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22 Cards in this Set
- Front
- Back
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Inspecting the ears list the landmarks...
a. external (9) |
a. try naming in order around ear
i. auricle ii. helix iii. anti-helix iv. tragus v. anti-tragus vi. lobule vii. concha viii. external auditory canal ix. triangular fossa |
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Inspecting the ears list the landmarks...
b. internal (5) |
b. pull ear lobe first... if tender assume otitis externa, to look in straighten pull on helix superior and posterior
i. manubrium ii. umbo iii. pars tensa iv. pars flaccida v. chorda tympani nerve |
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Explain the Weber and Rinne tests...
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Weber Test: sound will localize in the middle if hearing is normal or symmetrical (sound will lateralize away from bad ear for sensorineural problem (to good ear) (nerves to ear are not sending info from sound waves to brain, middle ear to brain) and toward conductive loss bc still have sensory
Rinne Test: normal - air conduction is longer that bone conduction AC > BC (if sound heard equally in bone conduction and air conduction there is conductive loss) - tuning fork on mastoid process and then brought around to ear - if BC > AC then conductive loss also air conduction loss: cant get sound in table 12-2 in Bates if AC > BC but less than 2:1 then sensorineural |
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Describe the inspection of the nose and the parts...
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Use light to check external things noting masses, lesions, asymmetry, obstruction
a. bridge b. tip c. columella d. vestibule e. ala nasi |
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Upon internal inspection of the nose what are you looking for and at?
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- note color of vestibule
- look specifically for perulent material throughout - holes in septum could indicate pathology or lifestyle - also note any polyps around turbinate |
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Describe the full evaluation of the sinuses...
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includes frontal, maxillary, and ethmoid (no frontal for children)
1. inspection 2. palpation- grading for tenderness, comparing sides 3. percussion- bilateral sounds, 4. light transilumination- shine light through frontal to ethmoid (behind eyes), maxillary (open mouth) |
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Describe the external landmarks of the mouth (2) and what to note upon inspection...
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1. Lips-
i. color, moisture, cracks, ulcers, rashes, 2. vermillion border- could see cheilitis in B12 deficient |
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Name the markers of inspection in internal mouth exam (10)...
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From open mouth top to bottom
1. frenulum (upper labral) 2. gingiva Roof of mouth- 3. hard palate 4. soft palate 5. tonsil palatine 6. posterior wall 7. uvula Base of mouth 8. tongue 9. lingual frenulum 10. sublingual caruncle |
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Describe the inspection of the following internal mouth structures...
a. gingiva b. teeth c. tongue |
a. ulcers, color should be pink and moist, margins for swelling, and recession
b. color, deformed, proper place, number c. color, notches, white patches, ulcers, midline position otherwise assume CN12 dysfunction, if hard nodules or lesions on side or base suspect cancer |
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Describe the inspection of the following internal mouth structures...
a. roof of mouth and what it includes |
includes- hard/soft palate checking for architecture and torus palatinus
- uvula should be midline - palatine tonsils- looking for folds that have possible exudate |
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Describe the palpatory/inspection of posterior wall/pharynx of interior mouth...
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Put gloves on and ask person to say "ah" pushing tongue blade on tongue to see soft palate rise...
- if it doesnt rise may have a CN10 proglem - inspect for color, symmetry, swelling, ulceration, tenderness of soft palate and gag reflex CN9,10 |
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What inspection findings should you look for on chest exam...?
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shape, color, hair distribution, landmarks, resp rate and pattern (using accessory muscles?), ribs movement symmetry
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What landmarks are sited during inspection of chest?
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1. midsternal sternal line
2. midaxillary (anterior and posterior) 3. midclavicular line 4. manubrium 5. suprasternal notch 6. 2nd rib 7. angle of louis 8. xiphoid process 9. scapula 10. thoracic vertabrae 11. pectus carinatum (chicken breast deformity 12. pectus excavatum |
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When evaluating respiration what is the key points?
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1. Rhythym
2. Pattern 3. Rate Position of trachea looking for JVD, and or tracheal deviation |
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Describe the palpated aspects of the chest and explain what the third one is and how to do it?
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1. rib motion
2. thoracic expansion 3. tactile fremitus- using the ulnar surface of hand on posterior lateral thorax over entire costal margin on front - should be able to feel vibrations from bronchopulmonary tree to chest wall - as patient is speaking "99" - with pneumonia and atelectasis the sound increases - with emphysema and pneumothorax the sounds decease |
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Describe the percussing of the chest, what are the sounds and where you should hear what sounds...
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One side to another and then down to evaluate
sounds: 1. resonant- normal lungs low long duration 2. flat- high pitched short duration 3. dull- medium pitched... how liver sounds or when fluid or solid tissue replaces air containing lung or occupies pleural space: pneumonia, effusion, hemothorax, empyema 4. tympanic- high pitch gastric air bubble or puffed out cheek 5. hyperresonant- lower pitched and longer very loud, COPD and pneumothorax |
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Briefly describe the auscultation of the lungs..
What are the three main lung sounds and describe each ones location/characteristics... |
Using diaphragm listen to lungs for pitch, length of expiration/inspiration, other adventitious sounds (wheezing, crackles, rhonchi, pleural friction rub)
-listen in symmetrical manor 1. Vesicular: soft and low sound without pause all lung fields; inspiratory longer than expiratory 2. brochovesicular- over right and left mainstem bronchus; heard in inspiratory and expiratory equally 3. brochial/tracheal- over trachea; expiratory sounds last longer |
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Explain the "E" test that is auscultated for...and further 99 whispering
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Listening for E sound if sounds like "A" indicated Egophony
If loud sounds are heard indicates bronchophony -Ask to whisper 99 and if heard louder than murmuring it is called Whispered Pectoriloquy |
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Name the surface anatomy/ boney land marks anterior and posterior for thoracic inspection... (16)
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1. C7 and T1 vertebrae
2. Spine of scapula 3. Inferior angle of the scapula 4. Scalene muscles 5. Trapezius muscle 6. Sternocleidomastoid muscle 7. Pectoralis muscle 8. Serratus anterior muscle 9. Manubrium Clavicle 10. Body of the sternum 11. Xiphoid process 12. First Rib 13. Ribs 2-10 with intercostal spaces 14. Floating ribs (11 and 23) 15. Midclavicular line 16. Midaxillary line |
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Evaluate the thoracic spine for dysfunction and explain how you would classify it?
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Put pt. in prone position and find C7 and then count down.
Thumbs on transverse processes load and springing, feeling for hard end feel (if you have a R hard end feel then it is rotated right and restricted left). Check to see if there is a group of hard end feels... If group found you know type one dysfunction. (Neutrall Side bent R, Rotated Left) If only one is found Put the person in cat position (flexion) and if hard end feel gets better we know that it likes flexion... so it is therefore a flexion rotated R and sidebent left |
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TONGO?
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type one neutral group opposite
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Explain the rule of 3's
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rule made to explain the change in curvature of the spinous process of thoracic vertebra as they descend from the cervical vertibra.
T1-3 spinous process is level with the Transverse process of the same vertabra T4-6 spinous process is in between the transverse process of the inferior vertabra and its own T7-9 spinous process is located in line with the transverse process of the inferior vertebra T10- same as T-8 T11 same as T4-6 T12 same as T1-3 |
