8QCCEFinalExamReview

I.PrognosisGuidelines

Px
Description
TimeFrame
Excellent
anexpectationfortotalsymptomatic
24weeks
andfunctionalimprovementanda
completereturntopreconditionstatus

Good
symptomaticandfunctional
48weeks
improvementsareexpected,eventhough
theetiologyofthepresentationorthe
presenceofcomorbidconditionsor
complicatingfactorsisexpectedtoprolong
acompleterecovery

Fair
symptomaticandfunctional
812weeks
improvementsareexpectedbutfull
resolutionoftheclinicalpresentationis
inquestion

Poor
thepresentingconditionisunlikelyto

fullyresolvewithanytypeofcare,butalso
thattheconditionhasthepotentialto
worsenevenwithcare

Guarded
thepatientsconditionhasthepotential
todeterioratetoapointthatcouldrequire
urgentmedicalintervention

Unstable
reservedforthosepatientswhose

conditionisunresponsiveand,infact,
declinesafteratrialofcare

II.HeadandNeckInspection

1.Whatarewecheckingforwiththyroidinspection?
Goiter,Nodules,andMasses

2.Whatarewecheckingforwithtracheapalpation?
Midlineposition

3.Whatpartofthehandsdoweusetopalpatethelymphnodes?
Fleshyfingerpads

%Improved
100%

>70%

>50%


4.Whatarethecervicallymphnodes?
Submental
Suboccipital
Submandibular
AnteriorCervical
Tonsillar
PosteriorCervical
Preauricular
Supraclavicular
Postauricular

5.Whatarethe5stepsinthethyroidexam?
i.watchthefirstswallow
ii.laterallyflexandpalpatetheanteriorSCM
iii.sameontheC/Lside
iv.laterallyflexandpalpatetheposteriorSCM
v.sameonC/Lside

6.Whatistheinnervationforthemusclesoffascialexpression?
CNVII/FacialNerve

7.WhatarethetestsfortheFacialNerve?
Smile
Frown
Puckerthelips
Puffthecheeks
Platysma
Raisetheeyebrows
Furrowtheeyebrows
Squeezetheeyesshut

8.WhatisthescorefortheFacialmuscles?
x/5(MuscleGradingScale)

9.Howdowetestthemusclesofmastication?
Bitethetonguebladeandapplypressure.
Resistlateralshiftofthejaw.

10.Whatarethemusclesofmasticationtestedwithlateralshiftingofthejaw?
MedialandLateralPterygoids

11.Whatinnervatesthemusclesofmastication?
CNV(Trigeminal)

12.Whatisthenormalconsistencyofthethyroidgland?
Rubbery

13.Whataresomecausesfortrachealdeviation?
Goiter
Tumor
Pneumothorax
Atelectasis
Masses
ThyroglossalDuctCyst

14.Whatmusclesaretestedwithbitingatongueblade?
Masseters,Temporalis
15.Whatnerveistestedwithpainandlighttouchoftheface?
CNV(Trigeminal)

III.EyeInspection

1.Whatcranialnervesaretestedwithdirectandconsensuallightreflex?
CNII,III(Optic,Oculomotor)

2.WhichonecarriestheAfferentfibers?
CNII

3.WhichonecarriestheEfferentfibers?
EdingerWestphalNucleusprojectsparasympatheticfibers,withCNIII,to
thepupilconstrictors

4.HowfardoyouholdthepenlightfortheCardinalFieldsofGaze?
1218away

5.WhatnervesareinvolvedwiththeCardinalFieldsofGaze?
CNIII,IV,VI(Oculomotor,Trochlear,Abducens)

6.WhatarewecheckingforwithCardinalFieldsofGaze?
Nystagmus

7.WhatarewelookingfortheeyestodowhentestingAccommodation?
Convergence&Constriction

8.Whatisthescientifictermforpupilconstriction?
Miosis

9.WhatpartoftheeyecontrolsAccommodation?
TheLens

10.WhatarethenormalanglesforCentralandPeripheralFieldexams?
Superior:
50
Inferior:
70
Nasal:
60
Temporal:
90

11.WhatnerveistestedwithCentral&PeripheralFields?
CNII(Optic)

12.Whatisindicatedifthepatienthasablindspotarea?

