Clinical Skills Flashcards
Causes of peripheral cyanosis and how to check for it
Can be caused by central cyanosis or decrease in peripheral circulation. Check fingers for colour.
Where is the supresternal notch?
Examination for central cyanosis
Detected by blue discolouration of the tongue
Surface anatomy for anterior borders of the lung upper lobes
The line of the 4th rib medio-laterally.
Basic Activities of Daily Living
Dressing
Eating
Ambulating
Toileting
Hygiene
ISBAR
For rapid communication regarding urgent care. Identification of self and pt Situation - quick Background Assessment - more details and why is the ddx Response - I need you to come and what should I do in the meantime
Term for a sternum that is unusually convex
Pectus carinatum
Surface landmarks for the boundaries of the right middle lobe of the lung.
The inferior borders are marked by the oblique fissure, which runs down from T3 and meets the 6th rib at the bid-clavicular line. The line along the 6th rib makes up the remainder of the inferior border. The superior border is marked by the 4th rib and travels laterally until it meets the oblique fissure in the axilla.
Identify the costal angle
Why might fremitus be decreased?
Soft voice, blockage of vibrations with tumour, fibrosis, thick chest wall
Instrumental Activities of Daily Living
Shopping
House-keeping
Account
Food preparation
Transport/telephone
Causes of peripheral cyanosis and how to check for it
Can be caused by central cyanosis or decrease in peripheral circulation. Check fingers for colour.
How to identify C7 and why this is a useful surface anatomy marker
An alternate method of numbering the ribs posteriorly is to count down from C7. Lower your chin to your chest, please. With the patient’s neck flexed forward, find the most prominent spinous process, which is usually at C7. Then feel and count from C7 to T12. You can often palpate and count the processes below them, especially when the spine is flexed. This is one way to find the oblique fissue which runs from T5 down to the 6th rib anteriorly.
ABCD
For assessing a patient’s status: Airways - speaking Breathing - RR Circulation - O2 sat Disability level - deterioration of condition
CUS terms
I am concerned …. uncomfortable This is a safety issue
Term for a sternum that is unusually concave
Pectus excavatum
Normal respirtory rates for…
- newborn
- 1-12 months
- 1-5 yr
- 5-10 yr
- 10-16 yr
- adult
- Newborn: 30-60
- 1-12 months: 25-40
- 1-5 years: 20-30
- 5-10 years: 15-25
- 10-16 years: 15-20
- adult: 12-20
Distinguish between the internal jugular pulsation snad carotid pulsations.
Internal Jugular Vein
- Rarely palpable.
- 2 or 3 components (a, c, v waves).
- Eliminated by light pressure on the vein just above the sternal end of the clavicle.
- Pulsations vary with position.
Carotid Artery
- Palpable.
- Single component with vigorous thrust.
- Pulsation not eliminated.
- Pulsation not affected by position.
How to locate the JVP
Extend the patient’s neck and slightly turn his head to the left (to examine the right internal jugular). Look for the pulsations of the internal jugular vein between the clavicular and sternal arms of the sternocleidomastoid. If necessary, raise or lower the bed so that the oscillation point of the internal jugular vein is visible.
Why might fremitus be decreased?
Soft voice, blockage of vibrations with tumour, fibrosis, thick chest wall).
Adventitious sounds
added sounds, indicating there may be something unusual/wrong in the lung. These include crackles (rales), wheezes (rhonchi), rubs and stridor.
On percussion of the lungs from top to bottom posteriorly, you can detect dullness at the level of T8 on the left and T10 on the right. What may explain the differences between the two sides?
common systems for defining regions of the abdomen:
Dividing the abdomen into 4 quadrants (right and left upper quadrants, and right and left lower quadrants) Epigastric, umbilical/periumbilical and hypogastric/suprapubic region.
Ask the patient to push the abdomen out to the examiner’s hand or suck in the abdomen. WHY?
Understand that a patient who can do these manoeuvres is unlikely to have any acute inflammatory process in the abdominal cavity.
the word for an abdomen that is curved in??
scaphoid
word for abdomen that is curved out
protuberant
Examination of the liver in an abdominal physical exam
Locate the upper border of the liver: Percuss downward in the midclavicular line, on the right side of the patient. Start over the lungs, and listen for the change from resonance to dullness as you move down.
Locate the lower border of the liver: Start in the right lower quadrant, in the midclavicular line. With your fingertips pointing toward the head of the patient, put your hand on the abdomen. Ask the patient to take a deep breath. As the patient inhales, hold your fingers still, and feel the liver edge coming down to meet your fingers. If you can’t feel the liver at this level, move your fingers closer to the ribcage, and repeat.
Once you have located the upper and lower borders of the liver, measure the distance between the two points – normal is 6-12 cm at the mid-clavicular line.
Examination of the spleen in an abdominal physical exam
- If you suspect an enlarged spleen, with the patient supine, percuss in the lowest intercostal space in the left anterior axillary line. Continue to percuss while the patient takes a deep breath.
- Normally this area is tympanic and remains tympanic with a deep breath. If the spleen is enlarged, it will move into this area during a deep breath, and the percussion note will change to dull. This is called “Castell’s sign”
- Alternately, percuss in Traube’s space. Traube’s space is bordered the 6th rib superiorly, the mid-axillary line laterally, and the left costal margin inferiorly and medially. With the patient supine and breathing normally, percuss in several areas within Traube’s space.
- Normal percussion yields a resonant or tympanic note, whereas the percussion note is dull in splenomegaly.
- Palpation for an enlarged spleen:
- Stand on the patient’s right side. Place your left hand on the patient’s posterior costal margin to elevate the left rib cage. With the right hand, press very gently toward the costal margin, with your fingertips pointing toward the spleen, and starting at the umbilicus. Ask the patient to breathe in deeply while you hold your hand still and feel for the edge of the spleen as it comes down to meet your fingertips. Repeat, if necessary, after moving your hand toward the ribcage.
- If you can feel the spleen, it may be enlarged.
McBurney’s point
it is located maximally at a point ⅔ of the way from the umbilicus towards the anterior superior iliac spine. Used to detect appendicitis.
