PA lab Flashcards
1
Q
inspecting trachea
A
position
massess
symmetry
2
Q
throid
A
size
shape
position
fullness/enlargement
nodules
tenderness
3
Q
when inspecting lymph nodes, you are looking at
A
size
consistency
mobility
tenderness
symmetry
normal is non-palpable
4
Q
when are you concerned about lymph node palpation
A
palpable in multiple areas
lots of palpable lymph nodes
panLESS nodes are more concerning than painful
rock-hard
larger than 1 cm (jelly bean)
matted/stuck together
more features are more concerning
5
Q
where do we palpate lymph nodes
A
- occipital
- post-auricular: behind ear
- pre-auricular: in front of tragus
- retropharyngeal/tonsilar: angle of mandible and below 1 finger (overlap with anterior cervical)
- submandibular: under mandible (not including under chin)
- submental: under chin
- posterior cervical: posterior SCM
- anterior cervical: anterior SCM
- supraclavicular: over clavicle (have patient shrug shoulder forward)
- axially: patient supine with hand over head, be sure tissue is slackened so you can palpate deep along ribs
- inguinal: femoral artery/triangle, along ASIS to pubic
6
Q
virchow’s nodes
A
- supraclavicular nodes
- tell patient to round shoulder, palpate divets on patient
7
Q
quadrants
A
8
Q
positioning for abdomen physical exam
A
- patient supine with knees flexed, arms along body to slacken abdominal tissue
- drape and gown to exposure area of palpation
9
Q
seuqnce for performing abdominal exam
A
- inspection
- auscultation
- percussion
- light palpation
- deep palpation
10
Q
skin inspection: what are we looking for
A
- discoloration - abnormal venous patterns, striae (stretch marks)
- contour - flat, rounded, scaphoid
- asymmetry
- abdomen with head lifted - look for massess, midline, hernia, midline defects
“Abdomen appears flat, symmetric, without deformity”
11
Q
ascultation
A
- ascultate 4 abdominal quadrants before palpation, looking for:
- bowel sounds in all four quadrants (normal is sounds)
- aorta for bruits using bell (normal is NO sound) - halfway between xipoid and umbilicus and L of midline
- femoral arteries for bruits using bell (normal is NO sound) - same place you palpated inguinal nodes
12
Q
how to do percussion
A
- push firmly with finger, lift other fingers
- tap with opposite hand fingers or relfex hammer
13
Q
where do you percuss
A
- all four quadrants, identify presence of fluid or solid masses
- liver spane (normal 6-12 cm) if enlargement suspected: start at R midclavicular line abdomen over area of resonance, percus up until dull and mark, percuss in intercostal space/chest and go down until dull and mark
14
Q
percussion sounds
A
- dull: fluid, liver, feces, suprapubic area, solid masses
- resonant: gastric air bubble, non-solid areas, healthy lungs
15
Q
palpation order
A
- light palpation (up to 1/2 inch depth) in all four quadrants to assess for tenderness, deformity, surface masses
- deep palpation (up to 1 inch depth) in all four quadrants to assess organs and for masses
- liver, spleen, kidney, aorta, epigastric, peri-umbilical, suprapubic
16
Q
liver palpation
A
- hard to detect healthy liver
- place one hand beneath patient, pressing upward
- place other hand on abdomen, fingers pointing toward liver
- have patient take a deep breath
- fingers at edge of ribs and push into abdomen and inferiorly, almost going under ribs
17
Q
spleen palpation
A
- hard to detect health spleen, easier if enlarged (in mono or direct injury - sports, MVA)
- place one hand beneath patient, pressing upward
- place other hand on abdomen, fingers point toward spleen
- have patient take a deep breath
18
Q
kidney palpation
A
- ballottement method
- eed to feel deep and consider that much of kidney is obscured behind lower ribs
- left kidney: like spleen palpation, palpate deeply with R hand
- right kidney: one hand beneath patient, palpate deeply with other hand
i don’t know, man
19
Q
aorta palpation
A
slight left of midline
20
Q
epigastric palpation
A
light initially, then deeper
for stomach irritability
21
Q
perip-umbilical palpation
A
around belly button
“umbilicus” for the smart kids in the room
22
Q
suprapubic palpation
A
yall know
23
Q
rebound tenderness (Blumberg’s sign)
A
- patient supine
- palpate deeply and slowly away from suspected or painful area, remove quickly
- (+) for peritonitis (peritoneum inflammation) if pain experienced in area of inflmmation
- deep press and release quickly in LLQ for appendicits
24
Q
McBurney’s point
A
- patient supine
- palpate deeply halfway between umbilicus and R ASIS
- severe pain is (+) for appendix
25
iliopsoas sign
* patient supine
* patient raises each leg with and without resistance
* (+) iliopsoas sign is pain in ipsilateral lower quadrant
* screen for appendicits on R side
26
murphy's sign
* for inflamed gall bladder (gall bladder includes many pain fibers, liver does not)
* patient supine
* place fingers below R costal margin at mid-clavicular line (liver/gall bladder) as patient exhales
* ask patient to inhale while pressing tips of fingers upward - gall bladder descends
* (+) is abrupt cessation of inspiration
27
costovertebral angle (CVA) tenderness in sitting
* place one hand flat over kidney, percuss with ulnar (hypothenar) surface of opposite fist over each kidney
* (+) if intense pain (UTI)
28
what can cause concerning findings in RUQ
gall bladder
liver
29
what can cause concerning findings in RLQ
appendix
diverticulitis
endometriosis
30
what can cause concerning findings in LUQ
pancreas
spleen
31
what can cause concerning findings in LLQ
diverticulitis
endometriosis
32
what can cause concerning findings in epigastric region
pancreas
stomach
33
what can cause concerning findings in suprapubic region
uterine fibroids or endometriosis in females
bladder mass or distension in males and females
34
what can cause concerning findings in generalized abdomen
peritonitis
35
ABCDE of melanoma screening
* asymmetry: mole has odd shaped, one half does not match other half
* border: ragged or irregular
* color: uneven
* diameter: bigger than the size of a pea or pencil eraser
* evolving: changes in size, shape or color
36
heart sounds
37
lung sounds
