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Physical Exam > OSCE 1 > Flashcards

OSCE 1 Flashcards

1
Q

Locate Superficial Temporal arteries

A

Continuation of the external carotid artery as it emerges from the parotid gland, between the TMJ and the ear. It runs anterior to the ear over the zygomatic arch into the termporal region of the skull

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2
Q

Parotid gland

A

Behind and superficial to the mandible, below the zygomatic arch and in front of the ear

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3
Q

Submandibular gland

A

Area deep to or at the inner surface of the mandible

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4
Q

Papillae of the ducts of the submandibular glands

A

Wharton’s duct, located in the mouth at the base of the tongue, on both sides of the midline of the lingual frenulum. Student shoud ask patient to curl their tongue or touch the tongue to the roof of the mouth. Utilize a light source and a tongue depressor to move the buccal mucosa laterally away from the gums

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5
Q

Opening of the parotid glands

A

Stenson’s duct, located in the mouth at the 2nd upper molar on the buccal mucosa by a small papillae

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6
Q

Locate and examine the trapezius muscles

A

Tests CN XI, should ask the patient to “shrug” shoulders upwards

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7
Q

Locate and examine the sternocleidomastoid muscles

A

Tests CN XI. Ask patient to turn head to each side against students hand. As the patient turns head to each side, observe the contraction of the opposite sternocleidomastoid. The right sternocleidomastoid contracts and turns patient’s head to the patients left.

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8
Q

Locate and identify the borders of the anterior triangles

A

Each side of the neck is divided into 2 triangles, by the diagonally running sternocleidomastoid muscle

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9
Q

Locate and identify the external jugular vein

A

Perform a valsalva maneuver. The vein is identified behind the clavicular head of the sternocleidomastoid or roughly about the middle third of the clavicle and then passes diagonally over the surface of the sternocleidomastoid and up behind the angle of the mandible. Valsalva maneuver is forced expiration against a closed glottis. May need to lay the patient supine or at 30 -45 degrees to best deomnstrate

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10
Q

Locate and palpiate carotid artery

A

In the lower neck, the carotid artery is deep to the sternocleidomastoid muscle and as you move higher up the neck, the artery is anterior to the sternocleidomastoid muscle. Only palpate ONE carotid at a time

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11
Q

Locate and identify the location of the thyroid gland

A

May ask patient to take a sip of water to facilitate this step. Student places finger pads of both hands so that the index fingers are just below the cricoid cartilage. Ask the patient to swallow and the student attempts to feel the thyroid rising under their finger pads. Student’s fingers should be a little lateral to midline. The thyroid has 2 lateral lobes and a midline isthmus and is usually located between the levels of the C5 and T1 verts.

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12
Q

Locate and identify the structures that make up the external ear

A

Cartilaginous ear, auricle, pinna. Outermost rim - helix, antihelix is internal to helix, and the tragus lies in front of the external auditory meatus. The ear lobule has no cartilage

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13
Q

Locate and identify the external auditory canals

A

Canal is behind the tragus of the ear. The canal is normally about 2-3 cm long in adults

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14
Q

Locate and examine the tympanic membrane with otoscope

A

make sure otoscope light works, and uses and ear speculum. student should stand close to the patient and warn the patient before they start. Student gently pulls the ear upward, backward, outward, to straighten the canal for easy visualization. Identify the normal anatomy of the eardrum, including the pars tensa, with the handle and short process of the malleus. Observe for blood, inflammation, swelling, foreign bodies

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15
Q

Locate and identify the pre and post auricular lymph nodes

A

preauricular - parotid lymph nodes would be in front of the ear
post-auricular - mastoid lymph nodes would be behind the ear and superficial to the mastoid process

