NBCE Part 4 Clinical & Set-Ups 2024 Study Guide

Case History - - Identifying Data (name, age, etc.) - Chief Complaint - Present Illness (OPPQRST) - Past History - (SHITM) - Family History - Occupational History - Social History - Review of Systems Vitals - - Temperature - Pulse - Respiration - Blood Pressure - Height - Weight Blood Pressure - How to do Blood Pressure: 1. Patient seated 2. Arm elevated (doctor braces patient's wrist) 3. Empty air from cuff, wrap tight on patient 4. Palpatory systolic (on the way up until disappears) 5. Place stethoscope in ears 6. Pump 30-40 higher 7. Auscultate to O (recording true systolic/diastolic values) Physical Exam - - Skin Exam XXX - Eye Exam - Nose Exam XXX - Ear Exam - Mouth & Throat Exam XXX - Endocrinology Exam XXX - Genital Exam XXX - Lymphatic Exam - Peripheral Exam - Lung Exam - Heart Exam - Abdominal Exam Eye Exam: CN III, IV, VI - Cardinal Field of Gaze Eye Exam: CN II & III - - Direct (ipsilateral eye) - Indirect ( contralateral eye) Eye Exam: CN II & III Accommodation reflex - Accommodation: Converge & Constrict Follow up questions to a + Eye Exam? - - headaches? - trouble reading? - last eye exam? - normally wear glasses/contacts? Ear Exam: Weber & Rhinne - - Preform WEBER first - Then preform Rhinne on the EAR that CAN HEAR - *Every case has been Meinier's disease* (ask: ringing?, deafness?, dizzyness?) Lymphatic Exam: palpation - palpate w/ 3 fingers - *Neck* (EENT questions) - Supraclavicular (ROS) - *Axillary* (breast, chest, and arms questions) 4 walls - Inguinal (legs/STDs) Peripheral Vascular Exam (PVE): upper extremity palpation - *3 of them/ Seated* - Unlar - Radial - Subclavian - Carotid - Temporal Peripheral Vascular Exam (PVE): lower extremity palpation - *Supine* - Femoral - Popliteal - Posterior Tibial - Dorsal Pedis Peripheral Vascular Exam (PVE): special tests - - Capillary Refill - Allen's Test - Claudication Test - Buerger's test - Homan's test Peripheral Vascular Exam (PVE): auscultation - *BELL* - @ carotid bifurcation (c4) - bruit -turbulance Heart Exam: palpate & auscultate valve sites - *A* - 2nd right intercostal space (parasternal) *P* - 2nd left intercostal space (parasternal) E - *NOT A VALVE* *T* - 4th/5th left intercostal space ( parasternal) *M* - 5th left intercostal space (midclavicular) *location of the apical pulse* Heart Exam: PERCUSSION (borders of the heart) - a) Left side (lateral to medial) 3, 4, & 5 intercostal spaces b) Right side (superior to inferior) right sternal border Abdominal Aorta Exam - Auscultate with bell Palpate lateral to medial Lung Exam: Posterior Thoracic Palpation - *SEATED* - Respiratory Excursions/expansion - *Tactile Fremitus* ("99"): Lung Exam: Posterior Thoracic Percussion - "Scan APEX (3 taps) *Sounds* - Flat: tumor/collapse - Dull: fluid - Resonant: normal - Hyperresonant: Air (COPD) *Diaphragmatic Expansion* Lung Exam: Posterior Thoracic Auscultation - - deep breath - whispered pectoriloquy ("1,2,3") - bronchophony ("99") - egophony ("E") Lung Exam: Anterior Thorax - - Fremitus ("99") - Percussion - Auscultation Abdominal Exam: auscultation - - Bowel sounds (diaphragm) indicates: borborygmi - Vessels (bell) aorta, renal & iliac; indicates: vessel turbulence Abdominal Exam: percussion - - 9 quadrants - organ size (liver & spleen)