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65 Cards in this Set
- Front
- Back
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Introduction to patient (prior to starting exam) (0)
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(Say)
-Hi, how are you? My name is __________ & I am a physician assistant student & I will be examining you today. |
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Wash hands (prior to starting exam) (0)
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(Say)
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(A) General Survey
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(A) General Survey
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Inspection (13)
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(Say)
(1) Apparent state of health (2) Level of consciousness (3) Signs of distress (4) Body habitus (build)/stature (5) Skin color and obvious lesions (6) Personal hygiene (7) Dress (8) Grooming (9) Facial expression (10) Body & breath odors (11) Motor activity (12) Gait (13) Posture |
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(B) Vitals
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(B) Vitals
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Check height (0)
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(Ask pt.)
[Over 3 y/o, given in feet' inches''] [Under 3 y/o, given in cm] |
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Check weight (0)
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(Ask pt.)
[Given in lbs or kg] |
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Check BMI (1)
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(Say)
BMI = Wt (lb) x 700 ---------------------- Ht (in) ------------------------------- Ht (in) |
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Check temperature (1)
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(Say)
(1) Report degree (F or C) and route taken (oral, aural, rectal, axillary) [Normal oral: 98.6 F (37 C)] [Normal range: 96.4 - 99.1 F (35.8 - 37.3 C)] |
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Radial pulse (1)
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(Do & give result)
(1) Palpate radial pulse for at least 15 seconds (result x 4), noting rate and rhythm [Normal: 60-100 bpm] |
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Respiratory rate (1)
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(Do & give result)
(1) Count respirations for at least 15 seconds (result x 4) -Do after taking pulse while still holding pt's wrist -Place hand on pt's back and thumb in supraclavicular area [Normal: 14 - 20 breaths/min] |
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Blood pressure (7)
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(Do & give result)
(1) Palpate brachial artery (2) Position arm slightly flexed & cuff at heart level (3) Apply cuff to bare arm approx. 1 inch above antecubital fossa (4) Determine cuff systolic pressure by palpation & wait 15-30 seconds after deflation (Say would wait) -Add 30 mm to where feel pulse disappear & reinflate cuff to this determined level (5) Use bell to ausculatate over brachial artery (6) Deflate slowly at 2-3mm/sec to 0 (7) Perform bilaterally [Normal: <120/80 mm Hg] [Pre-HTN: 120/80 to 139/89] [HTN Stage 1: 140/90 to 159/99] [HTN Stage 2: >160/100 |
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Check for orthostatic blood pressure (3)
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(Do & give result?)
(1) Check BP in supine position (2) Repeat BP within 3 minutes of standing (3) Note criteria for positive tilt test (greater than 20 mm Hg systolic or 10 mm Hg diastolic drop) |
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(C) Skin
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(C) Skin
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Important general things (2)
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(1) Demonstrate appropriate draping
(2) Properly expose areas while inspecting |
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Inspection and palpation of skin (6, 6-5)
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(Say would do this in all skin areas)
(1) Color (2) Moisture (3) Temperature using the back for the fingers (4) Texture (5) Mobility & turgor by lifting a fold of skin & noting the ease with which it lifts up (mobility) and the speed with which it returns to place (turgor) (6) Note for any lesions (a) location (b) distribution (c) arrangement (d) type (e) color |
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Screening nevi for possible melanoma (5)
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(Say would do this for all nevi found)
(1) A: asymmetry (2) B: borders - irregular (3) C: color - blue or black (4) D: diameter - >6mm (5) E: elevation or enlargement |
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Head (2, 1-6)
(Pt sitting with gown opening in front) |
(Do)
(1) Inspect and palpate head & hair noting: (a) quantity (b) distribution (c) texture (d) pattern of loss (e) nits (f) dandruff (2) Scalp inspected & palpated -Part hair so can see scalp |
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Face and neck (1)
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(Do)
(1) Inspect face & neck |
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Hands and arms (5, 4-4)
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(Do)
(1) Inspect & palpate flexor surfaces and extensor surfaces bilaterally (2) Inspect palms bilaterally (3) Inspect interdigits bilaterally (4) Inspected & palpate nails bilaterally, noting: (a) color (b) shape (c) texture (d) lesions (e) capillary refill (5) Inspect & palpate axilla -Push gown sleeve up to shoulder -Palpate all nails |
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Trunk and groin (anterior) (2)
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(Do)
(1) Inspect trunk anteriorly (2) Inspect groin |
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Legs and feet (anterior) (4, 4-5)
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(Do)
(1) Inspect & palpate flexor surfaces bilaterally (2) Inspect soles bilaterally (3) Inspect interdigits bilaterally (4) Inspect and palpate nails bilaterally, noting: (a) color (b) shape (c) texture (d) lesions (e) capillary refill |
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Trunk (posterior) (1)
(Pt standing with gown opening in back) |
(Do)
(1) Inspect posteriorly -Up to bikini line/buttocks |
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Legs (posterior) (1)
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(Do)
(1) Inspect & palpate flexor surfaces |