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16
Q

Locate and identify the occipital lymph nodes

A

at the base of the skull, posteriorly

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17
Q

Locate and identify the submental lymph nodes

A

a few cm behind the tip of the mandible

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18
Q

Locate and identify the superficial cervical lymph nodes

A

superficial to the surface of the sternocleidomastoid muscles

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19
Q

Locate and identify the posterior cervical lymph nodes

A

located along the anterior border of the trapezius muscles

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20
Q

Locate and identify the supraclavicular lymph nodes

A

Part of the deep cervical lymph nodes, located in the angle formed by the clavicle and the clavicular head of the SCM

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21
Q

Locate and identify the sternal angle of Louis

A

The bony ridge joining the manubrium to the body of the sternum. The 2nd costal cartilages are adjacent to the sternal angle

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22
Q

Identify and locate the second intercostal space

A

inferior to the 2nd costal cartilage, which is lateral to the sternal notch. This is important in helping doctors count ribs and ICS to name a location on the chest wall along with the vertical axis

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23
Q

Locate and identify the midsternal line

A

a vertical line that runs through the middle of the sternum and xiphoid process

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24
Q

Locate and identify the midclavicular line

A

a vertical line running through the midpoint of the clavicle and inferiorly

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25
Q

Locate and identify the anterior axillary line

A

A vertical line running inferiorly from the anterior axillary muscle fold

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26
Q

Locate and identify the posterior axillary line

A

a vertical line running inferiorly from the posterior axillary muscle fold

27
Q

Locate Lungs

A

Anterior: the apex of each lung rises 2-4 cm abouve the inner third of the clavicle. The lower border of the lung crosses the 6th rib at the midclavicular line.
Laterally: the lower lung border crosses the 8th rib at the mid axillary line
Posteriorly: the lower border of the lung lies at about the level of T10. During normal breathing, the lower border of the lung may descend about 5-6 cm as the diaphragm contracts.

28
Q

Fissures and lobes of lungs

A

lungs have oblique fissure which is approximated by a line from T3 spinous process posteriorly and then runs obliquely down and around the chest to the 6gh rib in the midclavicular line.
Posteriorly, above this line are the upper lobes and below is the lower lobe. The righ lung also is further divided by a horizonatal fissure. Anteriorly this fissure runs from about the 4th rib and then travels roughly and travels horizontally around the chest to the 5th rib in the midaxillary line. Above this fissure is RUL, and below is RML. The RML does not have a posterior projection. To examine the RML, you need to auscultate/percuss in the lateral and anterior chest. Most of the upper lobes are best auscultated anteriorly

29
Q

Test for respiratory expansion

A
  1. Inspect the chest wall of symmetric expansion
  2. place hands on the lower posterior chest wall with their thumbs at about the level of 10th rib and parallel to the 10th rib. Slide the thumbs medially so that they raise a vertical skin fold medial to their thumbs and lateral to the patietn’s spine. Ask the patient to take a deep breath.
30
Q

Respiratory Rate

A

Ideally the student should count for 30 seconds to 1 min. Do it sneakily while doing the pulse.

31
Q

Test for tactile fremitus

A

detects palpable vibrations transmitted through the broncho-pulmonary tree to the chest wall. Looking for increased, decreased, or absence of tactile fremitus. Ask the patient to grab their opposite shoulder with their hands so as to move the scapulae laterally and increse the examinable area of the posterior lung fields. Do on skin
Place either the dorsal surface of the fingers or the ulnar surface of the hands on patient’s posterior chest beginning at the top of the chest first. Ask patient to repeat the phrase ninety-nine. If can’t feel ask for louder or lower.