Scotoma

13.AtwhatangledoweapproachthepatientwithOpthalmoscopy?
15Temporal

14.Whatisindicatedwithabsenceoftheredreflex?
CataractorDetachedRetina

15.HowdowechecktheMacula?
Havethepatientlookatthelight

16.Whatelsearewecheckingfor?
Papilledema,AbnormalCuptoDiscRatio,AVNicking,CottonWoolPatches,
Neovascularization,etc.

IV.EarExam

1.Whatcranialstructuredowepalpatealongwiththeear?
MastoidProcess

2.Whatarewecheckingforwithearpalpation?
Tenderness,Nodules

3.HowfardowestandwiththeGrossHearingExam?
2feet

4.WhatnervearewetestingwithGrossHearing?
CNVIII(Vestibulocochlear)

5.WhatisthepurposeoftheGrossHearingTest?
Toestablishtheproblemside.

6.WhattuningforkdoweuseinWebers&Rinnestests?
512Hz

7.Whattypeofhearinglosswillresultinhearingthetuningforkbetteronthe
problemside?
Conductive

8.Whattypeofhearinglosswillresultinhearingthetuningforkbetteronthe
normalside?
Sensorineural

9.WhatisapositiveonRinnestest?

NormalAir:Bone=2:1

10.Whatcausesa<2:1onRinnes?
ConductiveHearingLoss
11.Whatcancause2:1onbothsides,butanoveralldecreaseononeside?
SensorineuralHearingLoss

12.Inwhatdirectiondowepulltheearforanadultvs.achild?
AdultSuperolaterally
ChildLaterally

13.Whereshouldtheconeoflightbe?
AnteriorInferiorQuadrantoftheTympanicMembrane

14.WhatcolorshouldtheTympanicMembranebe?
Pearlygray

15.WhatelsearewecheckingforwithOtoscopy?
ExcessCerumen,Tympanosclerosis,PerforationorBulgingoftheTympanic
Membrane

V.Nose/Sinus/MouthInspection

1.WhatarewecheckingforwithRhinoscopy?
Lesions,Exudates,SeptalDefects,Epistaxis

2.WhatnervedowetestwiththeSmellTest?
CNI(Olfactory)

3.WhatisindicatedwithB/Llossofsmell?
Chemicalexposure,Druguse(Cocaine),Infection,Congenitaldefect

4.WhatisindicatedwithU/Llossofsmell?
FrontalLobeLesion(rare)

5.Whatisindicatedwitharedandswollencolorinsidethenose?
Rhinitis

6.Whatisindicatedwithapaleorbluishnose?
AllergicRhinitis

7.Whatsinusesdowetest?
Frontal&Maxillary

8.Ifthesinusesaretenderuponpalpation,whatisindicated?

Sinusinfectionorinflammation

9.Whatisindicatedwithasmoothtongue?
VitaminorMineralDeficiency

10.Whatisthetermfortheinspectionoftheuvula?
Virnetrideau

11.Anormaluvulawillmoveinwhatdirection?
Superiorly

12.WhatcranialnerveistestedwithVirnetrideau?
CNX(Vagus)

13.ACNXlesionwillresultinwhichdeviationoftheuvula?
Awayfromthesideofthelesion

14.WheredowetesttheGagReflex?
PosteriorPharyngealArches

15.Whatcranialnervesarewetesting?
CNIX,X(Glossopharyngeal,Vagus)

16.WhichnervecarriestheAfferentfibersfortheGagReflex?
CNIX

17.WhichnervecarriestheEfferentfibersfortheGagReflex?
CNX

18.WhatarewecheckingforwithTongueProtrusion?
DeviationandAtrophy

19.Whatnervearewetesting?
CNXII(Hypoglossal)

