Final Practicum

Question 1

General Survey

Answer 1

Introduction, wash hands, explain visit, acknowledge VS and visual acuity.
Pt appropriately exposed

Question 2

Psych

Answer 2

A and O to person, place, time, and event

Hygiene and affect appear appropriate

Question 3

Derm

Answer 3

Inspect: lesions, nevi, color
Palpate: verbalize turgor, temp, moisture
Hair: verbalize color, distribution, quantity
Nails: Pigmentation, clubbing, ridging, peeling, nail angle

Question 4

Head

Answer 4

Inspect: head, scalp, facies
Palpate: for areas of tenderness or masses

Question 5

Eyes: Inspect

Answer 5

Inspect: eyebrows and lids. conjunctiva and sclera for injection drainage or jaundice. Lacrimal apparatus for signs of redness or blockage. PERRLA + accom + converg. Corneal light reflection. EOMs. Visual fields by confrontation

Question 6

Eyes: palpate

Answer 6

Palpate: lacrimal glands and ducts for tenderness, inflammation
Orbits with eyes closed

Question 7

Fundoscopy

Answer 7

Evaluate anterior chamber for white cells, blood. Identify red reflex and optic disc.
Optic disc for sharpness, color, size.
Retinal vessels for AV nicking, copper wiring,
Locate fovea centralis
Comment on papilledema, hemorrhages, exudates

Question 8

Ears

Answer 8

Hearing acuity - finger rub. Verbalize webber/rinne
Inspect auricle, canal, mastoid, lesions, masses
Otoscopy for canal, TM - note landmarks
Palpate auricle and tragus for pain

Question 9

Nose/Sinuses

Answer 9

Inspect - external nose size, shape, color, deformity, patency. Internal mucous membrane, septum, turbinates, discharge
Palpate frontal/maxillary sinuses for tenderness

Question 10

Mouth/Throat

Answer 10

Inspect: lips, tongue, palate, mucosa, tonsils for: symmetry, edema, color, lesions.
Teeth for caries, loose/missing teeth, bite occlusion
Palpate: verbalize lips, tongue, gingiva, and base of mouth for tenderness/masses

Question 11

Neck

Answer 11

Inspect: swelling, deformity, tracheal deviation
Inquire: neck pain or tenderness
Palpate: pain or tenderness, trachea midline, thyroid

Question 12

Lymph nodes

Answer 12

Inspect: swelling, deformity
Palpate: for masses/tenderness: pre/post auricular, occipital, subtonsilar, submandibular, submental, ant/post chain, supra/infra clavicular
Verbalize axillary, epitrochlear, femoral, and popliteal

Question 13

Pulmonary

Answer 13

Inspect: respirations, use of accessory muscles, shape of chest, AP diameter, audible wheezing/stridor
BONUS: surgical scars, physical characteristics, PMI
Palpate: AP/lat compression, equal expansion
Percussion: all fields ant/post
Auscultate: w/ diaphragm all fields for R/R/W/C

Question 14

Cardio

Answer 14

Inspect: do with pulm inspection
Palpate: verbalize heaves/lifts/thrills and PMI
Auscultate: Name and listen A/P1/P2/T/M for murmurs. Carotids with bell for bruits. Verbalize LLD and supine
Pulses: Brachial, radial, femoral, popliteal, DP, PT. CAP REFILL

Question 15

ABD

Answer 15

Inspect: shape, symmetry, scars, color, contour
Auscultate: all quadrants for BS. Listen for bruits at abd aorta, renal, iliac, and femoral arteries.
Palpate: w/ flexed knees, light/deep in all quadrants. Palpate liver, spleen, kidneys. CVA tenderness
Percuss: all quadrants for masses. Liver/spleen for size. Nl is 6-12cm

Question 16

MSK

Answer 16

Inspect: full inspection for tone, atrophy, symmetry, spasm
ROM: CS, TS, LS, BUE, BLE
Palpation: For tenderness/spasm throughout
Strength testing: check for 5/5 throughout BUE/BLE in all planes

Question 17

Neuro

Answer 17

CNI-XII
Sensory testing: superficial light touch, verbalize sharp/dull
Cerebellar fxn: RAM, heel to shin, romberg, finger to nose
Reflexes: bicep, tricep, brachioradialis, patella, achilles, babinski, ankle clonus

Question 18

Extremities

Answer 18

C,C,E, skin changes, hair distribution

Palpate: warmth, tenderness, pitting