32
Q

Percussion

A

purpose: to determine if the tissues 5-7 cm deep to underlying the percussed site are air filled, fluid filled, or solid
Ask the patient to grab their opposite shoulders, done on skin. Percuss in IC space
Always start at the top of the lungs and compare right to left. Do 3 on back, 1 lateral, 3 on front

33
Q

Three types of normal breath sounds

A

Bronchial - heard over the manubrium
Bronchovesicular - hear between the scapulae
vesicular - heard throughout the rest of the lungs

34
Q

Technique of auscultation

A

Ask patient to grab shoulders, do on skin. Listen with the diaphragm of the stethoscope, begins at apices, compares right to left at each level, asks patient to breath through their mouth, student should NOT move stethoscope to next position until complete breath. Auscultate 3 on back, 1 lateral, 2-3 on front

35
Q

How to test for vocal fremitus

A

While auscultating ask patient to say EEEEEE each time the student moves the stehoscope. Broncophony - ninety-nine is heard louder and clearer than expected. Egophony - EEE is heard as a nasal “ayy” and whispered pectoriloquy is shispered “ninety nine” is heard louder and clearer than expected. All indications of airless or consolidated lungs

36
Q

Locate and count radial pulse

A

use finger pads and describe beats/min, rhythm

37
Q

Identify and locate the apex and base of the hear

A

base is the junction between the heart and the great vessels; lies just below sternal angle
Apex is the tip of the LV; normally found in midclavicular line, about 5th intercostal space

38
Q

Costal margin

A

The costal margin is made of the cartilagionous border of ribs 7-10 anteriorly

39
Q

Identify and locate the xiphoid process

A

midline fingerlike projection from the most inferior part of the body of the sternum

40
Q

Midline which is overlying the linea alba

A

linea alba runs from the xiphoid process inferiorly to the symphysis pubis

41
Q

Locate the rectus abdomninis muscle

A

Ask patient to raise their head and shoulder from the supine position. These muscle run abou 7-10 cm lateral to and parallel to the linea alba. The lateral border of the rectus is known as the lineal semilunaris. The rectus arises from the pubic crest and inserts onto the anterior surface of ribs 5-7 and the xiphoid process

42
Q

Umbilicus

A

Normally at about L3 - L5.

43
Q

Identify and locate the symphysis pubis

A

in the midline where the 2 pubic bones articulate

44
Q

Pubic tubercle

A

bony prominence, which may or may not be palpable on the pubic bone. About one inch lateral to the midline. Moving from medial to lateral, you have the symphysis pubis, pubic crest, and then pubic tubercle

45
Q

Anterior Superior iliac spine

A

the most anterior part of the iliac crest. It is usually prominent and palpable

46
Q

Inguinal ligament

A

extends from the pubic tubercle to the ASIS. separates the abdomen above from the thigh below

47
Q

Iliac crest

A

Superior edge of the wing-like portion of the ileum bone. Anteriorly the iliac crest ends in the anterior superior iliac spine. Posteriorly, the iliac crest ends as the posterior superior iliac spine.

48
Q

Surface markings of the four abdominal quadrants

A

defined vertical line running through the umbilicus and horizontal line through the umbilicus.

49
Q

Surface markings of the colon

A

Approximately 5 ft in length. Begins in the RLQ as the cecum. hepatic flexure at about the 9th intercostal space. Thr transverse colon is longest and most mobile, runs fromt he hepatic flexure to the splenic flexure. At the pelvic brim the descending colon becomes sigmoid colon and finally terminates in the rectum and anus.

50
Q

Surface markings for the spleen

A

Just inferior to the diaphragm in the LUQ at the level of 9-11 ribs, POSTERIOR to the left midaxillary line

51
Q

Surface markings for the pancreas

A

Normally not palpable as it is retroperitoneal. Lies in both RUQ and LUQ. Head lies in the C of the duodenum to the right of the patients midline. The body of the pancrease crosses the midline at about L1 and L2. The tail of the pancreas extends upward and to the left to the hilar surface of the spleen, roughly at the mid-clavicular line

52
Q

Surface markings for the kidneys

A

Bean shaped organs about 11 cm long, 5-6 cm wide, 3 cm thick and 4-5 cm from the midline at the level of about T12 through the L3 vertebrae. Posterior retroperitoneal organs. Their upper poles are protected by the 11th and 12th ribs posteriorly. The inferior poles may be 3-4 cm above the iliac crests. The right kidney is slightly lower than the left kidney.