VI.LungExam

1.Whatarewecheckingforinthefaceandhands?
Cyanosis,ClubbedFingers,DistressedBreathing

2.Whatpulsesdowecheck?
Radial,Brachial,Carotid

3.Whatarewecheckingforbilaterally?
PulseAmplitude


4.Whatistheorderofalunginspection?
Inspection
Percussion
Excursion
Auscultation
Fremitus

5.WhatarewecheckingforwithInspection?
Asymmetry,AccessoryBreathing,Trauma,ChestWallDeformities

6.HowfarapartdoyouputyourthumbsatthebeginningofExcursion?
24

7.WhatareyoucheckingforwithExcursion?
Asymmetry

8.Whatisthetermfortheareafromtheupperborderoftheclavicletothe1st
intercostalspaceintheback?
KronigsIsthmus

9.WhatisindicatedwithincreasedvibrationononesidewithFremitus?
Moresolidlung:Consolidation,LobarPneumonia,LungTumor

10.WhatisindicatedwithdecreasedvibrationononesidewithFremitus?
Decreasedairflow:ObstructedBronchus,Atelectasis
Moreairinthelung:Emphysema,Pneumothorax
Thickenedwall:PleuralEffusion

11.Whatisthetermforthe3rdDIPJointthatyouuseforpercussion?
Pleximeter

12.Whatisthetermforthe3rdtipofthefingerusedtotaponthePleximeter?
Plexor

13.Whatisthetermfornormalpercussionnotes?
Resonance

14.WhatcancauseHyperresonance?
Emphysema

15.WhatcancauseTympany?
LargePneumothorax

16.WhatcancauseaDullsound?
TumororConsolidation

17.WhatcancauseaFlatsound?
PleuralEffusion

18.WhatarewecheckingforwithAuscultation?
Crackles,Wheezes,&Stridor(gratingnoise)

19.WhatarethenormalsoundswithAuscultation?
Vesicularmostofthelungfield&periphery
Bronchovesicular1st&2ndICS,betweentheScapulae
BronchialManubrium
TrachealTrachea

20.Whatisindicatedwithabsenceofthesesounds?
Decreasedorabsentairflow

21.Whatisindicatedwithanormalsoundinanabnormalarea?
Pathology

VII.HeartInspection

1.Whatarewecheckingforwithinspectionoftheprecordium?
ChestWallDeformities,Trauma,Pulsations

2.WhereisthePointofMaximalImpact(PMI)?
5thICS,Midclavicularline

3.Whatpartofthefingersdoweusetopalpate?
FingerpadsorMCPjoints

4.Whatareasdowepalpateandwherearethey?
Aortic
Right2ndICS,Parasternal
Pulmonic
Left2ndICS,Parasternal
ErbsPoint Left3rdICS,Parasternal
EctopicPoint Left3rdICS,Midclavicular
Tricuspid
Left5thICS,Parasternal
Mitral
Left5thICS,Midclavicular
Epigastric
BelowtheXyphoid

5.WhatcancauseaThrillwithPalpation?
AorticorMitralStenosis,VentricularSeptalDefect

6.WhataccompaniesthrillsonAuscultation?
Murmurs

7.WhatcancauseaHeavewithPalpation?

Hypertrophy

8.WhatcancauseaPulsationwithPalpation?
Cardiacenlargement,displacement,oraneurysm

9.WhatdoweneedtorecordwithPalpation?
Amplitude,Duration,&Location
10.WhatareasdoweAuscultate?
A/P/E/M/T

11.Howlongdoweneedtolistenfor?
35seconds

12.Whatsoundsdowehearwiththebell?
Lowpitch

13.Whatsoundsdowehearwiththediaphragm?
Highpitch

14.Whatnormalsoundsdowelistenfor?
S1,S2,SilentintervalsbetweenSystoleandDiastole,HeartRateandRhythm

