Physical Exam Techniques

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4 KEY POINTS OF PHYSICAL EXAMINATION POINTS

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INSPECTION
PALPATION
PERCUSSION
AUSCULTATION

Front 2

WHAT IS INSPECTION

Back 2

THE PROCESS OF INFORMED OBSERVATION

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WHAT IS PALPATION

Back 3

USING YOUR SENSE O TOUCH TO GATHER INORMATION

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PERCUSSION SOUND

TYMPANY

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DRUMLIKE, LOUD, HIGH, MEDIUM, PERCUSSION SOUNDS HEARD IN THE STOMACHE

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PERCUSSION SOUND

HYPERRESONANCE

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BOOMING, LOUD, LOW PITCH, MEDIUM DURATION, SOUNDS HEARD IN HYPERINFLATE LUNG

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PERCUSSION SOUND

RESONANCE

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HOLLOW, LOUD, LOW PITCH, LONG DURATION, SOUNDS HEARD IN A NORMAL LUNG

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PERCUSSION SOUND

DULL

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THUD, MEDIUM INTENSITY, MEDIUM PITCH, MEDIUM DURATION, SOUNDS HEARD IN HOLLOW ORGANS

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PERCUSSION SOUND

FLAT

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EXTREMELY DULL PITCH, SOFT INTENSITY, HIGH PITCH, SHORT DURATION, SOUNDS HEARD IN MUSCLE, ATELECTAIS

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WHAT IS PERCUSSION?

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PERCUSSION IS THE PRODUCTION OF SOUND WAVES BY STRIKING ONE OBJECT AGAINST ANOTHER......

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HOW DO YOU USE PERCUSSION TO ASSESS A PT?

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PLACE ONE HAND ON THE AREA OF THE BODY YOU WISH TO PERCUSS. USE A FINGER OF THAT HAND (GENERALLY THE MIDDLE FINGER) AS THE STRIKING SURFACE. SHARPLY TAP THE DISTAL KNUCKLE OF TAT FINGER WITH THE TIP OF YOU OTHER MIDDLE FINGER

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WHAT IS AUSCULTATION?

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LISTENING WITH A STETHESCOPE FOR SOUNDS PRODUCED BY THE BODY

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OPHTALMOSCPE

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HANDHELD DEVICE USED TO EXAMINE INTERIOR OF THE EYE

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OTOTSCOPE

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HANDHELD DEVICE USED TO EXAMINE INTERIOR OF EARS AND EYES

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WHAT ARE YOU LOOKING FOR IN A GENERAL SURVEY?
PG 39

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APPEARANCE
VITAL SIGNS
PULSE OX
CAPNOGRAPHY
CARDIAC MONITORING
D- STICK

Front 15

WHAT ARE THE MAIN PERIPHERAL PULSE SITES ON THE HUMAN BODY?

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RADIAL, CAROTID, BRACHIAL, POPLETIAL, FEMORAL, PEDAL

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WHAT IS RESPIRATION?

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RESPIRATION IS THE EXCHANGE OF OXYGEN ADN CARBON DIOXIDE IN THE LUNGS AND AT THE CELLULAR LEVEL?

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WHAT IS RESPIRATORY RATE?

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NUMBER OF TIMES PT BREATHES IN 1 MINUTE

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WHAT IS TACHPNEA?

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RAPID BREATHING

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WHAT IS BRADYPNEA?

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SLOW BREATHING

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WHAT IS RESPIRATORY EFFORT?

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HOW HARD THE PT WORKS TO BREATHE

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INSPIRATION IS WHAT TYPE OF PROCESS?

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INSPIRATION IS AN ACTIVE PROCESS. NORMAL INHALATION INVOLVES USING THE RESPIRATORY MUSCLES (DIAPHRAGM AND ITERCOSALS) TO INCREASE THE CHEST'S INNER DIAMETER. IT IS AN ACTIVE PROCESS THAT REQUIRES ENERGY, THE INCREASING SPACE CREATED NEGATIVE PRESSURE, THAT DRAWS AIR INTO THE LUNGS.

