PALPATE: auricles and mastoid for tenderness, swelling, or lesions.
  2. INSPECT with OTOSCOPE: auditory canal for erythema, discharge, lesions, or foreign bodies.
  3. INSPECT with OTOSCOPE: tympanic membrane for color, contour, landmarks, perforations and fluid.
  4. TEST: hearing- all exams performed bilaterally.
    a. PERFORM: whisper test. Instruct patient to occlude contralateral ear. (CN VIII)
  5. TUNING FORK EXAMS
    b. Perform Weber Test. Instruct patient to indicate which ear the sound is heard louder or are they equal. (CN VIII)
    c. Perform Rinne test. Time bone conduction and air conduction then compare. [Target time AC to BC is a 2:1 ratio] (CN VIII)
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10
Q

Nose and Sinuses

A
  1. INSPECT: nose for shape, and presence of drainage.
  2. TEST: each nostril for patency.
  3. PALPATE: nose for masses or tenderness.
  4. PALPATE: frontal and maxillary sinus areas for tenderness
  5. PERCUSS: frontal and maxillary sinus areas for tenderness
  6. INSPECT with OTOSCOPE: nasal mucosa, septum and turbinates for color, alignment, discharge, swelling, bleeding, polyps, and septal deviation.
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11
Q

Mouth and Pharynx

A

**USING A LIGHT, GLOVES, AND A TONGUE BLADE**

  1. INSPECT: lips for color and lesions.
  2. INSPECT: buccal mucosa and parotid ducts (Stensen’s ducts).
  3. INSPECT: gingivae for hyperplasia or lesions.
  4. INSPECT: teeth for occlusion, caries, loose or missing teeth and appliances.
  5. INSPECT: tongue at rest, protruded, and raised behind upper teeth noting color, lesions, fasiculations, deviation (CN XII) and submandibular ducts (Wharton’s ducts).
  6. INSPECT: palate and uvula. Ask patient to say “ah” and observe for symmetrical elevation of soft palate and uvula (CN IX and X).
  7. INSPECT: tonsillar area and oropharynx for erythema, tonsillar enlargement and exudates.
  8. TEST: tongue for muscle strength - ask pt to press tongue against cheek bilaterally (CN XII).
  9. PALPATE: lips for tenderness and lesions
  10. PALPATE: gingivae for tenderness, thickening or lesions.
  11. PALPATE: floor of mouth bimanually for masses or thickening.
  12. PALPATE: tongue for lesions by grasping with gauze
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12
Q

Neck

A
  1. INSPECT: the neck for symmetry and thyroid for enlargement -ask patient to swallow when inspecting.
  2. PALPATE: the trachea for midline position.
  3. PALPATE: the lymph nodes for size, consistency, tenderness and mobility.
    * Occipital, posterior auricular, preauricular, tonsillar, submandibular, submental, superficial anterior cervical and deep cervical, posterior superficial cervical, supraclavicular
  4. PALPATE: the thyroid gland for size, consistency, tenderness and nodules. Examine from posterior approach with the neck flexed slightly forward and laterally toward the side being examined. Ask patient to swallow during palpation of each lobe.
  5. PALPATE: the carotid arteries (one at a time) bilaterally for rate, rhythm, contour and amplitude.
  6. AUSCULTATE: the thyroid gland with bell for bruits - ask patient to hold breath.
  7. AUSCULTATE: the carotid arteries with bell for bruits- ask patient to hold breath.
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13
Q

Chest and Lungs (First Thing)

A
  1. INSPECT: during QUIET AND DEEP respirations the anterior and posterior chest for AP vs. transverse diameter, symmetry, size, shape of chest, pattern of breathing, retractions, bulging or use of accessory muscles - ask pt. to take a deep breath.
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14
Q

Chest and Lungs (Posterior and Lateral Chest)

