Skills Check

Question 1

Nose, Mouth, Pharynx & Ear

Answer 1

Patency of nares
Describe nasal turbinates
Check sense of smell
Describe septum
Presence of polyps or lesions
Palpate Maxillary and Frontal Sinuses
Check TMJ
Describe lips and buccal mucosa
Locate opening of parotid ducts (Stenson's duct)
Describe teeth and gums
Locate Wharton's ducts
Check tongue surface & movement
Describe hard/soft palate characteristics
Movement of Uvula
Describe tonsils & posterior pharyngeal wall, color, exudate
Palpate for lesions

Ear
Placement
Describe pinna, tragus, external canal, discharge
Describe TM landmarks- umbo, cone of light, handle of malleus, short process
Hearing tests- Perform and describe results
Whisper, weber, rinne

Question 2

Head, Neck, Lymph, Eye (Hair and Nails)

Answer 2

Skin
Color, temperature, moisture
Edema, texture, turgor
Vascularity, scars, lesions, color, type, grouping, distribution

Hair & Nails
Texture, distribution, color, capillary refill, normal angle 160 degrees

Face
Symmetry, muscles, CN VII, CN VIII
Mastoid tenderness

Neck/Lymphatic
ROM, cervical spine tenderness, trachea, thyroid, JVD
Lymph nodes

Eye
Visual acuity- CN II- Snellen, color, near vision
External structures- lashes, eyebrows, eyelids, conjunctivae, cornea, iris, sclera
Pupils- direct and consensual
Visual fields- direct confrontation; peripheral
EOM
Cardinal fields of gaze
Cover/uncover
Hirschberg; Bruckner
Accommodation
Fundoscopy- red reflex; av ration: retina, macula

Question 3

Thorax, Lungs, Abdomen

Answer 3

Thorax and Lungs
Inspect skin, respirations, musculature, symmetry, atrophy, movement, accessory muscles, bony compartment- shape; posture, ap diameter

Palpate- temperature, tenderness, lesions, tracheal position, resp. excursion, tactile fremitus “99”

Percussion- side to side, describe sound. Anterior chest, posterior chest, diaphragmatic excursion.

Auscultate- side to side- identify breathe sounds and locations
Identify adventitious sounds

Egophony, bronchophony, pectoriloquy

Abdomen
Inspect- contour, symmetry, movement; lesions, color, vascular pattern. Umbilicus
Auscultate- BS, pitch, frequency. Aorta and Femoral areas.
Percussion- gas pattern, location of organs
Liver, spleen, bladder, stomach
Liver span
CVA tenderness
Palpation
Light palpation, deep palpation, liver, spleen, kidney

Question 4

Heart/Peripheral Vascular/Abdomen

Answer 4

CV
Inspect- JVD, pulsation, color
Palpation- Carotid/bruits, PMI, heaves/thrills
Ausculation- S1 and S2 in 5 Valvular areas with bell and diaphragm A,P,E,T,M

Peripheral vascular
Inspect extremities
Palpate- calf tenderness, homans sign
Pulses- R,U,B,P,PT,DP
Arterial insufficiency- Allen's test, Bergers test

Abdomen
Inspect- contour, symmetry, movement; lesions, color, vascular pattern. Umbilicus
Auscultate- BS, pitch, frequency. Aorta and Femoral areas.
Percussion- gas pattern, location of organs
Liver, spleen, bladder, stomach
Liver span
CVA tenderness
Palpation
Light palpation, deep palpation, liver, spleen, kidney

Question 5

Mental Status, Neuro, Musculoskeletal

Answer 5

Mental Status Exam
Attention/Appearance
Behavior
Conversation
Recent memory- Weather
Remote memory-Jobs attended? President before this one?
Information- proverb, similarities, serial 7’s,
Abstract reasoning; judgment
CN assessment
Sterognosis; graphesthesia
Cerebellar exam
Gait; heel/toe walking; Romberg; pronator drift
Upper/Lower extremities for rapid alternating and point to point
Motor/musculoskeletal
Inspect and palpate joints for lessons, discoloration; swelling, asymmetry, atrophy, contractures, tenderness, heat, crepitus
ROM
Upper joint
Lower joint
Muscle strength bilateral
Bones that articulate: shoulder (scapula, clavicle, humerus), elbow (humerus, radius, ulna), wrist (radius, ulna, carpal bones), hip (femur, acetabulum), knee (patella, femur, tibia), ankle (tibia, fibula, talus)
Muscles responsible for movement-

Identify spinal nerves responsible for movement of        
Neck- C1-6
Shoulder- C4
Upper arm-C5-6
Lower arm-C5-C7
Hand- C8-T1
Thigh- L1-S1
Lower leg-L4-S1
Foot- L4-S2

Spine- tenderness, curvature, ROM
Sensory- light touch, pain, vibration
Deep tendon reflexes- biceps, triceps, patella, Achilles, plantar