Intro to Instruments

Question 1

6 positions of physical examination

Answer 1

Sitting, standing, prone, supine, left lateral recumbent, right lateral recumbent

Question 2

Inspection

Answer 2

assess appearance of age, posture, mobility asymmetry, color changes

Question 3

Auscultation

Answer 3

With a stethoscope. Listen to lungs, heart, GI, vascular sounds.

Question 4

Percussion

Answer 4

Performed with hands.

1. Flatten fingers over thorax/abdomen
2. Strike distal knuckle with 3rd finger to elicit sound.
3. Note the sound difference when percussing over hollow organ v. bone.
4. Dull sound = fluid, Flat sound = solid, Tympanic sound = air.

Question 5

Palpation

Answer 5

Perform with hands. Superficial and deep palpation.

Question 6

Goals of Osteopathic Structural Exam (OSE)

Answer 6

1. Integrates information about the musculoskeletal system even when dealing with non-musculoskeletal complaints.
2. Recall that the body is a unit and possesses self-regulatory mechanisms and that structure and function are reciprocally interrelated.
3. Rational therapy is based upon an understanding of body unity, self-regulatory mechanism and inter-relationship of structure and function.

Question 7

Opthalmoscope

Answer 7

Used in eye exams, specifically to examine the fundus, retina, posterior chamber, direct and consensual pupillary reflex and red reflex.

Question 8

Snellen Eye Chart

Answer 8

Used to test visual acuity. 20/20 is normal. 20/40 means patient sees something at 20 feet that a healthy person can see at 40 feet.

Held at ~14 inches from the eyes. Test with the patient opening both eyes, then one eye covered at a time.

Question 9

Otoscope

Answer 9

Used for ear and oropharyngeal examination.

To examine the ears: Grasp the auricle. For children >12 months or adult, pull up, out and back. For children <12 months, pull down, out, and back.

To examine the oropharyngeal region: use a tongue depressor. To raise the soft palate, have patient say “AHH”.

Question 10

Tuning Fork

Answer 10

Air conduction: lasts longer. Hold fork at external auditory canals.

Bone conduction: lasts less than air conduction. Hold handle at mastoid process posterior to the ear.

Vibratory sense: Place handle on patella and compare duration bilaterally.

Question 11

Reflex Hammer

Answer 11

Used to elicit Deep Tendon Reflex (DTR), involuntary response. Check and compare these bilaterally, with patient relaxed.

Patellar, Achilles, Biceps, Brachioradialis, and Triceps tendons.

Question 12

Stethoscope

Answer 12

Used to listen for breath sounds, heart and vascular sounds.

Diaphragm (larger circle) used for higher frequency sounds (breath and heart sounds).
Bell (smaller circle) used for lower frequency sounds (bruits).
Ear pieces should face forward in external auditory meatus.

Question 13

Blood pressure cuff/sphygmomanometer

Answer 13

Used to test blood pressure. There are multiple sizes of cuffs. The cuff chosen for the patient should be which the width of the bladder is ~40% of upper arm and the circumference should be ~80% of the length. Have the patient relax their arm. Stethoscope diaphragm should be placed on the brachial artery. Listen for the Korotkoff sounds to start (systolic) and end (diastolic).

Question 14

Universal Precautions

Answer 14

Hand washing before and after wearing gloves and entering and leaving the room. Gloves should be worn in the presence of blood or bodily fluids.

Question 15

Proper Glove Use Steps

Answer 15

To put on:

1. Wash and dry hands.
2. Put on gloves.

To remove:

1. Grab glove at the wrist.
2. Remove glove and hold it at open end.
3. Pull cuff over hand and encase gloves.
4. Dispose in proper container.
5. Wash hands.