A
  1. Ask patient to CROSS ARMS ANTERIORLY
  2. PALPATE: posterior chest for tenderness.
  3. PALPATE: lateral chest for tenderness.
  4. PALPATE: posterior chest for thoracic expansion.
  5. PALPATE: posterior chest for tactile fremitus – ask pt to say “Ninety-nine”
  6. PALPATE: lateral chest for tactile fremitus – ask pt to say “Ninety-nine”
  7. PERCUSS: posterior chest.
  8. PERCUSS: lateral chest.
  9. PERCUSS: posterior diaphragmatic excursion - mark with pen and measure bilaterally
  10. AUSCULTATE: posterior chest for normal and adventitious sounds.
  11. AUSCULTATE: lateral chest for normal and adventitious sounds.
  12. AUSCULTATE: posterior chest for vocal resonance – ask pt to say “Ninety-nine”.
  13. AUSCULTATE: posterior chest for egophany – ask pt to say “eeeee”
  14. AUSCULTATE: lateral chest for vocal resonance – ask pt to say “Ninety-nine”.
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15
Q

Chest and Lungs (Anterior Chest)

A

(bilaterally)

  1. PALPATE: for tracheal deviation (if not already performed).
  2. PALPATE: anterior chest for tenderness.
  3. PALPATE: tactile fremitus – ask pt to say “Ninety-nine”
  4. PERCUSS: anterior chest, including apices.
  5. AUSCULTATE: anterior chest, including apices, for normal and adventitious sounds.
  6. AUSCULTATE: anterior chest for vocal resonance – ask pt to say “Ninety-nine”
  7. AUSCULATE: anterior chest for egophany – ask pt to say “eeeee”
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16
Q

Heart (First Step)

A
  1. Expose chest fully
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17
Q

Heart (Precordium - Sitting, leaning forward)

A

(best position for high pitched murmurs) 1. INSPECT: with tangential lighting for pulsations, lifts, heaves, and apical impulse 2. PALPATE: apex, left sternal border and base for lifts and thrills 3. PALPATE: for apical impulse and point of maximal impulse (PMI) 4. AUSCULTATE: with diaphragm and then bell for rate, rhythm, S1, S2, diastole, systole, S3, S4, splitting, extra sounds and murmurs a. Aortic valve area (Rt. 2nd ICS, RSB) Diaphragm - Bell b. Pulmonic valve area (Lt. 2nd ICS, LSB) Diaphragm - Bell c. Second pulmonic area (Lt. 3rd ICS, LSB) Diaphragm - Bell d. Tricuspid valve area (Lt. 4th ICS, LSB) Diaphragm - Bell e. Mitral valve area (Lt. 5th ICS, MCL) Diaphragm - Bell

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18
Q

Heart (Precordium - Supine)

A
  1. INSPECT: with tangential lighting for pulsations, lifts, heaves, and apical impulse. 2. PALPATE: apex, left sternal border and base for lifts and thrills. 3. PALPATE: for apical impulse and point of maximal impulse (PMI). 4. AUSCULTATE: with diaphragm and then bell for rate, rhythm, S1, S2, diastole, systole, S3, S4, splitting, extra sounds and murmurs a. Aortic valve area (Rt. 2nd ICS, RSB) Diaphragm - Bell b. Pulmonic valve area (Lt. 2nd ICS, LSB) Diaphragm - Bell c. Second pulmonic area (Lt. 3rd ICS, LSB) Diaphragm - Bell d. Tricuspid valve area (Lt. 4th ICS, LSB) Diaphragm - Bell e. Mitral valve area (Lt. 5th ICS, MCL) Diaphragm - Bell
19
Q

Heart (Precordium - Left Lateral Recumbent)

A

(best position for low pitched filling sounds) 1. INSPECT: with tangential lighting for pulsations, lifts, heaves, and apical impulse 2. PALPATE: apex, left sternal border and base for lifts and thrills 3. PALPATE: for apical impulse and point of maximal impulse (PMI) 4. AUSCULTATE: with diaphragm and then bell for rate, rhythm, S1, S2, diastole, systole, S3, S4, splitting, extra sounds and murmurs a. Aortic valve area (Rt. 2nd ICS, RSB) Diaphragm - Bell b. Pulmonic valve area (Lt. 2nd ICS, LSB) Diaphragm - Bell c. Second pulmonic area (Lt. 3rd ICS, LSB) Diaphragm - Bell d. Tricuspid valve area (Lt. 4th ICS, LSB) Diaphragm - Bell e. Mitral valve area (Lt. 5th ICS, MCL) Diaphragm - Bell

