UPAP Tutorial: IPE

Cranial Nerves

*II Visual Acuity *III EOM *IV EOM V V1, V2, V3 sensation, Clinch masseter *VI EOM VII Squint eyes shut, raise eyebrows, smile, puff cheeks *VIII Rub Fingers *IX Say "AH", Gag reflex X Say "AH", Gag reflex XI Shrug shoulders XII Stick tongue out

Abdominal Auscultation

Auscultate prior to palpation Bowel sounds Abdominal aorta Renal artery L/R Iliac artery L/R Femoral artery L/R

Nodes

Axillary Supraclavicular Anterior Cervical Pre Auricular Post Auricular Submandibular Submental Posterior Cervical Occipital

Cardiac Auscultation

Bell & Diaphragm Aortic Pulmonic Tricuspid Bicuspid Left Lateral Decubitus (Bell)

Reflexes

Biceps Brachioradialis Triceps Patellar Achilles Plantar

UE Strength

C-5 Resist T C-6 Forearm Push C-7 Forearm Pull C-8 Spread Fingers T-1 OK sign

Percussion CVA/Lungs

CVA for tenderness 5xPosterior 4xAnterior 2xLateral sides Percuss Left to Right

Neck ROM

Chin to Chest Chin to Ceiling L/R 90* L/R Ear to Shoulder

Funduscopic

Darken room Ask patient to focus distantly Move as a unit Right hand, Right eye Left hand, Left eye Verbalize following vessels medially to optic disc, disc appears to have clear edges and is symmetric

Auscultates Lungs

Deep open mouth breaths 5xPosterior 4xAnterior 2xLateral Sides Auscultate Left to Right

Lower Extremity

Draped appropriately Inspect skin Inspect muscle Inspect joints Palpate skin/muscle/joint Palpate pre-tibial area Palpate dorsalis pedis Palpate posterior tibial

Abdominal Palpation

Femoral pulse Inguinal nodes Light and deep 4 quadrants

Back

Flexion Extension L/R lateral Palpate spinous processes

Ears

Inspect auricle Assess acuity (Rub fingers) Inspect Canal (Negative for erythema, pearly gray membrane, cone of light)

Eyes

Inspect conjunctiva/sclera Assess pupil symmetry Assess R/L direct Assess R/L consensual Assess near reaction Assess corneal light reflex Assess EOM (CN III, IV, VI)

Thorax/Back

Inspect thorax Observe symmetric expansion Inspect back

Head

Inspection Palpation

Pharynx

Inspects with light source Lips and tongue Dentition and gingiva Mucous membranes Uvula Hard/soft palate Pharynx and tonsils Push tongue against cheek

Lower Extremity ROM

Knee flexion and extension Hip internal and external rotation

Abdominal Observation

Knees bent (pillow) Draped Appropriately Inspect for scars and lesions

Extremity Dermatomes

Lateral elbow C5 Thumb C6 Middle Finger C7 Pinki C8 Medial elbow T1 Medial lower thigh L2-3 Medial calf L4 Lateral calf L5 Lateral foot S1

Genital/Pelvic/Rectal/Breast Exam

Mention

Introduction

Name, PA Student Wash Hands

Upper Extremity

Palms Nails Joints Muscles Skin

Spleen

Palpate Deep breath

Liver

Palpate liver edge Deep breath Percuss span in MCL

Thyroid

Palpation Visualization Swallow

General Appearance

Pleasant, Well-developed, Well-Nourished, Alert

Nose

Plug R/L nostril breath in Light exam (mucous membranes pink and moist)

Cardiac Palpation

Positon table to supine Palpate PMI at MCL

Precordium

Postion table to 30* Inspect precordium Palpate precordium (ulnar surface of hand) Observe for JVD

Skin

Rashes Abrasions Lesions

Gait

Romberg Pronator drift Standing/Normal gait Knee extension Heel gait (Anterior tibialis) Toe gait (Gastrocnemius) Great toe extension Tandem Gait

UE ROM

Shoulder flexion/extension Elbow flexion/extension Wrist flexion/extension

Vital Signs

Temperature RR HR BP Visual Acuity Within Normal Limits