Physical Exam Mentionables Flashcards
General Appearance
general health, consciousness, affect, distress level
BMI classifications
<18.5, 18.5-24.9, 25-29.9, >30
BP recommendations
Calm and comfortable (at rest for a few minutes) in a seated position with the back supported and legs uncrossed. No recent caffeine, tobacco, or exercise. Arm at heart level with restrictive clothing removed. Correct cuff size should be used. All recommendations improve accuarcy.
Which arm should we check BP on?
Both
Why is the bell side of stethoscope recommended for BP?
Bell is better at picking up lower tones. Korotkoff sounds are low pitched.
Utility of palpating radial artery
Estimate systolic BP and minimize patient discomfort with overinflating the cuff or with several measurements.
Symptoms of orthostatic hypotension
Fainting, dizziness, light-headedness, and confusion that is associated with transitions to a standing position
Orthostatic Hypotension clinical definition
Reduction in BP: >20 mmHg Systolic, >10 mmHg Diastolic or an increase in pulse >20 between sitting BP and standing BP (within 3 minutes of transition)
Normal pulse range
60-100 BPM
Other components of pulse to monitor
rate and rhythm
What to do if pulse is irregular
Listen to heart sounds at cardiac apex
Normal respiratory rate
12-20 breaths/minute
questions to ask if patient is in pain
OLD CARTS (Onset, location, duration; Characteristics, aggravating/relieving factors, treatments, severity). How is the pain impacting activities of daily living
How to ask about pain with children
Range of faces on card
Skin inpection
Jaundice, pallor, cyanosis. Injury: Lesions, trauma, bruising, and infection/inflammation. Could also observe temperature, turgor, and moisture
Eyes inspection
Pupils (Equal in size and in reactivity to light. Pupils are both round [PERRLA]. Also inspection of the conjuctivae and sclerae for jaundice, redness or discharge
Ears evaluation
form assessment during general conversation. If concerned, perform whisper and finger rub test to identify gross frequencies of loss.
Heart evaluation
Auscultate at 4 locations, listening to rate, rhythm, and for any abnormal sounds such as murmurs, clicks, rubs, or other extra sounds
Lungs inspection
Observe general rate and rhythm of breathing pattern (labored, SOB, distress, and retractions) Check for cyanosis around fingertips and lips
Lungs auscultation
Listen for abnormal sounds such as wheezing, crackles, or rhonchi
Abdominal inspection
contour, lesions, scarring
Abdominal auscultation
listen to bowel sounds for abnormalities
Abdominal palpation
palpate each quadrant for tenderness and organomegaly
Musculoskeletal inspection
Abnormal gait pattern (shuffling, imbalance), slow/quick or unsteady chair transitions. Inspection for deformities, posture deficiencies
Neurological inspection
assessment of balance, strength, reflexes, and signs of tremor
Psychologic eval
During the encounter, I am grossly assessing the patient’s alertness, mood/affect, hygiene, overall behavior, and thought patterns.
Order of Physical Exam
wash hands, introduce self, general appearance, vitals (BMI, BP, OH, Pulse, RR), pain, Skin, eyes, ears, heart, lungs, abdomen, MSK, Neuro, psych