Clinical Skills Flashcards
1
Q
General Appearance
A
Note the apparent state of health, level of consciousness, signs of distress, height, build, weight, skin color, obvious lesions, dress, grooming, personal hygiene, facial expression, odors, posture, gait, and motor activity. (P109‐111)
2
Q
Vital Signs
A
- Examine radial pulses (P482)
Note rate, rhythm, and strength. - Take blood pressure in one arm (P116‐117)
Estimate systolic by palpation and release. Then pump to 30 mmHg above estimated systolic
and slowly release. - Determine respiratory rate (P119)
Note rate, rhythm, and effort.
3
Q
Skin Exam
A
- Check skin color (P163‐169)
- Check skin texture and turgor (P169)
- Check skin for moles and other lesions (P169‐188)
4
Q
Head Exam
A
- Examine the scalp, hair (P192), and bony configuration of skull (P205)
- Examine for Frontal and Maxillary Sinus Tenderness (P231)
5
Q
Eye Exam
A
- Estimate visual acuity (near or far) in each eye separately (P211‐212), using a hand held eye
chart. Cover one eye, and read the smallest line possible. Note: If patient wears glasses other
than for reading have them put their glasses on - Inspect eyelids, sclera, and conjunctiva with penlight (P213‐214)
Ask patient to look up. Note color, vascular pattern, nodules, and swelling. - Check pupils for reaction to light and accommodation (P215‐216)
Ask patient to look in the distance and shine pen light into each pupil. Note direct and
consensual reaction for each eye.
6
Q
Ear Exam
A
- Auditory Acuity (P226)
To estimate hearing, test one ear at a time. Ask patient to close their eyes. Place your fingers
near patients ears, rub your finger, ask patient what side they hear finger rub. Do other ear
If hearing is diminished, conduct the Weber and Rinne tests.
a. Weber test (P227)
Place lightly vibrating 512 Hz tuning fork on top of patient’s head. Ask patient if the
sound is heard on one or both sides. Sound lateralizes towards impaired side in
conductive hearing loss, and away from impaired side in sensorineural hearing loss.
b. Rinne test (P227)
Press lightly vibrating 512 Hz tuning fork behind patient’s ear. When patient can no
longer hear the sound (via bone conduction), moving tuning fork next to ear canal and
ask patient if the sound can be heard again. The “U” of the fork should face forward to
maximize its sound for the patient. - Inspect ear and external auditory canal (P225)
Inspect the auricle and surrounding tissues for deformities, lumps, or skin lesions. If ear pain
discharge or inflammation is present, move the auricle up and down, press the tragus, and press
firmly just behind the ear. - Using otoscope inspect the external auditory canal and tympanic membranes (P225)
Gently pull auricle up, back, and out. Insert speculu
7
Q
Nose Exam
A
- Check for tenderness of frontal and maxillary sinuses (P 231)
Press pads of thumbs firmly onto sinuses. Ask about any tenderness. - Inspect nasal vaults using the otoscope (P229‐230)
8
Q
Throat Exam
A
- Use tongue blade to inspect: (P231‐236)
a. mucous membranes
b. salivary ducts
c. tonsils
d. teeth
e. gums
9
Q
Neck Exam
A
- Palpate the lymph nodes in the: (P236‐240)
a. Anterior triangles
b. Supraclavicular areas
c. Submandibular areas
d. Posterior cervical nodes - Note the position of the trachea by palpating in sternal notch (P240)
Run one finger along each side of the trachea. The space between the trachea and
sternomastoid muscle should be equal on both sides. - Inspect thyroid (P241)
Tilt the patient’s head back slightly. The thyroid is visible just below the cricoid cartilage. - Palpate thyroid for isthmus and size and movement (P242)
Ask patient to swallow and feel for movement of the thyroid gland. Displace trachea to one
side, then the other to palpate lobes. Use fingers of both hands to feel for isthmus of thyroid.
10
Q
Respiratory Exam
A
- Inspect posterior chest for symmetry or deformity (P297)
- Check thoracic expansion (P298). Place hands on back with thumbs on 10th rib. Ask patient to
inhale deeply, watching and feeling for symmetry and range of motion. - Palpate for tactical fremitus (P298), Ask patient to repeat the words “ninety‐nine” or “one‐oneone.”
