NBCE Part 4 Clinical & Set-Ups

NBCE Part 4 Clinical & Set-Ups
Case History - ANS - Identifying Data (name, age, etc.)

- Chief Complaint

- Present Illness (OPPQRST)

- Past History

- (SHITM)

- Family History

- Occupational History

- Social History

- Review of Systems



Vitals - ANS - Temperature

- Pulse

- Respiration

- Blood Pressure

- Height

- Weight



Blood Pressure - ANS 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 - ANS - 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 - ANS Cardinal Field of Gaze



Eye Exam: CN II & III - ANS - Direct (ipsilateral eye)

- Indirect ( contralateral eye)



Eye Exam: CN II & III Accommodation reflex - ANS Accommodation: Converge & Constrict



Follow up questions to a + Eye Exam? - ANS - headaches?

- trouble reading?

,- last eye exam?

- normally wear glasses/contacts?



Ear Exam: Weber & Rhinne - ANS - 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 - ANS 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 - ANS *3 of them/ Seated*

- Unlar

- Radial

- Subclavian

- Carotid

- Temporal



Peripheral Vascular Exam (PVE): lower extremity palpation - ANS *Supine*

- Femoral

- Popliteal

- Posterior Tibial

, - Dorsal Pedis



Peripheral Vascular Exam (PVE): special tests - ANS - Capillary Refill

- Allen's Test

- Claudication Test

- Buerger's test

- Homan's test



Peripheral Vascular Exam (PVE): auscultation - ANS *BELL*

- @ carotid bifurcation (c4)

- bruit

-turbulance



Heart Exam: palpate & auscultate valve sites - ANS *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) - ANS a) Left side (lateral to medial) 3, 4, & 5 intercostal
spaces

b) Right side (superior to inferior) right sternal border



Abdominal Aorta Exam - ANS Auscultate with bell



Palpate lateral to medial