Intro to Physical Diagnosis Lecture

Question 1

Physical exam definition

Answer 1

Process by which the clinician investigates the body of a patient for signs of disease

Question 2

Physical exam sense utilization

Answer 2

Sight, hearing, touch, and smell

Question 3

History and physical exam relationship

Answer 3

A thorough history will help alert to pertinent exam findings and type of exam to perform, whether obtained from patient or family or chart

Question 4

Exam room environment

Answer 4

Privacy, good lighting, tangential light (ability to focus light)

Question 5

Complete exam

Answer 5

Head to toe exam, given when first meeting a patient or very vague issues

Question 6

Focused exam

Answer 6

Problem oriented exam, given when established patient or very specific issues

Question 7

Always approach patients from the…

Answer 7

right

Question 8

How to observe precautions during a physical

Answer 8

• Handwashing before and after exam

- Appropriate PPE when necessary

Question 9

Insufflator bulb

Answer 9

Allows to squirt small amount of air to test tympanic membrane mobility

Question 10

128 Hz tuning fork

Answer 10

Larger fork that tests for vibratory sensation

Question 11

512 Hz tuning fork

Answer 11

Smaller tuning fork to allow for Weber & Renne’ hearing test

Question 12

Pan-optic opthalmoscope

Answer 12

Gives a more magnified image of the retina

Question 13

Diaphragm of stethescope

Answer 13

Large dial on end of stethoscope that listens to high pitched sounds

Question 14

Bell of stethoscope

Answer 14

Small dial on end of stethoscope that listens to low pitched sounds

Question 15

Proper sequence of examination (IPPA)

Answer 15

Inspection
Palpation
Percussion
Ascultation

Question 16

Exception to IPPA rule

Answer 16

Abdomen:
Inspection
Ascultation
Percussion
Palpation

Question 17

Inspection

Answer 17

Visual, olfactory, and auditory inspection of patient assessing size, position, symmetry, etc

Question 18

Palpation

Answer 18

Use of touch to gather information (therapeutic as well as diagnostic), various areas of hands better than others for specific sensations

Question 19

Pads of fingers

Answer 19

Useful for discriminating pulsation better than tip

Question 20

Ulnar surface

Answer 20

Feel vibratory sensations

Question 21

Dorsal of hand

Answer 21

Feel temperature

Question 22

Indirect percussion

Answer 22

Often used in medicine through striking middle finger at middle phalanx with nail or distal phalanx of other hand by swinging wrist

Question 23

Thorax percussion tones and what they indicate

Answer 23

Resonance - normal lung

Hypersonant - empysematous lung

Question 24

Abdomen percussion tones and what they indicate

Answer 24

Tympany - gastric bubble
Dull sound - liver
Flat sound - muscle

Question 25

Ascultation environment and technique

Answer 25

- Skin contact required - Quiet without background noise - Measuring intensity, duration, pitch, quality - Last step except for in the case of abdominal exam

Question 26

Sequence of exam steps

Answer 26

``` General assessment Vital signs HEENT Neck Thorax and lungs Breasts Cardiac Vascular Abdomen GU Rectal Extremities Musculoskeletal Skin Neuro ```

Question 27

General assessment

Answer 27

-Performed informally, getting global impression of patient's health status within seconds of entering room, looking for gestalt or most obvious features

Question 28

Examples of visual general assessment cues

Answer 28

abdominal fat, moon face, apparent state of health, level of consciousness, acromegaly, labored breathing, wincing, poor eye contact, nutrition, skin color and obvious lesions, dress, grooming/personal hygeine

Question 29

Example of olfactory general assessment cues

Answer 29

Urine smells, alcohol, tobacco, acetone (ketoacidosis), body odor, decomposing tissue, fruit smell

Question 30

Example of extracorporal general assessment cues

Answer 30

Clothing, reading materials, familial support