Comprehensive Physical Exam

Question 1

Why record Date and Time of History

Answer 1

In urgent, emergent, or hospital could matter for patient care; liability reasons (personal, legal)

Question 2

Identifying Data

Answer 2

age, gender, marital status, and occupation

Question 3

Source of history or referral

Answer 3

patient, a family member or

friend, an officer, a consultant, or the clinical record (source dictates reliability)

Question 4

Reliability of history

Answer 4

if relevant, “patient is vague when

describing symptoms”

Question 5

Chief Complaint(s)

Answer 5

quote the patient—–no specific

complaints, report their reason for the visit

Question 6

Present Illness

Answer 6

complete, clear, and chronologic

description of the problems prompting the patient’s visit

Question 7

Present Illness: principal symptom

Answer 7

(1) location; (2) quality; (3) quantity or
severity; (4) timing, including onset, duration, and frequency; (5) the setting in which it occurs; (6) factors that have aggravated or relieved the symptom;and (7) associated manifestations.

Question 8

Present Illness: Pertaining details

Answer 8

Example: Risk factors - Coronary artery disease can be associated with chest pain; effect on patients life; each symptom gets its own paragraph; Medications (name, dose, route, freq); allergies; tobacco; alc & drug

Question 9

Past history

Answer 9

Childhood Illnesses; Adult Illnesses: Health Maintenance—be specific about every vaccine and screening test (get yes or no for each)

Question 10

Family History

Answer 10

outline the age and health, or age and cause of death, of each immediate relative including parents, grandparents, siblings, children, and grandchildren—-hypertension, coronary artery disease, elevated cholesterol levels, stroke, diabetes, thyroid or renal disease, arthritis, tuberculosis, asthma or lung disease, headache, seizure disorder, mental illness, suicide, substance abuse, and allergies, as well as symptoms reported by the patient. Ask about any history of breast, ovarian, colon, or prostate cancer.

Question 11

Personal and Social History

Answer 11

Personality and interests, sources of support, coping style, strengths, and concerns. Expanded Personal and Social history personalizes your relationship with the patient and builds rapport.

Question 12

Review of Systems

Answer 12

Start with a fairly general question as you address each of the different systems,
then shift to more specific questions about systems that may be of concern—-“How about your lungs and breathing?”—-major health events discovered during the Review of Systems should be moved to the Present Illness or Past History

Question 13

Approach to the Patient

Answer 13

identify yourself as a student–calm and organized–, avoid interpreting your findings

Question 14

Adjust the Environment

Answer 14

adjust bed, patient, good lighting( Tangential lighting), quiet when possible, temp. when possible

Question 15

Check Your Equipment

Answer 15

Peads equipment, batteries, general

Question 16

Make the Patient Comfortable

Answer 16

Patient Privacy and Comfort, Draping the Patient, Courteous Clear Instructions, Keeping the Patient Informed

Question 17

Observe Standard and Universal Precautions (Standard and MRSA precautions)

Answer 17

all blood, body fluids, secretions, excretions (except sweat), nonintact skin, and mucous membranes may contain transmissible infectious agents

Question 18

Hand Washing

Answer 18

1. a. before touching a patient, even if gloves are worn;
   b. before exiting the patient’s care area after touching the patient or the
   patient’s immediate environment;
   c. after contact with blood, body fluids, or excretions, or wound dressings;
   d. prior to performing an aseptic task (e.g., placing an intravenous drip, preparing an injection);
   e. if hands are moving from a contaminated-body site to a clean-body site
   during patient care; and
   f. after glove removal.
2. Use soap and water when hands are visibly soiled (e.g., blood, body fluids), or after caring for patients with known or suspected infectious diarrhea
   (e. g., Clostridium difficile, norovirus).

Question 19

Universal precautions

Answer 19

prevent parenteral, mucous membrane, and noncontact exposures of health care
workers to bloodborne pathogens

Question 20

Potentially Infectious Body Fluids

Answer 20

visible blood, semen, and
vaginal secretions and cerebrospinal, synovial, pleural, peritoneal, pericardial,
and amniotic fluids

Question 21

The Cardinal Techniques of Examination

Answer 21

Inspection, Palpation, Percussion, Auscultation

Question 22

Sequence of Examination

Answer 22

“head to toe”:

Maximize the patient’s comfort—Avoid unnecessary changes in position—Enhance clinical efficiency

Question 23

Examining from the Patient’s Right Side

Answer 23

jugular venous pressure are more reliable, the palpating hand rests more
comfortably on the apical impulse, the right kidney is more frequently palpable
than the left, and examining tables are frequently positioned to accommodate a
right-handed approach.

