System Return 2

Question 1

Thorax

Answer 1

1. Thoracic/abdominal breathing, symmetrical expansion of the thorax
2. Percuss anterior and posterior chest
3. Auscultate anterior and posterior chest
4. Describe and compare lung sounds

Question 2

Thoracic/abdominal breathing, symmetrical expansion of the thorax

Answer 2

1. Inspect rate and expansion of the chest.
2. Note effort of breathing.
3. AP ratio should be 2:1
4. ) Anteriorly cusp of thorax from behind and have patient take deep breath in and note movement of your thumbs as they breath in.

Question 3

Percuss anterior and posterior chest

Answer 3

1. Alternate sides percussing to compare sounds.

2. Looking for resonance between ribs.

Question 4

Auscultate anterior and posterior chest

Answer 4

1. Start above clavicle and work way down.
2. Anteriorly you will hear tracheal and vestibular.
3. Posteriorly you will hear tracheal and vesicular.

Question 5

Describe and compare lung sounds.

Answer 5

Lungs clear bilaterally.

Question 6

Abdomen

Answer 6

1. Turgor, scars, pigmentation, striae and contour
2. Auscultate bowel sounds
3. Percuss 4 quadrants, liver and spleen
4. CVA tenderness (12th rib and spine)
5. Palpate (light and deep) 4 quadrants, liver and spleen
6. Inguinal lymph nodes
7. Femoral pulses and hernias
8. Palpate for rebound tenderness
9. Palpate for McBurney’s sign

Question 7

Turgor, scars, pigmentation, striae and contour

Answer 7

1. Examine abdomen, note any scars, pigmentation.

Question 8

Auscultate bowel sounds

Answer 8

1. Listen in all 4 quadrants for 5 minutes. If no bowel sounds are heard before saying they are “absent”.

Question 9

Percuss 4 quadrants, liver and spleen

Answer 9

1. Percuss in all 4 quadrants.
2. Listen for tympanic sound.
3. For liver, start MCL at the umbilicus and percuss cephalad until it changes from a tympanic to a dull sound.
4. Mark that level.
5. Percuss between ribs working down and mark it the liver border.
6. Should be 4-7 centimeters.
7. Hard to percuss spleen. Mid axillary 10th ICS. Have them deep breathe in and should be dull to indicate no spleen enlargement.

Tympany over stomach and small intestines.
Hyper-resonance over umbilicus.

Question 10

CVA tenderness (12th rib and spine)

Answer 10

1. Place hand on lower back and hit fist against hand.
2. Assessing for tenderness.
   * * If tender may have kidney issue.

Question 11

Palpate (light and deep) 4 quadrants, liver and spleen

Answer 11

1. Lightly palpate all 4 quadrants with pads of fingers.
2. For liver, press down and up under ribs.
3. Do the same thing in LUQ, but you should not be able to feel the spleen.
4. Palpate deeply in lower 2 quadrants.

Question 12

Inguinal lymph nodes

Answer 12

** Don’t have to do, just note that you would do it.

Question 13

Femoral pulses and hernias

Answer 13

** Don’t have to do, just note that you would do it.

Question 14

Palpate for rebound tenderness

Answer 14

1. Put hand into abdomen and withdraw quickly to assess for pain from appendicitis.
2. Ask patient which pressure hurt more - the initial pressure or the rebound pressure.

Question 15

Palpate for McBurney’s Sign

Answer 15

1. Find anterior superior iliac spine and belly button.

2. Press deeply to elicit response.

Question 16

Heart

Answer 16

1. Abnormal chest configuration, all visible cardiac movement
2. Palpate PMI, pulsations, thrills, heaves or retractions
3. Auscultate 5 cardiac areas
4. Identify each area and describe heart sounds
5. Jugular pulsations and distension
6. Carotid, brachial, and radial pulses
7. Describe what you would expect to observe with right sided heart failure
8. Describe what you would expect to observe with left sided heart failure

Question 17

Abnormal chest configuration, all visible cardiac movement

Answer 17

1. Observe chest wall movement and look for abnormal movements or pulsations.

Question 18

Palpate PMI, pulsations, thrills, heaves or retractions

Answer 18

1. Palpate with pads of fingers at all 5 heart locations.
2. Feel for thrills or heaves (pulsations that will lift fingers up).
3. PMI is felt at 5th ICS MCL.
4. If you cannot feel it, have patient lie down on left side.

Question 19

Auscultate 5 cardiac areas

Answer 19

1. Aortic: Right sternal border 2nd ICS
2. Pulmonic: Left sternal border 2nd ICS
3. Erbs Point: Left sternal border 3rd ICS
4. Tricuspid: Left sternal border 4th ICS
5. Mitral: 5th ICS MCL

Question 20

Identify each area and describe heart sounds

Answer 20

** S1 and S2: no murmurs

Question 21

Jugular pulsations and distension

Answer 21

1. Have patient lie back 45 degrees.
2. You want o be on the right side.
3. Look for pulsation of internal jugular vein.

Question 22

Carotid, brachial and radial pulses

Answer 22

1. Feel pulses bilaterally.

2. Feel for carotid in lower half on neck.

Question 23

Describe what you would expect to observe with right sided heart failure

Answer 23

• Peripheral edema
• Hepatomegaly
• JVD

Question 24

Describe what you would expect to observe in left sided heart failure

Answer 24

• Pulmonary edema
• SOB
• Crackles

Question 25

Peripheral Circulation

Answer 25

1. Lower extremity skin color, temperature, lesions, ankle edema
2. Hair on toes and condition of toenails
3. Foot lesions, calluses and toe webs
4. Dorsalis pedis and posterior tibial pulses
5. Light touch sensation of the toes, metatarsals and heels

Question 26

Lower extremity skin color, temperature, lesions, ankle edema

Answer 26

1. Skin is warm and dry.
2. No lesions.
3. No ankle edema.

Question 27

Hair on toes and condition of toe nails

Answer 27

1. Observe hair on toes - if there is no hair and it (nail?) is shiny , the patient may have a vascular problem.

Question 28

Foot lesions, calluses and toe webs

Answer 28

1. Observe foot for any lesions, calluses, or slow healing sores.

Question 29

Dorsalis pedis and posterior tibial pulses

Answer 29

1. Feel dorsalis pedis pulse (top of foot).

2. Feel posterior tibial pulse (inside of ankle).

Question 30

Light touch sensation of the toes, metatarsals and heels

Answer 30

1. Have patient close eyes and touch cotton ball to their foot and have them tell you when they feel it.