20
Q

Vascular System (Sitting)

A
  1. PALPATE: pulses bilaterally for rate, rhythm, contour and amplitude a. carotid (if not already performed elsewhere) b. brachial c. radial d. femoral (to be performed with abdominal exam) e. popliteal f. posterior tibial g. dorsalis pedis
21
Q

Vascular System (Supine - Shoulders at 45 degrees elevation)

A
  1. INSPECT: jugular veins bilaterally 2. PERFORM: jugular venous distention (See Appendix A)
22
Q

Abdomen

A
  1. SUPINE position with arms at sides and knees flexed 2. INSPECT: the skin for striae, scars, color or venous pattern 3. INSPECT: the contour noting masses and distention 4. INSPECT: for movement noting peristalsis or pulsation 5. INSPECT and TEST: for hernias and diastasis recti, asking the patient to raise head and shoulders from supine position and bear down 6. INSPECT and TEST: for superficial abdominal reflexes 7. AUSCULTATE: four quadrants with diaphragm for bowel sounds 8. AUSCULTATE: with bell for bruits - Aorta (1) - Renal (2) - Iliac (2) - Femoral (2) 9. PERCUSS: four quadrants for tympany and dullness 10. PERCUSS: gastric air bubble 11. PERCUSS: mark and measure liver borders at midclavicular line (normal span 6 to 12 cm) 12. PALPATE: lightly in all four quadrants looking for muscular resistance, tenderness and masses 13. PALPATE: deeply in all four quadrants for masses and tenderness 14. PALPATE: liver border while patient takes a deep breath 15. PALPATE: spleen while patient takes a deep breath (supine position only) 16. PALPATE: kidneys while patient takes a deep breath 17. PALPATE: aortic pulsation 18. PALPATE: femoral pulse and inguinal nodes
23
Q

Abdomen: Special Testing Procedure for Peritoneal Irritation

A
  1. TEST: for rebound tenderness 2. TEST: gallbladder for Murphy’s sign while patient takes a deep breath 3. TEST: appendix for McBurney’s sign (RLQ) 4. TEST: appendix for Rovsing’s sign (LLQ) 5. PERFORM: obturator test 6. PERFORM: iliopsoas test
24
Q

Abdomen: Special Testing Procedure for Peritoneal Irritation (Sitting)

A
  1. TEST: for costovertebral angle (CVA) tenderness with patient in sitting position
25
Q

Abdomen: Special Testing Procedure for Peritoneal Irritation (Standing)

A
  1. PERFORM: heel jar test (Markle sign) 6. PERFORM: rectal exam (may omit, but must be verbalized)
26
Q

Musculoskeletal (General Inspection)

A
  1. OBSERVE: for general posture and balance, deformities, asymmetry, atrophy, or hypertrophy.
27
Q

Musculoskeletal (Neck)

A
  1. INSPECT: for symmetry of skin folds and muscles. 2. PALPATE: cervical spine, paravertebral musculature, trapezius, and sternocleidomastoid muscles. 3. ASSESS: active ROM a. Flexion (450) b. Extension (550) c. Lateral flexion -ear to shoulder (400) d. Rotation (700) 4. ASSESS: strength by having the patient turn head side to side against resistance (CN XI)
28
Q

Musculoskeletal (Thoracic and Lumbar Spine)

A
  1. INSPECT: for spinal curvature during slow forward flexion. (Also observe from the patient’s side to assess spinal flexion (see 3a below*) 2. PALPATE: spinous processes and paravertebral muscles for tenderness or muscle spasm. 3. ASSESS: active ROM a. Flexion* (750) – performed above b. Extension (300) c. Lateral flexion (350) d. Rotation - stabilize patient’s pelvis (300)
29
Q

