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OSCE IV > Head to Toe Exam > Flashcards

Head to Toe Exam Flashcards

1
Q

Perform Part 1 of the Head to Toe exam

Part 1: Vital Signs, HEENT, Cranial Nerves, Neck Exam

A

Patient sitting:

General Appearance

Vitals:

  1. Wash hands
  2. Radial pulse 15 sec x4
  3. RR 30 sec x 2
  4. BP. Palpate for brachial artery
    1. Feet on floor, back supported, support arm with elbow at level of heart

Patient move to exam table: sitting.

Eyes:

  1. Eyes: Ask pt to pull lower lid down and upper lid up, look in each direction
  2. Visual acuity (cover one eye at a time)
  3. Visual fields with static finger counting from 3 ft away. Test in 4 quadrants in each eye
  4. Pupillary responses by ask pt to look into distance and observe direct and consensual responses
  5. Extraocular movements (H in air). Pause during upward and lateral gaze to detect nystagmyus.
    1. Convergence

Cranial Nerves:

  1. CNV: Ask pt to bite down, check masseter muscle strength bilaterally. Check sensation in all 3 areas
  2. CNVII: ask pt keep eyes closed against resistance, wrinkle forehead, puff out cheeks
  3. CNVIII: occlude opposite ear and test with finger rub

Ears:

  1. Inspect external ears, palpate pinna and mastoid
  2. Examine each ear canal and TM with otoscope

Nose:

  1. Inspect external nose
  2. Use otoscope to examine nasal turbinates while avoiding contact with septum

Mouth/CN cont:

  1. Examine lips, buccal mucosa, and top/sides/undersurface of tongue *using a light*.
    1. Have pt show you lower lip and upper lip on own
  2. Examine post oropharynx and test CNX by have pt say “ah”
  3. CNXII: have pt stick out tongue and move side to side
  4. CNXI: have pt rotate head against hand on each side, shrug against resistance

Neck:

  1. Palpate lymph nodes (ant cervical, post cervical, submandibular, supraclavicular)
  2. Inspect and palpate thyroid gland. Ask pt to swallow water as palpate anteriorly or posteriorly
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2
Q

Perform Part 2 of the Head to Toe exam

Part 2: Pulmonary, Cardiovascular, Abdominal Exams

A

Ask Patient to Move to Exam Table

Posterior Lung:

  1. Ask pt to untie the back of the gown. Observe posterior chest
  2. Tap (ladder)
  3. Listen (ladder), ask pt to take big breaths in and out with an open mouth

Anterior Lung:

  1. Auscultate (ladder)

Lower exam table to 30-45 degrees. Provide drape for LE!!

Neck:

  1. JVP (ask pt turn head to left, use pen light, measure + 5 cm)
  2. Listen: carotids (ask pt hold breath, breath in between)

Lower exam table to 0 degrees

Cardiac: ask pt to lower gown to below ribs/drape appropriately to maintain pt comfort in patient with breasts

  1. Observe anterior chest (stand at pt’s right side)
  2. Palpate with fingers in 3rd-5th interspaces for apical impulse. Can move pt to LLD
  3. Auscultate APTM with diaphragm, TM with bell

Pulses:

  1. PT pulses
  2. DP pulses
  3. Assess pedal edema

Abdominal:

  1. Inspect
  2. Listen: aorta, renal arteries, bowel sounds all 4 quadrants
  3. Percuss abdomen: all 4 quadrants
  4. Palpate abdomen: lightly in all 4 quadrants, deeper in all 4 quadrants
  5. Percuss liver: mid-clavicular line. assess liver span (from where dullness starts and stops, can measure). Should be dull
  6. Palpate liver: pt take deep breath while press inward while press upward posteriorly
  7. Percuss spleen: mid-axillary line. Should be tympanitic
  8. Palpate spleen: press inward while pt take deep breath, press upward posteriorly
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3
Q

Perform Part 3 of the Head to Toe Exam

Part 3: Musculoskeletal and Neurologic Exams

A

Patient Sitting

MSK UE:

  1. Inspect hands. Palpate wrists and MCP joints. Test wrist extension/flexion/radial and ulnar deviation. Test flexion and ext of fingers by have pt make fist and extend/spread fingers. Test abduction/adduction by ask pt to spread fingers apart and back together. Ask pt to touch thumb to each of other fingertips
  2. Inspect elbows. Palpate medial and lateral epicondyles. Ask pt to flex and extend elbows, then pronate and supinate forearms.
  3. Inspect shoulders. Palpate landmarks (AC joints and biceps tendon). Ask pt to flex/extend shoulder fully, then place both hands behind head, both hands behind back. (this combines abduction/ext rotation as well as adduction/internal rotation)

Neuro UE:

  1. Assess tone in UE b/l
  2. Test deltoid muscle strength
  3. Test biceps and triceps muscle strength
  4. Test strength of wrist flexion and extension
  5. Test finger abduction strength b/l
  6. Test hand grip
  7. Biceps reflex (strike finger)
  8. Triceps reflex (strike tendon 1-2 in above elbow)
  9. Brachioradialis reflex (forearm pronated partly and slightly flexed, strike styloid process of radius 1-2 in above wrist)
  10. Light touch in UE (close eyes, say yes when you feel this)
  11. Check pain sensation in UE
  12. Finger-nose test (pt start in bat wing position and fully extend arm at elbow, repeat on opposite side)

