OSKI (things to memorize)

Question 1

Locate and identify the superficial temporal arteries

Answer 1

the continuation of the external carotid artery as it emerges from the parotid gland, between the TMJ and the ear. It runs anterior to the ear over the zygomatic arch into the temporal region of the skull

Question 2

Locate and identify the parotid glands

Answer 2

The are abehind and superficial to the mandible, below the zygomatic arch and in front of the ear

Question 3

Locate and idetntify the submandibular salivary glands

Answer 3

deep/inner surface of the mandible

Question 4

Locate and identify the opening of the parotid gland

Answer 4

Stensen’s duct, located in the mouth at the 2nd upper molar on the buccal mucosa by a small papilla

Question 5

Locate and examine the trapezius muscle

Answer 5

ask patient to shrug shoulders upwards

Question 6

Locate and examine sternocleidomastoid muscle

Answer 6

ask patient to turn head to each side against hand

Question 7

Locate and identify borders of the anterior triangles

Answer 7

Mandible, sternocleidomastoid muscle, and midline of neck

Question 8

Locate and identify the external jugular vein

Answer 8

Perform a valsalva manuever (forced expiration against a closed glottis). It is begind the clavicular head of the sternocleidomastoid or roughly about the middle third of the clavicle and then passes diagonally over the surface of the sternocleidomastioid and up behind the angle of the mandible.

Question 9

Locate and identify the location of the thyroid gland

Answer 9

Student may ask patient to take a sip of water to facilitate this step. Student places finger pads of both hands to that the index fingers are just below the cricoid cartilage. Ask the patient to swallow and the student attempts to feel the thyroid rising under their finger pads. Student’s fingers should be a little lateral to the midline. The thyroid has 2 lateral lobes and midline isthuus and is usually located between the levels of the c5 and t1 vertebrae.

Question 10

Locate and identify the papillae of the ducts of the submandiublar glands

Answer 10

Wharton’s duct, location in the mouth at the base of the tongue, on both sides of the midline lingual frenulum. Have patient touch tongue to roof of the mouth, use a light source and tongue depressor to move the buccal mucosa laterally away from the gums

Question 11

Locate and identify the carotid artery

Answer 11

In the lower neck, the carotid artery is deep to the sternocleidomastoic muscle and as you move higher in the neck, the carotid artery is anterior to the sternocleidomastoic muscle. Only palpate one at a time!

Question 12

Locate and identify the sturctures that make up the external ear

Answer 12

Cartaliginous ear-aurcle=pinna. Outermost rim-helix, anti helix is internal to helix. Tragus lies in front of the external auditory meatus. The ear lobule has no cartilage.

Question 13

Locate and identify the external auditory canals

Answer 13

The canal is located behind the tragus of the ear. The canal is normally 2-3 cm long in adults.

Question 14

Locate and examine the tympanic membrane with an otoscope

Answer 14

Gently pull the ear upward and then backward to straighten the canal for easy visualization (up, out and back). Identify the pars tensa. Observe for blood, inflammation, swelling, cerumen, foreign bodies, or purulent secretion in the auditory canal.

Question 15

Locate and identify the pre and post auricular lymph nodes

Answer 15

pre-auricular: parotid lymph nodes in front of the ear

Post auricular: mastoid lymph nodes behind the ear and superficial to the mastoid process

Question 16

Locate and identify the occipital lymph nodes

Answer 16

At the base of the skull, posteriorly

Question 17

Locate and identify the submental lymph nodes

Answer 17

A few centimeters behind the tip of the mandible (chin)

Question 18

Locate and identify the superificial cervical lymph nodes

Answer 18

These are superifical to the surface of the sternocleidmastoid muscles

Question 19

Locate and identify the posterior cervical lymph nodes

Answer 19

These are located along the anterior border of the trapezius muscle

Question 20

locate and identify the supraclavicular lymph nodes

Answer 20

these are part oft he deep cervical lymph nodes, located in the angle formed by the clavicle and the claviuclar heads of the SCM

Question 21

Locate and identify the sternal angle of Louis

Answer 21

The bony ridge joining the manubrium to the body of the sternum. The 2nd costal cartilages are adjacent to the sternal angle

Question 22

Identify and locate the second intercostal space

Answer 22

Inferior to the 2nd costal cartilage, which is lateral to the sternal notch. This is important in helping doctors count ribs and ICS to name a location on the chest wall along with the vertical axis

Question 23

Locate and identify the midsternal line

Answer 23

a vertical line that runs through th emiddle of the sternum and xiphoid process

Question 24

Locate and identify the midclavicular line

Answer 24

A vertical line running through th emidpoint of the clavicle and inferiorly.

