PHYSICAL EXAMINATION

Question 1

(a) Patients with pain should be assessed for onset, duration, characteristics,
location, severity, associated symptoms, and treatment of pain.

(b) Specific data include factors that influence the pain, the type of discomfort
(e.g., radiation of pain or position related relief), symptoms (e.g., dizziness
or cyanosis), and use of nitroglycerin.

(c) Other considerations include cough, difficulty breathing, and loss of
consciousness.

Answer 1

History of Present Illness: Chest Px

Question 2

Relevant data include associated symptoms (e.g., dyspnea or anorexia), as
well as any interruption in usual activities or bedtime changes.

Answer 2

History of Present Illness: Fatigue

Question 3

Patients with a cough should be assessed for the onset and duration of the
cough, as well as the character of the cough (dry, wet, night-time, aggravated
by lying down).

Answer 3

History of Present Illness: Cough

Question 4

History of Present Illness: Difficulty breathing (dyspnea, orthopnea)

Answer 4

Relevant data include aggravating factors (e.g., with exertion, lying down, or
climbing stairs) and paroxysmal nocturnal dyspnea.

Question 5

History of Present Illness: Loss of consciousness

Answer 5

(transient syncope)

Question 6

History of Present Illness: Leg pain or cramps

Answer 6

(a) Patients having leg discomfort should be assessed for onset and duration of pain and whether leg elevation or immobilization changes pain.

(b) The character of discomfort should be described, and questions should be directed toward any burning in toes, changes in skin color or temperature,
dizziness, limping, or discomfort during the night.

Question 7

History of Present Illness: Severe headaches

Answer 7

Patients having severe headaches should be assessed for onset and duration, location, character, and known history of hypertension.

Question 8

History of Present Illness: Swollen ankles

Answer 8

(a) Patients having swollen ankles should be assessed for onset and duration, related circumstances, and associated symptoms.
(b) Treatment includes rest, massage, heat, elevation, and medication.

Question 9

History of Present Illness: Family History:

Answer 9

Pertinent data includes family members with diabetes, heart disease,
hyperlipidemia, hypertension, obesity, congenital heart defects, sudden death, and risk
factors related to the cardiovascular system.

Question 10

History of Present Illness:
Associated symptoms/complaints with respect to the initial CC of Chest Pain:

Answer 10

(a) Anxiety
(b) Dyspnea
(c) Diaphoresis
(d) Dizziness
(e) Nausea
(f) Vomiting

Question 11

Personal and Social History

Answer 11

Relevant data include employment risks, tobacco habits, nutritional status, alcohol
consumption, personality assessment, usual exercise activities, relaxation patterns, and
drug use.

Question 12

Age and Condition- Related Variations:

Answer 12

(1) Pregnant women
(a) History of cardiac disease or surgery; dizziness or faintness on standing; indications of heart disease during pregnancy; progressive or severe dyspnea,
progressive orthopnea, paroxysmal nocturnal dyspnea, hemoptysis, syncope with exertion, and chest pain related to effort or emotion.

(2) Elderly
(a) Lower extremity swelling, reproducible lower extremity pain with exertion resolving with rest (claudication), venous-stasis ulcers.

Question 13

Stethoscope with bell and diaphragm use

Answer 13

1) The bell is used for low frequency sounds.
2) The diaphragm is used for high frequency sounds.

Question 14

There are four (4) components to a heart examination and must be completed in this
order:

Answer 14

(a) Inspection
(b) Palpation
(c) Percussion (Omitted for the heart examination)
(d) Auscultation

Question 15

Apical impulse location

Answer 15

(a) 5th L intercostal space
(b) Midclavicular line

*checks for enlarge left ventricle

Question 16

Preparation and Positioning PCL

Answer 16

leaning forward, supine,
left lateral recumbent positions.

Question 17

S1

Answer 17

closure of mitral/tricuspid valves.

Question 18

S2

Answer 18

closure of aortic/pulmonic valves (sometimes split).

Question 19

S3

Answer 19

early diastole (passive filling) vibration of ventricular walls.

hr scar

Question 20

S4

Answer 20

ventricular filling from atrial kick (late diastole) loss of compliance or increase stroke volume secondary to high output.

small squeeze

Question 21

Wide apical pulsation may indicate

Answer 21

left ventricular hypertrophy. Loss of palpable
apical pulsation may indicate fluid, air, or displacement.

Question 22

Thrills are associated with

Answer 22

failure of semilunar valve to close, aortic or
pulmonary stenosis, or atrial septal defect.

Question 23

Normal findings heart

Answer 23

1) Resting heart rate is 60 to 90 min and regular.
2) No bruits or murmurs are present.

Question 24

Loud S1 suggests

Answer 24

increased blood velocity, mitral stenosis, heart block,
hypertension, or calcification of mitral valve.

Question 25

Potential bruits

Answer 25

(turbulent blood flow)

Question 26

First Korotkoff sound indicated

Answer 26

systolic B/P.

Question 27

The last Korotkoff sound heard before it disappears is

Answer 27

the diastolic B/P.

Question 28

The amplitude of the pulse is described on a scale of 0 to 4:

Answer 28

1) 4 Bounding, aneurysmal
2) 3 Full, increased
3) 2 Expected
4) 1 Diminished, barely palpable
5) 0 Absent, not palpable

Question 29

Pitting Edema scale

Answer 29

1) 1+ Slight pit, disappears rapidly (2-3 mm in depth).
2) 2+ Somewhat deep pit, disappears in 10 to 15 seconds (4-5 mm in depth).
3) 3+ Noticeable deep pit that lasts more than a minute (6-7 mm in depth).
4) 4+ Very deep pit that lasts 2 to 5 minutes (8-9 mm in depth).

Question 30

(a) Redness, thickness of the vein, tenderness along superficial vein, and warmth.
(b) Can be indicated through taking a good history and exam.
(c) Use Doppler for confirmation of diagnosis.
(d) Clinical test for thrombosis, use Homan’s sign.

Answer 30

Palpate and assess for thrombosis

Question 31

A value of less than 9 cm

Answer 31

suggests ventricular failure.

Question 32

Normal Adult Exam

Answer 32

(1) Patient exhibits no visible pulsations or heaving chest.
(2) Pulses are symmetric.
(3) Bilaterally, pulse amplitude is 2+.
(4) Bilateral extremities are warm and pink with hair present.

Question 33

The difference between the systolic and diastolic pressures is the pulse pressure.

Answer 33

The pulse pressure should range from 30 to 40 mm Hg, even to as much as 50 mm Hg.

Question 34

Positive Homan’s sign indicates

Answer 34

venous thrombosis

Question 35

Older Adults
(1) Normal findings

Answer 35

(a) Blood pressure <140/90
(b) The systolic blood pressure increases with age, while the diastolic blood pressure decreases