Practicum Part 2

Question 1

Head/Face

Answer 1

Inspection
* Skin (color, masses, lesions/scars)
* Hair growth pattern
* Facial Symmetry
* CN7 (facial expressions: smile, frown, puff cheeks, raise eyebrows, close eyes)
Palpation
* Hair
* Scalp/Skull
CN5
* Jaw movement (motor: temporal and masseter)
* Superficial pain (Sensory: use cotton ball)

Question 2

Neck

Answer 2

Inspection:
* Skin, Contour, Symmetry
Palpation:
* Tracheal placement (midline)
* Thyroid Gland (enlargement)
* ROM (Flexion/Extension, Crepitus?)
CN11:
* ROM L/R with resistance
* Tapezius Strength (shrug shoulder with resistance)
Lymph Nodes:
* Preauricular
* Postauricular
* Occipital
* Tonsillar
* Submandibular
* Anterior and Posterior Cervical
* Deep Cervical
* Supraclaviuclar
* Infraclavicular

Question 3

Eyes

Answer 3

Inspection:
* Eyebrows (symmetric, able to raise)
* Eyelashes (long and curved)
* Eyelids (drooping/sagging?)
* Sclera (color)
* Bulbar Conjunctiva (transparent)
* Iris (note size and shape of pupils)
Eye Tests:
* CN2 Rosenbaum or Snellen
* Corneal Light reflex
* CN2&3 Pupil Responses (direct and consensual)
* CN 2&3 Accommodation of pupils
* CN 3,4, &6: (EOMs using 6 cardinal fields of gaze)
* Note Presence of Strabismus or Nystagmus

Question 4

Ears

Answer 4

Inspection:
* External Ear (skin, shape, placement, discharge)
Palpation:
* Pinna (tender?)
* Tragus (Tender?)
* Percussion of Mastoid Process (pain?)
* CN8 (whisper test)

Question 5

Nose

Answer 5

Inspection:
* Septum (midline)
* Internal structure (note mucosa pallor, inflammation, moistness, discharge, with LIGHT SOURCE)
* Nares Patency
* CN1: Sense of smell

Question 6

Mouth and throat

Answer 6

Inspection: (WITH LIGHT SOURCE)
* Lips (symmetry, dryness, cracking?)
* Oral mucosea (using tongue blade and light. Note hydration, inflammation, lesions, white patches)
* Teeth (note cracks or missing fillings)
* Tongue and Tonsils 1+ (note redness, lesions, exudates)
* CN 9&10: Rising of uvula (AHH) and swallow test
* CN12: Light Tight Dynamite

Question 7

Musculoskeletal

Answer 7

Inspection:
* Spine (lateral view, “Doule-S Curve)
* Scoliosis (posterior view)
Palpation
* Palpate spine and around vertebral column
* Note abnormal lateral curvature (bend forward)
Observe Inflammation & Edema, ROM, Crepitus & Tenderness, and Strength (5+) of the following:
* Jaw & Neck
* Shoulder
* Elbow
* Wrist
* Forearm
* Fingers/Hands
* Hips
* Knees
* Ankles

Question 8

Neurological

Answer 8

Inspection:
Cerebellar Function
* Gait
* Tandem Walking
* Toe Walking
* Heel Walking
* Romberg’s
* Ankle to Shin
* Rapid Alternating Movement
* Finger to Nose
Palpation:
* Sensory (sharp/dull with eyes closed on upper and lower extremities)
* Posterior Column Tract: Vibration Test (on joints & great toe)
Percussion:
* DTRs of Biceps and Patellar Tendons (Name and Grade: 2)