Question 25

Locate and identify the anterior axillary line

Answer 25

A vertical line running inferiorly from the anterior axillary muscle fold.

Question 26

Locate and identify the posterior axillary line

Answer 26

A vertical line running inferiorly from the posterior axillary muscle fold

Question 27

Locate and identify the surface markings of the lungs

Answer 27

Anteriorly: the apex of each lung rises about 2-4 cm above the inner third of the clavicle. The lower border of the lung crosses the 6th rib at thte midclavicular line.
Laterally: The lower lung border crosses the 8th rib at the midaxillary line
Posteriorly: the lower border of the lung lies at about the level of T10. During normal breathing, the lower border of the lung may descend about 5-6 cm as the diaphragm contracts.

Question 28

Locate and identify the lobes and fissures of the lungs

Answer 28

Each lung is divided in half by an oblique-mjaor fissue. tThis fissue can be approximated by a line from the T3 spinous process posteriorly and then runs obliquely down and around the chest to the 6th rib in the midclavicular line.
Posteriorly, above this line ar ethe upper lobes, and below is the lower lobe. The right lung is further divided by a horizontal=minor fissure. Anteriorly, this fissure runs from about the 4th rib and then travels roughly horizontally around the chest wall to the 5th rib in the midaxillary line. Above this fissure is the RUL, and below is the RML. The RML has no posterior projection. To examine, you need to auscultate/percuss in the laterla and anterior chest. Most of the upper lobes are best auscultated anteriorly.

Question 29

Technique for respiratory expansion

Answer 29

Inspect the chest wall for symmetric expansion. Place handes on the lower posterior chest wall with their thumbs at about the level of the 10th rib. As the student grasps the lower chest wall, they should slide their thumbs medially so that they raise a vertical skin fold medial to their thumbs and lateral to the patients spine. Students should then ask the patient to take a deep breath. As the patient breates, the student’s hands and thumbs should move laterally and equally about 2-5 inches as the chest expands. The skin fold the student created should also decrease in size as the chest wall expands.

Question 30

Take the patient’s respiratory rate

Answer 30

Ideally the student should count for thirty seconds to a minute

Question 31

Test for tactile fremitus

Answer 31

Purpose: detects palpable vibrations transmitted through the broncho-pulmonary tree to the chest wall.
technique: ask patient to grab opposite shoulder with their hands to move the scauplae laterally and increase the examinable area of the posterior lung fields. Students should place ulnar surface of hands on skin of posterior chest, begining at top of the chest first. Ask patient to repeat ninety-nine each time the hands move down the back. check posterior upper, middle, right, and then laterally for right lobe. You can also test 3 areas anteriorly: upper and lower parasternal areas and then in anterior axillary line

Question 32

Demonstrate the technique of percussion

Answer 32

Purpose: to determine if the tissues 5-7 cm deep are air filled, fluid filled, or solid.
Technique: Have patient grab shoulders with their hands to move scapulae laterally. On skin, place finger on posterior chest, in intercostal space (not over rib). Don’t rest any other part of hand over chest. Using other hand, strike finger quickly, with flexion coming from wrist. Start at top of lungs and compare right side to left side at any given area. Percuss upper, middle, and lower posterior chest wall and then lateral chest wall and 3 areas anteriorly.

Question 33

State the 5 percussion notes and an example of each

Answer 33

Flatness: thigh
Dullness: Liver
Resonance: Normal lung
Hyperresonance: None normally
Tympany: gastric air bubble or puffed out cheek

Question 34

Identify three types of normal breath sounds

Answer 34

Bronchial: head normally over the manubrium
Bronchovesicular: heard normally between the scapulae
Vesicular: heard normally throughout the rest of the lungs

Question 35

Demonstrate the technique of auscultation

Answer 35

Students ask patient to grab their shoulders. On skin, listen with diaphgram of stethescope, begin at apices, compare right to left at each level, ask patient to breathe through their mouth. Student should not move stethescope until the complete respiratory cucle is done (inspiration and all of expiration. Auscultate upper, mid, lower, and lateral lung fields and then 2-3 areas anteriorly.

