Physical Exam Techniques Flashcards
what are the four basic exam techniques?
IPPA: inspect, palpate, percuss, auscultate
name 9 factors to assess during inspection
- body features
- symmetry
- contour
- shape
- size
- color
- moisture vs. dryness
- intact vs. disrupted
- pulsations/movement
what senses should you use during inspection?
sight, smell
discuss how different parts of the hand can be used for palpation
- palmar surface of fingers: fine detail
- ulnar surface of hand: vibrations
- dorsal hand: heat differential
when might assessing vibrations be valuable in the PE?
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.
explain the difference between light and deep palpation
- light palpation: up to 1cm deep, one handed technique, move in circular pattern
- deep palpation: two handed technique, second hand on top of first, mostly used in abd. palpation, up to 4 cm deep
discuss how to use your hands for percussion
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
plexor
long finger of dom. hand, used as a hammer during percussion
pleximeter
long finger of non-dom. hand, DIP of this finger is used as the area that is struck by the plexor
why is percussion clinically relevant?
can determine abnormal densities. (e.g. dullness over an air filled space may indicate a mass)
when should you perform auscultation?
at the end of the exam, EXCEPT in abd. exam (should be done before palpating abd. because percussing could change the sound)
discuss 3 ways to aid proper auscultation
- room should be quiet
- steth should be over bare skin
- close eyes to better hear sounds
what is blunt percussion?
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.
direct percussion over sinuses
type of blunt percussion to elicit pain over the sinuses, w/ one finger
what are the 4 locations where you might use blunt percussion?
- liver
- kidney
- sinuses
- gallbladder
what is another name for blunt percussion?
direct percussion
what does factor determines tone during percussion? how does it alter tone?
density of the medium. the denser the medium, the quieter the tone
describe possible notes during percussion and typical locations for each (list from quietest to loudest)
- flatness: over muscles (won’t be used clinically)
- dullness: over solid organs, subcostal margin of liver
- resonance: over air-filled spaces, lung
- hyperresonance: describes abnormality of excess air (COPD, asthma)
- tympany: drum-like sound, over air and fluid filled cavities, belly
what sounds are best heard with the bell and diaphragm of stehoscope?
bell: low-pitched sounds
diaphragm: high pitched sounds
example of high pitched sound
S2, diastole (ventricles relaxing) dub
example of low pitched sound
S1, systole (ventricles contracting) lub
bruit
low-pitched sound that is heard because of turbulent blood flow through a vessel, the sound that is heard during taking BP
murmer
turbulent blood flow through a valve
what is considered the most reliable indicator of pain?
self-report pain rating scales
