Observed Physical Exam - Sheet1

Question 1

What are the first steps to do when walking into a patients room?

Answer 1

1. Wash Hands
2. Introduction
3. Describe General Appearances (so and so looks well. There doesn’t seem to be any sign of discomfort or distress.)
4. Sitting Blood Pressure
5. Pulse
6. Respiratory Rate (15-20/min)

Question 2

After the introduction, what is the next step?

Answer 2

Observe head, and begin the eye exam.

Question 3

What are the 4 steps (5 points) of the eye exam?

Answer 3

1. Extra-ocular muscles (draw H)
2. Pupil check to near and far
3. pupil check to light
4. Conjunctiva
5. Fudoscopic exam.

Question 4

What exam comes after the eye exam?

Answer 4

The ear, nose, and throat!

Then the lungs…

Question 5

What are five parts that constitute ENT?

Answer 5

1. external ear
2. auditory canal and middle ear
3. hearing
4. nose and oral cavity (say ahh and smile!)
5. Thyroid and Anterior/Posterior Cervical Adenopathy

Question 6

What lymph node chains are you supposed to examin?

Answer 6

Anterior and posterior cervical adenopathy

Question 7

You have done the ear, nose, and thoat. What’s next?

Answer 7

Lungs! (4 steps)

Question 8

What are the parts of the lung exam?

Answer 8

1. Ascultate Anterior Fields (2 places–1 per side)
2. Ascultate Posterior Fields (6 places)
3. Percussion of posterior lung fields
4. Costovertebral angle tenderness

Question 9

The heart is a complicated exam. What sections come before and after the heart exam.

Answer 9

before = lungs

after = abdomen

Question 10

Alright, now go through the heart exam…

Answer 10

1. Ascultate sitting (4 locations)
2. Ascultate supine (4 locations)
3. PMI
4. JVD and HJR
5. Peripheral pulses (carotid, radial, femoral, doralis pedis)

Question 11

How are you going to explain the JVD?

Answer 11

Jugular venus distention

To determine the Jugular Venus pressure, I would place the patient’s torso at a 45 degree angle and measure the vertical distance between the sternal angle and the height of pulsations in the internal jugular vein, which lies medial to the external jugular vein. To calculate the Jugular venus pressure, I would then add 5cm to the vertical height I calculated. To aid in this measurement, I would have the patient valsalva or bear down.

Question 12

Ok where does the abdominal exam fit in the grand scheme of things?

Answer 12

after the heart exam and before the musculoskeletal exam

Question 13

What’s the order in things of the abdominal exam?

Answer 13

1. Position patient correctly (hands at sides, knees flexed–to relex the muscles)
2. Auscultate for bowel sounds
3. Palpate the four quadrents
4. Percuss for hepatic and spleen size.

Question 14

What is the first stage of the musculoskeletal exam?

Answer 14

Range of motion. Start high and go low–standing.

1. neck, shoulders, spine
2. elbows, forearms
3. wrists and digits

Question 15

What is the second stage of the musculoskeletal exam?

Answer 15

Strength of the upper extremity! Standing!

1. shoulder (5x)
2. elbow (2)
3. wrist (4)
4. phalanges (2)

Question 16

What is the third stage of the musculoskeltal exam?

Answer 16

Lower extremity range of motion. Supine!

1. Hip (4)
2. knee (2)
3. foot (4)

Question 17

What is the fourth stage of the musculoskeletal exam?

Answer 17

Lower extremity strength test. Supine and/or sitting!

1. Hip (4)
2. knee (2)
3. foot (4)

Question 18

What is the fifth stage of the musculoskeletal exam?

Answer 18

Deep tendon reflexes!

1. Biceps
2. triceps
3. brachioradialis
4. patellar achilles

Question 19

What comes immediatly after the musculoskeletal exam?

Answer 19

Inspection of the hands and feet (clubbing, arthritis, sores, rashes, etc.)

Question 20

What is the final thing to do in the observed physical exam?

Answer 20

SCALES!

1. pulses (0-3, with 2+ normal)
2. reflexes (0-4, with 2+ normal)
3. Muscle strength (0-5, with 5 normal)
4. Murmers (1-6) with no rating being normal.