Question 36

Test for vocal fremitus

Answer 36

Asp patient to whisper ninety-nine or say EEEE each time student moves stethescope. In bronchophony-ninety nine is heard louder and clearer than expected. In egophany, EEE is heard as nasal ayy. Transmitted voice sounds are all abnormal and are indictations of airless or consolidated lungs.

Question 37

Locate and count and describe the patient’s radial pulse

Answer 37

Technique: should should use finger pads, not tips, and decscribe beats/min and rhythm.

Question 38

Identify and locate the apex and base of the heart

Answer 38

Base is the junction between the heart and great vessels, and lies just below the sternal angle.
Apex is the tip of the left ventricle, normally found in midclavicular line, about 5 intercostal space.

Question 39

Identify and locate the costal margin

Answer 39

The costal margin is made of the cartilaginous border of ribs 7-10 anteriorly

Question 40

Identify and locate the xiphoid process

Answer 40

The xiphoid process is a midline fingerlike projection from the inferior part of th ebody of the sternum

Question 41

Identify and locate the midline which is overlying the linea alba

Answer 41

Linea alba runs from the xiphoid process inferiorly to the symphysis pubis

Question 42

Identify and locate the rectus abdominus muscle

Answer 42

Ask patient to raise their head and shoulders from the supine position. These muscle run about 7-10 cm lateral to and parallel to the linea alba. The lateral border of the rectus abdominus muscle is known as the linea semilunaris. The rectus abdomnis muscle arises from the pubic crest and inserts onto the anterior surface of ribs 5-7 and the xiphoid process

Question 43

Identify and locate the umbilicus

Answer 43

Normally at about L3 to L5

Question 44

Identify and locate the symphysis pubis

Answer 44

The symphysis pubis is a cartilaginous joint in the midline where the two pubic bones articulate

Question 45

Identify and locate the pubic tubercle

Answer 45

The pubic tubercle is a bony prominence, which may or may not be palpable on the pubic bone. The pubic tuberce is about one inch lateral to the midline. Moving from medial to lateral, you have the symphysis pubis, pubic crest, and then pubic tubercle.

Question 46

Identify and locate the anterior superior iliac spine

Answer 46

Most anterior part of the iliac crest, it is usually prominent and palpable.

Question 47

Identify and locate the inguinal ligament

Answer 47

The inguinal ligament extends from the pubic tubercle to the anterior superior iliac spine. Posteriorly, the iliac crest ends as the psoterior superior iliac spine

Question 48

Identify and locate the surface markings of the four abdominal quadrants

Answer 48

Defined by vertical line running through the umbilucus and a horizontal line running through the umbilicus.

Question 49

Identify and locate the surface markings of the colon

Answer 49

The colon is approximately 5 ft in length. The colon begins in the RLQ as the cecum. The appendix is also located in the RLQ and joins the ceum inferior to the ileocecal junction. The colon then turns into the ascending colon as it ascends to hepatic flexure (just under the liver) at the 9th intercostal space. The tranverse colon is the longest and most mobile part of the colon. It runs from the hepatic flexure in the RUQ to the splenic flexure in the LUQ. The colon then turns into the descending colon. At the level of the pelvic brim, the descending colon becomes the sigmoid colon and finally terminates in the rectum and anus.

Question 50

Identify and locate the surface markings of the spleen

Answer 50

The spleen is nromally just inferior to the diapghram in the LUQ at the level of the 9th-11th ribs, posterior to the left midaxillary line

Question 51

Identify and locate the surface markings of the pancreas

Answer 51

The pancreas is normally not palpable as it is a deep retroperitoneal organ. THe pancreas lies in both RUQ and LUQs. The head of the pancreas lies within the C shaped cruve of the dueodenum to the right of the patient’s midline. The body of the pancreas crosses the midline at about L1 and L2. The tail of the pancreas extends upwards and to the left to the hilar surface of the spleen roughly at the mdi clavicular line.

