Midterm

Question 1

The four types of assessment techniques and proper order

Answer 1

inspection- look, smell, hear; examine size, shape, color, symmetry, position
palpation- use touch; examine size, consistency, texture (front of hand), temp (back of hand), location, tenderness
percussion
auscultation- listen to sounds with stethoscope or doppler

Question 2

skin assessment techniques

Answer 2

inspect for color, lesions, visible edema, erythema, varicosity (even pigmentation, and none of the things listed)
capillary refill (<3 seconds bilaterally)
check turgor/mobility pinch under clavicle or forearm (instant recoil, no tenting)
palpate skin w/back of hand to check temp on face, arms, and legs (warm bilaterally)
palpate skin w/palm of hand for moisture and texture on arms and legs (dry, smooth bilaterally)
palpate pretibial edema, depress 5 seconds
separate toes and note condition, capillary refill

Question 3

musculoskeletal normal findings

Answer 3

all joints bilaterally symmetrical, no gross deformities, skin intact, no visible lesions or redness bilaterally; no tenderness, masses, crepitus bilaterally with palpation, full range of motion (FROM) bilaterally; muscle strength 5/5 bilaterally

Question 4

musculoskeletal shoulder

Answer 4

cup w/hands

abduction (arms move laterally away from body and overhead),
adduction (arms move across midline to 50°),

Question 5

musculoskeletal hip

Answer 5

cup w/hands

lateral abduction (40-45°), 
medially adduction (30°)

Question 6

musculoskeletal ankle/foot/toes

Answer 6

plantar flexion (45°), 
dorsiflexion (20°),

Question 7

eye assessment exams

Answer 7

inspect extraocular muscle (EOM) function, shine light between eyes (corneal light reflex symmetrical, light will be in middle of both)
PERRLA inspect pupil constriction w/light (pupils equal, round, react to light, accommodation) (move pen towards face, and shine light in each eye from side)
inspect 6 cardinal positions of gaze (have them focus on pen, pupils move parallel in 6 cardinal fields of gaze)
cover eye, steady gaze
fundoscopic exam - red reflex

Question 8

assess trigeminal (CN 5)

Answer 8

face sensation, motor and strength of jaw
attempt to separate jaw by pushing down on chin w/cotton wisp test sensory on forehead, cheeks and chin, ask if they felt

Question 9

assess facial (CN 7)

Answer 9

face movement, expression
have pt smile, frown, close eyes tightly and resist attempts to open
lift eyebrows, show teeth, puff out cheeks (push on cheeks and note air escape)

Question 10

Lymph node normal result assessment; names of head and neck lymph nodes

Answer 10

not swollen, should not be able to palpate

Question 11

neuro assessment gait

Answer 11

pt walk across room and turn and walk back (steady, smooth w/appropriate arm swing)

Question 12

neuro deep tendon reflexes response for triceps, quadriceps, plantar/ Babinski reflex

Answer 12

triceps (with pointed side of reflex hammer)
quadriceps/patellar and plantar/Babinski bilaterally (flat side of reflex hammer)
plantar toes should curl (negative)

Question 13

lungs auscultation exam

Answer 13

listen posteriorly in 8-9 bilateral locations, including at least 2 lateral sites
listen anteriorly in 5-6 bilateral locations, including at least 2 lateral sites (begin above clavicle)

Question 14

lung sounds

Answer 14

bronchial sounds (neck, carotid), 
bronchial vestibular (middle chest), 
vestibular sounds (bottom, outside chest)

Question 15

proper use of stethoscope, bell vs diaphragm

Answer 15

diaphragm for high pitched, can push down and make a seal on skin
bell for low pitched and abnormal, don’t push down hard
ear pieces pointing towards nose

Question 16

cardiac anatomical (APET Mouse) with placement of stethoscope

Answer 16

Aortic- pt right of sternum 2nd intercostal space
Pulmonic- left of sternum 2nd ICS
Erb’s point- left of sternum 3rd ICS
Tricuspid- left of sternum 4th ICS
Mitral- left of sternum 5th ICS, lateral (inline w/nipple), point of maximum impulse

Question 17

abdominal assessment (review skills steps)

Answer 17

Inspect, Auscultate bowel sounds using diaphragm in 4 quadrants, Light palpation in all 4, depress about 1 cm, palpate bladder, no rebound tenderness (no pain when pressing)
start in RLQ and move around in the same direction each time, if don’t hear sounds within a few seconds listen for 5 min