Chapter 3: Examination Techniques and Equipment

Question 1

Infection Precautions and Latex Allergy

Answer 1

Precautions:
Standard Precautions
Transmission-Based Precautions

Latex allergy:
Occurs when the body’s immune system reacts with proteins found in latex
Skin/mucous membrane contact or airborne exposure
Rash, itching, blisters, asthma, GI symptoms, lung damage, anaphylaxis
Healthcare workers and patients with multiple surgeries at risk

Question 2

Patient Positions and Draping

Answer 2

Seated
Supine
Prone
Dorsal recumbent
Lateral recumbent
Lithotomy
Sims

Question 3

Examination Technique: Inspection

Answer 3

Process of observation beginning with the initial meeting of the patient and continuing through the history and physical examination

Guidelines
Provide for privacy.
Ensure adequate lighting.
Inspect in an unhurried and careful manner.
Expose what you want to inspect.
Validate findings with patient.

Question 4

Examination Technique: Palpation

Answer 4

Use of hands and fingers to gather information through the sense of touch

Hand areas:
Palmar surface of the fingers and finger pads: Position, texture, size, consistency, fluid, crepitus, form of a mass, or structure
Ulnar surfaces of hand and fingers: Vibration
Dorsal surface of hand: Temperature

Question 5

Examination Technique: Percussion

Answer 5

One object striking against another produces vibrations and sound waves.
Tapping finger causes vibrations by impact on underlying tissues.
Sound waves arise from vibrations and produce percussion tones (resonance).
Tone is related to density of underlying tissue.

Question 6

Percussion Tones

Answer 6

Tympany―loud, high, drumlike
Gastric bubble

Hyperresonance―very loud, low, booming
Emphysematous lungs

Resonance―loud, low, hollow
Healthy lung tissue

Dullness―soft, moderate, thudlike
Over liver

Flatness―soft, high, dull
Over muscle

Question 7

Percussion Techniques

Answer 7

Immediate (direct)―Finger strikes directly against body.

Mediate (indirect)―Middle finger of dominant hand is hammer; middle finger of nondominant hand is placed on body and struck.

Fist―Nondominant hand is placed on body and struck with fist of dominant hand.
Most commonly used to elicit tenderness arising from the liver, gallbladder, or kidneys.

Question 8

Examination Technique: Auscultation

Answer 8

Listening for sounds of the body
Environment should be free of noise and distractions.
Place stethoscope on bare skin, not over clothing.
Listen for intensity, pitch, duration, and quality.
Concentrate on one sound at a time.

Question 9

Patients With Mobility Impairment and Disabilities

Answer 9

Mobility impairment transfers:
Pivot transfer
Two-person transfer
Cradle transfer
Equipment: Slide board and Lifts

Spinal cord disabilities:
Bowel and bladder concerns
Autonomic hyperreflexia
Hypersensitivity; spasticity
Cognitive delay; chronic pain
Feeding concerns

Question 10

Patients With Sensory Impairment

Answer 10

Impaired vision
Identify yourself clearly.
Orient patient to surroundings.
Canes and guide animals

Impaired hearing or speech
Allow patient to choose appropriate form of communication.
Sign language interpreter
Lipreading
Writing
Talk To You (TTY)

Question 11

Height and Weight Measurement

Answer 11

Adult
Standing platform scale with height attachment
Electronic scale

Child (when able to stand)
Stadiometer: stature-measuring device -Movable headpiece attached to a rigid measurement bar and platform

Infant
Weight on platform scale sitting or lying
Height on measuring device with rigid headboard and movable footboard

Question 12

Thermometer

Answer 12

Electronic temperature measurement has decreased the time required for accurate temperature readings
Disposable sheath-covered probe can be used in oral, rectal, or axillary regions.
Rectal temperature is preferred in infants 0 to 90 days of age.
Infrared thermometer

Question 13

Stethoscope

Answer 13

Required for amplification in auscultation

Four types:
Acoustic
Stereophonic
Magnetic
Electronic

Technique:
Stabilize stethoscope between the fingers.
Diaphragm use—press firmly against the skin.
Bell use—place evenly and lightly on the skin.

Question 14

Sphygmomanometer

Answer 14

Blood pressure is measured indirectly with a stethoscope and either an aneroid or mercury sphygmomanometer.

Electronic sphygmomanometer does not require the use of a stethoscope.
It does not, however, indicate the quality, rhythm, and other characteristics of a pulse and should not be used in place of touch in assessing pulse.

Cuff bladder should encircle 80% or more of the patient’s arm circumference.
Cuff too small-falsely elevated BP

Question 15

Pulse Oximeter

Answer 15

Measures the percentage of hemoglobin saturated with oxygen (oxyhemoglobin)

Measures how much oxygen the blood is carrying as a percentage of the maximum it could carry

Requires a reasonably translucent site with a good circulation
Finger
Toe
Pinna

Question 16

doppler

Answer 16

Ultrasonic stethoscopes used to pick up pulses not heard with stethoscope
Detects blood flow rather than sounds

Common uses
Detect systolic blood pressure
Auscultate fetal heart activity
Locate vessels
Take weak pulses
Assess vessel patency

Question 17

Portable Ultrasound

Answer 17

Compact portable units analyze echoes and transform them into a two- or three-dimensional image of the organs or tissues.

