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28 Cards in this Set
- Front
- Back
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List the steps of a physical examniation.
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1. Inspection
2. Palpation 3. Percussion 4. Auscultation |
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When examining the skin, which aspects are you examining ?
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1. Colour and pigmentation
2. Hydration, turgor and elasticity 3. Vascularity and erythema 4. Temperature |
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What does a quick general screen consist of ?
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J- Jaundice
A- Anemia C- Cyanosis C- Clubbing O- Oedema L- Lymphadenopathy |
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List the different lymph nodes of the neck.
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1. Pre-auricular - In front of the ear
2. Posterior-auricular - Superficial to the mastoid process 3. Occipital - Posterior at the base of the skull 4. Tonsillar - At the angle of the mandible 5. Submandibular - Halfway between the point and the angle of the mandible 6. Submental - At the midline behind the point of the mandible 7. Anterior cervical chain - Superficial to the sternocleidomastoid muscle 8. Posterior cervical chain - Next to the anterior margin of the trapezius muscle 9. Deep cervical chain - Deep under the sternocleidomastoid muscle 10. Supraclavicular - Deep in the angle formed by the clavicle and the sternocleidomastoid muscle |
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What position should a patient be in an abdominal examination ?
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Flat on their back.
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During inspection of the abdomen, what are you looking for ?
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Skin :
i. Colour ii. Lesions iii. Scars iv. Striae v. Hair Distribution vi. Distended Veins Shape of abdomen i. Enlarged ii. Flat iii. Scaphoid Distension i. Fat ii. Fluid iii. Faeces iv. Flatus v. Foetus vi. Full Bladder vii. Fibroids viii. Filthy (tumour) Assymetry i. Enlargement e. Pulsations i. Epigastric (Abdominal Aorta) ii. Costal Margin (Renal Arteries) iii. Lateral of the Umbilicus (Iliac Arteries) iv. Femoral Peristalsis – Intestinal Activity Hernias – Ask patient to cough to look for any protrusions |
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During palpation of the abdomen, what are you looking for ?
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Skin
i. Temperature ii. Texture iii. Oedema iv. Hydration Superficial palpation Palpation of the liver i. Liver span Palpation of the spleen |
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List the different regions of the abdomen.
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1. Right Hypochondrium
2. Epigastric 3. Left Hypochondrium 4. Right Lumbar Region 5. Umbilical Region 6. Left Lumbar Region 7. Right Iliac Fossa 8. Hypogastric 9. Left Iliac Fossa |
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List the different quadrants of the abdomen.
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• Right Upper Quadrant
• Left Upper Quadrant • Right Lower Quadrant • Left Lower Quadrant |
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What is Mc Burney's point and where is it found ?
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The point lies two thirds down from an imaginary line drawn from the umbilicus to the right anterior superior iliac spine. It is the site of the appendix.
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Describe how you would superficially palpate the abdomen.
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• Start at Mc Burney’s point
• Ascending colon • Hepatic flexure • Transverse colon • Splenic flexure • Descending colon • Sigmoid colon • Suprapubic region • Peri-umbilical region • Epigastric region |
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Describe how you would palpate the liver.
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1. Determine rectus abdominis
2. Palpate from Mc Burney’s point upwards |
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Describe how you would determine the liver span.
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• Percuss down from the right midclavicular line in the intercostal spaces until a dull sound is heard
• Percuss upwards from Mc Burney’s point on the midclavicular line until a dull sound is heard • A normal liver span is <13 cm |
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Describe how you would auscultate the abdomen ?
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• Bowel sounds in all four quadrants
• Can be heard every 5-10 seconds |
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What is the normal range of heart rate ?
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60-100 beats per minute.
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List the different pulses, the landmarks used to locate them and what you can determine from each.
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1. Carotid pulses
Landmark: Medial to the sternomastoid muscle Determine: Rate, Rhythm, Volume and Character 2. Brachial pulses Landmark: Antecubical fossa, medial to the biceps tendon about one third of the way across the fossa Determine: Rate, Rhythm and Volume 3. Radial pulses Landmark: Radial side of the flexor surface of the forearm, a few centimetres proximal to the wrist, lateral to the flexor carpi radialis Determine: Rate, Rhythm and Volume 4. Femoral pulses Landmark: Groin, the patient lies flat; the femoral artery is half way between the pubic tubercle and anterior superior iliac crest. Determine: Rate, Rhythm and Volume 5. Popliteal pulses Landmark: The patient lies flat, bend the knee to 120 ͦ Place the thumbs on either side of the tibial tuberosity and press with the fingers into the popliteal fossa against the tibia Determine: Rate, Rhythm and Volume 6. Posterior tibialis Landmark: Feel with the index and middle fingers just behind the medial mal |
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In what position must your patient be during a respiratory and cardiovascular examination ?
