Skills Exam 1

Question 1

Measure oral temp

Answer 1

step 1 thermoseter under tongue, step 2 close mouth.

Question 2

Determine hydration status

Answer 2

Examine skin.

Turgor= pinch skin on dorsum of hand. decreased turgor=dehydration or malnutrition. pedatricians use skin on belly.

Question 3

Name and do parts of gen survey

Answer 3

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”

Question 4

Obtain BP in one arm

Answer 4

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

Question 5

Determine heart rate and rhythm.

Answer 5

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.

Question 6

Inspect pupils

Answer 6

Shine light and comment on PERRL. There is no accomodation.

Question 7

Test for nystagmus with EOMs

Answer 7

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

Question 8

Test cardinal fields of gaze

Answer 8

Instruct PT to follow finger in H pattern with eyes and hold head still. Verbalize “(LR6SO4)3“.

Question 9

Perform cover test for right sided monocular esotropia. (to confirm a tropia aka manifest tropia)

Answer 9

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.”

Question 10

Test for near reaction

Answer 10

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.

Question 11

Perform hirschberg test

Answer 11

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

Question 12

Test for direct and indirect light reflex

Answer 12

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.

Question 13

Test for relative afferent pupil defect RAPD aka marcus gunn pupil. Proctor will say it’s their left eye.

Answer 13

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”.

Question 14

Percuss sinuses

Answer 14

Frontal just above eyebrows, maxillars below eyes, verbalize reason “the PT’s symptoms are suspicious for sinusitis or rhinosinusitis”.

Question 15

Test CN 1

Answer 15

Olfactory. Occlude opposite nare and use scent. DO NOT USE ALCOHOL or s/t with astringent properties.

Question 16

Test CN 10

Answer 16

Vagus. Have PT say “ahhhh” and verbalize normal finding “symmetrical rise of uvula and pallet”

Question 17

Test CN 11

Answer 17

Spinal accessory. Turn next against resistance in both directions, shoulder shrug against resistance

Question 18

Test CN12

Answer 18

Hypoglossal. Stick tongue out and verbalize “tongue remains midline”.

Question 19

Percuss thorax

Answer 19

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”.

Question 20

Percuss for diaphragmatic excursion

Answer 20

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.

Question 21

Identify sternal angle (aka angle of louie)

Answer 21

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.

Question 22

Ausculate for transmitted voice sounds posteriorally

Answer 22

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”

Question 23

Auscultation of lungs

Answer 23

6 pairs anterior, 7 pairs posterior. Use ladder technique for comparison.

Question 24

Test for mobility of tympanic membrane

Answer 24

PT performs valsalva or use pneumatic otoscopy.

Question 25

Determine gross hearing

Answer 25

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.

Question 26

Perform Rinne Test

Answer 26

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.

Question 27

Perform Webber test

Answer 27

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.

Question 28

Palpate Thyroid gland

Answer 28

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.

Question 29

Palpate lymphnodes of head and neck

Answer 29

preaucicular
postaucicular
occupital
tonsilar
submandibular
submental
ant cervical
deep cervical
post cervical
supraclavicular