Pulm/Cardio/Abd practicum

Question 1

General

Answer 1

Introduce self
Wash hands
Obtain Consent
Explain exam
Pt is appropriately draped
Note HR, BP, RR, Pulse ox all within normal limits

Question 2

Pulmonary - Inspection

Cardiovascular - Inspection

Answer 2

Size/Shape, AP diameter, physical characteristics (pectus excavatum/carinatum)
Use of accessory muscles
Note any audible wheezing, DOE
Inspect for lifts, heaves, apical impulse

Question 3

Pulmonary - palpation

Answer 3

Verbalize: thoracic expansion, crepitus, tactile fremitus

Question 4

Pulmonary - auscultate

Answer 4

With diaphragm of stethoscope: ant/post/lat fields

Listening for rales, rhonchi, crackles, wheezing, friction rubs

Question 5

Cardiovascular - palpate

Answer 5

Verbalize: locate and measure PMI (normal is mid clavicular line 5th ICS)
Verbalize: palpation for lifts, heaves, thrills

Question 6

Cardiovascular: Auscultate

Answer 6

With diaphragm, verbalize bell
Name and listen over Aortic, pulmonic 1, pulmonic 2, tricuspid, and mitral areas.
Listening for rate, rhythm, S1/S2, splitting S3/S4
Listening for any murmurs/clicks/gallops/rubs/snaps

Question 7

Abd Exam - general

Answer 7

Inquire about areas of pain, tenderness, or discomfort
All 4 quadrants of abd exposed
Start with areas of lesser or no pain
Position patient with small pillow under head and knees

Question 8

Abd - Inspection

Answer 8

Skin characteristics
Venous Return Patterns
Symmetry
Surface motion
Masses
Hernias
Diastasis Recti

Question 9

Abd - Auscultation

Answer 9

All 4 quadrants for bowel sounds with diaphragm

Listen for bruits with bell - aorta, renal, iliac, femoral arteries

Question 10

Abd - Percussion

Answer 10

Percuss in all 4 quadrants
Percuss Liver stating normal is 6-12 cm
Percuss spleen for dullness in midaxillary line from umbilicus

Question 11

Abd - palpation

Answer 11

Light palpation in all 4 quadrants for tenderness, masses
Deep palpation in all 4 quadrants for tenderness, masses
Palpate umbilicus and umbilical ring
Palpate liver in right costal margin
Palpate Gallbladder below liver margin
Palpate right and left kidney in bimanual position
Palpate abdominal aorta, state normal is <3cm

Question 12

Abd - Special tests

Answer 12

Murphy sign for cholelithiasis
Rebound tenderness over McBurney point
Rovsing sign - referred pain for appendicitis
Psoas sign for appendicitis/peritoneal sign
Obturator sign for appendicitis
Attempt to demonstrate shifting dullness
Palpate the umbilicus and rectus abdominus for hernias with C/S flexed
Bilaterally check for CVA tenderness in seating position