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EXHALATION IS WHAT TYPE OF PROCESS?

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EXHALATION IS A PASSIVE PROCESS. THE MUSCLES OF THE RESPIRATORY SYSTEM ELASTIC RECOIL

Front 23

WHAT IS QUALITY OF RESPIRATIONS?

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DEPTH AND PATTERN OF BREATHING

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WHAT IS TIDAL VOLUME?

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TIDAL VOLUME IS THE AMOUNT OF AIR ONE BREATH MOVES IN AND OUT OF THE LUNGS

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WHAT IS BLOOD PRESSURE

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BLOOD PRESSURE ISTHE FORCE OF BLOOD AGAINST ARTERIES' WALLS AS THE HEART CONTRACTS AND RELAXES

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WHAT IS SYSTOLIC B/P?

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SYSTOLIC B/P IS THE FORCE OF BLOOD AGAINST ARTERIES WHEN THE VENTRICLES CONTRACT

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WHAT IS DIASTOLYIC B/P?

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DIASTOLIC B/P IS THE FORCE OF BLOOD AGAINST ARTERIES WHEN VENTRICLES RELAX

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WHAT IS KOROTKOFF SOUNDS?

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KOROTOKOFF SOUNDS IS THE SOUND OF BLOOD HITTING ARTERIAL WALLS

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WHAT IS PERFUSION?

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PERFUSION IS HE PASSAGE OF BLOOD THROUGH AN ORGAN OR TISSUE

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WHAT IS PULSE PRESSURE?

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PULSE PRESSURE IS THE DIFFERENCE BETWEEN SYSTOLIC AND DIASTOLIC PRESSURES

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BREATHING PATTERNS

WHAT IS EUPNEA?

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EUPNEA IS NORMAL BREATHING RATE AND PATTERN

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BREATHING PATTERNS

WHAT IS TACHYPNEA?

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TACHYPNEA IS INCREASED RESPIRATORY RATE

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WHAT CAUSES TACHYPNEA?

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TACHYPNEA IS CAUSED BY FEVER, ANXIETY, EXERCISE, AND SHOCK

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BREATHING PATTERNS

WHAT CAUSES BRADYPNEA?

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BRADYPNEA IS DECREASED RESPIRATORY RATE

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WHAT CAUSES BRADYPNEA?

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BRADYPNEA IS CAUSED BY SLEEP, DRUGS, METABOLIC DISORDER, HEAD INJURY, STROKE

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BREATHING PATTERNS

WHAT IS APNEA?

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APNEA IS THE ABSENCE OF BREATHING

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WHAT CAUSES APNEA?

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APNEA IS CAUSED BY DECEASED PT, HEAD INJURY, STROKE

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BREATHING PATTERNS

WHAT IS HYPERPNEA?

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HYPERPNEA IS RESPIRATIONS AT A NORMAL RATE, BUT EXCESSIVELY DEEP

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WHAT CAUSES HYPERPNEA?

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HYPERNEA IS CAUSED BY EMOTIONAL STRESS, DIABETIC KETOACIDOSIS

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BREATHING PATTERNS

WHAT IS CHEYNE-STOKES?

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CHEYNE-STOKES IS GRADUAL INCREASES AND DECREASES IN RESPIRATIONS WITH PERIODS OF APNEA.

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WHAT CAUSES CHEYNE-STOKES?

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CHEYNE-STOKES IS CAUSED BY INCREASING INTERCRANIAL PRESSURE, BRAINSTEM INJURY

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BREATHING PATTERNS

WHAT IS BIOT'S RESPIRATIONS?

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BIOT'S RESPIRATIONS ARE RAPID, DEEP RESPIRATIONS ( GASPS ) WITH SHORT PAUSES BETWEEN SETS

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WHAT CAUSES BIOT'S RESPIRATIONS?

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BIOT'S RESPIRATIONS ARE CAUSED BY SPINAL MENINGITITS, MANY CNS CAUSES, HEAD INJURY

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BREATHING PATTERNS

WHAT IS KUSSMAUL'S RESPIRATIONS?