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(D) Eyes
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(D) Eyes
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Inspection of surrounding eye structures (4)
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(Say)
(1) Note quantity & distribution of eyebrows (2) Note eyelid position in relation to eyeballs & adequate closure -Have pt close eyes (3) Note direction of eyelashes and presence of lesions (4) Note lacrimal apparatus for redness and swelling |
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Inspection of external eye structures (3)
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(Say)
(1) Note color & vascular pattern of conjunctiva and sclera -Ask pt to look up, down, & side to side as you depress lower lids with your thumbs (2) Note cornea, lens, & iris for any opacities using oblique lighting -Check for crescent shadow on medial side or iris (3) Note pupil size, shape, & symmetry & check alignment |
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Assess visual acuity (3)
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(Do)
(1) Test each eye individually by having pt cover opposite eye with palm of hand (OD/OS) (2) Test both eyes together (OU) (3) Note with or without corrective lenses [Pt can miss not more than 2 letters to qualify for that line acuity] |
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Assess color vision (1)
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(Do)
(1) Test each eye individually uncorrected & have pt identify green & red |
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Assess visual fields (6)
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(Do)
(1) Test both eyes simultaneously (2) Ask pt if there is anything missing or blurry on your face (3) Provide appropriate instructions to pt (4) Examiner is positioned properly (approx. 6 in. from pt with hands placed approx. 2 ft. apart) (5) Check lateral, superior, and inferior fields of vision (6) If a visual field defect is noted, check each eye individually in all six fields with the examiner as a control |
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Assess extraocular eye muscles (5)
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(Do)
(1) Perform test at same eye level as pt -From 1-2 ft in front of pt (2) Test all 6 cardinal positions -Pt's right -Pt's right & up -Pt's right & down -Pt's left without pausing in middle -Pt's left & up -Pt's left & down (3) Hold position at pt's exterme lateral gaze to check for nystagmus (4) Bring your finger towards the center of his/her nose - checking for convergence of the eyes (5) Assess lid lag |
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Assess near reaction
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(Do)
(1) Have pt focus on an object at a distance and then on your finger approx. 10 cm away checking for pupil constriction |
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Assess pupillary reaction to light: direct and consensual (2)
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(Do)
(1) Dim lights (2) Shine a light into the pt's eye 2 times assessing pupillary constriction, for direct & consensual reaction |
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Perform fundoscopic exam (4)
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(Do)
(1) Dim lights (2) Examiner's thumb placed on pt's brow (3) Pt instructed to maintain gaze at a distant point (4) Hold ophthalmoscope in right hand when inspecting right eye, and left hand when expecting left eye -Have index finger on lens wheel & thumb on light source -Start with lens wheel on 0 -Stand about 15 in and 15 degrees lateral to pt's line of vision -Follow the vessels peripherally in 4 directions |
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Inspection of internal eye structures (6)
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(Say & do)
(1) Note red reflex (2) Note size of vessel & character of arteriovenous crossings (3) Note any exudates or cotton wool patches (4) Note color & size of optic disc and physiologic cup (5) Note retina for an lesions (6) Ask pt to look directly at light - note fovea & macula for any abnormalities |
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(E) Ears
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(E) Ears
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Inspect auricle (external ear) & back of ears (1)
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(Say)
(1) Note presence of deformities, lumps, or lesions |
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Palpate the auricle (3)
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(Do)
(1) Pull auricle up when palpating (2) Ask pt if s/he feels any tenderness (3) Perform bilaterally |
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Palpate the tragus (3)
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(Do)
(1) Apply pressure on tragus (2) Ask pt if s/he feels any tenderness (3) Perform bilaterally |
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Palpate the mastoid process (3)
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(Do)
(1) Apply pressure on the mastoid process (2) Ask pt if s/he feels any tenderness (3) Perform bilaterally |
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Inspect ear canal (3, 3-5)
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(Do)
(1) Brace hand against pt's face/head (2) Straighten canal by pulling auricle up & back (3) Insert speculum, note any: (a) discharge (b) foreign objects (c) cerumen (d) redness of skin (e) swelling |
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Inspect tympanic membrane (2)
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(Do)
(1) Advance the speculum w/o causing pain to pt (2) Note color of TM, while visualizing the cone of light & its landmarks -TM = pearly gray, slightly concave -Landmarks (a) triangular cone of light = in ant. inf. quadrant (b) umbo = at center of drum (c) malleus = extends up & ant. from umbo to near rim of drum (d) short process of malleus = project outward near the rim (e) pars flaccida = just above the short process of malleus |
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Test auditory acuity (2)
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(Do)
(1) Occlude one ear while testing the opposite ear (2) Ask pt to repeat whispered numbers or equally accented syllables |
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Weber test: lateralization (2)
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(Do & say)
