Integration

Question 1

CN I (Olfactory)

Answer 1

Sense of smell, patency

Question 2

CN II (Optic)

Answer 2

Snellen chart, confrontation test, use ophthalmoscope to determine color, size, and shape of optic disc

Question 3

CN III (Oculomotor), IV (Trochlear), and VI (Abducens

Answer 3

Check pupils for size, consensual light reaction, and accommodation

Six Cardinal Positions of Gaze

Question 4

CN V (Trigeminal)

Answer 4

Motor: assess muscles of mastication by palpating temporal and masseter muscles as person clenches teeth

Sensory: test light touch sensation by touching a cotton swab to forehead, cheeks, and chin

Question 5

CN VII (Facial)

Answer 5

Have person close eyes, frown, show teeth, and puff cheeks

Question 6

CN VIII (Vestibulocochlear)

Answer 6

Test hearing acuity using the whispered voice test

Question 7

CN IX (Glossopharyngeal) and X (Vagus)

Answer 7

Depress tongue with a tongue blade and have person say “aaah;” note the gag reflex

Question 8

CN XI (Accessory)

Answer 8

Examine sternomastoid and trapezius muscles for equal size

Have patient rotate head and shrug shoulders against resistance

Question 9

CN XII (Hypoglossal)

Answer 9

Inspect tongue and have person say “light, tight, dynamite”

Question 10

Rapid Alternating Movements

Answer 10

Ask person to touch the thumb to each finger on the same hand, starting with the index finger, and then proceed in the reverse direction

Question 11

Finger-to-Finger Test

Answer 11

Ask the patient to use their index finger to touch your finger and then his or her own nose as you move your finger to different spots

Question 12

Finger-to-Nose Test

Answer 12

Ask person to close eyes and stretch out arms, and then touch the tip of their nose with each index finger

Question 13

Heel-to-Shin Test

Answer 13

Have patient lay supine and then place the heel of one leg onto the opposite knee and run it down the shin from the knee to the ankle

Question 14

Spinothalmic Tract Tests

Answer 14

Pain: apply sharp and dull touches in a random, unpredictable order and have patient identify dull or sharp
Light Touch: use cotton ball and brush on random sites, have patient tell you when they feel it

Question 15

Posterior Column Tract Tests

Answer 15

Vibration, kinesthesia, stereognosis, graphesthesia, two-point discrimination, extinction, and point location

Question 16

Vibration

Answer 16

Use a tuning fork and hold over bony prominences, and tell patient to tell you when it starts/stops

Question 17

Kinesthesia

Answer 17

Close patient’s eyes and move their fingers in directions that they have to identify

Question 18

Stereognosis

Answer 18

Have person close eyes and name a random object placed in their hands

Question 19

Graphesthesia

Answer 19

Have patient close eyes and trace a single digit number in their palm

Question 20

Two-Point Discrimination

Answer 20

Apply two points onto the skin and tell patient to tell you how many points they feel as you move them closer

Question 21

Extinction

Answer 21

Touch both sides of the body and have patient tell you how many sides you touched and where

Question 22

Point Location

Answer 22

Touch the skin and withdraw promptly, and have patient touch where you touched them

Question 23

Auscultation of Bowel Sounds and Vascular Sounds

Answer 23

Check bowel sounds in all four quadrants and check for vascular sounds in the abdominal aortic area

Question 24

Percussion of Abdomen

Answer 24

Move clockwise in all four quadrants.

Liver Span: begin in area of lung resonance and percuss down the interspaces until the sound changes to a dull quality. Usually around the 5th ICS. Then find abdominal tympany and percuss up in the MCL, normally changes from tympany to dull at the right costal margin. Ranges from 6-12 cm.

Question 25

Scratch Test

Answer 25

Place stethoscope over xiphoid while lightly stroking the skin with one finger up the MCL from the RLQ and parallel to the liver border

Question 26

Blumberg Sign

Answer 26

Choose a site away from the painful area, hold your hand perpendicular to the abdomen, and push down slowly and deeply. Then quickly retract your hand and assess for pain.

Question 27

Murphy Sign

Answer 27

Hold your fingers under the liver border and ask person to take a deep breath. Normal response is to deep breathe without pain.

Question 28

Snellen Eye Chart

Answer 28

20 feet away using an opaque card covering one eye, and then the other. Only remove reading glasses. Ask them to read the smallest line they can all the way through.

Question 29

Jaeger Card

Answer 29

Hold the card 14 inches away and cover one eye, and then the other. Read the smallest line they can. They may wear glasses.

Question 30

Confrontation Test

Answer 30

Position yourself 2 feet away from patient and each cover up the same eye. Use a wiggling finger and slowly advance it into view and have the patient indicate when they see it.

Question 31

Corneal Light Reflex

Answer 31

Shine a light on the eyes to make sure there is no strabismus by noting where the corneal light reflex dot is on both eye. It should be in exactly the same spot on the eyes.

Question 32

Pupillary Light Reflex

Answer 32

Shine light on eyes in a dark room and note whether or not the pupils dilate or constrict (should constrict)

Question 33

Accommodation

Answer 33

Ask person to focus on a distant object and then have the person focus on your finger 3 inches away. Move it closer to their face and watch for pupillary constriction and convergence.

Question 34

Red Reflex

Answer 34

Using an ophthalmoscope, hold light 10 inches away from face and note for red glow filling the person’s pupil.

Question 35

Symmetric Expansion

Answer 35

Place warmed hands sideways on the back of the chest wall at T9 or T10. Ask person to inhale deeply and look for thumbs to move apart symmetrically.

Question 36

Tactile Fremitus

Answer 36

Use palmar base of hand to touch person’s chest as they say “ninety-nine” and test for vibrations. Do this symmetrically in 5 spots on the back. Do this anteriorly and posteriorly.

Question 37

Percussion of the Lung Fields

Answer 37

Start at apices and then percuss the band of resonant tissue across the tops of the shoulders. Percuss at 5cm intervals and make sure you are doing side-by-side comparisons all the way down the lung region. Should have resonance until visceral dullness occurs at lower lung borders. Do this anteriorly and posteriorly

Question 38

Auscultate Posterior Chest

Answer 38

Use the diaphragm of stethoscope and have patient take a breath every time you touch them. Go from the apices of shoulders to the bases of the lungs.

Question 39

Bronchial

Answer 39

High pitched, loud, harsh, hollow, tubular, found in trachea and larynx

Question 40

Bronchovesicular

Answer 40

Moderate pitch and volume, mixed quality, over major bronchi between scapulae

Question 41

Vesicular

Answer 41

Low pitched, soft, rustling, over peripheral long fields

Question 42

Bronchophony

Answer 42

Have person repeat “ninety-nine,” voice transmission should be soft and indistinct

Question 43

Egophony

Answer 43

Have person say “eeee,” and you should hear “eeee” through the stethoscope

Question 44

Whispered Pectoriloquy

Answer 44

Have person whisper “one two three,” response should be muffled and faint

Question 45

Auscultate the Carotid Artery

Answer 45

Use the bell of the stethoscope to auscultate at 1) the angle of the jaw, 2) the midcervical area, and 3) the base of the neck

Question 46

Palpate the Apical Impulse

Answer 46

Roll the person to their left side; apical impulse should be located at the fifth intercostal space, left midclavicular line

Question 47

Auscultation of the Heart

Answer 47

Aortic → Pulmonic → Left Atrium (Erb’s Point) → Left Ventricle (Mitral Area) → Right Ventricle (Tricuspid Area) → Right Atrium

Question 48

Ounces to Milliliters

Answer 48

1 oz = 30 mL