Foundations Phase I- CAPE History and Physical Flashcards
Lower MSK- Inspect (Always)
Inspect: skin color, rashes, masses, swelling, gross deformities, alignment, symmetry, muscle hypertrophy/atrophy, fasciculations, and spasms
Lower MSK- Spine
Check alignment and symmetry [bend forward]. Palpate features. Spine ROM. Neck ROM. Deep tendon reflexes at knee and ankle. Perform straight leg raising test (sciatica).
Lower MSK- Hip
Palpate surface features: pubic tubercle, anterior superior iliac spines, greater trochanters, and ischial tuberosity. Hip ROM (pt supine- rotation, flexion, ad/ab, extension (standing).
Lower MSK- Knee
Palpate surface features: patella, patellar tendon, head of fibula, medial and lateral joint lines. Knee ROM. Drawer test for ACL and PCL. Lachman for ACL. Valgus and Varus for MCL and LCL. McMurray Test for menicus integrity.
Lower MSK- Foot
Palpate surface features- plantar fascia, medial and lateral malleoli, achilles, posterior and anterior and peroneal tendon, and toe extensors. ROM.
Upper MSK- Inpect
Inspect: color, swelling, rashes, masses. Observe for overall size, gross deformity, bony enlargement, alignment, contour, and symmetry.
Upper MSK- Shoulder
Palpate clavicle, AC joint, bursa, coracoid process, and deltoid insertion. ROM- with hands placed on shoulders. Neer’s Impingement Test (hand on scapula and raising hand. Supraspinatus (empty can test).
Upper MSK- Elbow
Palpate medial and lateral epicondyles, radial head, olecranon process, and olecranon bursa. ROM (f/e/s/p). Tenel’s Test for ulnar compression. Test for lateral epicondylitis: forced wrist extension, grip test.
Upper MSK- Hands and Wrist
Palpate radial and ulnar styloid process, thumb abductor tendons, and anatomical snuffbox. Wrist ROM. MIP, PIP, DIP flexion and extension. Finger abduction and adduction. Thumb opposition, flexion, extension, abduction, adduction. Form a fist. Tinels for median nerve and Phalens (wrist held in acute flexion).
Lungs
Assess: RR and breathing pattern.
Inspect: size, shape, and symmetry, use of accessory muscles, retractions, skin for cyanosis, nails for clubbing.
Palpations: sternal notch, sternal angle, costal sternal articulation of the second rib, thoracic muscles and skeleton, tactile fremitus (99 x4).
Percuss anterior, posterior, and diaphragmatic excursion.
Auscultate: Anterior chest, posterior chest, axillae, egophony and bronchophony.
Cardiovascular
Assess: HR and BP
Inspect and Palpate Extremities: capillary refill, cyanosis, edema, skin discoloration and abnormal hair growth.
Pulses: carotid, brachial, radial, femoral, popliteal, posterior tibial, dorsalis pedis.
Inspect and palpate precordium: costochondral joint tenderness, PMI, Lifts/ Heaves.
Auscultate with patient supine, and bell with tricuspid and apex, and apex again in left lateral decubitus, Pt sitting listen in tricuspid and apex.
Abdomen
Inspect: pt is supine. Color, lesions, scars, dilated veins, size, contour, symmetry, pt lift head for any bulges (hernia)
Ausculate for bowel sounds and bruits.
Percuss: 4 quadrants and liver span.
Palpate: light and deep, Murphys sign for gall bladder (take in deep breath)). McBurney’s. Rebound tenderness (Rovsing’s). Liver, spleen (x2, once laying on right side). Aortic pulsations.
Assess for pain: rebound tenderness and costovertebral tenderness.
Head and Scalp
Inspect- skull shape, symmetry, hair distribution, and texture, scalp for lesions.
Inspect: symmetry, deformity, skin, hair distribution, areas of swelling.
Palpate: cranial bones, frontal bones, maxillary sinus (thumbs pressed in on cheek bones). TMJ. Temporal arteries.
Neck
Inspect: trachea position, thyroid size.
Palpate: Masses, Isthmus and lobes of thyroid.
Lymph Nodes
Inspect and Palpate: occipital, postauricular, preauricular, submandibular, anterior cervical, posterior cervical, supraclavicular, infraclavicular.
Ears
Inspect: external ear alignment, symmetry, mastoid area and behind auricle.
Palpate: auricle and mastoid process.
Evaluate: whisper test, weber test (tuning fork on top of head), rinne test- mastoid process then in air.
Otoscope: auditory canal for redness, sweeling, discharge/cerumen, color. Tympanic membrane for color, landmarks, light reflex, and mobility.
Nose
Inspect symmetry, deviations, discharge, skin lesions. Inspect using otoscope: mucosa for color, masses, lesions, exudates, bleeding. Septum for color, masses, lesions, perforations, and deviations.
Mouth and Throat
Inspect: Lips, teeth, gums, mucous membranes, tongue, palate, tonsils, pharynx.
Palpate: teeth and gums, buccal mucosa.
