Skills Exam 1 Flashcards
Measure oral temp
step 1 thermoseter under tongue, step 2 close mouth.
Determine hydration status
Examine skin.
Turgor= pinch skin on dorsum of hand. decreased turgor=dehydration or malnutrition. pedatricians use skin on belly.
Name and do parts of gen survey
state of health, LOC, signs of disress, skin color, skin lesions, dress/groming/personal heigeine (aka mental status exam), facial expression, body odor/breath, posture/gait/motor activity
Health Loves Dessert. Skipping Dessert is Especially Bad Practice.
Health. LOC. Distress. Skin. Dress. Expression (facial). Body/breath odor. Posture. “Ashley Marnell”
Obtain BP in one arm
9 steps- brachial art at heart level, place cuff 2-3cm above antecubital crease, feel radial art while inflating until disappears, add 30mmHg to reading, deflate cuff quickly, listen with stethoscope over brachial art with diaphragm, inflate to number + 30 then slowly deflate cuff, identify systolic and diastolic pressure, verbalize parameters of results, verbalize parameters of normal systolic <120 diastolic <80
Determine heart rate and rhythm.
Compress radial pulse with index and middle fingers, not thumb! Do both arms at the same time to feel symmetry of radial pulses. If regular count for 30sec x2 SAY THIS and give number. Say regular or irregular. Verbalize parameters of normal HR “60-90 to 100” beats per minute in adults.
Inspect pupils
Shine light and comment on PERRL. There is no accomodation.
Test for nystagmus with EOMs
Step 1=Instruct PT to follow finger with their eyes make sure to tell PT to hold head still,
Step 2=Use the H or star pattern
step 3=Verbalize that nystagmus is possible in lateral and upward gaze. VERTICAL=pathological d/t brain issues
Test cardinal fields of gaze
Instruct PT to follow finger in H pattern with eyes and hold head still. Verbalize “(LR6SO4)3“.
Perform cover test for right sided monocular esotropia. (to confirm a tropia aka manifest tropia)
Cover left eye, right eye moves corrects to midline, and say this “corrects to midline”.
state reason for test=“to confirm a tropia/esotropia aka manifest tropia.”
Test for near reaction
PT instructed to focus on finger/pencil 2-3ft away and then to move on close to nose and say “pupils constrict”. Neurosphyllis test won’t constrict.
Perform hirschberg test
Step 1=Shine light on ridge of nose 20-24” in front
Step 2= interpret test exotropia light on medial aspect, esotropis on lateral aspect, hypertropia light on inferior aspect, hypotropia light on superior aspect of cornea
Test for direct and indirect light reflex
Step 1=shine light in one eye and comment on pupil constriction in that one eye and then comment on other eye consensual response.
Step 2=shine light twice in each eye. then go to the other eye and repeat and comment on direct and indirect.
Test for relative afferent pupil defect RAPD aka marcus gunn pupil. Proctor will say it’s their left eye.
Swing light from right eye and check for miosis. Then do affected eye and will see midriasis. Pass flashlight from right to left x2. verbalize “when light swings to affected eye partial dilation will occur in both eyes”.
Percuss sinuses
Frontal just above eyebrows, maxillars below eyes, verbalize reason “the PT’s symptoms are suspicious for sinusitis or rhinosinusitis”.
Test CN 1
Olfactory. Occlude opposite nare and use scent. DO NOT USE ALCOHOL or s/t with astringent properties.
Test CN 10
Vagus. Have PT say “ahhhh” and verbalize normal finding “symmetrical rise of uvula and pallet”
Test CN 11
Spinal accessory. Turn next against resistance in both directions, shoulder shrug against resistance
Test CN12
Hypoglossal. Stick tongue out and verbalize “tongue remains midline”.
Percuss thorax
Press deeply into tissue with pleximer finger, percuss over DIP joint. 6 pairs anterior, 7 pairs posterior. Use ladder technique to compare findings on either side. Verbalize “Resonance sound is normal as expected”.
Percuss for diaphragmatic excursion
Verbalize that you percuss during quiet respiration, posterior thorax vantage. Percuss inferiorly until dulness replaces resonance and mark skin, then have PT inhale and hold breath which causes diaphragm to move down then percuss inferiorly from marked area from resonance to dullness and mark skin, measure difference and repeat on other side. Tell PT they can now breathe. Normal is 3-5.5cm.
Identify sternal angle (aka angle of louie)
Step 1=palpates where manubrium joins body of sternum,
Step 2= palpates and names adjacent rib (rib #2)
Step 3= palpates and intercostal space below ICS 2. Named for rib above.
Ausculate for transmitted voice sounds posteriorally
Pick one spot and then use opposite side.
Broncophony= direct PT to verbalize 99.
Egophony= direct PT to verbalize “e”.
Whispered pectorlilquiy=direct PT to verbalize “123”. verbalize interpretation “lung tissue not filled with airless mass aka consolidation. airless lung tissue=consolidation”
Auscultation of lungs
6 pairs anterior, 7 pairs posterior. Use ladder technique for comparison.
Test for mobility of tympanic membrane
PT performs valsalva or use pneumatic otoscopy.
Determine gross hearing
Use whispered voice. Pinch ear and stand 1-2ft away from PT and whisper into open ear a two syllabul word “99” “baseball”. PT should repeat word and do on other side.
Perform Rinne Test
Place vibrating tuning fork on mastoid bone and time how long the PT hears it, tell PT when no longer heard put finger up and then put fork near auditory ear canal and ask if hears sound and time, this is the air conduction. AC>BC. Rinne done after abnormal Webber test.
Perform Webber test
Place base of vibrating tuning fork on midline of head on vertex or forehead. Verbalize interpretation of the results.
Unilateral conductive hearing loss=heard/lateralized to impaired ear. Unilateral sensorineural=heard/lateralized to good ear.
Palpate Thyroid gland
From posterior side of PT.
Step 1=place fingers from posterior apprach from base of anterior next and tell PT to swallow.
Step 2=verbalize findings size shape symmetry consistency “normal size, shape, symmetry, and consistency” and explain abnormalities this test might reveal such as mass, goiter, or nodule.
Palpate lymphnodes of head and neck
preaucicular postaucicular occupital tonsilar submandibular submental ant cervical deep cervical post cervical supraclavicular