Feel for vibration with ulnar surface of hand. Compare sides at 4 locations as shown. - Percuss posterior lung fields both sides (P299‐302)
Press last joint of middle finger on skin. Strike joint with tip of other middle finger (may sound
flat, dull, resonant, hyperresonant, or tympanic). Compare from side to side.5. Measure excursion of the diaphragm (P302), Percuss level of dullness (diaphragm) at full
inspiration. Do both sides - Auscultate the upper, mid, lower lung fields (P302‐304)
Listen for crackles, wheezes, and rhonchi. Note duration of inspiration and expiration. Compare
sides as shown above.
With the patient lying down 30 degrees of elevation:
Respiratory Exam - Auscultate anterior lung fields from supraclavicular area to 6th rib (P308)
11
Q
Cardiovascular Exam
A
- Observe the neck veins (P349‐351)
Visualize the highest point of biphasic pulsation in right internal jugular vein. - Measure the jugular venous pressure , Measure vertical distance above sternum (normal is
<4cm above sternal angle) - Palpate carotid pulses (P352)
Gently press medial to the sternomastoid muscle, below the Adam’s apple.
Note presence of thrills. Only palpate one side at a time! - Auscultate carotid pulses ( P355‐356), Listen for Bruits or transmitted murmurs
- Inspect and palpate precordium (P355‐356)
Note any lifts, thrills and heaves. Gently displace the breast if necessary.
(Continue) With the patient lying down 30 degrees of
elevation:
6. Palpate the apical impulse (P357)
Note: If you cannot identify the apical pulse with the patient supine, ask the patient to roll partly
onto the left side and palpate again using your fingers.
7. Roll patient left Lateral Position, use the Bell part of your stethoscope to auscultate over the
apex
8. Auscultate the heart with the diaphragm: (P361‐368)
a. Apex (M)
b. Lower left sternal border (T)
c. 2nd left interspace (P)
d. 2nd right interspace (A)
With the Patient Sitting and Leaning Forward:
Cardiovascular Exam
1. During exhalation auscultate left sternal border with diaphragm (P364) (A)
12
Q
Abdominal Exam
A
- Inspect abdomen (P434‐435)
Look for bulges, masses and skin lesions. Watch for peristalsis and pulsations. Note the contour
as well as any scars, striae, or dilated veins. - Auscultate bowel sounds (P436)
Use diaphragm, listen for bowel sounds - Auscultate epigastrium and each upper quadrant for bruits (P436)
Use diaphragm, listen for bruits - Percuss all 4 quadrants (P437)
Note areas of tympany or dullness. - Palpate gently in all 4 quadrants (P437)
Use one hand to feel for tenderness or resistance. Note any superficial masses.(Continue) with the Patient lying flat: - Palpate deeply in all 4 quadrants (P438)
Use two hands to feel for masses. Note location, size, shape, consistency, tenderness,
pulsations, and mobility. - Palpate the aorta (P447), Identify aortic pulsations in upper abdomen. Measure width of aorta
by pressing deeply with one hand on each side of the aorta (should not be more than 3 cm
wide). - Percuss liver span (P439‐440)
Find the lower border of dullness along the right midclavicular line, starting at the level of the
umbilicus. Identify the upper border, starting at the nipple line. - Palpate liver edge (P441‐442) Place your left hand behind the patient. Press your right hand
below the border of liver and feel for liver edge as patient inhales. - Percuss spleen (P 443‐444). Percuss the lowest interspace in the left anterior axillary line.
Percussion note is tympanitic, and should remain tympanitic when patient inhales. - Palpate spleen (P444‐445)
With left hand under patient, press right hand below left costal margin. Ask patient to inhale
and feel for tip of spleen. - Palpate the inguinal area for lymph nodes (P483)
- Palpate the femoral pulses (P484)
- Palpate the popliteal pulse (P484)
- Palpate posterior tibial pulses (P485)
- Palpate dorsalis pedis pulses (P485)