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KUSSMAUL'S RESPIRATIONS ARE TACHYPNEA AND HYPERPNEA

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WHAT CAUSES KUSSMAUL'S RESPIRATIONS?

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KUSSMAUL'S RESPIRATIONS ARE CAUSED BY RENAL FAILURE, METAOLIC ACIDOSIS, DIABETIC KETOACIDOSIS

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BREATHING PATTERNS

WHAT IS APNEUSTIC RESPIRATIONS?

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APNEUSTIC RESPIRATIONS ARE PROLONGED INSPIRATORY PHASE WITH SHORTENED EXPIRATORY PHASE

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WHAT CAUSES APNEUSTIC RESPIRATIONS?

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APNEUSTIC RESPIRATIONS ARE CAUSED BY A LESION IN THE BRAIN STEM

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WHAT IS HYPERTENSION ?

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HTN IS A BLOOD PRESSURE HIGHER THAN NORMAL.
WNL IS SYSTOLIC 100-135mmHG
DIASTOLIC 60 - 80 mmHG

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HOW DO YOU DETERMINE PULSE PRESSURE?

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SYSTOLIC B/P - DIASTOLIC B/P
EX. - 160/90
160-90= 70
PT HAS A PULSE PRESSURE OF 70

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HYPOTENSION

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HYPOTENSION IS DEFINED AS A B/P THAT IS LOWER THAN USUAL

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WHAT ARE ORTHOSTATIC VITAL SIGNS?

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TAKING A PULSE AND B/P ON A PT IN THE LYING, SITING UP, AND STANDING POSITION. IF YOU FIND THAT THERE IS A PULSE INCREASE OF 10 TO 20 BPM OR IF THE SYSTOLIC B/P DROPS 10 mmHG .....INDICATES HYPOVOLEMIA....SPECIFICALLY DEHYDRATION

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WHAT IS PULSUS PARADOXUS?

PG 46

Back 52

PULSUS PARADOXUS IS AN EXAGGERATED FALL IN SYSTOLIC B/P DURING INSPIRATION

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PULSUS PARADOXUS IS FOUND WITH WHAT CONDITIONS?

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COPD, ASTHMA, PERICARDIAL TAMPONADE, HYPOVOLEMIA, PERICARDIAL EFFUSIONS

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WHEN TAKING A B/P HOW SHOULD YOU DEFLATE THE CUFF?

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2-3 mmHG PER HEARTBEAT

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HOW TO CHECK FOR PULSUS PARADOXUS?

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TO CHECK FOR PULSUS PARADOXUS, INFLATE THE B/P CUFF UNTIL IT IS ABOVE THE PT'S SYSTOLIC PRESSURE. AUSCULTATE THE BRACHIAL ARTERY - LISTEN FOR KOROTKOFF SOUNDS - THEY ARE HEARD DURING INSPIRATION AND EXPIRATION - DEFLATE THE CUFF, IF THERE IS MORE THAN A 10mmHG DROP DURING QUIET RESPIRATION, YOUR PT IS + FOR PARADOXICAL PULSE

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WHAT IS HYPERTHERMIA?

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HYPERTHERMIA IS AN INCREASE IN BODY'S CORE TEMPERATURE.
102 = INCREASES METABOLISM
103 = THE NEURONS OF THE BRAIN DENATURE
104 = BRAIN CELLS DIE AND SEIZURES MAY OCCUR

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WHAT IS HYPOTHERMIA?

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HYPOTHERMIA IS A DECREASE IN THE BODY'S CORE TEMPERATURE.
93 = THE BODY'S WARMING MECHANISMS FAIL
90 = SHIVERING, HEART SOUNDS DIMINISH, CARDIAC IRRITABILITY INCREASES
LOWER THAN 70 = DEATH LIKE APPEARANCE, IRREVERSABLE ASYSTOLE

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WHAT IS A PULSE OXIMETER?