Musculoskeletal (Shoulders)

A
  1. INSPECT: clavicles, scapulae, and area muscles for symmetry, muscle atrophy, deformity, effusion or soft tissue swelling 2. PALPATE: sternoclavicular joints, clavicles, acromioclavicular joints, greater tuberosity of humerus, bicipital groove, coracoid process, scapulae, and area muscles for tenderness. 3. ASSESS: active ROM a. Forward flexion -raise arms above head (1800) b. Extension - stretch arms behind back (500) c. Abduction - raise arms laterally above head (1800) d. Adduction - arms across front of body (500) e. Internal rotation - arms behind back (900) f. External rotation - arms behind head (900) 4. ASSESS: strength - shrug shoulders against resistance (CN XI) 5. ASSESS: rotator cuff strength a. Supraspinatus – “empty can” test b. Subscapularis – resisted internal rotation with elbows at sides, flexed to 90 degrees c. Infraspinatus – resisted external rotation with elbows at sides, flexed to 90 degrees 6. PERFORM: Neer test 7. PERFORM: Hawkins test 8. PERFORM: Apprehension test for shoulder dislocation (See Appendix A)
30
Q

Musculoskeletal (Elbows)

A
  1. INSPECT: for symmetry, muscle atrophy, deformity, effusion, soft tissue swelling and the carrying angle (normally 5-150 of valgus) 2. PALPATE: for tenderness - with elbows flexed to 900 a. Extensor surface of the ulna b. Olecranon c. Medial epicondyle d. Lateral epicondyle 3. PALPATE: epitrochlear lymph nodes for size and tenderness 4. ASSESS: active ROM a. Flexion (1600) b. Extension (00 or 1800) c. Pronation - with elbow flexed at 900 (900) d. Supination - with elbow flexed at 900 (900) 5. ASSESS: muscle strength against resistance a. Flexion b. Extension 6. ASSESS: medial joint stability with valgus stress test (See Appendix A)
31
Q

Musculoskeletal (Hands and Wrists)

A
  1. INSPECT: for symmetry, muscle atrophy, deformity, effusion or soft tissue swelling (including thenar and hypothenar eminence) 2. PALPATE: joints for nodules, swelling, or tenderness a. Distal interphalangeal (DIP) b. Proximal interphalangeal (PIP) c. Metacarpophalangeal (MCP) d. Radiocarpal e. Anatomical snuff box (for suspected scaphoid fracture) 3. ASSESS: active ROM a. MCP flexion - make fist (900) b. MCP extension (up to 300) c. Thumb opposition (Thumb to each fingertip and to the base of the little finger) d. Wrist flexion (900) e. Wrist extension (700) f. Radial deviation (200) g. Ulnar deviation (550) 4. ASSESS: muscle strength against resistance a. Grip strength (grasping of two fingers) b. Finger abduction c. Finger adduction d. Thumb adduction (Thumb to base of little finger against resistance) e. Wrist flexion f. Wrist extension 5. PERFORM: Tinel test for carpal tunnel syndrome (See Appendix A) 6. PERFORM: Phalen’s test for carpal tunnel syndrome (See Appendix A)
32
Q

Muscuoloskeletal (Hips & Lower Extremities - STANDING)

A
  1. INSPECT: for symmetry, muscle atrophy, deformity, effusion or soft tissue swelling (observe patient from behind) 2. INSPECT and PALPATE: lower extremities for temperature, hair distribution, color, texture, thickening and tenderness 3. INSPECT and PALPATE: lower extremities for varicose veins 4. ASSESS: lower extremities for edema
33
Q

Muscuoloskeletal (Hips & Lower Extremities - SUPINE)

