Pcom- Health Assessment Physical Final

Front 1

Vital Signs

Back 1

?

Front 2

Skin, Hair and Nails

Back 2

Skin Front and Back. mainly inspection.
INSPECTION:
1. See color, looking for any pigmentation of the skin, any pallor (enema) if yellowish, jaundice and Carotenosis- CYANOSIS CENTRAL OR NOT. Lesions, Moles; A,B,C,D and E's. Nevus
2.temperature using the back of your fingers. See moisture. Is it dry or Moist. Hypo or Hyperthyroidism. 3. Skin rough or smooth. Skin Mobility. and turgor ( goes back to the normal position) It will be difficult to fold.
PALPATION : do if nodules, lesions
then
HAIR: Inspect and Palpate- hair _ quantity/distrubution/ texture quality texture ( hyper-( Dry) hyper (silky)
NAILS: of both finger and feet. ( looking color pink, cyanosis, skin also cyanosis- Hair nail clubbing. Angle with be lost Schamroth's window. Pitting, paronychia, Mees lines, Bowl line, onycholysis koilonchia ( All fingers )

Front 3

EYE
4. Examine visual fields. Do the screening test and further test.
5. Examine the conjunctiva and sclera. What are the conditions are you looking for?
6. Examine the pupils. What you are looking in inspection? Do pupillary reactions to light both direct and consensual. Do near reaction.
7. Examine extraocular muscles? Do the light reflection on the cornea, six extraocular movements of the eye, and examination of lid lag, and test for convergence.

Back 3

INSPeCT Structure of the eye:
1. Position of the eyes.
2. sclera, conjuctiva, iris, cornea, limbus (junction between cornea and sclera) lacternal gland. ( swelling) punter ( 2 tiny openings) , and lacternal sac and duct.
3. VISUAL FIELD: Screening
ask pt to look at you. Standing in front of pt with your arms apart, ask pt to tell you when they see your hands come into vision and if its both hands - Temporal first- then back diagonal. If anything wrong do the right side or left side separately. ( cover one eye with paper)
Conjunctiva and sclera. Pull the lower eye lid , ask to up, pull the upper eye lid ask to look up( looking for anemia , jaundice, episcleritis, ( redness) terisiter! ( over growth of tissue)
Pupil: examine both. size ( 4mm) shape ( round) symmetry.
Light reflex. Dilate and construction. ( direct) Now look at the walls consensual.
Near direct ( figure 4 inch in front) Ask pt to look to the wall then pen.
ASk pt look at the light 1 foot away. Reflection should be medial to the center of the pupil. ( reflection of the light) Means the eye ball is in the right direction)
4. Extracylar muscle: 'H' first extreme right then upper right then down left ...
Lid lag is the corena paritailly covered by the lid. Ask pt to look down.
test for convergenge: Look at pen move it towards pt. ( does the eyeball converge)
opthalmoscope - should not be straight to be at a angle. set at zero - right eye. Right eye right hand - red reflex then follow

Front 4

EARS
8. Do the Tug test for Otitis externa. Examine the ear canal and tympanic membrane using otoscope. What you are looking for.
9. Examine auditory acuity. Do the whisper and tuning fork tests.

Back 4

Inspect. Helix, antihelix, tragus, antitragus, ear canal, and tympanic membrane.
Tug test. move orticle traggis. - otitis externa. not medial.
Otoscope - examine ear canal and tympanic membrane. which ear canon would you choose. Pull upward, backward and a little away. Inside downwards and forward otoscope. Looking for discharge, wax , sweling , tymbrain should be shining. Looking for holes where?
Auditory acuity: Whisper test: 1222 behind the patient.
the WEber: hold n pt head. Do you hear clearly on both sides? then you do the Rinne. first apply on the mastoid then when can't hear , move to ear. If pt can still hear it. Air conduction is better than bone conduction, which is normal.