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A PULSE OXIMETER IS A NONINVASIVE DEVICE THAT MEASURES THE OXYGEN SATURATION OF BLOOD.

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NORMAL OXYGEN SATURATION SHOULD BE WHAT?

Back 59

95 TO 100% ON ROOM AIR

Front 60

WHAT OTHER GAS WILL BIND WITH HEMOGLOBIN BESIDES OXYGEN?

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CARBON MONOXIDE
IT WILL SATURATE THE HEMOGLOBIN MOLECULE AT 200 TIMES MORE EASILY THAN OXYGEN. THE PULSE OX MACHINE CAN NOT DESCRIMINATE BETWEEN OXYGEN AND CO2....SO THE PT'S HEMOGLOBIN COULD BE SATURATED AND THE PT COULD STILL SEVERLY HYPOXIC

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WHAT IS CAPNOGRAPHY?

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CAPNOGRAPHY IS REAL-TIME MEASUREMENT OF EXHALED CARBON DIOXIDE CONCENTRATIONS.

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WHAT IS AN END-TIDAL CARBON DIOXIDE DETECTOR?
ETCO2?

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AN ETCO2 DETECTOR IS A DEVICE USED IN CAPNOGRAPHY TO MEASURE EXHALED CARBON DIOXIDE CONCENTRATIONS.

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WHEN AN ETCO2 DETECTOR IS USED ON AN ET TUBE, WHAT COLOR SHOULD YOU SEE TO HELP CONFIRM TUBE PLACEMENT?

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THE ETCO2 DETECTOR SHOULD TURN YELLOW WITH INCREASED CO2 EXPIRATION.
IT WILL TURN PURPLE IF IT HAS DECREASED CO2

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CAPNOGRAPHY CAN PROVIDE WHAT TYPE OF INFORMATION?

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INDIRECT ESTIMATION OF CARDIAC OUTPUT, PULMONARY BLOOD FLOW AND THE EFFECTIVNESS OF CPR DURING CARDIAC ARREST

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D-STICKS SHOULD ALWAYS BE PERFORMED WHEN?

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UNRESPONSIVE PT, ALTERED MENTAL STATUS, ETOH PT'S, Hx OF DIABETES

Front 66

THE SKIN MAKES UP WHAT PERCENT OF OUR TOTAL BODY WEIGHT?

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THE SKIN MAKES UP 15% OF OUR TOTAL BODY WEIGHT

Front 67

SIX CHARACTERISTICS OF SKIN TO ASSESS

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COLOR
MOISTURE
TEMPERATURE
TEXTURE
MOBILITY AND TURGOR
LESIONS

Front 68

HAIR IS WHAT TYPE OF SENSORY ORGAN?

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HAIR IS A TACTILE SENSORY ORGAN

Front 69

THERE ARE TWO TYPES OF HAIR

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VELLUS
TERMINAL

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VELLUS HAIR IS ...

Back 70

SOFT, LIKE PEACH FUZZ

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TERMINAL HAIR IS ....

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TERMINAL HAIR IS ROUGH, COARSER, AND PIGMENTED
EX - A MAN'S BEARD,

Front 72

WHAT IS HIRITUISM?

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HIRTUSISM IS ABNORMAL FACIAL HAIR GROWTH IN WOMEN

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BEAU'S LINES ARE WHAT?

PG 57

Back 73

BEAU'S LINES AR TRANSVERSE LINES ACROSS THE NAILS. IT INDICATES THAT THEY PT HAS HAD A SERIOUS SYSTEMIC ILLNESS WITHIN THE LAST 2 TO 3 MONTHS - DURING THE ILLNESS, THE NAILS GROW MUCH SLOWER THUS CAUSING THE LINES

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CLUBBING OF THE FINGERNAILS INDICATES THAT THE PT HAS WHAT?

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CONESTIVE HEART FAILURE

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CLUBBING OF THE FINGERNAILS IS CAUSED BY ?

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CHRONIC HYPOXIA FOUND IN CARDIOPULMONARY DISEASES AND LUNG CANCER

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ABNORMAL NAIL FINDINGS

WHAT IS PARONYCHIA?

