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
