CLINICAL SKILLS FINAL EXAM STUDY
GUIDE QUESTIONS WITH COMPLETE
SOLUTIONS
What is dystonia? - Answer-Sustained muscle contraction causes twisting and
repetitive movements or abnormal posture.
What is pronator drift? - Answer-Pt. holds both arms out in front of them w/palms up
and holds the position. If they cannot = Positive test result for upper motor neuron
weakness.
NOTE: In upper motor neuron weakness, supination is weaker than pronation in the
upper extremity, leading to a pronation of the affected arm.
What is ataxia? - Answer-State of being unsteady, uncoordinated
What is fasciculation? - Answer-muscle twitch
What is a tremor? - Answer-Somewhat rhythmic, muscle contraction, and relaxation.
How are reflexes graded? - Answer-Scale of 0-4:
0 = Absent
1+ = Hypoactive
2+ = "Normal"
3+ = Hyperactive w/o clonus
4+ = Hyperactive w/clonus
e.g. +2/+4 = "normal" reflex
NOTE: clonus = muscular spasm involving repeated, often rhythmic, contractions
How are pulses graded? - Answer-Scale of 0-4:
4 = bounding
3 = full, increased
2 = expected
1 = diminished, barely palpable
0 = absent
e.g. 2/4 = expected pulse
What are vesicular breath sounds? - Answer-low pitched, low intensity, heard over
healthy lung tissue
https://www.youtube.com/watch?v=_z6Ado_L20w
What are bronchovesicular breath sounds? - Answer-heard over major bronchi and
typically moderate in pitch and intensity
,https://www.youtube.com/watch?v=_z6Ado_L20w
What are bronchial breath sounds? - Answer-highest in pitch and intensity, ordinarily
heard over the trachea
https://www.youtube.com/watch?v=_z6Ado_L20w
What are the two types of adventitious breath sounds? - Answer-1. Continuous
2. Discontinuous
What are the 2 continuous adventitial breath sounds? - Answer-1. Rhonci: loud, low,
course like a snore, during inspiration OR expiration, may clear with cough (I
remember a waterfall I saw in Brazil. It's called "Roncador" = "The Snorer" because it
had a peculiar and distinct snore-like noise to it.)
2. Wheezes: musical noise, can be heard w/inspiration OR expiration, usually louder
during expiration
What is the 1 discontinuous adventitial breath sound and its 2 subtypes? - Answer-
Crackles:
1. Fine: high pitched, DURING THE END OF INSPIRATION, not cleared by cough
2. Coarse: loud, bubbly DURING INSPIRATION, not cleared by cough
What is pleural friction rub? - Answer-Squeaking or grating sound, occur when the
pleural layers are inflamed and have lost their lubrication, common in pneumonia,
pulmonary embolism, pleurisy. Appear on inspiration AND expiration.
Where does the bifurcation of the trachea (and carina) occur? - Answer-Just under
the Angle of Louis (2nd rib attachment to the sternum at the manubriosternal joint).
How are tonsils graded? - Answer-Scale of 0-4
0 = surgically removed
1 = tonsils hidden w/in tonsil pillars
2 = tonsils extending to the pillars
3 = tonsils are beyond the pillars
4 = tonsils extend to midline
What and where is Stensens duct? - Answer-Opening for the parotid gland into the
mouth. Located under the back molar on the cheek.
What and where is Whartons duct? - Answer-Opening for the submandibular gland
into the mouth. Located under the tongue.
What are the two hearing tests used to compare bone conduction and/or air
conduction? - Answer-1. Weber (performed 1st): compares bone conduction in the
two ears
2. Rinne (performed 2nd): compares bone to air to determine what Webers results
meant.
, How is the Weber test performed? - Answer-Place tuning fork in the midline of the
skull. Lateralized sound is indicative of conductive deafness in the affected ear or
nerve hearing loss in the unaffected ear. Perform Rinne to determine which.
How is the Rinne test performed? - Answer-Tuning fork on the mastoid until patient
cannot hear, then placed just lateral to ear (with prongs of tuning fork perpendicular
to EAC). Bone conduction greater than air conduction means conductive hearing
loss.
Where are the majority of glandular ducts in the breast located? - Answer-1/2 are
located in the upper outer quadrant.
NOTE: 50% of ALL BREAST CANCERS occur in this area
Where do other breast cancers occur and with what frequency? - Answer-18% of
malignant cancers in the subareolar region.
15% in the upper inner quadrant.
11% in the outer lower quadrant.
6% in the inner lower quadrant.
What are supernumerary nipples, where do they occur, and what do they signify? -
Answer-A supernumerary nipple (also known as a third nipple, triple nipple,
accessory nipple, polythelia or the related condition: polymastia) is an additional
nipple occurring in mammals, including humans.
They occur along the milk line.
They are congenital in nature along w/inverted nipples.
What is fibrocystic disease? - Answer-Benign fluid-filled cyst formation caused by
ductal enlargement.
Usually bilateral and multiple.
MC in women 30-55 yrs old
What is Paget's disease? - Answer-Crustiness (not "Crusty-Crust") of the nipple,
areola, and surrounding skin, may be unilateral or bilateral.
Surface manifestation of underlying DUCTAL CARCINOMA.
What are signs of breast cancer? - Answer-Blood discharge
Nipple dimpling
Lymph node enlargement
Paget's disease
Peau d'orange
(and others)
What is Peau d'orange? - Answer-Dimpling of the skin in the breast.
Can be indicative of inflammatory carcinoma, issues w/the lymphatic system, or
obstruction of the dermis.
