Intro to Physical Exam and Instruments Flashcards
What is a fundoscopic exam?
eye exam looking at retina
When do you use the medium light on your ophthalmoscope?
in a dark, non-dilated pupil
what must you include when documenting an allergy?
The reaction
What is a useful mnemonic for spirituality and religion questions?
FICA
faith and belief
importance
community
address in care
How long should you scrub your hands when washing them?
at least 20 seconds
What is low-risk drinking for men?
no more than 4 drinks on a single day and no more than 14 drinks per week
What are the CAGE questions?
Has anyone ever suggested you Cut back?
Are you ever Annoyed when people talk about your drinking?
Do you ever feel Guilty about your drinking?
Do you ever need a drink in the morning to steady your nerves (an Eye opener)?
When checking the ear of a child > 12 months or an adult, how do you pull the ear back?
hold otoscope in same hand as ear you are viewing and use free hand to pull ear up and back
For women and those over 65, what is low-risk drinking?
no more than 3 drinks on any single day and no more than 7 drinks per week
What is the CAGE questionnaire useful for?
to screen pts who drink more than one drink daily OR who drink a lot on the weekends
can open door to conversation about getting help
How should you angle the tip of the otoscope when performing an exam?
When should you stop?
slightly toward the pt’s nose to follow ear canal
Stop at any sign of increased pain
In a child <12 months, how do you pull the ear back during an ear exam?
down and back
How long do you measure a regular pulse?
How long do you measure an irregular pulse?
30 seconds –> multiply number by 2
full 60 seconds
What are the 5 ways you can measure temperature?
orally
rectally (0.5-0.7 degrees higher than mouth)
axillary (usually 0.3-0.4 degrees lower than mouth)
ear
skin
How is bp written?
systolic/diastolic
What are the 3 types of sphygmomanometers used to measure bp?
What is the gold standard of reading bp?
mercury, aneroid, and digital
gold std = auscultation
If bp is elevated, what should you do?
measure 2 additional times, waiting a few minutes btw measurements
What do you ask a pt to do when examining their eyes with an ophthalmoscope? Where do you put your hand?
look over your shoulder - pick a spot Put your hand on pt’s forehead
What can cause falsely high bp?
brachial artery below heart
cuff too small/narrow
cuff too large/wide on a large arm
What is the 5 step approach to pt-centered interviewing?
- Set the stage for the interview
- Elicit chief complaint and set agenda for visit
- Open the HPI
- Continue pt-centered HPI
- Transition to the clinician-centered process
When do you use the bell of a stethoscope?
low pitched sounds (bruits)
What are the 5 parts of a physical exam?
inspection auscultation palpation olfaction percussion
What do you set the lens selector to on your ophthalmoscope?
“o”
For men that have ever smoked at least 100 cigarettes in lifetime, what is recommended?
One-time screening for abdominal aortic aneurysm
What are the AUDIT-C questions and scoring?
How often do you have a drink containing alcohol?
How many drinks containing alcohol do you have on a typical day when you are drinking?
How often do you have six or more drinks on one occasion?
Score: max is 12, greater than or equal to 4 = above recommended levels for men; above 2 = above recommended levels for women
When do you use the diaphragm of a stethoscope?
for high-pitched sounds (breath sounds and hear tones)
Where is the arm supposed to be when measuring bp?
at heart level
In what case is lung cancer screening recommended?
annual screening w/ low-dose computed tomography in adults aged 55-80 who have 30 pack-year smoking history and currently smoke or have quit within the past 15 yrs
What is the accronym to remember social history?
FEDTACOS
food
exercise
drugs
tobacco
alcohol
caffeine
occupation
spirituality and sexual relationships
Among the 7% of women who reported same-sex sexual relationship, what percent still identify as heterosexual?
50%
What is the gold standard technique for hand hygiene? When is the other technique preferred?
hand rubbing with an alcohol-based hand rub washing with soap and water - when visibly dirty; after using toilet; when exposed to potential spore-forming pathogens is suspected
What is the metal part of the stethoscope attached to the eartips called?
biaural spring
What is the ausculatory gap?
What is its clinical significance?
period of diminished/ absent korotkoff sounds during measurement of bp
can get confused by this and underestimate systolic or overestimate diastolic
What are the 5Ps of the sexual history?
Partners
Practices
Prevention of Pregnancy
Protection from STIs
Past History of STIs
What is an ophthalmoscope used for?
to visualize inner aspect of eye - retina, vascular supply, optic nerve, etc.
What percentage of women who report same-sex sexual behavior have had/still have male sex partners?
50-97%
when do you use the half light on your ophthalmoscope?
if pupil is partially obstructed (cataracts) half circle can be used to pass light through only the clear portion to avoid reflection
What is the AUDIT questionairre useful for?
better sensitivity that CAGE
more questions, somewhat difficult to score
If you are looking at a pt’s right eye, which of your eyes do you use to look through the ophthalmoscope?
your right eye - use the same eye to examine the pt’s eye
Who and what should you include in family history?
first degree relatives
things that run in the family
When should you wear gloves?
if there is obvious blood or body fluid (wash hands before and after wearing gloves)
According to the KCU SOAP note template, how do you start your note?
with the chief complaint
What is normal temperature?
97.8-99 degrees F
What is the pneumoic on how to be empathetic in a pt encounter?
NURSE:
name
understand
respect
support
explore
When do you use the small light on your ophthalmoscope?
when the pupil is very constricted; well-lit room w/ no dilator used
How many times do people try to quit smoking before success?
7-8 times
When do you use the large light on your ophthalmoscope?
when you use mydriatic eye drops to dilate
What is percussion?
taping over an area to differentiate air, fluid or solid underneath surface
What are the 7 key active listening skills?
- be attentive
- ask open-ended questions
- Ask probing questions
- Request clarification
- Paraphrase
- Be attuned to and reflect feelings
- Summarize
What can cause falsely low bp
brachial artery above heart
cuff too large/wide on a small arm
How high should you inflate the bp cuff?
180 mmHg or roughly 30 higher than estimated systolic pressure
According to the Joint Commission, what % of accidental deaths and injuries and linked to communication failures?
70%
what percentage of patients walk out of a doctor’s office not knowing what they were told or what they are supposed to do?
50%