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PARONYCHIA IS AN INFLAMMATION OF THE PROXIMAL AND LATERAL NAIL FOLDS. IT MAY BE ACUTE OR CHRONIC. THE FOLDS APPEAR RES AND SWOLLEN AND TENDER. THE CUTICLE MAY NOT BE VISIBLE. PROPLE WHO FREQUENTLY IMMERSE THEIR HANDS IN WATER ARE SUSCEPTIBLE

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ABNORMAL NAIL FINDINGS

WHAT IS ONYCHOLYSIS?

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ONYCHOLYSIS IS WHERE THE NAIL BED SEPARATES FROM THE NAIL PLATE. IT BEGINS DISTALLY AND AND ENLARGES THE FREE EDGE OF THE NAIL. THERE ARE MANY CAUSES, INCLUDING HYPERTHYROIDISM

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ABNORMAL NAIL FINDINGS

WHAT IS TERRY'S NAILS?

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TERRY'S NAILS APPEAR AS A MOSTLY WHITISH NAIL WITH A BAND OF REDDIS-BROWN AT THE DISTAL NAIL TIP. THIS MAY BE SEEN IN AGING AND ITH PEOPLE SUFFERING FROM LIVER CIRRHOSIS, CHF, AND DIABETES

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ABNORMAL NAIL FINDINGS

WHAT IS WHITE SPOTS?

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WHITE SPOTS GENERALLY INDICATE A PAST TRAUMA TO THE NAIL, THAT GROW OUT.

Front 80

WHAT ARE THE FIVE LAYERS OF THE SCALP?

Back 80

SKIN
CONNECTIVE TISSUE
APONEUROSIS
LOOSE TISSUE
PERIOSTEUM

Front 81

BILATERAL BLACK EYES ARE ALSO CALLED WHAT?

Back 81

PERIORBITAL ECCHYMOSIS OR RACOON EYES

Front 82

PROPTOSIS IS WHAT?

Back 82

PROPTOSIS IS BLUDGING EYE BALLS

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WHAT IS PTOSIS?

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PTOSIS IS DROOPING OF THE EYE LIDS

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WHAT ARE THE THREE COMPONENTS OF THE EAR?

Back 84

INNER EAR
OUTER EAR
MIDDLE EAR

Front 85

DISCHARGE FROM THE EAR CANAL IS CALLED?

Back 85

OTORRHEA IS DISCHARGE FROM THE EAR CANAL

Front 86

WHAT IS THE MEDICAL TERM FOR A RUNNY NOSE?

Back 86

RHINITIS

Front 87

WHAT IS THE MEDICAL TERM FOR A BLOODY NOSE?

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EPISTAXIS

Front 88

LIP ABNORMALITIES

DRY/CRACKED LIPS

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DRY/CRACKED LIPS ARE CAUSED BY DEHYDRATION, WIND DAMAGE

Front 89

LIP ABNORMALITIES

SWELLING/EDEMA

Back 89

SWELLING/EDEMA TO THE LIPS IS CAUSED BY INFECTION, ALLERGIC REACTIONS, BURNS

Front 90

LIP ABNORMALITIES

LESION

Back 90

LESIONS ARE CAUSED BY INFECTION, IRRITATION, SKIN CANCER

Front 91

LIP ABNORMALITIES

PALLOR

Back 91

PALLOR OF THE LIPS IS CAUSED BY ANEMIA AND SHOCK

Front 92

LIP ABNORMALITIES

CYANOSIS

Back 92

CYANOSIS OF THE LIPS IS CAUSED BY CARDIAC OR RESPIRATORY INSUFFICIENCY

Front 93

WHAT ARE THE FIVE VITAL STRUCTURES OF THE NECK?

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SPINAL CORD
CAROTID ARTERIES
JUGULAR VEINS
LARYNX/TRACHEA
ESOPHAGUS

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FLAT JUGULAR VEINS =

Back 94

BLOOD LOSS