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PD Block I > Physical Exam Techniques > Flashcards

Physical Exam Techniques Flashcards

1
Q

what are the four basic exam techniques?

A

IPPA: inspect, palpate, percuss, auscultate

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2
Q

name 9 factors to assess during inspection

A
  1. body features
  2. symmetry
  3. contour
  4. shape
  5. size
  6. color
  7. moisture vs. dryness
  8. intact vs. disrupted
  9. pulsations/movement
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3
Q

what senses should you use during inspection?

A

sight, smell

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4
Q

discuss how different parts of the hand can be used for palpation

A
  1. palmar surface of fingers: fine detail
  2. ulnar surface of hand: vibrations
  3. dorsal hand: heat differential
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5
Q

when might assessing vibrations be valuable in the PE?

A

using the ulnar surface of the hand to feel over the valve of the heart. Also, noting an absence of fremitus over the clavicle could indicate pneumonia.

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6
Q

explain the difference between light and deep palpation

A
  1. light palpation: up to 1cm deep, one handed technique, move in circular pattern
  2. deep palpation: two handed technique, second hand on top of first, mostly used in abd. palpation, up to 4 cm deep
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7
Q

discuss how to use your hands for percussion

A

long finger of dom. hand acts as the PLEXOR, or hammer. long finger of non-dom. hand acts as the PLEXIMETER, DIP of contralateral finger

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8
Q

plexor

A

long finger of dom. hand, used as a hammer during percussion

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9
Q

pleximeter

A

long finger of non-dom. hand, DIP of this finger is used as the area that is struck by the plexor

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10
Q

why is percussion clinically relevant?

A

can determine abnormal densities. (e.g. dullness over an air filled space may indicate a mass)

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11
Q

when should you perform auscultation?

A

at the end of the exam, EXCEPT in abd. exam (should be done before palpating abd. because percussing could change the sound)

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12
Q

discuss 3 ways to aid proper auscultation

A
  1. room should be quiet
  2. steth should be over bare skin
  3. close eyes to better hear sounds
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13
Q

what is blunt percussion?

A

a type of percussion to elicit pain, use open hand to touch patient, fist to strike your hand. used to test for tenderness over kidneys, liver.

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14
Q

direct percussion over sinuses

A

type of blunt percussion to elicit pain over the sinuses, w/ one finger

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15
Q

what are the 4 locations where you might use blunt percussion?

A
  1. liver
  2. kidney
  3. sinuses
  4. gallbladder
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16
Q

what is another name for blunt percussion?

A

direct percussion

17
Q

what does factor determines tone during percussion? how does it alter tone?

A

density of the medium. the denser the medium, the quieter the tone

18
Q

describe possible notes during percussion and typical locations for each (list from quietest to loudest)

A
  1. flatness: over muscles (won’t be used clinically)
  2. dullness: over solid organs, subcostal margin of liver
  3. resonance: over air-filled spaces, lung
  4. hyperresonance: describes abnormality of excess air (COPD, asthma)
  5. tympany: drum-like sound, over air and fluid filled cavities, belly
19
Q

what sounds are best heard with the bell and diaphragm of stehoscope?

A

bell: low-pitched sounds
diaphragm: high pitched sounds

20
Q

example of high pitched sound

A

S2, diastole (ventricles relaxing) dub

21
Q

example of low pitched sound

A

S1, systole (ventricles contracting) lub

22
Q

bruit

A

low-pitched sound that is heard because of turbulent blood flow through a vessel, the sound that is heard during taking BP

23
Q

murmer

A

turbulent blood flow through a valve

24
Q

what is considered the most reliable indicator of pain?

A

self-report pain rating scales

25
Q

what are the 7 aspects of pain that you should evaluate?

A
  1. quality/character (what does it feel like?)
  2. severity/intensity (0-10)
  3. frequency
  4. radiation (does it radiate?)
  5. location/distribution
  6. onset/duration
  7. exacerbating/alleviating factors
26
Q

if someone is writhing?

A

nephrolithiasis

27
Q

what is examined using the otoscope?

A

external auditory canal and tympanic membrane

28
Q

what technology does the tympanic thermometer use?

A

infrared

29
Q

what is the difference between the Snellen and Rosenbaum visual acuity tests?

A
  1. Snellen: read at 20 feet, assesses distance vision

2. Rosenbaum: read at 10-14”, assesses near vision

30
Q

explain 20/200 vision

A

the patient can see at 20 feet what a normally sighted person can see in 200 feet

31
Q

what is the 512Hz tuning fork used for?

A

auditory capabilities

32
Q

what is the 128Hz tuning fork used for?

A

vibratory sensations

33
Q

which one is the fork with the balls on the end?

A

128Hz (for vibrations)

34
Q

what is the percussion (reflex) hammer used for

A

tests deep tendon reflexes

35
Q

Tanner stage

A

evaluation of stage of life by assessing secondary sex characteristics

PD Block I (6 decks)

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