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45 degrees.
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Describe how you would determine the JVP.
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• Identify heads of attachment of sternocleidomastoid muscle because pulsation is between its sternal and clavicular head
• Internal jugular lies posteromedially to sternocleidomastoid muscle • Measuring the JVP o Sternal angle o Indentify the point of pulsation o Measure the height between the top of the pulsation and the sternal angle o Normal JVP is 3-4 cms |
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What are the differences between a carotid pulse and a jugular venous pulse ?
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Carotid-
1. May be visible but is palpable 2. Single wave 3. Unchanged with respiration and position 4. Unaffected by pressure at base of neck JVP- 1. May be visible but not palpable 2. Complex wave form 3. Changes with respiration and position 4. Obliterated when pressure applied to base of neck |
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Describe how you would inspect the cardiovascular system during examination.
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1. Shape
2. Scars 3. Pacemakers 4. Visible pulsations |
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Describe how you would palpate the cardiovascular system during examination.
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The apex beat (the most lateral inferior point where cardiac impulse is palpable)
i. Locate the sternal angle ii. Locate the 2nd intercostal space iii. Move down on the mid-clavicular line to the 5th intercostal space iv. Move 1cm medially to the mid clavicular line v. Feel first with the palm and then locate the apex beat with a single finger Parasternal Heave Palpable Thrills |
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Describe how you would percuss the cardiovascular system during examination.
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Percuss down the anterior chest till dullness in 4th intercostal space.
Percuss laterally from the left of sternum until dullness is reached – lateral border. |
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Describe how you would auscultate the cardiovascular system during examination.
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Mitral area
i. 5th intercostal space ii. Inside of the midclavicular line iii. On the left Tricuspid area i. 4th intercostal space ii. Parasternally to the left Pulmonary area i. 2nd intercostal space ii. Left parasternally Aortic area i. 2nd intercostal space ii. Right parasternally |
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Describe the different heart sounds.
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S1
o Closure of mitral and tricuspid valves o Ventricular contraction o Synchronises with carotid or radial pulse S2 o Closure of aortic and pulmonary valve o Ventricular relaxation |
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Describe what you should say after inspecting the chest during a respiratory examination.
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a. There are no lesions, masses or skin irritations
b. There are no deformities of the chest or spinal column c. The antero-posterior dimension in relation to the lateral is 1:2 d. Normal breathing rate 12-20 e. Breathing is regular, unforced and no use of accessory muscles f. The movements are symmetrical and not weak g. No abnormal movements |
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Describe what you should do during palaption of the chest during a respiratory examination.
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Respiratory movements and chest expansion
i. Placing hands below sternum and measuring the distance between thumbs ii. Normal distance 2-5cm Vocal fremitus i. Move palms of hands along chest ii. Palpate while patient says 99 iii. See if fremitus is symmetrical Normal findings i. Skin temperature is normal ii. No masses iii. No signs of distress iv. No tenderness during palpation v. Chest expansion is symmetrical and normal vi. Vocal fremitus normal with great intensity at anterior and posterior bases of neck and less felt over scapulae and bases of lung Examination of the trachea i. Feel space between trachea and sternocleidomastoid muscle and compare both sides |
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Describe what you should do during percussion of the chest during a respiratory examination.
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Listen for resonant and dullness
Anteriot start by percussing directly onto clavicle Posterior start by percussing in supraclavicular fossa Normal findings i. Normal resonant sounds ii. Normal areas of dullness over liver on right chest and heart on left chest |
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Describe what you should do during auscultation of the chest during a respiratory examination.
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Anterior auscultate 2-3 cm from sternum
Posterior auscultate 2-3 cm from midline Patient breathe slowly and deeply through mouth Compare both sides Normal Findings i. Normal vesicular breathing is soft low pithced sounds which are louder and longer on inspiration ii. No gap between inspiratory and expiratory sounds |
