Nr 509 Immersion Exam Questions & Correct Answers
- inspection of face/head - ANSWER-note the face is symmetrical without
discoloration or lesions. next I inspect the head noting it is midline and symmetrical.
- palpating lymph nodes for tenderness and enlargement. - ANSWER-begin with
pre articular, in front of the ears, move to postauricular, behind the ears. Then occipital, at the base of the posterior scalp, the tonsils lymph nodes, near the angle of the jaw. Then the submandibular and submental nodes. Next palpate the anterior cervical and posterior lymph nodes. And lastly the supraclavicular lymph nodes.Note that there is no swelling and they are equal bilat.
- Test cranial nerve #5 the trigeminal nerve. - ANSWER-Motor component. I will
palpate over the massiter muscle while she clenches her jaw. Note distortions and strength. Sensory- I will have her close her eyes and tell me where I am touching.(touch areas of face)
- Test CN #7 facial nerve - ANSWER-I will have her do some facial expressions.
raise eyebrows, smile, frown, puff out cheeks, pucker lips. Note symmetry and strength of these.
- Inspect EARS - ANSWER-Look for swelling, redness, nodules, symmetry.
inspect the auditory canal for redness, clear, no swelling, no drainage, no cerumen, Tympanic membrane pearly gray, no effusion.
- Palpate Ears - ANSWER-palp pinnas for nodules or tenderness. palp tragus
- Test CN #8 vestibulocochlear nerve - ANSWER-Perform whisper test. cover one
ear then the other. provider covers mouth. 1 / 2
- Inspect EYES - ANSWER-Look at lids, conjunctiva- pink, clear, no lesions, no
drainag; sclera- white
- Test CN #2 Optic Nerve which controls central, peripheral vision and pupil
response - ANSWER-Snellen eye chart- have pt cover one eye, read the lowest line, cover the other eye and read lowest line, read lowest line with both eyes "20/20 in right, left and both eyes." Test peripheral vision with hands at side of head. "peripheral vision is intact". Check pupillary response to light. "pupils are 2- 3mm are reactive and appropriate response to light"
10 Test CN #3 occulomotor, CN #4 Trochlear and CN #6 Abducens which control extraocular movement - ANSWER-"Follow my finger with just eyes# and move in "H" pattern. "All EOMs intact"
11 Nose exam inspect - ANSWER-symmetrical and no deformities. Use otoscope push nose to side and up. "Turbinates mucous membranes are pink and moist. No bogginess no drainage. not obstructed septum is straight"
12 palpate the sinuses - ANSWER-Frontal and maxillary for tenderness
13 inspect throat and mouth - ANSWER-"Lips are pink moist symmetrical, teeth no decay or cracks, gums and buccal mucosa are pink and healthy no lesions, hard and soft palates intact pink and moist, tongue pink moist and smooth, floor of mouth no nodules pink. Posterior pharynx is pink no postnasal drainage, grade tonsils."
14 Test CN #9 glossalpharyngeal, #10 vagus and #12 hypoglossal - ANSWER-#9 gag reflex is not tested. The CN #10 vague nerve tested by "open, say AAH, the uvula rises symmetrically with phonation". CN #12 hypoglossal stick tongue out and move side to side. CN is intact."
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