A
  1. PALPATE: Hips and pelvis for instability or tenderness 2. PALPATE: Trochanteric bursa bilaterally for tenderness 3. ASSESS: active ROM a. Flexion – with knee flexed (1200) b. Flexion – with leg straight and knee extended (900) c. External rotation - with hip and knee flexed to 900 (450) d. Internal rotation - with hip and knee flexed to 900 (400) e. Abduction (450) f. Adduction (300) 4. ASSESS: muscle strength against resistance a. Flexion b. Abduction c. Adduction 5. PERFORM: Patrick test for disease of the hip and SI joints (if positive - palpate sacroiliac joints) 6. PERFORM: Straight leg raising test bilaterally for lower lumbar nerve root compression (See Appendix A)
34
Q

Muscuoloskeletal (Hips & Lower Extremities - LYING PRONE)

A

[alternate position lying on side: right side then left side] 7. ASSESS: active ROM a. Extension of the hip - with leg straight and knee extended (300) 8. ASSESS: Muscle strength against resistance

35
Q

Musculoskeletal (Knee - SUPINE)

A
  1. INSPECT: extended knee for symmetry, muscle atrophy, deformity, effusion, soft tissue swelling and leg alignment (angle between femur and tibia should be less than 150) 2. INSPECT and PALPATE: popliteal fossa for tenderness, masses or Baker’s cysts 3. PALPATE: patella, patellar tendon, tibial tubercle, medial and lateral tibiofemoral joint space, and medial and lateral collateral ligaments for tenderness [in 3 positions: full extension, 45⁰, 90⁰] 4. ASSESS: active ROM a. Flexion (1300) b. Extend fully (00 or 1800) c. Hyperextension (150) 5. ASSESS: muscle strength against resistance a. Extension b. Flexion 6. PERFORM (See Appendix A) a. Lachman’s test for anterior cruciate ligament tears b. McMurray test for torn meniscus c. Anterior and posterior drawer test for cruciate ligament tear d. Varus Stress Test(Knee flexed to 00) for lateral collateral ligament tear e. Valgus Stress Test (Knee flexed to 0 and 30 degrees) for medial collateral ligament tear
36
Q

Musculoskeletal (Feet & Ankles -SITTING)

A
  1. INSPECT: for symmetry, muscle atrophy, deformity, effusion or soft tissue swelling 2. INSPECT: longitudinal arch for abnormalities (pes cavus or pes planus) 3. PALPATE: Achilles’ tendon, medial and lateral malleolus, tibiotalar (ankle) joint, and metatarsophalangeal (MTP) joints for tenderness or deformity. 4. ASSESS: active ROM a. Plantar flexion (450) b. Dorsiflexion (200) c. Inversion (300) d. Eversion (200) e. Flexion of the toes f. Extension of the toes 5. ASSESS: muscle strength against resistance a. Plantar flexion of foot b. Dorsiflexion of foot c. Flexion of the great toe d. Extension of the great toe 6. ASSESS: joint stability a. Talar tilt b. Anterior drawer
37
Q

Muscuoloskeletal (Feet & Ankles - KNEELING/PRONE)

A
  1. PERFORM: Thompson’s test for Achilles tendon rupture. (may be done prone or standing) (See Appendix A)
38
Q

Neurological (Mental Status)

A
  1. ASSESS: Physical appearance and behavior appropriate for situation, age, and gender 2. Cognitive abilities 1. ASSESS: State of consciousness / response to questions a. Ask to identify self b. Ask about current date or time c. Ask about interview place 2. ASSESS: Attention a. Ask the patient to subtract 7’s from 50 or 100; spell “WORLD” backwards 3. ASSESS: Memory a. Immediate recall (gives 5 numbers and has the patient repeat them back) b. Recent memory (describes 3 to 5 objects and asks the patient to repeat them now and then again in 5 to 10 minutes from now (see #6 below)) c. Remote memory (ask about verifiable data such as place of birth, mother’s maiden name, etc.) 4. ASSESS: Attention span a. Ask the patient to follow a short series of commands 5. ASSESS: Judgment or Reasoning a. Practical (ask their role in planning their future) b. Abstract (ask to explain a situation or proverb) c. If abnormalities are suspected, perform a mini-mental state exam (MMSE) 6. ASSESS: Recent memory a. Ask the patient to repeat previously described 3 to 5 objects 2. Emotional stability (thought processes, content, and delusions - auditory and/or perceptual) a. ASSESS: mood and feelings - ask pt about mood swings, appropriate feelings to a situation, anxiety and/or depression. 3. Speech and Language Skills a. ASSESS: voice quality, articulation, coherence and comprehension (This is being done during the entire exam)
39
Q

