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PCM_MIDTERM 01 > Lecture 2: Introduction to Physical Exam and Instruments > Flashcards

Lecture 2: Introduction to Physical Exam and Instruments Flashcards

First Midterm

1
Q

When should you wear gloves?

A

Obvious Blood or body fluid

Patient presenting with diarrhea

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2
Q

When should you wash your hands (related to gloves?)

A

Before and after wearing gloves

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3
Q

What are the 5 steps of hand washing?

A
  1. Wet: wet hands with clean water and apply soap
  2. Lather: Rub hands together with soap
  3. Scrub: Wash hands for at least 20 seconds
  4. Rinse: Get rid of soap
  5. Dry
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4
Q

What are clinical scenarios in which you should wear clinical gloves?

A 
Office/Clinic
Hospital 
ER 
Scene of Accident 
Sporting Event 
Restaurant 
Any other situation where skills are put to work
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5
Q

When percussing different parts of the body, what type of sounds should you hear for fluid, solid, and air?

A

Fluid: dull sound
Solid: flat sound
Air: tympanic sound

Flatten fingers over thorax/abdomen and strike distal thrid finger kuckle to elict sound

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6
Q

What are some things you inspect about general appearance?

A

Level of Consciousness
Signs of Distress
Skin abnormalities (lesions, bruises, cuts, etc)

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7
Q

The bell of the stethoscope is used to hear what kind of sounds?

A

low pitched sounds (e.g. bruits)

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8
Q

The diaphragm of the stethoscope is used to hear what kind of sounds?

A

High pitched

e.g. Breath sounds and heart tones

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9
Q

When checking a child’s ear (>12 mo) with an otoscope, move the ear ___

A

Up and back

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10
Q

When checking a child’s ear (<12 mo) with an otoscope, move the ear ___

A

Down and back

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11
Q

The length of a blood pressure cuff’s bladder should be at least ____ of the upper arm

A

80% of the circumference

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12
Q

The width of a blood pressure cuff’s bladder should be at least ____

A

40% the length of the upper arm

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13
Q

The first knocking sound you hear when measuring blood pressure is the subject’s ______

A

Systolic pressure (Korotkoff sound)

Disappears at diastolic pressure

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14
Q

When can you get a falsely high BP?

A
  1. If cuff is too small
  2. If cuff is too large on a large arm
  3. Brachial artery is below heart
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15
Q

When can you get a falsely low BP?

A
  1. If cuff is too large on small arm

2. Brachial artery is above heart

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16
Q

What are locations to measure pulse?

A 
Radial A.
Dorsalis pedis A. 
Carotid A. 
Brachial A. 
Abdominal aorta 
Femoral A. 
Popliteal A.

-put pads of index and middle finger
dont use thumb

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17
Q

What are the 4 techniques of examination?

A

Inspection
Auscultation
Percussion
Palpation

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18
Q

Goals of an osteopathic structural exam

A

Integrates information about the musculoskeletal system even when dealing with non-musculoskeletal complaints

The body is a unit and possesses self regulatory mechanisms and structure and fxn are reciprocally interrelated

Rational therapy is based upon an understanding of body unity, self-regulatory mechanism and inter-relationship of structure and function

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19
Q

The opthalmascope is an example of a ____ instrument

A

Fundoscopic

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20
Q

What is one thing you should always do?

A

Compare bilaterally

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21
Q

What is palpation and what types are there?

A
  • Preformed with your hands

- superficial and deep

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22
Q

How should sthecoscope earpeices face?

A

should face foward in exteramal audtiory meatus

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23
Q

Name the four types of hand washing:

A
  • normal hand washing
  • antiseptic hand washing (wash with detergent containg antiseptic shit)
  • alcohol based hand rub: rubbing hands with alcohol containg prepration
  • surgical hand hygiene: using an alcohol based hand rub before operations by surgical personal
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24
Q

How do you apply and remove gloves

A
  • first wash hand or use hand sanitizer
  • then apply gloves
  • remove one glove and hold on to it
  • pull cuff over the hand and encase the glove
  • dispose in red bag
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25
Q

prone

A

on stomach

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26
Q

supine

A

on back

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27
Q

lateral recumbant

A

lie on ur left or right side

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28
Q

percuss

A

tap on

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29
Q

palpate

A

examine

30
Q

insepect

A

look at

31
Q

ascultate

A

listen to: heart, lungs gi, and vascular sounds

32
Q

Wrap the blood pressure cuff ___ above the ____.

A

1 inch above the anticubital fossa

-arrow of the cuff should be aligned with the brachial artery of the patient

33
Q

What should you record for BP?