MSK:

  1. Palpate ant sup iliac spines and greater trochanter of both hips for tenderness
  2. Assess active ROM (flexion, abduction, adduction, internal/external rotation)
  3. Inspect knees for swelling. palpate joint lines. Check full ROM of flexion and extension one knee at a time
  4. Inspect ankles and feet. Palpate medial and lateral malleoli and Achilles tendon. Compress forefeet to evaluate for pain. Dorsiflex/plantarflex ankles. Test for inversion and eversion at subtalar and transverse tarsal joints. Flex/extend toes

Neuro LE:

  1. Assess tone in LE b/l
  2. Hip flexor strength (one at time)
  3. Quadriceps strength and hamstring strength b/l
  4. Strength of foot dorsiflexion/plantarflexion
  5. Great toe extension strength
  6. Knee reflex
  7. Ankle reflex (dorsiflex foot)
  8. Babinski reflex
  9. Light touch in LE (close eyes, say yes when you feel this)
  10. Check pain sensation in LE
  11. Ask pt to close eyes and test vibratory sensation of great toe
  12. Position sense of great toes (move toe at least 3 times)
  13. Test heel-shin b/l

Patient Standing

MSK:

  1. Assess ROM of neck (flex, extend, lat bending, rotation)
  2. Inspect and palpate spine and sacroiliac joints
  3. Assess ROM of spine: bend to touch toes, bend to right and left while keep hips still

Neuro:

  1. Romberg. Feet together and eyes closed. Tell pt you won’t let them fall. Stand close with arms ready in case sway
  2. Assess normal gait and tandem gait (heel to toe)
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4
Q

Perform Part 3 of the Head to Toe Exam (Alternative Order)

Part 3: Musculoskeletal and Neurologic Exams

Note: feel free to ignore this card, this order is more intuitive to me!

A

Modified MSK/Neuro component of Head to Toe Exam

UE:

  1. Tone (assess b/l)
  2. Shoulder:
    1. Inspect
    2. Palpate: AC joints and biceps tendon
    3. ROM: Ask pt to flex/extend shoulder fully, then place both hands behind head, both hands behind back. (this combines abduction/ext rotation as well as adduction/internal rotation)
    4. Strength: test deltoid strength
  3. Elbow:
    1. Inspect
    2. Palpate: medial and lateral epicondyles.
    3. ROM: Ask pt to flex and extend elbows, then pronate and supinate forearms.
    4. Strength: test biceps and triceps strength
  4. Wrist
    1. Inspect
    2. Palpate: wrist
    3. ROM: Test wrist extension/flexion/radial and ulnar deviation
    4. Strength: wrist flexion and extension
  5. Hand
    1. Inspect
    2. Palpate: MCP joints
    3. ROM: Test flexion and ext of fingers by have pt make fist and extend/spread fingers. Test abduction/adduction by ask pt to spread fingers apart and back together. Ask pt to touch thumb to each of other fingertips
    4. Strength: test finger abduction strength b/l, test hand grip
  6. Finger-nose test (pt start in bat wing position and fully extend arm at elbow, repeat on opposite side)
  7. Light touch in UE (close eyes, say yes when you feel this)
  8. Check pain sensation in UE
  9. UE reflexes
    1. Biceps reflex (strike finger)
    2. Triceps reflex (strike tendon 1-2 in above elbow)
    3. Brachioradialis reflex (forearm pronated partly and slightly flexed, strike styloid process of radius 1-2 in above wrist)

LE:

  1. Assess tone in LE b/l
  2. Hip
    1. Inspect
    2. Palpate: ant sup iliac spines (ASIS), greater trochanter of both hips
    3. ROM (active): flexion, abduction, adduction, internal/external rotation
    4. Strength: hip flexors (one at a time)
  3. Knee
    1. Inspect (note any swelling)
    2. Palpate: joint lines
    3. ROM: Check full ROM of flexion and extension one knee at a time
    4. Strength: quadriceps strength and hamstring strength b/l
  4. Ankle/foot
    1. Inspect
    2. Palpate: Palpate medial and lateral malleoli and Achilles tendon. Compress forefeet to evaluate for pain
    3. ROM: Dorsiflex/plantarflex ankles. Test for inversion and eversion at subtalar and transverse tarsal joints. Flex/extend toes
    4. Strength: foot dorsiflexion/plantarflexion, great toe extension
  5. LE reflexes
    1. Knee reflex
    2. Ankle reflex (dorsiflex foot)
    3. Babinski reflex
  6. Light touch in LE (close eyes, say yes when you feel this)
  7. Check pain sensation in LE
  8. Ask pt to close eyes and test vibratory sensation of great toe
  9. Position sense of great toes (move toe at least 3 times)
  10. Test heel-shin b/l

Patient Standing

Spine:

  1. Inspect
  2. Palpate: spine and sacroiliac joints
  3. ROM:
    1. Neck: flex, extend, lat bending, rotation
    2. Spine: bend to touch toes, bend to right and left while keep hips still
  4. Misc neuro:
    1. Romberg. Feet together and eyes closed. Tell pt you won’t let them fall. Stand close with arms ready in case sway
    2. Assess normal gait and tandem gait (heel to toe)
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OSCE IV (4 decks)

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