Quiz Number 2 And Things Like It Flashcards
What is the proper order technique to examine the abdomen?
Inspection, auscultation, percussion, palpation
Things to looks at on inspection
Overall appearance
- contours, bulges
- movement: peristalsis, pulsation
- skin
- umbilicus
What information does auscultation provide us with
Bowel motility
What do you always do before percussion/palpation and why
Auscultation
-if you start palpating you might mess up the bowel sounds
Normal bowel sound on auscultations
5-34 clicks and gurgles per minute
Borborygmi
Changes of bowel movements and auscultation
Any type of illness (inflamamtion;l diarrhea, etc)
Bruits on auscultation of bowel
Noticeable in HTN or some blockage, turbulent flow
Friction rubs on aucultation of bowel
Liver and spleen
-can happen in infection, cancer, infarction around these organs
What information does percussion tell us
Amount of distribution of gas in the abdomen and viscera
- masses (solid, fluid filled)
- size (liver, spleen)
Tympany vs dullness on percussion of abdomen
Left side with by tympani and the right side will have dullness
Palpation tells us what information
- tenderness
- muscular resistance (infection, guarding)
- masses and superficial organs
Light palpation
- one hand and forearm on horizontal plane
- fingers together and flat
- palpate with light gentle dipping motion
- raise it just off the skin as you switch to the next quadrant
Deep palpation
- two hands and forearm on horizontal plane
- fingers together and flat
- palpate with deep gentle dipping motion
- raise it just off the skin as you switch to the next quadrant
- this lets us detect liver edge, kidneys, abdominal masses
Percussion of the liver
We can get an estimate of the size of the liver this way
- measure vertical span of liver dullness in right midclavicualr line
- light moderate percussion
- start under umbilicus in RLQ percussing upwards
- stop at midclavicualr line where the border is
- move from nipple line downward
- stop at midclavicualr line again finding upper border
- measure distance between the two points
Normal liver on palpation
Soft, sharp, regular with a smooth surface
Hooking technique for palpating the liver
Used in obese
Dullness of percussion of spleen
Positive plenty pressure sound
How common is it to be able to palpate the spleen?
Not very
Only 5% of adults can you feel it on
When is the spleen more palpable
When there are abnormal findings
-8x more likely if palpable
When should you be able to palpate a normal bladder
Only if bladder is disenteded
Cannot feel the bladder in normal people
Risk factors for AAA
Males
Smokers
>65
First degree relative
Palpating the aorta
Identify aortic pulsation and width of aorta
Normal width of aorta
3cm wide
Findings suggestive of AAA
- periumbilical/upper abdominal mass
- expansile pulsation
- > 3cm: as AAA increases, palpation pain increases
- > 4cm: risk factors + pain= 15x more likely with a 85-90% mortality rate
Distribution of tension type HA
Band across forehead, down the back of the neck
Constant pain
Distribution of migrain type HA
Unilateral
Irregular pattern with variable remission periods
Distribution of cluser type HA
Multifocal, vascualrity
Could be right around the eye
Occur in several daily bouts with long remission periods
Sound enters the external acoustic meatus and vibrates the
Tympanic membrane
Vibration is transmitted by the tympanic membrane to the
3 ossicles in the middle ear
The sound wave is detected by specialized sensory neurons in the
Cochlea
Otitis externa
- canal is often swollen, narrowed, moist, pale, and tender. It may be reddened
- in chronic otitis externa, the skin of the canal is often thickened, red, and itchy
- pain experienced during inspection and manipulation of the article or tragus is associated with inflammation/infection of the external ear
Nontender nodular swellings covered by normal skin deep in the ear canals
Suggests exostoses
-these are nonmalignant overgrowths which may obscure the ear drum
Tympanic membrane is retracted
Appears bowed inward toward, ossicles more prominent than normal
-associated with blockage of Eustachian tube
Membrane is bulging externally
Indicates increased pressure/material in middle ear, such as excess serous fluid, infection, pus build up
Color changes in the tympanic membrane
- amber or yellow color suggests serous fluid build up
- white suggests infection
- red suggests blood in the middle ear
- all assocauted with otitis media
Perforation of the tympanic membrane, often followed by closure and scarring are associated with
Otitis media
What shape is the tympanic membrane in otitis media
Convex
Frequency specific hearing loss
Age related loss if high frequency sensitivity suggests selective loss of hair cells in cochlea
Generalized hearing loss
Not frequency specific
Can originate from pathology at various levels: external ear, middle ear, non specific damage to hair cells across cochlea
Unilateral hearing loss
Localization from external ear to ipsilateral medial (auditory nucleus). Lesions further along auditory pathway in the brain do not result in unilateral deafness
Sensorineural vs conductive hearing loss
Sensorineural hearing loss involves cochlea or neurological pathology.
Conductive hearing loss is a problem involving tympanic membrane and ossicles.
Can be distinguished using the Rinne test or Webers test, involving a tuning fork
Transillumination of sinuses is used to detect
Obstruction, inflamamtion, infection
- if these are present, there will be less transillumination
- dull=reduced transillumination
- opaque=no transillumination
Normal vs abnormal tonsils
Can be large without pathology
Suspicious is they are displaced such that the uvula deviates
Also note if posterior pharyngeal surface protrudes into pharynx
Must depress the tongue to see epiglottis
Where is the thyroid situated
Between the cricoid cartilage and the sternum
To locate and palpate the TMJ
Place the tips of the index fingers just in front of the tragus of each ear and ask the patient to open their mouth. The fingertips should drop into the joint spaces as the mouth opens
What are we checking for when looking at the TMJ
Smooth range of motion; note any swelling or tenderness
Snapping or clicking may be felt or heard in normal people
Swelling, tenderness, reduced ROM indicates inflammation or arthritis
Chronic pain is associated with HA and stress
Pain during chewing occurs with local pathology: trigeminal neuralgia, temporal arteritis
Forward flexion of spine
The lumbar concavity should flatten out
Bony landmarks for tenderness/pain/swelling for shoulders
Acromion
Acromioclavicualr joint
Coracoid
Bony landmarks for tenderness/pain/swelling for the elbow
Olecranon process, ulna
Epicondlyes of humerus
Assessing for bursitis or artheritis
Bony landmarks for tenderness/pain/ swelling for wrist and hand
- radius and ulna at the wrist
- carpal bones and MCP, PIP, DIP joints
- anatomic snuffbox (between 2 tendons of thumb
Bony landmarks and bursa for tenderness/pain/swelling for the hip
- inguinal ligament (region) for inguinal lymph nodes
- bursa: trochanteric bursa, ischigluteal bursa
GREATER TROCHANTER
Bony landmarks and bursa for tenderness/pain/swelling for knee
- femoral epicondyles
- medial and lateral collateral ligaments
- patella, tibial tuberosity, insertion of patellar tendon to tibia
- bursa: trochanteric bursa, ischiglureal bursa
Bony landmarks and bursa for tenderness/pain/swelling for ankle and foot
- anterior surface of ankle joint
- medial and lateral malleolus
- metatarsophalangeal joints and compress squeeze forefoot
- heads of the metatarsals and spaces between them