Question 24

Examining the Patient at Bedrest

Answer 24

changes sequence of examination—head, neck, and anterior chest with the patient lying supine—roll the patient onto each side to listen to the lungs, examine the back, and
inspect the skin—finish supine

Question 25

The Physical Examination-General Survey

Answer 25

health, height, build,
and sexual development, obtain the patient’s height and weight, posture and gait, hygiene, odors, facial expression and affect when reacting to environment

Question 26

The Physical Examination-Vital Signs

Answer 26

blood pressure, pulse and respiratory

rate, if indicated body temperature

Question 27

The Physical Examination-Skin

Answer 27

moisture

or dryness and temperature, lesions, noting their location, distribution, arrangement, type, and color, hair and nails

Question 28

The Physical Exam-Head, Eyes, Ears, Nose, Throat (HEENT)

Answer 28

Head: Examine the hair, scalp,skull, and face;
Eyes: Check visual acuity and screen the visual fields.;
Ears: Inspect
the auricles, canals, and drums. Check auditory acuity
Nose and sinuses; external nose, light and a nasal speculum, inspect the nasal mucosa, septum, and turbinates;
Throat (or mouth and pharynx): Inspect the lips, oral mucosa, gums, teeth, tongue, palate, tonsils, and pharynx

Question 29

The Physical Exam-Neck

Answer 29

Inspect and palpate: cervical lymph nodes, deviation of the trachea, sound and effort of the patient’s breathing, thyroid gland

Question 30

The Physical Exam-Back

Answer 30

Inspect and palpate the spine and muscles of the back, shoulder symetry

Question 31

The Physical Exam-Posterior Thorax and Lungs

Answer 31

Inspect, palpate, and percuss the chest, level of diaphragmatic dullness on each side, listen to the breath sounds, if indicated, listen to the transmitted voice sounds

Question 32

The Physical Exam-Breasts, Axillae, and Epitrochlear Nodes

Answer 32

inspect the breasts

with her arms relaxed, then elevated, and then with her hands pressed on her hips. Both sexes axillae nodes

Question 33

A Note on the Musculoskeletal System

Answer 33

with the patient still sitting, examine the hands, arms, shoulders, neck, and temporomandibular joints. Inspect and palpate the joints and check their range of motion

Question 34

The Physical Exam-Anterior Thorax and Lungs

Answer 34

Inspect, palpate, and percuss the chest. Listen

to the breath sounds. If indicated transmitted voice sounds

Question 35

The Physical Exam-Cardiovascular System

Answer 35

jugular venous pulsations and measure the jugular venous pressure, palpate carotid pulsations. Listen for carotid bruits. Inspect and palpate the precordium. Note the location, diameter, amplitude, and
duration of the apical impulse. Listen at each auscultatory area with the diaphragm of the stethoscope. Listen at the apex and the lower sternal border with
the bell. Listen for the first and second heart sounds and for physiologic splitting
of the second heart sound. Listen for any abnormal heart sounds or murmurs.

Question 36

The Physical Exam-Abdomen

Answer 36

Inspect, auscultate, and percuss the abdomen. Palpate lightly, then
deeply. Assess the liver and spleen by percussion and then palpation. Try to palpate the kidneys. Palpate the aorta and its pulsations.

Question 37

The Physical Exam-Lower Extremities

Answer 37

Three systems while the
patient is still supine:
Peripheral vascular system- Palpate the femoral pulses, lower extremity edema, discoloration, ulcers, or pitting edema
Musculoskeletal system-deformities or enlarged joints. If indicated,
palpate the joints, check their range of motion, and perform any necessary
maneuvers.
Nervous system-
lower extremity muscle bulk, tone, and strength; also
assess sensation and reflexes. Observe any abnormal movements.

Question 38

With the patient standing

Answer 38

-Peripheral vascular system. Inspect for varicose veins.
-Musculoskeletal system. Examine the alignment of the spine and its range of
motion, the alignment of the legs, and the feet.
-Genitalia and hernias in men. Examine the penis and scrotal contents and
check for hernias.
-Nervous system. Observe the patient’s gait and ability to walk heel-to-toe,
walk on the toes, walk on the heels, hop in place, and do shallow knee
bends. Do a Romberg test and check for pronator drift.

Question 39

Nervous System

Answer 39

Mental Status, Cranial Nerves, Motor System, Sensory System, Reflexes

Question 40

Additional Examinations

Answer 40

rectal and genital