When is the best time to do a breast exam? Why? - Answer-Early in the menstrual
cycle (first 5-10 days after menses)
GUIDE QUESTIONS WITH COMPLETE
SOLUTIONS
What is dystonia? - Answer-Sustained muscle contraction causes twisting and
repetitive movements or abnormal posture.
What is pronator drift? - Answer-Pt. holds both arms out in front of them w/palms up
and holds the position. If they cannot = Positive test result for upper motor neuron
weakness.
NOTE: In upper motor neuron weakness, supination is weaker than pronation in the
upper extremity, leading to a pronation of the affected arm.
What is ataxia? - Answer-State of being unsteady, uncoordinated
What is fasciculation? - Answer-muscle twitch
What is a tremor? - Answer-Somewhat rhythmic, muscle contraction, and relaxation.
How are reflexes graded? - Answer-Scale of 0-4:
0 = Absent
1+ = Hypoactive
2+ = "Normal"
3+ = Hyperactive w/o clonus
4+ = Hyperactive w/clonus
e.g. +2/+4 = "normal" reflex
NOTE: clonus = muscular spasm involving repeated, often rhythmic, contractions
How are pulses graded? - Answer-Scale of 0-4:
4 = bounding
3 = full, increased
2 = expected
1 = diminished, barely palpable
0 = absent
e.g. 2/4 = expected pulse
What are vesicular breath sounds? - Answer-low pitched, low intensity, heard over
healthy lung tissue
https://www.youtube.com/watch?v=_z6Ado_L20w
What are bronchovesicular breath sounds? - Answer-heard over major bronchi and
typically moderate in pitch and intensity
,https://www.youtube.com/watch?v=_z6Ado_L20w
What are bronchial breath sounds? - Answer-highest in pitch and intensity, ordinarily
heard over the trachea
https://www.youtube.com/watch?v=_z6Ado_L20w
What are the two types of adventitious breath sounds? - Answer-1. Continuous
2. Discontinuous
What are the 2 continuous adventitial breath sounds? - Answer-1. Rhonci: loud, low,
course like a snore, during inspiration OR expiration, may clear with cough (I
remember a waterfall I saw in Brazil. It's called "Roncador" = "The Snorer" because it
had a peculiar and distinct snore-like noise to it.)
2. Wheezes: musical noise, can be heard w/inspiration OR expiration, usually louder
during expiration
What is the 1 discontinuous adventitial breath sound and its 2 subtypes? - Answer-
Crackles:
1. Fine: high pitched, DURING THE END OF INSPIRATION, not cleared by cough
2. Coarse: loud, bubbly DURING INSPIRATION, not cleared by cough
What is pleural friction rub? - Answer-Squeaking or grating sound, occur when the
pleural layers are inflamed and have lost their lubrication, common in pneumonia,
pulmonary embolism, pleurisy. Appear on inspiration AND expiration.
Where does the bifurcation of the trachea (and carina) occur? - Answer-Just under
the Angle of Louis (2nd rib attachment to the sternum at the manubriosternal joint).
How are tonsils graded? - Answer-Scale of 0-4
0 = surgically removed
1 = tonsils hidden w/in tonsil pillars
2 = tonsils extending to the pillars
3 = tonsils are beyond the pillars
4 = tonsils extend to midline
What and where is Stensens duct? - Answer-Opening for the parotid gland into the
mouth. Located under the back molar on the cheek.
What and where is Whartons duct? - Answer-Opening for the submandibular gland
into the mouth. Located under the tongue.
What are the two hearing tests used to compare bone conduction and/or air
conduction? - Answer-1. Weber (performed 1st): compares bone conduction in the
two ears
2. Rinne (performed 2nd): compares bone to air to determine what Webers results
meant.
, How is the Weber test performed? - Answer-Place tuning fork in the midline of the
skull. Lateralized sound is indicative of conductive deafness in the affected ear or
nerve hearing loss in the unaffected ear. Perform Rinne to determine which.
How is the Rinne test performed? - Answer-Tuning fork on the mastoid until patient
cannot hear, then placed just lateral to ear (with prongs of tuning fork perpendicular
to EAC). Bone conduction greater than air conduction means conductive hearing
loss.
Where are the majority of glandular ducts in the breast located? - Answer-1/2 are
located in the upper outer quadrant.
NOTE: 50% of ALL BREAST CANCERS occur in this area
Where do other breast cancers occur and with what frequency? - Answer-18% of
malignant cancers in the subareolar region.
15% in the upper inner quadrant.
11% in the outer lower quadrant.
6% in the inner lower quadrant.
What are supernumerary nipples, where do they occur, and what do they signify? -
Answer-A supernumerary nipple (also known as a third nipple, triple nipple,
accessory nipple, polythelia or the related condition: polymastia) is an additional
nipple occurring in mammals, including humans.
They occur along the milk line.
They are congenital in nature along w/inverted nipples.
What is fibrocystic disease? - Answer-Benign fluid-filled cyst formation caused by
ductal enlargement.
Usually bilateral and multiple.
MC in women 30-55 yrs old
What is Paget's disease? - Answer-Crustiness (not "Crusty-Crust") of the nipple,
areola, and surrounding skin, may be unilateral or bilateral.
Surface manifestation of underlying DUCTAL CARCINOMA.
What are signs of breast cancer? - Answer-Blood discharge
Nipple dimpling
Lymph node enlargement
Paget's disease
Peau d'orange
(and others)
What is Peau d'orange? - Answer-Dimpling of the skin in the breast.
Can be indicative of inflammatory carcinoma, issues w/the lymphatic system, or
obstruction of the dermis.
When is the best time to do a breast exam? Why? - Answer-Early in the menstrual
cycle (first 5-10 days after menses)
