Importance of verbalization during the assessment process.
Reinforcement of checklist format (Yes/No).
Initial Steps
Introduction of the Student: Inquiry if they want the vitals verbalized or performed.
If yes, proceed with vitals only after confirming the patient's preferences.
Washing Hands: Critical first step.
Vital Signs Assessment
Blood Pressure: Measure in both sitting and standing positions if requested by the patient.
State: "I will do blood pressure in sitting and standing positions. Do you want both?"
Respiration Rate: Count for 15 seconds, multiply by 4.
Pulse: Measure and verbalize findings while conducting.
Temperature: Insert thermometer in the mouth for ten seconds; verbalize process.
Skin Examination
Skin Turgor: Pull skin to assess elasticity.
Texture and Moisture: Use the palm for both to check skin integrity.
Superficial Masses: Also assess with the palm.
Temperature of Skin: Mention using dorsum of the hand if required.
Nail Assessment
Nail Bed Inspection: Observe for shape, signs of clubbing, pitting, and capillary refill.
Clarification on technique: Do not cover the nail while pushing on the pad for capillary refill.
Hair Inspection
Characteristics: Observe quantity, distribution, and palpate for texture, especially for patients wearing hijabs.
Head and Face Examination
Inspection of the Head and Face: Check for symmetry; palpate scalp and facial bones for tenderness.
Cranial Nerve Assessments:
Cranial Nerve VII (Facial Nerve): Ask patient to raise eyebrows, frown, smile, puff cheeks.
Cranial Nerve V (Trigeminal Nerve): Test sensation across V1, V2, V3 regions.
Assess with motor tests: Ask patient to clench teeth to feel the masseter muscle.
Eye Inspection
Upper and Lower Eyelids: Inspect both eyelids, lacrimal duct, sclera, and conjunctiva.
Visual Acuity: Use a pocket screening test at 14 inches; have patient cover one eye, reassure about glasses.
Clarify: "I would normally do both eyes; do you want me to continue?"
Cranial Nerves II, III, IV, VI: Evaluate extraocular muscle movements using specified motions.
Remember: "LR 6, SO 4, A 3", referencing the muscles involved.
Accommodation and Pupils
Pupil Accommodation: Monitor constriction to convergence.
Peripheral Field by Confrontation: Conduct either by covering eyes or bow ties with a finger approach.
Ear Examination
Otoscopic Exam: Inspect the tympanic membrane; description should include color: "tympanic membrane pearly gray with light reflex."
External Ear: Inspect and palpate for abnormalities. Pull the ear up for accurate otoscopic inspection.
Nose Examination
Inspection: Look for polyps, palpate for tenderness on the sinuses, check nasal passage patency and smell.
Mouth Examination
Inspection of Oral Cavity: Assess lip, teeth, gums, tongue, and soft/hard palates.
Visual Aid: Use a flashlight and tongue depressor.
Neck Assessment
Inspection: Check for symmetry, swelling, and assess range of motion (flexion, extension, lateral bending).
Palpation of Nodes: Describe palpation method for different nodes.
Function: Detail the importance of palpating the trachea and thyroid, noting the need for the patient to swallow during thyroid assessment.
Chest Assessment
Inspection: Evaluate for movement, discoloration, and symmetry.
Palpation: Check fremitus (have patient say '99').
Percussion: Auscultate for lung sounds in various regions (apex, lateral, posterior).
Cardiac Assessment
Inspection: Neck veins for distention, precordium for abnormalities.
Palpation: For thrills, apical impulse at the fifth intercostal space midclavicular line.
Auscultation: Use diaphragm for high-pitched sounds, bell for low-pitched sounds in proper locations.
Abdominal Examination
Inspection: Observe for discoloration, masses—clarify focus areas like liver span and gallbladder assessment.
Auscultation and Percussion: Renal arteries, iliac arteries, and abdominal sounds using the appropriate techniques.
Special Test: Shifting dullness and fluid wave tests explained, with an emphasis on modern diagnostic reliance.
Musculoskeletal and Neurological Assessment
Basic Movements: Observe symmetry of the spine, check range of motion in joints.
Special Tests: Include details of the Near test, Hawkins test, and documented signs for stability and movement.
Conclusion
General Advice: Encourage practice of verbalization to increase confidence and fluency in physical examinations. Emphasize close attention to detail and proper techniques to ensure accuracy in assessment operations.