Practicum

• Introduce self
• Ask name, age, marital status, current meds, allergies, tobacco, alcohol, drug use

• ask reason for exam
• wash hands

History: changes in skin, dryness, sores, or rashes

• Inspect & Palpate- color & temp
• Turgor- for hydration
• cap refill

History- headaches, dizziness, head trauma

Gloves- Examine hair, scalp: inspect and palpate for lesions, masses, lice

• Test CNVII- Facial- ask to make faces
• Test CNV- Trigeminal- cotton wisp on face, clench jaw to feel mastoid

History: any dizziness, seizures, stroke, pain

• cerebral:
• place, time, full name, first car
• mental reasoning ( meaning of finding a needle in a haystack)

• cerebellar:
• coor. of fine motorskills (fingers to thumb)
• balance (stand one foot, then the other)
• CN VIII- vestibulocochlear- romberg test (pt stands, eyes open, then eyes closed, note swaying)

sensory perception: dull & sharp of hammer

• Test deep tendon reflexes (bilaterally)
• -biceps, triceps, supinator, petallar, achilles, plantar

Grade outloud 1+ - 4+

History: nasal discharge, sinus pain, allergies

• Inspect & Palpate external nose
• Palpate frontal and maxillary sinuses
• Internal exam (penlight): not color of mucosa, check patency of nares

Test CNI- olfactory- sniff test (have pt id smell one nostril closed)

History: blurred vision, corrective lenses, surgeries

Test CNII-Optic (snellen eye chart)

Inspect conjunctiva (clear) & sclera (white) palpate lacrimal puncta (gloves)

Test Visual field CNII (cover same eye move finger into view)

Test CN III,IV,VI (6 cardinal fields of gaze) draw star

Test CN III (shine light in one eye, dilation in other)

Test CN III (acomodation) bring finger to nose

Observe for coordination (shine light btwn eyes, look for equal light reflection)

Red reflex (use fundoscope, red reflex & optic nerve visible)

History: any vertigo, hearing loss, ear pain

Inspect & palpate external hear (tenderness when moved up and out)

• Inspect canal (using otoscope)
• otoscopic exam of T.M.

Test CNVIII (Weber) tuning fork forehead

Test CNVIII (Rinne) tuning fork, mastoid to in front of ear (AC 2x BC *say)

Romberg: pt standing closes eyes (note swaying)

History: Any lesions, sore throat, difficulty swallowing, wisdom teeth

Inspect oral mucosa, tonsils, palate, pharynx, roof, sides and under tongue

inspect parotid & sublingual meatus (tongue blade; look under tongue & back of throat)

count teeth & observe condition (32)

• CN IX, X- mvmt of uvula (ahhh)
• CN VII, IX- discriminate test (salt, rinse, sugar)
• CN IX, X, XII- tests swallowing (water)
• CN XII- tongue strength, push against cheek

History: any stiffness, loss of ROM, pain, thyroid problems

ROM, test m. strength (turn head, resistance)

Test CN XI- shoulder shrug w/ resistance

Palpate lymph nodes *say (Submental, submaxillary, tonsillar, preauricular, posteriorauricular, occipital, superficial cervical, posterior cervical, deep cervical, supraclavicular, infraclavicular)

Palpate carotid pulse (one at a time)

Palpate Trachea, thyroid (drink water) *say "no bruits"

Social History: asthma, smoke, SOB, chest pain?

Family History: TB, Bronchitis, lung cancer?

Observe respiratory rate and effort

APL diameter (AP<L) (2:1)

Observe symmetrical expansion (hands on back)

Palpation: A, P & L chest surfaces (pulsations, bulges)

A, P & L tactile fermitus (symmetrical when pt. says "99")

Percussion: anterior, posterior and lateral lung fields

Auscultation: anterior, posterior and lateral lung

History: Arthritis, sore joints, skeletal deformities, surgery?

Observe gait when walking in

Inspection: upper & lower extremities (symmetry, tone)

Palpate- upper & lower extremities (tone, lumps, bumps) lymph nodes (central axillary, brachial axillary, subscapular, epitrochlear)

• Joint ROM and m. strength w/ resistance (arms over head, behind head, out to side)
• fingers, wrists, elbows, shoulders
• hips, knees, ankles
• adduction, abduction, leg forward, leg backward, knee to chest

Homan's sign- dorsiflex foot

Social History: chest pain, SOB, heartburn

Family History: diabetes, heart disease, hypertension

• Inspect precordium (pulsations)
• Palpate for thrills and PMI (5th ICS)

• Ausculatation (bell & diaphram) *say
• Aortic: 2nd ICS RSB S2>S1
• Pulmonic: 2nd ICS LSB S2>S1
• Erb's: 3rd ICS LSB S2=S1
• Tricuspid: 5th ICS LSB S2<S1
• Mitral: 5th ICS LMCL S2<S1

*say i would then listen again in sitting position

Count apical HR (1 min)

Palpate pulses: brachial, radial, dorsalis pedis, posterior tibialis, show femoral

History: nausea, vomitting, changes in BM, last BM?

Inspection: contour, skin, pulsations

Auscultation: Bowel sounds and abdominal aorta (bell 2 in above umbilicus)

Percussion: 4 quad (mostly tympany)

Palpation: light and deep, liver (RUQ) spleen (LUQ non palpable) kidneys

CVA tenderness