Produces dynamic moving images that can show the structure and movement of the body’s internal organs, as well as blood flowing through blood vessels

Used to detect cysts, tumors, fluid collection, infections, structural abnormalities of organs, and blockages in major blood vessels

Question 18

Fetal Monitoring Equipment

Answer 18

Used to determine fetal heart rate

Four types:
Fetoscope
Leff scope
Stethoscope
Doppler

Question 19

Ophthalmoscope

Answer 19

System of lenses and mirrors with light source and apertures enables visualization of interior structures of the eye.

Lenses vary in powers of magnification.

Magnification can be dialed up or down to compensate for myopia or hyperopia in both the examiner and patient.

PanOptic ophthalmoscope

StrasbismoScope

Photoscreening:
Detects strabismus and amblyopia.

Question 20

Vision Charts

Answer 20

Allen picture cards
HOTV
LH Symbols (LEA Symbols)
Broken wheel cards (near vision)
Snellen alphabet (>6 years old)
Rosenbaum and Jaeger charts
Newsprint
Amsler grid

Question 21

Otoscope and Tympanometer

Answer 21

Otoscope:
Illumination for viewing external auditory canal and tympanic membrane
Speculum attached to otoscope head directs beam of light down ear canal.
Pneumatic attachment used to evaluate fluctuating capacity of tympanic membrane

Tympanometer:
Assesses function of ossicular chain, eustachian tube, and tympanic membrane
Probe positioned at opening of ear canal measures sound energy and air pressure as each is introduced into the ear.

Question 22

Tuning Forks and Hammers

Answer 22

Tuning forks:
Auditory function and vibratory sensation
Auditory: estimates hearing loss by noting which vibrating tuning forks can be heard (500 to 1000 Hz).
Vibratory: measured by holding vibrating fork against a bony prominence (100 to 400 Hz)
Not useful in young children

Percussion (reflex) hammer: tests deep tendon reflexes (DTRs).

Neurologic hammer: measures sensory perception.

Question 23

Tape Measure and Transilluminator

Answer 23

Tape measure:
Determines circumference, length, and diameter in metric units/inches
Tape pulled closely without causing depression of skin
Serial measures obtained by placing tape in same location every time

Transilluminator:
Strong light source used to distinguish whether a body cavity contains fluid, air, or tissue

Question 24

Vaginal Speculum

Answer 24

Used to view vaginal canal and cervix
Consists of two blades and a handle

Three basic types:
Graves―standard
Pederson―women with small vaginal openings
Pediatric/virginal―children, adolescents

Specula are available in either disposable plastic or reusable metal.
Operate differently

Question 25

Goniometer

Answer 25

Determines degree of joint flexion and extension
Two straight arms that intersect and can be angled and rotated around a protractor.
Center placed over joint—arms aligned along long axis of extremity.
Degree of flexion/extension is measured on protractor.

Question 26

Wood’s Lamp

Answer 26

A light source with a wavelength of 360 nm (black light)

Turn black light on in dark room and shine on area of body being evaluated.

Certain conditions/substances fluoresce when illuminated with black light.
Fluorescein in the eye helps identify corneal abrasion.

Used primarily to determine presence of fungi, bacteria, pigment changes and other skin lesions.
Some skin fungi glow yellow-green.

Question 27

Monofilament

Answer 27

Tests for loss of protective sensation, particularly on plantar surface of foot

Bends at 10 g of linear pressure—patient has lost sensation if not felt when bent.

Guidelines:
Test various foot points with patient’s eyes closed.
Press and bend filament.
Have patient indicate whether filament is felt.

Question 28

Scoliometer

Answer 28

Measures the degree of rotation of the spine to screen for scoliosis

Patient bends forward slowly, stopping when the shoulders are level with the hips (Adam’s forward bending test).

Scoliometer is placed gently across any deformity and the number of degrees of rotation noted.

Considered positive if the reading on the scoliometer is 7 degrees or more
If positive, order spine films with Cobb angles.

Question 29

During palpation, which area of the hand is best for distinguishing vibration?
Palmer surface of the hand
Fingertips
Ulnar surface of the hand
Dorsal surface of the hand

Answer 29

ANS: C

Rationale: The ulnar surface of the hand and fingers is the most sensitive area for distinguishing vibration.

Question 30

When performing indirect percussion, the stationary finger is struck:
At the ulnar surface
At the middle joint
At the distal interphalangeal joint
When it is in contact with a fist

Answer 30

ANS: C

Rationale: Your finger functions as a hammer, and the impact of the finger against underlying tissue produces the vibration. The sound waves are heard as percussion tones.

Question 31

Expected normal percussion tones include:
Dullness over the lungs
Hyperresonance over the lungs
Tympany over an empty stomach
Flatness over an empty stomach

Answer 31

ANS: C

Rationale: A normal lung produces resonance percussion tones while an empty stomach is expected to produce tympany. Dull percussion tones are heard over the liver.