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MC II > PA lab > Flashcards

PA lab Flashcards

1
Q

inspecting trachea

A

position
massess
symmetry

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2
Q

throid

A

size
shape
position
fullness/enlargement
nodules
tenderness

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3
Q

when inspecting lymph nodes, you are looking at

A

size
consistency
mobility
tenderness
symmetry

normal is non-palpable

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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

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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
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6
Q

virchow’s nodes

A
  • supraclavicular nodes
  • tell patient to round shoulder, palpate divets on patient
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7
Q

quadrants

A
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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
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9
Q

seuqnce for performing abdominal exam

A
  • inspection
  • auscultation
  • percussion
  • light palpation
  • deep palpation
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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”

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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
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12
Q

how to do percussion

A
  • push firmly with finger, lift other fingers
  • tap with opposite hand fingers or relfex hammer
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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
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14
Q

percussion sounds

A
  • dull: fluid, liver, feces, suprapubic area, solid masses
  • resonant: gastric air bubble, non-solid areas, healthy lungs
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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
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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
Q

iliopsoas sign

A
  • 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
Q

murphy’s sign

A
  • 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
Q

costovertebral angle (CVA) tenderness in sitting

A
  • place one hand flat over kidney, percuss with ulnar (hypothenar) surface of opposite fist over each kidney
  • (+) if intense pain (UTI)
28
Q

what can cause concerning findings in RUQ

A

gall bladder
liver

29
Q

what can cause concerning findings in RLQ

A

appendix
diverticulitis
endometriosis

30
Q

what can cause concerning findings in LUQ

A

pancreas
spleen

31
Q

what can cause concerning findings in LLQ

A

diverticulitis
endometriosis

32
Q

what can cause concerning findings in epigastric region

A

pancreas
stomach

33
Q

what can cause concerning findings in suprapubic region

A

uterine fibroids or endometriosis in females
bladder mass or distension in males and females

34
Q

what can cause concerning findings in generalized abdomen

A

peritonitis

35
Q

ABCDE of melanoma screening

A
  • 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
Q

heart sounds

A
37
Q

lung sounds

A

MC II (7 decks)

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