Question 52

Identify and locate the surface markings of the kidneys

Answer 52

The kidneys are bean shaped organs, about 1 cm long, 5-6 cm wide, 3 cm thick, and about 4-5 cm from the midline at about the level of T12 through the L3 vertebrae. The kidneys are posterir/retroperitoneal organs. Their upper poles are protected by the 11th and 12th ribs posteriorly. The inferior poles may be about 3-4 cm above the iliac crests. The right kidney is slightly lower than the left kidney.

Question 53

Identify and locate the abdominal aorta

Answer 53

The abdominal aorta begins as a direct continuation of the thoracic aorta at the level of T12 to L1 where the thoracic aorta passes through the diaphram at the aoritc hiatus in the midline. The badominal aorta descends in front of th ebodies of the first four lumbar vertebrae in the midline or slightly to the left of the midline. At l4, the aorta bifurcates into common iliac arteries. The total length of the abdominal aorta is about 10 cm and normally its diameter is baout 2.5 cm.

Question 54

Identify and locate the renal arteries

Answer 54

These are located in the RUQ and LUQ. The renal arteries arise at right angless off the abdominal aorta at about L1 or L2.

Question 55

Identify and locate the iliac arteries

Answer 55

The common iliac arteries are a direct continuation of the abdomonial aorta. The common iliac artieries divide into the external and internal iliac branches about 4 cm laterally from the midline.

Question 56

Identify and locate the femoral arteries

Answer 56

The femoral artery is a continuation of the external iliac artery as it runs posterior ot the inguinal ligament at about ht emidpoint of th einguinal ligament.

Question 57

Auscultate abdomen in four quadrants

Answer 57

In the abdominal exam, auscultation always come before paplation since any contact with bowel can increase the boewel’s motility. Gently place the diapghram of the stethescope on the abdominal wall. Normally there are 5-34 bowel sounds per minute.

Question 58

Palpate for horizontal and vertical superficial inguinal lymph nodes

Answer 58

The horizontal superficial inguinal lymph nodes are inferior to the inguinal ligament. These drain the superficial portions of the lower abdomen and buttock, the external genitalie (but not the testes), the anal canal, the perineal area, and the lower vagina.
The vertical superficial inguinal lymph nodes cluster near the upper part of the saphenous vein.
Palpate medial and parallel to femoral artery below the inguinal ligament. These lymph nodes drain the lower limb, perineu, anterior abdominal wall to the umbilicus, gluteal region, and parts of the anal canal.

Question 59

Palpate the abdomen superficially and deeply

Answer 59

Place a hand flat on abdomen and keep fingers together, use gentle light dipping motions to palpate all 4 quadrants. Then using two handed technique, exert pressure from top hand and palpate with bottom hand, all four quadrants.

Question 60

Palpate for the liver edge and spleen

Answer 60

With right hand at level of umbilucus, and lateral to rectus abdominus muscle, press gently up and ask patient to take a deep breath. If liver edge is not felt, move up and do again. Try to feel edge as patient takes a deep breath. Spleen tip is not normally felt, so just move until hand is place near patient’s left costal margin.

Question 61

Percuss for liver span

Answer 61

Measure vertical span of liver in the right mid clavicular line. Must percuss above th eliver (in lung area) and below liver to hear different percussion notes. In abdomen, the sutdent shoudl start at the level of umbilucs and then percuss up toward the liver. The student shold not percuss over the gown. Normal adult liver is 6-12 in the right midclavicular line.

Question 62

Palpate for the kidneys

Answer 62

Not normal to feel them, except maybe in very thin and relaxed person. Try to trap kidney by placing right hand below the costal margin in the RUQ, lateral to the rectus abdominus muscle but parellal to it, and place left hand below and parallel to the 12th rib. While th eleft hand if lifting up, the patient is asked to take a deep breath nd at the peak of inspiration, the student presses deeply into the RUQ just below the costal margin and attempts to capture the right idney between two hands. As the pateint breathes out, the student slowly releases pressure from right hand, feeling at the same time for the kidney to slide back into its expiratory position higher up. If the kidney is trapped the patient can feel it. The RK is lower than LK and the LK is rarely palpable.

Question 63

Palpate for spleen

Answer 63

Have patient lay on right side, place left hand behind left lower ribs and gently press up and in as the patient takes a breath.