Chapter 2 - the medical examination Flashcards
Medical History
- take it
Sign
Refers to something that the clinical can see or feel in the pt.
- temperature, respiration, heart beat, and blood pressure
Symptom
Refers to something the pt. feels but the clinician can’t
- headache, nausea, dizziness, and pain
Comprehensive Medical History steps
- identify pt. age/gender
- CC = location, quality/quantity, frequency, onset/duration, associated factors (aggravate or alleviate)
- past history
- current health status (diet, drugs, immunizations)
- fam history = diabetes, hypertension etc.
Physical Exam
- pt. apparent state of health, level of consciousness, signs of distress, height/weight, skin color, hygiene, obvious lesions
- it begins with vital signs and skin and goes from there
Vital Signs
- height/weight
- blood pressure
- heart and respiratory rate
- body temp
Height and Weight
- baseline for future reference
- height measured with stadiometer
- weight is usually measured in Kg
Blood pressure
- stethoscope and sphygmomanometer (correct size)
- pt. has to rest for awhile before it is taken
- lower edge of cuff is 2.5 cm above antecubital crease
- inflate cuff to >200 mmHg
- deflate 2-3 mmHg/second
Blood pressure sounds
- examiner listens for two consecutive sounds = systolic pressure (ventricles contracting)
- when sound disappears = diastolic pressure (relaxation of ventricles)
- also known as fifth korotkoff sound
Pulse rate and rhythm
- radial pulse
- number of beats in 15 seconds x 4
- normal 60-72 bmp
- rate, rhythm and force
- normal for athletes to have bradycardia (100 bmp)
Respiratory Rate and Rhythm
- rate, effort, and depth of inspiration
- counting the number of respirations in 1 minute
- normal = 12-20 breaths/min
Temperature
- may be as low as 96.4 F in the morning or as high as 99.1 F in the evening
- rectal temperatures are higher by 0.4 - 0.5 C
Stethoscope
- examiner holds the end piece between the fingers, pressing the diaphragm firmly against the skin, whole contact
- don’t let tubing rub against itself
- listen for presence or absence of sound as well as intensity, pitch, duration and quality
- bell is used to hear low-pitched sounds
- diaphragm (big) is used to hear high-pitched sounds
Opthalmoscope
- viewing internal structures of the eye
- contains light source which allows us to view the inner eye (near/far focusing)
Otoscope
- viewing the external auditory canal/tympanic membrane
- has light and disposable speculums for cleanliness
- can also be used for the nose
Snellen Chart
- visual acuity
- stand 20 feet away covering one eye
- two wrong answers = inability to correctly read at that distance
Neurological Testing
- sensory, motor, and deep tissue reflexes
Dermatome
a specific area of skin innervated by a dorsal or sensory nerve root
Myotome
single muscles or groups of muscles innervated by a single ventral or motor nerve
DTR
involuntary motor reaction to a stimulus
- biceps tendon
- distal triceps tendon
- distal brachioradialis tendon
- patella tendon
- achilles tendon
Neurological Hammers
- sharp and brush end
- pt. close their eyes
- be careful
- use the same area of skin for sharp and brush
Cranial Nerve Assessment
C I = smell/sensory
C II = vision/sensory
C III = motor/PEARL & extraocular muscle movement
C IV = motor/etraocular (upward) muscle movement
C V = sensory & motor/muscles of mastication
C VI = motor/extraocular (lateral) muscle movement
C VII = sensory & motor/muscles of facial expression, taste, tears and saliva
C VIII = sensory/balance and hearing
C IX = sensory & motor/ taste and sensation of mouth
C X = motor & sensory/ swallowing and gag reflex
C XI = Motor/sternocleidomastoid, trap movement
C XII = motor/tongue movement
Percussion
- direct = lightly striking the chest or abdominal wall with the ulnar aspect of the fist
- indirect = finger of one hand acting as the hammer and striking the other finger that is resting on the body
- sound empty or full
Auscultation
- heart/lung/bowel are not audible without use of stethoscope