Front 5

NOSE AND SINUSES
10. Inspect the nasal cavity. What are you looking for? Examine the frontal and maxillary sinuses.
• Know both palpation and transillumination tests. How will you test for nasolacrimal duct obstruction

Back 5

• Looking for any deviation. Symmetry Inspect.
• Take Othoscope. Largest size. Ask pt to lift head slightly. First straight, then upward. I'm looking for color and condition of the nasal mucosa the cover the nasal septum and turbinates ( normal redder than ) no swelling, excudates perforation or deviation, bleeding, pulops or ulsers. both sides.
• Press up on the frontal side paranasal sinuses for tenderness
• Press on the nasolacrimal duct. looking to see if puss should come out if so it is blocked.
• paranasal sinuses

Front 6

MOUTH AND PHARYNX
11. Examine the mouth and pharynx. Make sure you examine all, lips, oral mucosa, gums and teeth, roof of the mouth, all sides of the tongue and pharynx including soft palate,uvula pilars and tonsils

Back 6

• Inspect outside of the lips for symmetry, moisture and ulcers, cracking and scaling.
• With good lighting and tongue blade, inspect mucosa for color, nodules, ulcers, light patches.
• Observe the gums for redness, swellings and teeth for abnormalities.
• Hard palate for color or form
• soft palate ulva for redness and swelling. Pt say ahhh note the soft palate should rise symmetrically and the ulva stay midline.
• finally inspect the pillars , tonsils, looking for redness, swelling . exudates or ulceration.
• Inspect the tongue, noteing symmetry, inspect undersurface,and sides, looking for white or reddened area, nodules or ulcers
•

Front 7

NECK
12. Examine the lymph nodes of the neck. Examine the trachea.
13. Examine the thyroid gland by inspection, palpation, and auscultation.
14. Inspect and palpate the posterior thorax. What are the normal and abnormal things are you looking and feeling for?

Back 7

• Inspect the neck visually, looking for symmetry, looking for any enlargement on the coriated or submandibular glands.lymph nodes or scars and Can ask pt to put hand on side of face and push into hand to see better.
•Palpate the lymph nodes. Feel for the pre-auricalar, postauricular, occipital, tonsillar,submandibular, submental, superfical cervical and posterior cervical node, deep cervical chain including the supraclavicular nodes.

Front 8

NECK continued.
13. Examine the thyroid gland by inspection, palpation, and auscultation.
14. Inspect and palpate the posterior thorax. What are the normal and abnormal things are you looking and feeling for?

Back 8

• Identify the Sternomastoid muscle. Anterior and posterior triangle, midline neck structures,Hyoid bone, thyroid cartilage, thyroid gland.
• Inspect and palpate the trachea for deviation.
• Inspect the thyroid, ask pt to tilt head slightly upward sip on some water and watch that thyroid cartilage ,cricoid cartilage moves upwards together, Palpate with fingers and feel for the thyroid isthmus ask the pt to shallow, then using both hand coming from behind the pt with index fingers just below the cricoid cartilage- ask pt to swollen. feel rise and fall,looking to see if there are any masses, swellings that don't move.
• Ausculate?

Front 9

THORAX AND LUNGS Posterior
14. Inspect and palpate the posterior thorax. What are the normal and abnormal things are you looking and feeling for?

Back 9

• pt sitting up. Observe the deep, rhythm and rate of their breath. 14-20/min
• Inspect for any retractions
• Have pt cross arms and observe the back, for shape symmetry, palpate for any lesion
• Chest expansion, place thumbs at the level of the 10th ribs, ask pt to inhale and exhale deeply and fully, watching divergence of the thumbs
• use diagram above for tactile fremitus pt repeats 99

Front 10

THORAX AND LUNGS Posterior continued
15. Percuss the posterior chest. Tell the normal and abnormal percussion notes.
16. Auscultate the posterior chest. Tell the normal and abnormal findings you expect

Back 10

• continue with these locations. Normal lungs are Resonance
• percuss for diaphragmatic dullness. when percussing down the expected place for dullness mark at full expiration.
• next ask pt to inhale then percuss downwards are full inspiration and mark. should be about 5-6cm
• repeat of other side.
• Ausculate the posterior chest same positions as above. Listen to one full breath in each position, intensity, pitch and duration. Vesticular breath sounds should be heard throughout.
• whisper pectoriloquy is an exaggerated form of bronchophony with consolidation of lung tissue a whisper would be louder or easily heard through stethoscope.
• e to a sounds egophony. Say EEE when have stethoscope on pt. eee becomes aaa when have consolidation.

Front 11

THORAX AND LUNGS anterior continued.

Back 11

• Inspect lying down?
• Inspection observe shape and