Mid-term Checkoff

Question 1

How do we assess the head (first step)

Answer 1

Describe the countour and symmetry of the face, eyes, and ears state head is normo-cephalic.

Question 2

How do we assess scalp (second step)

Answer 2

Describe cephalic hair and scalp condition

Question 3

How do we assess CN 5 (third step)

Answer 3

Assess CN 5 the trigeminal nerve: palpate clenched jaw for motor portion, Touch face bilaterally in 3 places with eyes closed for sensory portion.

Question 4

How do we assess CN VII (fourth step)

Answer 4

Assess CN VII the facial nerve. Assess motor Have them smile, frown, close eyes with examiner trying to open, raise eyebrows, puff out cheeks. Describe assessing for sensory by placing flavors on tongue

Question 5

How do we assess overall eye (fifth step)

Answer 5

Identify and describe bulbar conjunctiva overlies the sclera and is clear. Palpebral conjunctiva which lines upper and lower lids and is clear or pink. Eye lids, brows, and lashes are present, lashes flow outward. No ptosis (drooping of lid), and sclera is white with no redness or jaundice.

Question 6

How do we assess perrlac (sixth step)

Answer 6

Assess and describe the pupils: Equality - both pupils are equal and gauge size. They are round. Reactive to light both direct and consensual. Accommodation - describes pupillary constriction or dilation. Convergence - the axes of the eyes turn in. Define accommodation and Convergence

Question 7

How do we assess eye movement (seventh step)

Answer 7

6 cardinal positions of eye movement. State parallel tracking with no nystagmus noted. Cranial nerve III, IV, and VI are intact. State that those are Oculomotor, trochlear, and abducens.

Question 8

How do we assess vision (eighth step)

Answer 8

Verbalize how to do a snellen eye chart. Use the hand held vision screener 14 inches away. Covering one eye at a time testing bilaterally

Question 8

How do we assess the ears (ninth step)

Answer 8

Identify and describe the helix, antihelix, external auditory meatus, tragus, antitragus, and lobule

Question 8

How do we assess hearing (tenth step)

Answer 8

Whisper test, occlude one ear and stand 1-2 feet in front of patient covering mouth. Use a two-syllable word.

Question 9

How do we assess the nose (11th step)

Answer 9

Inspect and palpate nose. Describe deformity, nasal alignment, nasal mucosa, septum, and turbinates using penlight.

Question 9

How do we assess smell (12th step)

Answer 9

Name CN I Olfactory. Check for patency bilaterally. Identify aroma bilaterally with 2 scents.

Question 9

How do we assess the mouth (13th step)

Answer 9

Assess and describe the following structures of the mouth: Lips, buccal mucosa, gums, teeth, tongue, hard palate (anterior, white), soft palate (posterior, pink). Uvula, and grade tonsils

Question 9

How do we assess lymph nodes (14th step)

Answer 9

Identify and describe the following lymph nodes: Pre-auricular, post-auricular, occipital, tonsillar (jugulodigastric) - behind posterior portion of jaw bone, submandibular, submental, superficial cervical, posterior cervical, deep cervical, supraclavicular - have pt shrug shoulders and palpate top of clavicles.

Question 10

How do we assess CN XI (15th and last step)

Answer 10

Name CN XI spinal accessory. Turn head side to side against resistance. Raise shoulders against resistance.

Question 11

How do we state norms (first step of respiratory)

Answer 11

States normal adult breaths (12-20). States they would assess pattern of respiration as regular or irregular, use of accessory muscles. Describes different depths of respiration (moderate, deep, or shallow.

Question 12

How do we inspect in respiratory (second step of respiratory)

Answer 12

Look for 2:1 transverse: anterior/posterior diameter and look for symmetry. Note lesions anterior and posterior. Note scars anterior/posterior thorax. Note hair pattern anterior/posterior thorax. Note skin color compared to rest of the body

Question 13

How do we assess mucous membranes (third step of respiratory)

Answer 13

Describes lips, mucus membranes. Assess nails for contour and color, angle of nailbed (less than 160 degrees so no clubbing) and capillary fill time.

Question 14

How do we palpate (fourth step of respiratory)

Answer 14

Palpate the entire anterior and posterior thorax and describe findings: crepitation. Note chest expansion - symmetrical chest expansion both anterior and posterior.

Question 15

How do we auscultate (fifth and last step of respiratory)

Answer 15

Auscultate in correct locations and describe breath sounds: Vesicular over the peripheral lung fields has a low pitch, soft I greater than E. Bronchovesicular over major bronchi anterior and posterior; mod pitch, mod amplitude, I equal to E. Bronchial over trachea and larynx; High pitch, loud, I less than E. Discuss significance of adventitious findings and possible causes (e.g. wheezing due to asthma, rales and crackles due to pneumonia).

Question 16

How do we inspect and discuss norms (first step cardio)

Answer 16

Inspect and discuss location and findings of chest wall for apical impulse, apex, base, lifts/heaves, states normal adult heart rate 60-100 bpm, states they would assess whether heart rate is regular or irregular.

Question 17

How do we palpate (second step cardio)

Answer 17

Palpate the chest wall for apical impulse

Question 18

How do we auscultate for heart sounds (third step cardio)

Answer 18

Identify using anatomical landmarks and report findings of 4 major auscultatory areas. listen with bell and diaphragm for extra heart sounds, murmurs: Aortic - R 2nd intercostal space right sternal border. Pulmonic L 2nd intercostal space left sternal border. Tricuspid L 4th or 5th intercostal space left sternal border. Mitral 5th intercostal space in midclavicular line

Question 19

How do we discuss S1 and S2 (fourth step cardio)

Answer 19

S1 is loudest at the apex; S2 is loudest at base. S1 represents closure of AV valves. S2 represents closure of semilunar valves. S1 begins systole; S2 begins diastole. S1 is lub sound; S2 is dub sound.

Question 20

How do we assess for pulse deficit and carotid bruits (fifth step cardio)

Answer 20

Assess for a pulse deficit and auscultate for carotid bruits. Auscultate the apical heart rate while palpating the carotid pulse and describe results “they’re the same so no pulse deficit”. Listen for carotid bruits, must listen with bell

Question 21

How do we assess pulses (sixth step cardio)

Answer 21

Identify location of pulses bilaterally and grade as 2+: Radial, brachial, verbalize femoral location), posterior tibial, dorsalis pedis, and carotid (occlude one at a time).

Question 22

How do we assess for edema (seventh step cardio)

Answer 22

Inspect lower extremity stating no edema present

Question 23

How do we check the nailbeds (eighth and last step cardio)

Answer 23

Describe nails and nailbeds for: color, contour and degrees (160, no clubbing), and capillary fill time.