(1) Place base of vibrating tuning fork midline on top of pt's head & ask where the pt hears it: on right, left, or both sides equally (2) Note that unilateral conductive loss is heard in (lateralizes to) the impaired ear; unilateral sensorineural loss is heard in (lateralizes to) good ear -Say this |
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Rinne test (4)
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(Do & say)
(1) Place base of vibrating tuning fork on mastoid bone (2) When pt indicates s/he can no longer hear the sound, place the "U" of the fork close to the ear canal facing forward (3) Then ask pt if the sound can be heard again (4) Note that AC>BC is normal; BC=AC or BC>AC = conductive hearing loss; AC>BC = sensorineural loss -Say this |
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(F) Nose & Sinuses
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(F) Nose & Sinuses
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Inspection of external nose (3)
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(Say)
Note any: (1) asymmetry (2) deformities (3) lesions |
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Palpation of external nose (3)
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(Do)
(1) Apply pressure to the external nose (2) Ask pt if s/he feels any tenderness (3) Occlude each nostril in turn & ask pt to breathe in |
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Inspection of internal nose (4, 4-8)
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(Do & say)
(1) Tilt pt's head back (2) Ask pt to breathe through his/her mouth or hold his/her breath while inserting the speculum (3) Insert speculum w/o causing pain to pt (4) Note: (a) color (b) swelling (c) bleeding (d) exudates (e) septum deviations (f) perforations (g) ulcers (h) polyps |
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Palpation of frontal sinuses (3)
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(Do)
(1) Press thumbs under the bony brows (2) Ask pt if s/he feels any tenderness (3) Palpate each frontal sinus separately when comparing bilaterally |
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Palpation of maxillary sinuses (3)
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(Do)
(1) Press thumbs up on the cheek bone regions by the nose (2) Ask pt if s/he feels any tenderness (3) Palpate each maxillary sinus separately when comparing bilaterally |
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(G) Mouth and pharynx
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(G) Mouth and pharynx
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Inspection of external mouth structures (4, 1-3, 2-5)
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(Do & say)
(1) Note lips: (a) color (b) moisture of lips (c) presence of any lesions (2) Note gums: (a) color (b) gum margins (c) presence of swelling (d) ulcers (e) lesions (3) Note condition and absence of teeth (4) Use gloves when touching any mouth structures |
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Inspection of internal mouth structures (3, 2-4)
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(Do & say)
(1) Use flashlight while inspecting inside mouth (2) Note buccal mucosa: (a) color (b) presence of ulcers (c) white patches (d) lesions (3) Note color & architecture of hard palate |
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Inspection of pharynx - back of mouth (2, 1-4, 2-4)
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(Do & say)
(1) Note pharynx & soft palate: (a) color (b) presence of ulceration (c) exudates (d) lesions (2) Note tonsils: (a) color of tonsillar pillars (b) presence or absence of tonsils (c) tonsillar enlargement (d) presence of exudates |
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Request pt to say "AAH" (1)
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(Do)
(1) Observe symmetric rise of soft palate, using tongue blade if necessary (CN X - vagal nerve) |
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Test the gag reflex (1)
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(Do)
(1) Stimulate the back of the throat lightly on each side |
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Inspect and palpate the tongue (4)
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(Do & say)
(1) Ask pt to protrude tongue, note the color & texture of the surface (CN XII - hypoglossal nerve) (2) Ask pt to lift tip of tongue to roof of mouth, note the color & presence of any lesions on the undersurface (3) Use a square gauze to grasp tip of tongue and gently pull it to each side, note sides of tongue for white patches or lesions (4) Wearing gloves, inspect & palpate for induration |
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(H) Neck
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(H) Neck
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Inspection of neck & skin (3, 1-4)
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(Do & say)
(1) Inspect neck & skin for (a) masses (b) scars (c) lesions (d) enlarged glands or nodes (2) Note any tracheal deviation from midline (3) Request pt to sip some water & swallow during inspection observing the upwards movement of the thyroid gland & noting its contour & symmetry |
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Palpation of tracheal position (0)
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(Do)
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Palpation of thyroid (2)
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(Do)
(1) Palpate thyroid from behind by placing fingers of both hands on pt's neck just below cricoid cartilage (2) Ask pt to swallow again while feeling the isthmus rising under finger pads, moving fingers laterally to feel lobes |
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Auscultation of thyroid (1)
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(1) Listen over lateral lobes with the bell for bruits
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Palpation of lymph nodes (1)
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(Do)
(1) Palpate bilaterally with pads of index and middle finger using a circular motion |
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Location of lymph nodes
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(Do & say)
(1) Pre-auricular = in front of ears (2) Post-auricular = behind ear, superficial to mastoid process (3) Occipital = at base of skull posteriorly (4) Tonsillar = at angle of mandible (5) Submandibular = midway down base of the jaw (6) Submental = under chin (7) Superficial cervical = superficial to SCM (8) Posterior cervical = along anterior edge of trapezius (9) Deep cervical = deep to SCM (10) Supraclavicular = in angle formed by clavicles & SCM -Have pt hunch over foward |
