Introduction to Physical Exam Flashcards by Garrett Oberst

Two tiers of investigation

Screening for new patients

Extended or problem based

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Examination Techniques

Inspection (observation)
Percussion
Palpation
Auscultation

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Observation

Least mechanical part of physical exam

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More diagnoses made during which part of physical exam?

Inspection

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Observation includes

What you see, hear, olfactory diagnosis, emotions, dress and hygeine

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Inspection general appearance

State of consciousness
Signs of distress
Apparent state of health 
Skin
Dress and grooming
Facial expression 
Gai and posture 
Motor activity

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Olfactory diagnosis can help with

Certain diseases
Ingestion of toxins
Certain infections

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Percussion

Method of physical examination in which the surface of the body is struck to emit sounds that vary in quality according to the density of the underlying tissues

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Density and tone relationship

More dense, quieter tone

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Sound waves arise from how deep in body tissue?

4 to 6 cm

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Sonorous percussion

Determines density

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Definitive percussion

Maps extent of border of an area

Easier to move from resonance to dullness

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Uses of percussion

Sonorous
Definitive
ID area of tenderness

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Direct

Strinking finger, hand, or lunar aspect of fist against body

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Indirect

Dominant middle finger used as a hammer to strike the distal joint of non-dom middle finger

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Tympany

Gastric Air bubble

Similar to sound against side of mouth

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Hyperressonance

Emphysemic lung

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Resonance

Healthy lung

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Dullness

Liver

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Flatness

Muscle, thigh

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Tractile sense

Finger pads more sensitive than finger tips

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Vibratory sense

Ulnar aspect of hands, palmer metacarpaphalngeal joints

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Position and consistency

grasping fingers

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Temperature

Dorsum of hand

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Qualities elicited by palpatation

``` Texture Moisture Temperature Masses Precordial Cardiac thrust Crepitus (crunch of knee) Tenderness Vocal fremitus ```

Stethoscope mechanism

Conveys vibrating column of air from body wall to ears and does not amplify Excludes outside noise

heart and lung sound frequency

60-3000

Hearing range

30-20000

Components of stethoscope

Chest piece Rubber tubing Angled biaurals Ear pieces

Bell piece

Transmits all sounds Good for low pitches Lightly touch test Rubber edge

Diaphragm

Filters out low Better for high pitch Press firmly

Where to hold stethoscope

Between second and third fingers

Point ear pieces toward.....

the nose

Ophthalomoscope

Lenses and mirrors with a light source and various apertures

Opthalomoscope apertures

Small - small pupils Red free filter - green beam Slit - elevation of lesions Grid - size of lesions

Otoscope

Speculum narrows and directs beam of light into ears | Can be used for nasal exam too

Auditory tuning fork

500-1000 HZ

Vibratory tuning fork

128 HZ

3 types of reflex hammers

Tomahawk Babinski Neurologic

Sphygomanometer size

Width - 40% arm cicumference | Length - 80% arm circumference

Normal oral temp

98.6

Normal axillary temp

97.6

Normal rectal temp

99.6

Normal aural temp

99.6

Which temp is least and most accurate

Least - Axillary | Most - Rectal

Pyrexia

Fever

Hyperpyrexia

Greater than 106

Hypothermia

Less than 95

Flase temp measurements

Smoking or drinking hot/cold liquid Rapid resp rate Failure to use thermometer correctly

How to record temp

Temp, location, (type of thermometer)

Which artery to compress for pulse?

Radial

Regular pulse

Evenly spaced beats

Regularly irregular

Regular pattern with skipped beats

Irregularly irregular

Chaotic with no real pattern

Tachycardia

Pulse greater than 100 BPM

bradycardia

Pulse less than 60 BPM

Normal HR

50-100 BPM

How to do respiration

Don't tell patient and just observe breathing...normal or labored?

Normal respiratory rate

14-20 breaths per minute

Tachypnea

Rapid respiration

Diastole

Blood flows into ventricles

Systole

Blood flows out of ventricles

Systolic BP

Pressure generated by LV during systole when LV ejects blood into aorta

Diastolic BP

Pressure generated by blood remaining in arterial tree during diastole

Pulse pressure

Systolic-diastolic

Why is BP not 0?

When ventricle shuts, there is elasticity of aorta that causes recoil

Which part of stehoscope for BP

Bell

BP technique

``` no caffeine, tobacco, vigorous activity for 30 min Sit for 5-10 min Back supported, feet flat on ground, room quiet and warm, arm rested and free of clothing, Arm at level of heart Arm supported ```

Which artery for BP?

Brachial artery

Bottom of cuff should be how far above crease of cubital fossa?

2.5 cm

Arrow points toward

brachial artery

How to estimate systolic BP

Palpate radial artery and pump cuff til you cannot feel

Where to start BP cuff pressure

30 + estimated systolic

Auscultatory gap

Causes underestimation of BP by going silent before diastolic pressure present

Causes of increased BP

``` Loose or too small of cuff Bladder ballooning outsdie cuff Smoking Caffeine Being cold Athersclerosis White coat Circadian variations Physcial activity Artery below heart ```

Falsely decrease BP

Brachail artery too high Too large of cuff Circadian