Intro to physical exam Flashcards
Describe the use of universal precautions
a: protect patient and provider from spread of disease
b: gloves used in presence of blood/body fluids
c: wash hands before and after wearing gloves
Proper glove use
wash and dry hands
Remove glove and hold it at open end
Pull cuff over hand and encase the gloves
Dispose in proper container (red disposal if contaminated with body fluid or debris)
What are the 4 techniques of examination (in order)?
Inspection, auscultation, percussion, palpation
Describe inspection
asses appearance of age, posture, mobility, asymmetry, color changes
Describe auscultation
performed with stethoscope–> listen to lung, heart, GI
Describe percussion
Preformed with hands:
flatten fingers over thorax/abdomen
Strike distal knuckle with 3rd finger
Note the sound difference when percussing over hollow organ vs bone.
dull= fluid Flat= solid Tympanic= air
Describe palpation
done with hands. superficial and deep
Principles of osteopathic philosophy
- the body is a unit
- body is capable of self-regulation
- structure and function are reciprocally interrelated
- rational treatment is based upon an understanding of the basic principles of the previous principles/
Diaphragm
Larger circle.
Used for higher frequency (ex breath and heart sounds)
Bell
Smaller circle
Used for low frequency sounds (ex bruits)
What width should the BP cuff be?
40% of the circumference of the upper arm
What length should the BP cuff be?
80% of the circumference of the upper arm
What happens if the BP cuff is too small (too narrow)
BP reading will be high
What happens if the BP cuff is too large (too wide)
BP will read low on a small arm, high on a large arm
Where should you place the stethoscope to measure BP?
diaphragm goes just below the cuff over the brachial artery
Systolic number
first Korotkoff sound
What is a normal heart rate?
between 60-100 beats
What is a normal breaths per min?
14-20
How to do eye examination
hold ophthalmoscope in right hand to examine patient’s right eye. Move light lateral (15 degrees out) to medial until over iris then move toward patient.
Identify pupillary light reflex.
Direct pupillary light reflex
when light shined in the eye, the ipsilateral (same side) pupil constricts
Consensual pupillary light reflex
When light shines on one eye opposite side pupil also constricts
Swinging flashlight test
In dim light, note the size of the pupils. swing beam of light for 1-2 seconds into one pupil and then the other. The illuminated eye should constrict and the opposite eye should constrict.
What does 20/40 vision mean
The patient sees at 20 feet what a normal person sees at 40 feet.
How far away should you hold the snellen eye chart?
14 inches from eyes
Ear exam on child vs adult
Children (less than 12 months): pull down, out and back
Adult: pull up, out and back
Air conduction
lasts longer, hold fork at external auditory meatus
Bone conduction
Less than air conduction, hold handle at mastoid process posterior to the ear
Vibratory sense
Place handle on patella and compare left and right for duration
What nerve root is the patellar reflex?
L4
What nerve root is the achilles reflex?
S1
What nerve root is the biceps reflex?
C5
What nerve root is the brachioradialis reflex?
C6
what nerve root is the triceps reflex?
C7
Scale for grading reflexes
0-4
0= absent 1= diminished 2=normal 3=brisker than average 4= hyperactive
Name the 6 positions for a physical examination
sitting, standing, supine, prone, right lateral recumbent, left lateral recumbent
