,NBCE Part 4 Clinical & Set-Ups
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
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
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
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