Neurological (Cranial Nerves)

A

(if not already tested elsewhere) 1. TEST CN I (only tested when an olfactory problem is suspected, test each nostril separately) 2. TEST CN II a. Snellen for far vision b. Rosenbaum for near vision c. Visual fields by confrontation 3. TEST CN III, IV and VI a. Extraocular muscles (EOMs) b. Pupil size and equality 4. TEST CN V a. Motor -palpate masseter and temporalis muscles while pt is biting down and clenching teeth b. Sensory (sharp and dull in all 3 divisions bilaterally – Ask pt to close eyes) 1. Forehead-Ophthalmic 2. Cheek-Maxillary 3. Chin-Mandibular c. Sensory (light touch in all 3 divisions bilaterally - Ask pt to close eyes) 1. Forehead-Ophthalmic 2. Cheek-Maxillary 3. Chin-Mandibular d. Corneal sensitivity with a wisp of cotton (Sensory CN V and Motor CN VII) 5. TEST CN VII a. Motor 1. Raise eyebrows 2. Smile 3. Show teeth 4. Puff out cheeks 5. Purse lips 6. Squeeze eyes shut as examiner attempts to open them 6. TEST CN VIII a. Hearing (whisper, Weber, Rinne) 7. TEST CN IX and X a. Say “ah” (check if soft palate rises and uvula is midline) 8. TEST CN XI a. Shrug shoulders against resistance b. Turn head side to side against resistance 9. TEST CN XII a. Inspect tongue at rest b. Protrude tongue (assess for fasiculations or deviation) c. Press tongue against cheeks bilaterally

40
Q

Neurological (Propioception & Cerebellar Function- SITTING)

A
  1. TEST: coordination with rapid alternating movements a. Upper extremities - alternating supination/pronation movements of hands on thighs b. Lower extremities - tapping balls of patient’s feet on examiner’s hands 2. TEST: fine motor skills with accuracy of movement performed bilaterally a. Upper extremities - using patient’s finger alternately touch patient’s nose to examiner’s moving finger with patient’s eyes open b. Lower extremities - run heel from knee to ankle on opposite shin, repeat for opposite heel
41
Q

Neurological (Propioception & Cerebellar Function- STANDING)

A
  1. TEST: balance by Romberg test 4. TEST: gait by walking at normal stride away from examiner 5. TEST: gait by walking heel-to-toe returning toward the examiner
42
Q

Neurological (Sensory Function)

A

All tests are done bilaterally while the patient’s eyes are closed 1. TEST: primary sensory functions (hands, forearms, abdomen, lower legs, and feet) a. superficial touch (light touch) b. superficial pain (sharp and dull) c. vibratory (fingers and toes) d. joint position (fingers and toes) 2. TEST: cortical sensory function a. stereognosis (identify an object placed in the hand, bilaterally) b. two point discrimination c. graphesthesia (describe a letter or number traced on the skin) 3. TEST: Monofilament Test a. Test feet areas with monofilament for protective sensations

43
Q

Neurological (Reflexes)

A
  1. TEST: superficial reflexes a. abdominal (unless done elsewhere) b. cremasteric (tested in male GU exam) c. plantar (assess for Babinski sign) 2. TEST: Deep Tendon Reflexes (DTRs) (bilaterally, use reinforcement technique if necessary) a. biceps b. brachioradialis c. triceps d. patellar e. Achilles 3. TEST: ankle for clonus, bilaterally
44
Q

Neurological (Special Tests)

A
  1. TEST: Brudzinski sign for meningeal irritation 2. TEST: Kernig sign for meningeal irritation

Clinical Skills I (1 decks)

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