Comprehensive NR 509 Immersion
weekend study guide
Introduction - ANSWER Sarah, my name is Donna Preston, I will be doing your
examination today.
Head - ANSWER And I will begin with inspecting your face, and I see that I don't see
any discolorations or any lesions. Next, I will go and note her head, and I note that it is
midline and it is symmetrical.
Lymphnodes - ANSWER Next, I will proceed into palpating the lymph nodes, and I will
begin normally with the preauricular lymph nodes, right in front of the ear, and
postauricular, right behind the ear. Then I will palpate her occipital lymph nodes in the
back of the head. And then I'm gonna move forward and palpate the tonsillar lymph
nodes. Come under the jawline, the submandibular lymph nodes, and the submental.
Now I will go to the anterior cervical lymph nodes, and the posterior cervical lymph
nodes. And I will end with the supraclavicular lymph nodes right about the clavicles. I do
not feel any enlargement, and they are equal bilaterally.
Crainial Nerves - ANSWER Next, I will test the trigeminal nerve, which is cranial nerve
number five. It has a motor component, and I will palpate over the masseter muscle as
she clenches her jaw. And I don't feel any distortions, and she has great strength. Next,
I will test the sensory portion of the trigeminal nerve.
And I'll ask Sarah to close her eyes, and let me know where she feels my touch.
Forehead, right cheek, left cheek, chin, nose. Next, I will test her facial nerve, which is
cranial nerve number seven. And I'm gonna ask her to do some facial expressions. And
I'll ask for her to begin with a smile, and I know that is symmetrical.
Next, frown for me. OK. Now raise your eyebrows and go ahead and puff up your
cheeks, and you notice they're equal bilaterally. And now I want you to pucker your lips,
very tight pucker. So that looks good. Thank you, Sarah. [BLANK_AUDIO]
Ear - ANSWER Now, I'm gonna inspect Sarah's ears, and I'm looking for any nodules or
any skin lesions. Lets look at your other ear, Sarah, and they look nice. And now I'm
going to also note that they're symmetrical, and I'm now going to look inside her ear
canal with the otoscope. I'm gonna pull her ear up and back, and as I look in, I see that
the external auditory canal is clear, there's no swelling or redness or drainage or
cerumen.
The tympanic membrane is pearly gray, and there is no effusion in the middle ear. I will
do the same for her left ear, pull the ear up and back, looking into the external auditory
canal. I see there is no cerumen, there's no swelling or redness, there is no drainage.
Her tympanic membrane is pearly grey, and there's no fluid in the external auditory
canal. So you have very normal eardrums and ears. Now I'm going to palpate Sarah's
, Comprehensive NR 509 Immersion
weekend study guide
pinna, [BLANK_AUDIO] For any nodules or tenderness, any tenderness, Sarah? No.
And now her tragus, in front of the ear, any tenderness?
Acoustic Nerve - ANSWER No. Thank you, next I will be testing her acoustic nerve,
which is cranial nerve number eight, and that is her hearing. So I will be performing a
whisper test, so I'm gonna ask Sarah to cover one of her ears. And then I will stand
behind her, cover my mouth, and whisper three words.
One, two, three. And let's do the other side. Four, five, six. And her hearing is intact
bilaterally.
Eyes - ANSWER Now I'm going to assess Sarah's eyes, and first I'm gonna look at her
conjuctiva. I notice that they're pink and clear, no drainage or lesions.
And I'll also note that her sclera is white and clear. Now I'm going to test Sarah's cranial
nerve number two, the optic nerve, and this covers central vision. And I will use this
Snellen eye pocket chart. And I'll stand six feet away and ask Sarah to cover one eye.
And now read the lowest line possible. LTFPH. Repeat with the other eye. LTFPH. And
now with both eyes. LTFPH. And Sarah has normal vision, 20/20 in her left eye, right
eye, and with both eyes. And
Nose - ANSWER Now I'm gonna be checking Sarah's nose, and first I'm gonna inspect
her nose, and I do see that it is midline. I don't see any obstruction or any noticeable
fracture or swelling.
And now I will insert my speculum of the otoscope inside her nose. And I'm gonna tip
her nose up with the thumb. And I'll look inside her left turbinates, and I do see some
pink and moist turbinates in her septum midline. You wanna angle anteriorly, and I do
see that her septum is straight, there's no deviation.
Let me cover her right side, once again, looking at the septum anteriorly, or medially,
and I do see that she does have a straight septum, and her turbinates on the lateral
aspect are nice and pink, and healthy, there's no swelling or bogginess.
[BLANK_AUDIO] And now, we'll palpate Sarah's sinuses beginning with the frontal
sinuses.
Let me know if you feel any tenderness there, Sarah. No. And her maxillary sinuses,
any tenderness? No. Thank you.
mouth - ANSWER ting her lips, which are pink, and moist. And now, she will open her
mouth, and I am inspecting her teeth.
weekend study guide
Introduction - ANSWER Sarah, my name is Donna Preston, I will be doing your
examination today.
