Lymph Nodes
	Preauricular- front of ear
	Postauricular- behind ear
	Occipital- base of skull
	Submental-behind tip of madible
	Submandibular- halfway between angle and tip of mandible
	Jugulogastric-under angle of mandible
	Superficial cervical- overlying sternoid mastoid muscle
	Deep cervical- deep under sternomastoid muscle
	Posterior cervical- posterior triangle along trapezius muscle
	Supraclavicular- above clavicle
	
	Neuro
	Cerebellum- motor coordination of voluntary movements equilibrium and muscle tone
	Basal ganglia- contols automatic movements of the body arm swing with leg alternatively during walking
	Thalamus- main relay station for the nervous system
	Hypothalamus- major control center for temp, heart rate, bp, sleep, anterior/posterior pituitary regulator. 
•	Coordination of automatic nervous system activity
	
	Cerebellar functioning (testing of)
	
	Cranial nerves- 
•	enter and exit the brain rather than the spinal cord. Supply rarely the head and neck, except the VAGUS NERVE. 
o	Travels to the heart, respiratory, stomach, and gallbladder. 
	
	SLR- (musculoskeltal)- straight leg raises- help confirm the presence of herniated muscles
	
	Labs
	Prolactin- stimulates breast development and lactation during pregnancy
	FOBT-Fecal occult blood test- occult- hidden blood in stools
	CBC- Complete blood count
	TSH- Thyroid stimulating hormone
	HgB- Hemoglobin test
	HgB- diagnostic test for diabetes
	
	Lung Sounds
	Ronchi- (sonorous wheeze) loud, low, courses. Sounds like a snore most often heard continuously during insp. & exp.
•	Couging may clear sounds (usually means mucus accumulation in trachea or large bronchi). 
	Crepitus- crackly or crinkly sensation can be both palpated and audible: 
•	A gentle bubbly feeling. It indicates air in the subcu tissue from a rupture somewhere in the resp. system or by infection with a gas-producing organism. 
•	Localized ( over the suprasternal notch and base of neck) or cover a wider area of the thorax, usually anteriorly and toward the axilla. 
•	Always a sign of attention. 
	Breath Sounds
•	Vesicular- heard over peripheral lung fields where air flows through smaller bronchioles and alveoli
•	Bronchovesicular- heard over major bronchi where fewer alveoli are located
o	Posterior, between scapulae, esp on right anterior, around upper sternum in 1st and 2nd ics. 
•	Bronchial/tracheal- (tubular) heard over trachea and larynx. 
	Paroxysmal nocturnal dyspnea- patients who waken with sudden shortness of breath
•	Fluid overload from elevation of the legs, shifts fluids there to the body’s core. 
•	Excess fluid cannot be pumped through the heart and suddenly accumulates in the lungs causing dyspnea
	
	Phases of Pain
	4 phases
•	transduction-actual noctious stimuli (burn, cut, chemical)
o	nail hits foot
•	Transmission-pain impulses travel to brain
o	Nail in foot
•	Perception- conscious awareness of pain
o	I know the nail is in my foot
•	Modulation- andogenous
o	Endorphins seratonin
o	Chemicals that try to reduce the pain. 
	Duration- types of pain are categorized by 
•	Acute pain- short term and self-limiting.
•	Chronic pain- more than 6 months duration.
	
	Reflexes
	Reflex Arc- reflexes are the basic defenses mechanism of the nervous system. Involuntary, operate below level of conscious control, and help the body to maintain balance and appropriate muscle tone. 
	4 types
•	DTR- Deep tendon reflex-hammer/knee jerk
•	Superficial- corneal reflex
•	Visceral- papillary response to light
•	Pathologic- babinski test- going up the foot and feet spread baby
	
	Cardiac Sounds
	S1-normal  heart sounds- closure of av valves
	S2-normal heart sounds- closure of semilunar valves
	S3-pathologic- CHF- congestive heart failure- produces vibration
	S4-pathologic- produces vibration
	
	Exam Techniques. 
	
	Spinal Nerves
•	31 pairs
•	named for the region of the spine from which they exit.
•	Contain both sensory and motor fibers
o	8-cervical
o	12-thoracic
o	5-lumbar
o	5-sacral
o	1-coccyxgeal
•	Dermatomes-pg 689- area of skin that supplied from one spinal cord segment.
	
	HEENT Tests
	Rinne- Place tuning fork behind mastoid process (BC) until they can’t hear it, bring to front of ear (AC) should be able to hear sound
AC>BC
	Weber- place a tuning fork on top of forehead- can pt hear on equal sides? If it goes to one side there is a hearing deficit. 
	Visual activity via snellin chart (E Chart)
	Confrontation- gross measure of peripheral vision
	Corneal light reflex test- Hischberg Test- parallel alignment of eyes assessment
	Cover test- assess for deviation of one eye
	6 cardinal position of Gaze- asses for muscle weakness
	Eversion of eye- not routine- done in ER. Looking for foreign body in eye, flips eyelid inside out. 
	Patency- testing sense of smell