General PhysExam

Question 1

***General Survey (4 components)

Answer 1

Physical Appearance
Body Structure
Mobility
Behavior

Question 2

**Age appears Older –>

Answer 2

Appears older than stated age ETOH/Chronic illness

Question 3

**Physical Appearance:

Age, Sex, LOC, skin color, facial

Answer 3

**sex: Delayed puberty or precocious with ENDOCRINE DISORDER
**LOC: drowsy , lethargic, CONFUSED
Skin color: Pallor,cyanosis, jaundice, rashes,ERYTHEMA, Lesions, bruises

Question 4

*****Physical Appearance Acute distress:
Pain
Anxiety

Answer 4

Cardiorespiratory : SOB/labored, cough, wheezing,
Facial grimacing
-Anxious face, fidgety movements, cold, clammy, Palms

Question 5

***Body Structure Nutrition

What does _____obesity with ______ indicates_____

Answer 5

Cachectic, emaciated, simple obesity w/ even fat distribution
» Malnutrition, CA, DM, Chronic Infx., DEPRESSIOn
Truncal obesity w/ thin extremities
» Cushing’s Syndrome

Question 6

Body structure Posture

• Appropriate for age : Note the ____line

Answer 6

Note normal “plumb line” – Ear – Shoulder – Hip – Knee – Ankle

Question 7

• *Position
• ***Tripod—>
• ***Sitting straght
• **Curled up

Answer 7

• Sitting comfortably in chair, arms at side relaxed, facing
examiner
• Tripod – leaning forward arms braced on chair – COPD
• Sitting straight up, resists lying down – CHF
• Curled up – fetal position – ABD Pain

Question 8

**Arm span

Answer 8

** Arm span = height – Elongated arm span
» Marfan’s syndrome
• ↑ risk for Mitral Regurg. and/or Aortic Dissection

Question 9

**Gait abrnomal indicates

Answer 9

» Neuromuscular ds
» Cerebellar Ataxia (Etoh/barbiturates)
> Leg length discrepancy> 1”

Question 10

**» Leg Length Discrepancy

Answer 10

> 1”

Question 11

***» Marfan’s syndrome

Answer 11

• ↑ risk for Mitral Regurg. and/or Aortic Dissection

Question 12

***** ROM

normal Flexion ___ and Extension___

Answer 12

85% ; 70%

Question 13

***Examination techniques (4)

Answer 13

INSPECTION
PALPATION
PERCUSSION
AUSCULTATION

Question 14

Ball of hand (ulnar side)

Answer 14

vibration

Question 15

**Grasping (finger and thumb) – COPS

Answer 15

Consistency
OrganMASS
Position
SHAPE

Question 16

Dorsum of hands/fingers –

Answer 16

temperature

Question 17

**Palpation techniques
Start with ______
if ______palpation needed, use _______ rather than one long___________
• Avoid Deep palpation that could cause

Answer 17

• Start with Light palpation
• Deep palpation needed, use intermittent palpation , rather than one long continuous one.
• internal injury or pain

Question 18

*****Percussion
Involves ______method
Step 1. Place _______ of ________ on patient keeping_______
Step 2.

Answer 18

two hand
DISTAL INTERPHALANGEAL JOINT (DIP)
MIDDLE FINGER; Palm off the patient.
Tap DIP with tip of opposite finger middle finger.

Question 19

Percussion determines

Answer 19

Determines location, size, density of underlying organ

Question 20

Direct uses e hand – Indirect – most common

Answer 20

one hand
 two hands (most  common)

Question 21

Bone always sound

Answer 21

dull

Question 22

**Percussion Maps out ____ and ____of organ
**Signals _____ : ___, ____, or ____
**Detects what _________
***How deep does percussion penetrates?
**Deeper mass will______
Elicit pain if _____

Answer 22

Location and Size
Density – Air, Fluid or Solid
Where note changes at borders (ex. Liver edge)
Detects abnormal mass (if superficial) – Percussion penetrates about 5cm deep
• Deeper mass will not be detected
• Elicits Pain if underlying structure inflamed – Ex. sinus, kidney

Question 23

***Degree to which sound propagates is called

Answer 23

Resonance

Question 24

***Hyperresonant pitch; Ex

Flat High Bone, Muscle, Tumor

Answer 24

Lower; Emphysema

Question 25

***Tympanic pitch ; Ex

Answer 25

High Stomach, Intestine

Question 26

***Resonant pitch; Ex

Answer 26

Low ;Normal Lung

Question 27

***Dull Pitch : Ex

Answer 27

High ;Liver

Question 28

***Bell

Answer 28

low pitch sound, Extra heart sounds, murmurs

Question 29

***When auscultating

2 questions

Answer 29

Listen selectively, one thing at a time – What am I actually hearing? – What should I be hearing at this spot?

Question 30

***Use MCP for

Answer 30

Vibrations

Question 31

***Fingertips (LSPT)

Answer 31

Lumps
Swelling
Pulsations
Textures