53
Q

Identify and locate the abdominal aorta

A

begins as a direct continuation of the thoracic aorta at the level of T12 to L1 where the thoracic aorta passes through the diaphragm at the aortic hiatus in the midline. Descends in front of the bodies of the first four lumbar vertebrae in the midline or slightly to the left of the midline. At L4, the aorta bifurcates into common iliac arteries. The total length of the abdominal aorta is about 10 cm and normally its diameter is about 2.5 cm

54
Q

Renal arteries

A

Located in the RUQ and LUQ. The renal arteries arise at right angles off the abdominal aorta at about L1 or L2.

55
Q

Iliac arteries

A

The common iliac arteries are a direct continuation of the abdominal aorta. Divide into interanl and eternal iliac branches about 4 cm laterally from the midline.

56
Q

Identify and locate the femoral arteries

A

the femoral artery is a continuation of the external iliac artery as it runs posterior to the inguinal ligament at about the midpoint of the inguinal ligament

57
Q

Auscultate abdomen in 4 quadrants

A

always comes BEFORE palpataion since contact with bowel can increase the bowel’s motility. Gently place the diaphragm of the stehoscope on the abdominal wall. normally there are 5-34 bowel sounds per minute

58
Q

Palpate for horizontal and vertical superficial inguinal lymph nodes

A

The horizontal superficial inguinal lymph nodes are inferoir to the inguinal ligament. These drain the superficial portions of the lower abdomen and buttock, the external genitalia (but not testes) the anal canal, the perineal area, and the lower vagina
The vertical superficial inguinal lymph nodes cluster near the upper part of the saphenous vein. The student palpates medial and parallel to the femoral artery below the inguinal ligament. These lymph nodes drain the lower limb, perineum, anterior abdominal wall to the umbilicus, gluteal region and parts of the anal canal

59
Q

Palpate the abdomen superficially

A

hand flat on the abdomen use gentle dipping motions. ALL 4 QUADRANTS. Palpate deep and superficial

60
Q

Liver edge and spleen

A

right hand at about the level of the umbilicus and lateral to the rectus abdominus. press gently and ask the patient to take a deep breath. If no edge, reposition closer to costal margin. May place left hand behind the lower ribs and lift up while attemtptin to palpate the liver edge with the right hand. Spleen tip usually is not felt. Use same approach

61
Q

Percuss for the liver

A

Percuss in the right mid-clavicular line. percuss above the liver and below the liver to hear the different percussion notes of air in the lungs and bowels as opposed to the solid percussion note of the liver. In the abdomen, start at the level of the umbilicus and then percuss up toward the liver. Should not percuss over the gown. Normal liver is 6-12 cm in the right midclavicular line

62
Q

Palpate for kidneys

A

Mostly not palpable. May feel lower pole in thin relaxed person. Trying to trap the lower pole between hands as the patient takes a deep breath. place right hand below the costal margin in the RUQ, lateral to the rectus abdominus muscle but parallel to it and place left hand BELOW and parallel to the 12th rib (between lower end of the rib cage and the iliac crest). While the left hand is liftin up, the patient is asked to take a deep breath and at the peak of inspiration, the student presses deeply into the RUQ just below the costal margin and attempts to capture the right kidney. Then the patient can breathe out and the student slowly releases the pressure from their right hand, feeling at the same time for the kidney to slide back into its expratory position higher up.

63
Q

Palpate for the spleen

A

Patient in right lateral decubitus position. Spleen tip is not normally felt. If spleen is palpable, it is usually 3x its normal size. As the spleen enlarges, it enlarges diagonally from the left upper quadrant (LUQ) toward the RLQ it enlarges anteriorly, downward, and medially. Also, remember that the spleen is normally posterior to the midaxillary line. By having the patient lay on their right side, gravity may bring the spleen forward and to the righ into a palpable location. Again, the student may place their left hand behind the left lower ribs and then they gently press up and in as the patient takes a deep breath.

Physical Exam (2 decks)

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