Special Exams-Midterm Practical

Question 1

How do you perform orthostatic pulse & BP

Answer 1

take BP supine, sitting and standing

Decrease in systolic BP by 20mmHg or decrease in diastolic BP by 10mmHg is abnormal

Question 2

When would you palpate the temporal arteries

Answer 2

if temporal arteritis is on your differential (inflammation of medium and large arteries that supply the head area)

Sxs: HA, “it hurts when I comb my hair”

Question 3

How do you transilluminate the sinuses?

Answer 3

perform if sinuses ttp

Can transilluminate the frontal/maxillary sinuses

Dim the lights, use a strong narrow light source, visualization of a reddish glow is consistent with normal (air-filled) sinuses

Question 4

Why would you perform the cover-uncover test?

Answer 4

to evaluate for strabismus if corneal light reflexes are not symmetric

Question 5

How do you perform the cover-uncover test?

Answer 5

used to uncover an imbalance of extraocular eye muscle tone

1. Cover normal (strong) eye with a card
2. The abnormal (weak) eye will move to the correct position to fix on the light
3. uncover the normal eye
4. The abnormal eye will deviate again as the strong eye fixates on light

When the strong eye is covered, the abnormal eye can fixate correctly

Question 6

How can you test visual fields?

Answer 6

Have pt cover one eye

Place hands in two upper quadrants of visual fields and ask pt which fingers you are moving

Do the same for two lower quadrants

Have patient cover the other eye and repeat

Question 7

When would you perform a weber test? How is this done?

Answer 7

perform if hearing is diminished

Place vibrating tuning form on the top of the patient’s head. Ask the pt if they hear it on both sides equally or only on one side

If unilateral conductive hearing loss is present, sound lateralizes to the bad ear

If unilateral sensorineural hearing loss is present, sound lateralizes to the good ear

Question 8

When would you perform a rinne test? How is this done?

Answer 8

perform if hearing is diminished.

Place vibrating tuning fork on mastoid bone, behind ear at level of canal. When the pt can no loner hear the sound quickly place the tuning form close to the ear canal and assess whether or not sound can be hear. If sound is heard AC >BC

If sensorineural loss present, test is normal AC> BC

Question 9

When would you auscultate the thyroid for bruits?

Answer 9

if thyroid is enlarged

Use diaphragm and the bell

Question 10

Define fremitus

Answer 10

Increased transmission of vibration

suggests that normally air-filled lung has become airless (due to pna/consolidation)

Question 11

How do you perform tactile fremitus exam??

Answer 11

Ask the pt to say “99” each time you press against their back/chest . Palpate for tactile fremitus using ulnar sides of the hands and compare lung fields.

Increase fremitus: consolidation

Decreased fremitus: COPD, pleural effusion, pneumothorax

Question 12

How do you perform bronchophony test?

Answer 12

Ask pt to say “99” each time you place your stethoscope.

Louder clearer sound is bronchophony and suggests consolidation

Question 13

How do you perform egophony test?

Answer 13

Ask pt to say “eee” each time you move the stethoscope

“eee” sounding like “ay” is egophony and suggests consolidation

Question 14

How do you perform whispered pectoriloquy?

Answer 14

Ask pt to whisper “99” each time you place your stethoscope

louder clearer sound is whispered pectoriloquy and suggests consolidation

Question 15

How do you test chest expansion?

Answer 15

Place thumbs at level of the 10th rib with fingers loosely grasping & parallel to lateral rib cage

Ask pt to inhale deeply and watch distance between thumbs as they move apart during inspiration

Unilateral decrease in expansion may indicate underlying lung disease (fibrosis, lobar pna)

Question 16

How do you percuss for diaphragmatic excursion

Answer 16

Instruct pt to exhale completely and hold it

Then percuss for & mark level of dullness (boundary between resonant lung tissue & duller structures below diaphragm)

Then ask pt to inhale completely and hold it, percuss for & mark the level of fullness

Normal extent of diaphragmatic excursion is 5-6cm

Question 17

How do you auscultate for soft murmurs at base of heart?

Answer 17

The base of the heart is the best position for listening to soft murmurs

Ask pt to lean forward, exhale and hold breath in expiration

while pt is holding breath, auscultate at base of heart with diaphragm

Question 18

How can you check for hepatojugular reflux

Answer 18

apply firm pressure to the RUQ and observe for JVD

Question 19

When would you percuss for L border of the heart?

Answer 19

To check heart size when point of maximum impulse is not palpable

Dullness extending to the L of the MCL suggests cardiomegaly

Question 20

How can you auscultate for low pitched murmurs &S3 &S4 heart sounds at apex of heart

Answer 20

ask pt to roll onto their left side (left lateral decubitus position)

Auscultate apex of heart with the bell