Lecture 1: Intro to Physical Exam and Instruments

Question 1

What are Universal Precautions?

Answer 1

• standards set by CDC to protect patient/provider from spread of infection
• wear gloves if blood, bodily fluids, or diarrhea present
• wash hands before AND after wearing gloves

Question 2

What are the 4 types of Hand Hygiene based on CDC guidelines? (HAAS)

Answer 2

1. Handwashing - plain soap and water
2. Antiseptic Handwashing - contains antiseptic agent
3. Alcohol-based handrub - rub hands w/alcohol-containing prep.
4. Surgical hand hygiene/antisepsis - handwashing/alcohol-based handrub BEFORE operation by surgical personnel

Question 3

What are the 5 steps of Hand Washing?

Answer 3

• Wet, Lather, Scrub, Rinse, Dry

- scrub hands for at least 20 seconds

Question 4

Hand Rubbing vs Handwashing

Answer 4

Rubbing - gold standard technique for day-to-day occasions; recommended day to day decontamination

Handwashing (soap/water) - when hands are visibly dirty or soiled w/blood or other bodily fluids; after using toilet; exposure to spore-forming pathogens

Question 5

What are Red Bags used for?

Answer 5

for supplies contaminated with bodily fluid or potentially infectious debris

Question 6

5 steps of the Physical Exam (IAPOP)

Answer 6

1. Inspection (look)
2. Auscultation (listen)
3. Palpation (touch)
4. Olfaction (smell)
5. Percussion (tap to differentiate air, solid, fluid)

ALWAYS COMPARE BILATERALLY IF POSSIBLE

Question 7

What is an ophthalmoscope?

Answer 7

• helps visualize inner aspect of eye

- ask patient to look over shoulder (pick a spot)

Question 8

Ophthalmoscope settings (5 settings)

Answer 8

Half Light - pass through clear portion of eye w/cataract

Red Free - visualize vessels and hemorrhages (black and white retina)

Slit Beam - contour abnormalities of cornea, lens, retina

Blue Light - observe corneal abrasions and ulcers

Grid - rough approx. of relative distance of retinal lesion

Question 9

How should the ear be held using an otoscope while checking a child < 12 months vs > 12 months?

Answer 9

< 12 months: down and back

> 12 months: up and back

Question 10

What are the two tests that can be done with a tuning fork and what are their functions?

Answer 10

1. Hearing Eval: Air (longer) and Bone Conduction
2. Vibratory Sense: place on patella

Purpose: gross hearing of cranial nerves and vibration sense

Question 11

Reflex Hammer and Deep Tendon Reflexes

Answer 11

• used to elicit tendon reflex

- note speed/intensity and compare bilaterally

Question 12

Reflex Grading Scale (0-4)

Answer 12

4: very brisk/hyperactive
3: brisker than average, not necessarily disease caused
2: normal
1: low normal, somewhat diminished
0: reflex absent

Question 13

Stethoscope Bell vs Diaphragm

Answer 13

Bell = low pitched sounds (bruits)

Diaphragm = high pitched sounds

Question 14

Blood Pressure Cuff Selection

Answer 14

• length should be at least 80% of the circumference of the upper arm
• width should be at least 40% of the length of the upper arm
• wrap around 1 inch above cubital fossa

Question 15

Taking Blood Pressure

Answer 15

1. inflate to 180 mmHg or 30 mmHg higher than estimated systolic BP
2. 1st sound = Korotkoff (systolic), when knocking stops = diastolic pressure
3. if subjects pressure is elevated, measure two additional times

Question 16

What level is the heart at?

Answer 16

4th intercostal space

Question 17

Common Errors in BP monitoring (False High and Low)

Answer 17

False High: brachial A below heart, cuff to narrow, cuff to large on large arm

False Low: brachial A above heart, cuff to large on small arm

• avoid smoking, caffeine, exercise > 30 min prior; patient sits quiet for 5 min with feet on floor

Question 18

What is the Ausculatory Gap?

Answer 18

period of diminished/absent Korotkoff sounds during manual measurement of blood pressure

• associated with arterial stiffness and atherosclerotic disease

Question 19

Pulse Locations (7) and scale

Answer 19

• Radial, Dorsalis Pedis, Carotid, Femoral, Politeal, Brachial Arteries and Abdominal Aorta

3: bounding
2: brisk, normal
1: diminished, weaker
0: none

Question 20

What is the normal temperature of the human body?

Answer 20

97.8-99 degrees Fahrenheit

Question 21

What is an Osteopathic Structural Exam (OSE) and what are you documenting?

Answer 21

• OSE integrates info about Musculoskeletal system even when dealing w/non-musculoskeletal compaints
• structure and function are reciprocally interrelated and rational therapy is based on the understanding of body unity, self-regulatory mechanisms, and interrelationship of structure and function
• Documentation: Tissue Texture Changes, Asymmetry, Range of Motion, Tenderness

Question 22

What is normal pulse and respiratory rate?

Answer 22

Pulse = 60-100 beats per minute

Respiratory = 14-20 breaths per minute