Introduction to Patient Evaluation part 2

Question 1

Cardinal Techniques of Examination

Answer 1

inspection
auscultation (listening)
palpation (touching)
percussion (tapping)

Question 2

Inspection

Answer 2

process of observation - use your eyes and nose
learn as much as you can about a patient this way
-weight, skin color, mobility, demeanor, etc.
can be done throughout entire H&P
use appropriate lighting

Question 3

Palpation

Answer 3

using the hands and fingers to gather info through our sense of touch
palmar surfaces of fingers and hands are more sensitive than tips
-determine position, texture, size, consistency, masses, fluid, and crepitus
ulnar surfaces for vibration and dorsal surfaces for temp. estimation
can be light (1 cm) or deep (4 cm)
-always start with light to not cause tenderness
always wear gloves!

Question 4

Crepitus

Answer 4

grinding sound (like broken bones) 
sounds like velcro

Question 5

Fluctuant

Answer 5

like a balloon, touch one end and the other end moves

masses that are fluctuant usually need to be drained

Question 6

“laying of the hands”

Answer 6

therapeutic touch where we begin our physical invasion of the patient’s body

Question 7

Percussion

Answer 7

involves striking on object against another, thus producing vibration and sound
use finger as hammer
sounds waves are heard as percussion tones (called RESONANCE) arising 4-6 cm deep

Question 8

Sound Classifications

Answer 8

tympany
hyperresonance 
resonance - usually considered normal (depends on part of the body) 
dullness 
flatness - sound dies with the tap

Question 9

Auscultation

Answer 9

involves listening for sounds produced by the body
utilizes stethoscope
keep environment quiet and undistracting; close eyes if needed
listen for sound characteristics: intensity, pitch, duration, quality
reserve this technique for last
-gives patient time to relax

Question 10

General Appearance

Answer 10

apparent state of health (ill, frail, etc.)
level of consciousness
sign of distress (cardiac or respiratory, pain, anxiety/depression)
skin color and obvious lesions
dress, grooming, and personal hygiene (weather appropriate, clean)
facial expression (eye contact)
odors of body and breath
posture, gait, motor activity
height and weight (if obese, how is fat distributed? BMI?)

Question 11

Health Promotion and Counseling

Answer 11

clinicians educate patients
early detections of suspicious moles
protective measures for skin
hazards of excessive sun exposure
skin cancers are most common cancers in US
-most prevalent on hands, neck, and head

Question 12

Basal Cell Carcinoma

Answer 12

comprises 80% of skin cancers
seen frequently just below the eyes (where bags show)
shiny and translucent
grow slowly and rarely metastasize

Question 13

Squamous Cell Carcinoma

Answer 13

comprises 16% of skin cancers
Lips!
crusted, scaly, and ulcerated
can metastasize

Question 14

Melanoma

Answer 14

comprises 4% of skin cancers
rapidly increasing in frequency
spread rapidly

Question 15

HARMM

Answer 15

risk factors for melanoma...
History of previous melanoma 
Age over 50 
Regular dermatologist absent 
Mole changing 
Male gender

Question 16

Additional Risk Factors for Melanoma

Answer 16

50 or more common (noncancerous) moles
1-4 or more of atypical or unusual moles
-especially if dysplastic (precancerous)
red or light hair
actinic lentigines: macular brown or tan spots (usually on sun exposed areas)
heavy sun exposure (especially severe childhood sunburns)
light eye or skin color (especially freckles/burns easily)
family history of melanoma

Question 17

ABCDE Screening Moles for Possible Melanoma

Answer 17

A for asymmetry
B for irregular borders (especially ragged, notched, or blurred)
C for variation or change in color, especially blue or black
D for diameter 6 mm or greater or different from other moles, especially changing, itching, or bleeding
E for elevation or enlargement

Question 18

Intraoral Examination

Answer 18

dental examination

oral mucosal examination

Question 19

Extraoral Examination

Answer 19

facial inspection examination 
head and neck evaluation 
     -lymph node examination 
     -salivary gland examination 
     -thyroid examination 
temporomandibular examination 
cranial nerve examination 
     -often associated with unknown pain (source is not a tooth)