Head - ANSWER And I will begin with inspecting your face, and I see that I don't see
any discolorations or any lesions. Next, I will go and note her head, and I note that it is
midline and it is symmetrical.
Lymphnodes - ANSWER Next, I will proceed into palpating the lymph nodes, and I will
begin normally with the preauricular lymph nodes, right in front of the ear, and
postauricular, right behind the ear. Then I will palpate her occipital lymph nodes in the
back of the head. And then I'm gonna move forward and palpate the tonsillar lymph
nodes. Come under the jawline, the submandibular lymph nodes, and the submental.
Now I will go to the anterior cervical lymph nodes, and the posterior cervical lymph
nodes. And I will end with the supraclavicular lymph nodes right about the clavicles. I do
not feel any enlargement, and they are equal bilaterally.
Crainial Nerves - ANSWER Next, I will test the trigeminal nerve, which is cranial nerve
number five. It has a motor component, and I will palpate over the masseter muscle as
she clenches her jaw. And I don't feel any distortions, and she has great strength. Next,
I will test the sensory portion of the trigeminal nerve.
And I'll ask Sarah to close her eyes, and let me know where she feels my touch.
Forehead, right cheek, left cheek, chin, nose. Next, I will test her facial nerve, which is
cranial nerve number seven. And I'm gonna ask her to do some facial expressions. And
I'll ask for her to begin with a smile, and I know that is symmetrical.
Next, frown for me. OK. Now raise your eyebrows and go ahead and puff up your
cheeks, and you notice they're equal bilaterally. And now I want you to pucker your lips,
very tight pucker. So that looks good. Thank you, Sarah. [BLANK_AUDIO]
Ear - ANSWER Now, I'm gonna inspect Sarah's ears, and I'm looking for any nodules or
any skin lesions. Lets look at your other ear, Sarah, and they look nice. And now I'm
going to also note that they're symmetrical, and I'm now going to look inside her ear
canal with the otoscope. I'm gonna pull her ear up and back, and as I look in, I see that
the external auditory canal is clear, there's no swelling or redness or drainage or
cerumen.
The tympanic membrane is pearly gray, and there is no effusion in the middle ear. I will
do the same for her left ear, pull the ear up and back, looking into the external auditory
canal. I see there is no cerumen, there's no swelling or redness, there is no drainage.
Her tympanic membrane is pearly grey, and there's no fluid in the external auditory
canal. So you have very normal eardrums and ears. Now I'm going to palpate Sarah's
, Comprehensive NR 509 Immersion
weekend study guide
pinna, [BLANK_AUDIO] For any nodules or tenderness, any tenderness, Sarah? No.
And now her tragus, in front of the ear, any tenderness?
Acoustic Nerve - ANSWER No. Thank you, next I will be testing her acoustic nerve,
which is cranial nerve number eight, and that is her hearing. So I will be performing a
whisper test, so I'm gonna ask Sarah to cover one of her ears. And then I will stand
behind her, cover my mouth, and whisper three words.
One, two, three. And let's do the other side. Four, five, six. And her hearing is intact
bilaterally.
Eyes - ANSWER Now I'm going to assess Sarah's eyes, and first I'm gonna look at her
conjuctiva. I notice that they're pink and clear, no drainage or lesions.
And I'll also note that her sclera is white and clear. Now I'm going to test Sarah's cranial
nerve number two, the optic nerve, and this covers central vision. And I will use this
Snellen eye pocket chart. And I'll stand six feet away and ask Sarah to cover one eye.
And now read the lowest line possible. LTFPH. Repeat with the other eye. LTFPH. And
now with both eyes. LTFPH. And Sarah has normal vision, 20/20 in her left eye, right
eye, and with both eyes. And
Nose - ANSWER Now I'm gonna be checking Sarah's nose, and first I'm gonna inspect
her nose, and I do see that it is midline. I don't see any obstruction or any noticeable
fracture or swelling.
And now I will insert my speculum of the otoscope inside her nose. And I'm gonna tip
her nose up with the thumb. And I'll look inside her left turbinates, and I do see some
pink and moist turbinates in her septum midline. You wanna angle anteriorly, and I do
see that her septum is straight, there's no deviation.
Let me cover her right side, once again, looking at the septum anteriorly, or medially,
and I do see that she does have a straight septum, and her turbinates on the lateral
aspect are nice and pink, and healthy, there's no swelling or bogginess.
[BLANK_AUDIO] And now, we'll palpate Sarah's sinuses beginning with the frontal
sinuses.
Let me know if you feel any tenderness there, Sarah. No. And her maxillary sinuses,
any tenderness? No. Thank you.
mouth - ANSWER ting her lips, which are pink, and moist. And now, she will open her
mouth, and I am inspecting her teeth.
