Test Out

Question 1

Introduction

Answer 1

hand hygiene
introduce
2 patient identifiers
explain the exam
ask for consent
pain assessment
hand hygiene

Question 2

Cranial Nerves

Answer 2

CN 1
eyes closed, put smell in face, tell me smell – CN1 the olfactory nerve intact

CN 2
identify smallest line to read, both eyes, left eye, right eye – CN2 the optic nerve intact

CN 3, 4, 6
assess 6 cardinal field, follow pen w/o moving head – CN3 the oculomotor, CN4 the trochlear, CN6 the abducens nerve intact

CN 5
clench teeth when i press on temples and jaw – I felt tone in both masseter and temporal muscles CN5 the trigeminal nerve intact

CN 7
smile, frown, and shut eyes tight – CN7 the facial nerve intact

CN 8
stand in front of me, cover one ear and i will whisper, cover other ear – CN8 the vestibulocochlear nerve intact

CN 9, 10
say AHHHH – I saw the soft palate and uvula rise simultaneously, CN9 the glossopharyngeal nerve intact
check gag reflex, slide tongue depressor until you cough – she coughed CN10 the vagus nerve intact

CN 11
shrug shoulders against resistance – I felt resistance CN11 the spinal accessory nerve intact

CN12
stick tongue out and move it side to side – CN12 the hypoglossal nerve intact

Question 3

Eyes & Ears

Answer 3

Hand hygiene

palpate lacrimal sacs w/ pinky – pain/tenderness? – none, EF

Inspect conjunctiva
look up/check both – palpebral conjunctiva are pink/moist/vascular, which is EF
look down/check both – bulbar conjunctiva are white/moist, which is EF

Check PERRLA – pupils are equal, round, and reactive to light – EF
follow pen w/ eyes (crossed eyed) – eyes accommodate – EF

Check red reflex – I see the bright red – red reflex present – EF

palpate auricle and tragus – pain/tenderness? – none, soft/cartilaginous – EF

use otoscope to check tympanic membranes - i see cone of light at L7/R5 and membrane is pearly gray – EF

Question 4

Lymph Nodes, Head, & Neck

Answer 4

cover one nostril and sniff, other nostril – equal airflow, nares patent, EF

palpate frontal and maxillary sinuses using thumbs – pain/tenderness? – none, EF

palpate carotid arteries one at a time – both are +2, EF

palpate lymph nodes – pain/tenderness?
preauricular
postauricular
occipital
posterior cervical (back of neck)
tonsillar (back jawline)
submandibular (mid jawline)
submental (chin)
superficial cervical (by trachea)
deep cervical chain (along V)
supraclavicular (above clavicles)

palpate thyroid/assess motion – soft, supple, no nodules present – swallow – thyroid moves w/ motion of neck – EF

auscultate carotid arteries and thyroid w/ bell – i hear the mvmt of airflow, no bruits – EF

assess for JVD – lay down – see outline of jugular vein and pulsing of carotid artery, No JVD – EF

Question 5

Heart & Lungs

Answer 5

Inspect symmetry of thoracic cage – no changes in chest configuration, appear symmetrical, no malformations – EF

inspect precordium (chest) – no pulsations – EF

palpate upper chest/shoulders for crepitus – no pockets of air = no crepitus – EF

assess for tactile fremitus – face wall – will feel the blades of my hand and as they run down back, say 99 – equal vibrations on both sides – EF

i will place hands on your back – take a deep breath in/out – my thumbs come apart equally = bilateral equal lung expansion – EF

percuss over each lung lobe (9 total) – heard resonance in all lung fields – EF
auscultate over each lung lobe (9 total) – clear/non diminished lung sounds – EF

auscultate/identify 5 pints for heart
- find sternal notch, go down to angle of louie (bump on sternum)
- either side 2nd intercostal space, right side (aortic valve)
- left side (pulmonic valve)
- directly under (erbs points)
- directly under (tricuspid valve)
- midclavicular line 5th intercostal space (point of maximum impulse or mitral valve)
no adventitious cardiac sound – EF