Med Screening Final Practical

Front 1

what are the possible systems?

Back 1

Neuro
GI
Integument
Cardiovascular
Pulmonary

Front 2

give 4 ROS questions for Neuro

Back 2

H/A
changes in bowel or bladder function
changes in balance/walking - dizzy
dizzyness

Front 3

give 4 ROS questions for GI

Back 3

Do you have any problems with food intolerance
Have you had any changes in your appetite
Problems with nausea or vomiting
Any changes in your bowel habits

Front 4

give 4 ROS questions for Integument

Back 4

unusual hair loss or breakage
changes in nail bed
itching
recent skin changes

Front 5

give 4 ROS questions for Cardiovascular

Back 5

do you feel tired
angina
smoke
HTN

Front 6

give 4 ROS questions for Pulmonary

Back 6

smoke
cough
wheezing
breathing

Front 7

Neuro Exam (11)

Back 7

1. NAME?
2. LOCATION?
3. DAY/DATE?
4. SITUATION?

A. Show 2 fingers
B. wiggle toes

5. How many fingers am I holding up?
6. Pupillary exam (light)
7. extra ocular movements (H-Test)
8. Smile
9. Stick out tongue
10. Pronator Drift (palms up)
11. MMTs (UE and LE)

Front 8

GI Exam (10)

Back 8

1. Inspect - tangential lighting

2. Auscultate - all 4 quadrants (use diaphragm) for bowel sounds

3. Percuss - all 4 quadrants for density

4. Percuss for liver span

5. Palpate - light and deep, all four quadrants

6. Palpate liver

7. palpate femoral pulse and aorta

8. palpate lymph nodes

9. abdominal reflex

10. Special Exam: rebound tenderness OR iliopsoas mm test

Front 9

Integument Exam

Back 9

1. Inspection - use tangential lighting

2. Palpation of neck (areas of tenderness, deformity, masses)

3. Palpate: preauricular lymph nodes

4. palpate: postauricular lymph nodes

5. palpate: occipital lymph nodes

6. palpate: tonsillar lymph nodes (at angle of jaw)

7. palpate: submandibular lymph nodes (under jaw on side)

8. palpate: submental lymph nodes (under jaw at midline)

9. palpate: superficial anterior cervical lymph nodes (over and in front of the SCM mm)

10. palpate: supraclavicular lymph nodes (angle of SCM and clavicle

11. palpate: deep cervical chain of lymph nodes (tell pt it causes discomfort, hook fingers under ant edge of SCM. pt bends neck toward side being examined. move mm backwards and palpate for deep nodes underneath.

12. Special tests:
A. skin turgor
B. cap refill and dependent rubor

Front 10

Cardiovascular

Back 10

1. inspection: use tangential lighting (carotids, thyroid)

2. palpation: PMI (with pt in L sie laying, 7-9 cm lateral to L sternal border, 5th ICS

3. palpation: Thrills in all four areas

4. palpate and auscultate: carotid arteries (deep breath in, hold, exhale, switch to other side, take deep breath and hold)

5. auscultate: all four areas using diaphragm

6. auscultate: in forward lean and L sidelay for aortic murmur (4th ICS), and mitral murmur

SUPINE
7. inspect venous pattern, color, hair, varicosities, edema

8. palpate: for warmth, tenderness

9. palpate: edema (5 seconds hold)

10. palpate pulses (brachial, radial, ulnar, popliteal, dorsalis pedis, post tib)

Front 11

Pulmonary

Back 11

1. Inspection: AP diameter, asymmetry, rib angles, breathing quality, position of the scapula

2. palpation: chest expansion

3. palpation: tactile fremitus

4. percussion: tissue density

5. percussion: diaphragmatic excursion

6. auscultation: quality of breath sounds, adventitious breath sounds

7. auscultation: voice sounds: bronchophony, egophony, OR whispered pectoriloquy