physical exam skills

Question 1

Ankle brachial index

Answer 1

Norm: > 1.0
Borderline: .91 - .99
Mildly abnormal: .70 - .90
Moderately abnormal: .40 - .69
Severely abnormal: < .40

Question 2

Blood Pressure

Answer 2

Norm: <120/<80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2: >140/>90
HTN crisis: >180/>120

Question 3

Calf Girth Measurement

Answer 3

Compare sides
In conjunction with observation & pitting edema test

Question 4

Chest Mobility: Manual and Tape Measure

Answer 4

Manual: symmetry
Upper Norm excursion: 2.5 cm
Middle Norm excursion: 3-4 cm
Lower Norm excursion: 4-5 cm

Question 5

Heart Rate & Respiratory Rate

Answer 5

HR Norm: 60-100 bpm
RR Norm age 18+: 12-20

Question 6

Heart Sound Auscultations

Answer 6

Norm: S1 and S2
Abnormal: S3, S4, or murmur

Question 7

Intermittent Claudication

Answer 7

walking

Question 8

Lung Auscultation: Normal & Abnormal Breath Sounds

Answer 8

Upper: above T2-T3
Lower: below T3
Norm: Vesicular, bronchial, tracheal
Abnormal: crackles, wheezes, stridor
Consolidation = increased resonance, louder, “e” sounds like “a”

Question 9

Mediate Percussion

Answer 9

Dull=consolidation
Hyperresonant= air

Question 10

Tactile Fremitus: dull, deadened, hyper-resonant

Answer 10

Decrease vibration = air
Increase vibration = consolidation

Question 11

Observation: Consciousness, distress, breathing pattern, color, use of accessory muscles, upper chest vs diaphragmatic breathing, barrel chest, hands and fingers clubbing and color, ankle edema and skin integrity, audible noises, JVD, chest or spine deformity

Answer 11

look for these things

Question 12

Oxygen Saturation

Answer 12

Norm SpO2: >95%
Acceptable COPD SpO2 levels: 88-92%

Question 13

Rubor of Dependency and Venous Filling Time

Answer 13

Rubor of Dependency Norm: rapid, pink flush <30 seconds
Rubor abnorm: deep red after 30 sec
Venous Filling Norm: <15 sec to refill peripheral vein