And I will put my fingers on either side, between those two points, landmarks, and I'm actually gonna retract a little bit on one side and ask her to swallow. [BLANK_AUDIO] And I'm feeling the thyroid as it rises for size in any nodules. And now, when we retract on the opposite side, and ask her to swallow. And that would be the thyroid gland palpation. Next, I will palpate her carotid arteries one at a time, and that's on either side of the trachea. [BLANK_AUDIO] And they are normal and bounding. Now, I'm gonna auscultate Sarah's carotid arteries, and I'm checking for any bruits bilaterally. The technique involves asking her to hold her breath, and I'm auscultating the carotid arteries, so her breath sounds don't distort, or interfere with the auscultation of the carotid arteries. So Sarah, go ahead and take a breath in and hold it. [BLANK_AUDIO] And breathe. And take a breath in. Hold it. [BLANK_AUDIO] And breathe. [BLANK_AUDIO] Now, I will check her range of motion of the neck, and I'm gonna ask Sarah to go ahead and flex your neck, which means, go ahead and take your chin down to your chest. Now straighten your neck, and look up to the ceiling, and extension and now look forward. And I want you to look over your right shoulder. And that would be rotation, and now your left shoulder rotation. And now once again, I want you to do a flexion to the side, like ear to your shoulder. That's lateral flexion. And the other side, lateral flexion. Thank you, and those are all intact equally. Now, I will test the cranial nerve number 11, which is the spinal accessory nerve. And I'm gonna put resistance on her shoulders, and ask her to shrug her shoulders. And that's nice and equal, and intact. [BLANK_AUDIO] Now I'm going to evaluate Sarah's heart sounds. I begin with the auscultation in all five areas, with the bell and the diaphragm, with the patient sitting. And if you do not have a bell on your stethoscope, please just let your instructor know that you would be using the bell.
I do not have a bell, so I will be just using the diaphragm, and commenting later that I would use the bell as well in all five areas. So I begin with the aortic valve which, is the second intercostal space on the right sternal border. [BLANK_AUDIO] Next will be the pulmonic valve, which is going to be the second intercostal space to her left sternal border. [BLANK_AUDIO] Moving down to the Erb's point, which is the third intercostal space, left sternal border. And further down would be the tricuspid, which is the fourth intercostal space, left sternal border. And finish with the mitral area, which is the midclavicular line, fifth intercostal space. [BLANK_AUDIO] Now, I am going to inspect Sarah's anterior chest, for any obvious deformities in symmetry, and I do not see any. Now, I will auscultate her lung sounds in the interior lung fields, beginning at the intercostal spaces. Sarah, if you will take some normal breaths in and out through your mouth. [BLANK_AUDIO] And your breath sounds are nice and clear.
- Fall '15