A
  • RECORD pressure in both arms
  • differences
  • subjects position
  • which arm was used
  • what size of cuff was used
34
Q

How to use an opthalmoscope

A
  • identify the lens selector and select 0
  • turn on the light
  • have a patient pick a spot ofver your shoulder
  • hand on pts forehead
  • use your right hand and right eye to inspect their right eye
  • start 15 degrees laterally and move medially
35
Q

Half light

A

used if pupil is partially obstructed by lens with cateracts, half circle can be used to pass through the clear portion of the pupil to avoid light reflecting back

36
Q

red free

A

used to visualize the vessels and hemorrages by making a contrast –> retina will look b/w

37
Q

slit beam

A

used to examine the conture abmormalites of the cornea, lens and retina

38
Q

blue light

A

used with flurocesin yellow stain to oberve corneal abrasions and ulcers

39
Q

grid

A

used to make rough approximations of relitvie distances of retinal lesions

40
Q

For an otoscope what should you never do

A

never move through the cannal without looking into it. Ensure that you can see the path through the cannal.

41
Q

What two tests do a tuning fork do?

A

vibratory sense and hearing evaluation (air conduction and bone conduction). Does 2 neurological test (gross hearing for CN nerve and vibration sense.)

42
Q

Vibratory sense tuning fork test

A

place handle on patella, and compare l and r for duration

43
Q

air conduction

A
  • last longer than bone condution

- hold fork infront of external audatory meatus

44
Q

bone conduction

A

hold handle on boney area behind ear

45
Q

Common errors in BP monitoring

A
  • pt should aviod caffine, smoking and excercise 30 mins prior to measuring blood pressure
  • exam room should be quiet and warm
  • patient should sit quietly for 5 mins with feet on floor
  • arms should be free of clothing (no grafts, scars or lympadema)
  • heart should be in 4th intercostal space
46
Q

Auscultory gap

A

-period of dimineshed or absent kortokoff sounds during the manual measurment of blood pressure. Will cause underestimation of systolic BP and or over representation of diastolic BP.

47
Q

How to grade pulses

A

+3 - bounding
+2 - brisk, expected (nml)
+1 -diminished
0 -absent, unable to palpate

48
Q

Normal temp is

A

97.8-99 F

49
Q

rectal temp

A

.5-.7 degrees higher F than mouth (use glass or digital)

50
Q

Axillary temp

A

.3-.4 degrees lower than than taken by mouth (use glass or digital)

51
Q

Ear temp

A

normal, use a special thermoeter, reflects the body’s core

52
Q

Skin

A

special thermotere can measure the skin on forehead

53
Q

for pulse report what?

A
  • report per min
  • report if regular or irregular
  • \
54
Q

What is a normal pulse and normal RR

A
  • normal pulse 60-100 bpm

- normal RR: 14-20 BPM

55
Q

What is a direct pupillary light reflex?

A

when light shined in the eye –> same side (ipsilateral) pupil constricts

56
Q

What is conseual pupillary light reflex

A

when light shines in one eye –> conteralateral (opp side) pupil also constricts

57
Q

Swinging flash light test

A

in dim light, note the size of the pupils. Then swing a beam of light for 1-2 seconds into one pupil then the other. The illumatiated eye should constrict and the opp eye should aslo constrict.

58
Q

An opthalmoscope identifies what?

A

1) fundus, retina, posterior chamber, optic nerve
2) pupillary reflex (direct and consensual)
3) red reflex (which is the normal reflection of the retina).

59
Q

Snellen eye chart

A

assess visual acuity

  • 20/20 is nml
  • chart is heald 14 inches from eye
  • test with both eyes open and also one at a time
60
Q

20/40 vision

A

means that the test subject sees at 20 feet what a nml person sees at 40 feet

61
Q

How far should you insert the otoscope into the ear?

A

1/4 to 1/2 length of the speculum.

-identify canal, tympanic membrane, and reflected cone of light

62
Q

oropharyngeal exam

A

use tongue depressor for exam –> ask the patient to say AHH to raise the soft palate

  • indetify structures of the oral cavity.
63
Q

3 key steps for reflexes

A
  • relax pt
  • strike tendon quickly
  • obtain DTR bilaterally and compare speed and intensity
64
Q

patellar

A

L4 nerve root

65
Q

achillies

A

S1 NERVE root

66
Q

biceps

A

THUMB IN BETWEEN TENDON AND HAMMER

-c5 nerve root

67
Q

brachioradialis

A

c6 nerve root

68
Q

triceps

A

c7 nerve root

69
Q

scales for grading reflexes

A

0 - absent
1 -somewhat dimineshed
2- normal
3- brisker than average, possibly but not necessarly indctive of dz
4-very brisk, hyperactive with clonus (rythmic oscilations between flexion and extension)

70
Q

WHAT ARE THE 5 VITAL SIGNS?

A 
BP
PULSE
RR
TEMP
(PAIN)
71
Q

How do you get RR

A 
either:
look for chest rise and count
or 
listen while examining heart and lung with stheosocpe
-count for 30 seconds and multiply by 2
72
Q

How do you take BP

A

arm is at the level of their hear
put cuff on and make sure its the right size and make sure the cuff is aligned with the brachial atery (arrow)
then put the diaphram at the brachial artery

PCM_MIDTERM 01 (13 decks)

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