15.WhatvalvemovesagainstthechestwallintheLeftLateralDecubitusposition,
makingiteasiertoauscultate?
Mitral

VIII.AbdominalEvaluation

1.Whatistheorderofinspection?
Inspection
Auscultation
UmbilicalReflex
Percussion
Palpation

2.Whydoweusethisorder?
Leasttomostinvasive,whichaltersbowelfunction

3.Inwhatpositiondoweperformtheabdominalevaluation?
Supinewithkneesbent

4.Whatisindicatedwithpurplestriae?
CushingsSyndrome

5.Whatisindicatedwithasmallbulgeoftheumbilicusormidline?
Hernia

6.Whatisindicatedwithbulgingflanks?
Ascites

7.Whatisindicatedwithpulsations?
AbdominalAorticAneurysm

8.Whatareyoulisteningforintheabdominalquadrants,withthediaphragm?
Bowelsounds

9.Whatvesselsdowelistento,withthebell?
RenalArteries,AbdominalAorta,IliacArteries,FemoralArteries

10.Whatcancauseincreasedbowelsounds?
Diarrhea,earlyIntestinalObstruction

11.Whatcancauseabsentbowelsounds?
ParalyticIleusorlateIntestinalObstruction

12.WhatisindicatedwithBruits?
AbdominalAortaorIliacArteryAneurysmorStenosis
RenalArteryStenosis

13.WhatisindicatedwithaFrictionRub?
InflammationorInfectionoftheSpleenorLiver

14.WhatisindicatedwithaVenousHum?
LiverDisease

15.WhatorgandoyoupercussfromtheLeft2ndICS,Midclavicular,fromSI?
Stomach(Meganblase)

16.WhatorgandoyoupercussfromtheRightICS,Midclavicular,fromSI?
Liver

17.WhatorgandoyoupercussanteriortotheLeftMidaxillaryline,atanoblique
angle,fromLM?
Spleen

18.Whatisanormalabdominalpercussionsound?
Tympanic

19.Whatisanormalorganpercussionsound?

Dull

20.Whatisindicatedwithnormaldullingofthepercussionnotes?
Fecalmaterial,Fullbladder,PregnantUterus

21.Whatisindicatedwithabnormaldulling?
Tumor,Ascites,Hepatomegaly,Splenomegaly

22.WhathandpositiondoyouuseforGeneralPalpation?
Flatfleshyfingerswithoverlappinghands,movinginacircularmotion
23.WhathandpositiondoyouuseforLiverPalpation?
Knifeedge

24.WhathandpositiondoyouuseforSpleenPalpation?
Fingertips

25.WhathandpositiondoyouuseforKidneyPalpation?
Flatopenhands

26.WhatbreathinginstructionsdoyougivethepatientforKidneyCapture?
Exhalation

27.WhatarewecheckingforwithPalpation?
MassesandOrganomegaly

28.HowlowisanormalLiverpalpable?
4cmbelowtheribborder

29.InwhatdirectionwilltheSpleenenlarge?
Inferior&Medial,towardstheoppositeASIS

30.Whatpulsesdowepalpate?
Dorsalispedis,Popliteal,Femoral

31.Whatlymphnodesdowepalpatefor?
Inguinal

IX.LowerMotorNerveTest(*seeNeurologicalHandout)

X.Reflexes(*seeNeurologicalHandout)

1.HowdoyouperformtheMedialHamstring(L5/S1)DTR?
Hookandpullthehamstring,thentapyourfingers.

XI.UpperMotorNerveTest(*seeNeurologicalHandoutforUE)


1.WhatCervicalMotorNervetestsdoweperformandwhataretheirassociated
nerveroots?
Flexion:C16
Extension:C1T1
Lat.Flexion:C14,CNXI(SpinalAccessory)
Rotation:C18,CNXI(SpinalAccessory)

XII.Sensory(*seeNeurologicalHandoutforDermatomes)

1.ReviewLightTouch&Vibration