Lecture 1 - Physical Exam

Question 1

4 diagnostic techniques

Answer 1

1. inspection
2. palpation
3. percussion
4. auscultation

Question 2

Explain inspection part of physical exam and give general phases you can use

Answer 2

Information gathered from observation - hearing, smelling, vision.
“I am inspecting for general state of health…”
“You appear to be in no acute distress…”
“You appear well-nourished and well-developed…”

Question 3

Explain palpation part of physical exam and give general phrases you can use

Answer 3

Use pads of fingers in systemic sweeping motions.
“Skin turgor and temperature appear normal”
“I am palpating your abdomen for tenderness or rigidity”
“I am going to palpate your buccal mucosa by placing a gloved finger inside your…”

Question 4

Explain percussion part of physical exam and give general phrases you can use

Answer 4

Tapping a surface with your fingers and using the sound to determine density of underlying anatomy.
May be hyper- or hyporesonant
“I’m percussing the lung fields for resonance”
“I’m percussing the liver for size”

Question 5

Explain auscultation part of physical exam and give general phrases you can use

Answer 5

Listening to body functions.
Requires understanding of the stethoscope.
Never listen over clothing (unless over sports bra in practice lab)
“I’m auscultating for heart sounds…”

Question 6

Classic components of exam: heart, lungs, and abdomen

Answer 6

Inspection, palpation, percussion, and auscultation. Special tests. Changes during abdomen exam.

Question 7

Extremities

Answer 7

Inspection, palpation, range of motion/strength, neurologic, vascular, specialized tests

Question 8

Extremities - vascular tests

Answer 8

Capillary refill time, pulses

Question 9

What are standard vital signs?

Answer 9

Height, weight, temperature, pulse, respiration, blood pressure

Question 10

4 ways to measure temperature

Answer 10

Rectal - higher than oral
Oral - affected by beverages, respiratory rate
Axillary - lower than oral
Infrared measurement

Question 11

Infrared measurement methods

Answer 11

Tympanic membrane - close to core temp but accuracy varies
Temporal - affected by skin and vascular changes
NOT used for clinical decision making

Question 12

Pulse

Answer 12

Radial - count all the way to 60 seconds if any irregularity; otherwise, 15 sec and multiply by 4
Apical - peripheral pulse is difficult to obtain or questionable
Brachial - may be used - esp with children
Note quality of pulse (strength, regularity)

Question 13

Respiration

Answer 13

Count 15-30 seconds - esp with children
Keep fingers on radial pulse but watch chest rise and fall
In children - may be helpful to place hand on abdomen
Note effort of respiration with count

Question 14

Blood pressure

Answer 14

Measured by sphymomanometer
Measured in mmHg
Systolic = peak pressure
Diastolic = trough pressure
Difference between systolic and diastolic pressures is known as "pulse pressures"
Note position of patient

Question 15

To take blood pressure

Answer 15

Locate brachial artery
Center bladder of cuff over brachial artery about 2 cm over antecubital crease
Arm should be relaxed and flexed at elbow; arm supported
Position arm so brachial artery is at level of heart