Lecture I: The Physical Exam

Question 1

Develop a systematic approach to beginning the physical exam

Answer 1

1. reflect on your approach
2. Know task prior to entering the room
3. Wash hands in front of patient
4. Adjust noise and lighting
5. Ask to see if any part of the exam will make the patient uncomfortable
6. Give warnings and apologize but not too much
7. Give directions to resume normal state
8. Demonstrate maneuvers
9. Ask about any findings noted
10. Examine normal (right) side and compare
11. Explain portions of the exam
12. Interviewing skills: brief directions, summarizations, transitions, avoid medical jargon

Question 2

Explain why noise and lighting are important factors to control prior to beginning the physical exam

Answer 2

1. To see clearly
2. tangential-veins and tendons better
3. Perpendicular-light from above
4. Sets the mood of a professional environment

Question 3

Describe how to monitor for pain and comfort throughout the exam

Answer 3

1. Signs of discomfort
2. Give warnings
3. Directions to resume normal state
4. Demo
5. Ask about findings
6. Wincing, reluctance, facial expressions, contractions, goose bumps, toes curling, head moving

Question 4

Describe the basic principles of appropriate draping

Answer 4

1. Always examine exposed skin and then cover it after
2. Patient control gown/sheet
3. Avoid:
   - “pull down”
   - “slip in”
   - “feel”
4. Use:
   - “examine, find, place, locate, lower/remove”

Question 5

List the order of the standard examination sequence

Answer 5

1. Sequence of Maneuvers:
   - Inspection
   - Palpation
   - Percussion
   - Auscultation
2. Head-to-toe

Question 6

Regional Exams

Answer 6

Head and Neck
Thorax
Abdomen
Extremities

When: patient has complaint in that area of a new patient’s general exam

Question 7

System Exams

Answer 7

Cardiovascular
Neurologic

Usually occur within context of the patient visit

Question 8

Patient-Centered Exam

Answer 8

1. Head-to-toe
2. Go from least to most uncomfortable
3. Patient’s position changes minimized
4. Batch use of tools

Question 9

Identify the bell and the diaphragm of the stethoscope and know when to use each part

Answer 9

Bell: lower-pitched sounds

• apex
• mitral valve

Diaphragm: better for high pitched sounds

Question 10

Describe light and deep palpation and justify use of these techniques when examining patients.

Answer 10

• If in pain/ pressing on abdomen - use light palpation to identify the tender spots- if you don’t find tender areas then you can do deep palpation
o Look at face when palpating to determine discomfort/pain

Question 11

Identify the proper locations to auscultate the heart and lungs, and know why each of these locations is important.

Answer 11

Heart:

1. Aortic valve-right 2nd intercostal space near sternum
2. Pulmonic Valve-left 2nd intercostal space near sternum
3. Tricuspid Valve-left 3rd, 4th, and 5th spaces near sternum
4. Mitral Valve-left 5th interspace near midclavicular line

See images in PDS guide