Practical #3

Question 1

1 - 1

Answer 1

PULM INSPECTION: Assess respiratory effort and chest wall movement
“No respiratory distress, use of accessory muscles, or nasal flaring. Chest wall movement is symmetric

Question 2

1 - 2

Answer 2

PULM PALPATION - tactile fremitus

“Tactile fremitus is symmetric throughout the lung fields”

Question 3

1 - 3

Answer 3

PULM AUSCULTATION/EGOPHONY
“Posterior, Lateral, Anterior and apex lung fields are clear to auscultation.”
“No egophony appreciated”

Question 4

1 - 4

Answer 4

PULM PERCUSSION
“No CVA tenderness”
“No hyper-resonance or dullness to percussion throughout all lung fields”

Question 5

2 - 1

Answer 5

HEART INSPECTION

“On general inspection of the chest, there are no scars, pectus excavatum, or pectus carniatum”

Question 6

2 - 2

Answer 6

HEART PALPATION
“Upon palpation there are no thrills or heaves”
“Point of maximal impact is mid-clavicular and appropriate size”

Question 7

2 - 3

Answer 7

HEART AUSCULTATION
“Rate and rhythm are regular, S1 and S2 are present, no murmur, rubs or gallops - in sitting, supine, and left lateral decubitus position”
“No bruits noted in the carotids bilaterally”

Question 8

2 - 4

Answer 8

VASCULATURE INSPECTION
“No increase in JVP/JVD”
“Skin has no pallor, cyanosis, or jaundice”
“There is appropriate hair on toes”
“Capillary refill is less than 2 seconds on fingernails and toenails”

Question 9

2 - 5

Answer 9

VASCULATURE PALPATION
“Carotid pulse rate is regular and 2+ bilaterally”
“Radial pulse rate is regular and 2+ bilaterally”
“Dorsalis pedis pulse rate is regular and 2+ bilaterally”
“Posterior tibialis pulse rate is regular and 2+ bilaterally”

Question 10

3 - 1

Answer 10

ABDOMEN INSPECTION
“Inspection of abdomen reveals no cyanosis or jaundice, no protrusion or masses, no visible or dilated vessels, no herni, no diastasis recti, rashes, sores or lesions, or pulsations”
“Abdomen is symmetrical and the contour is flat”

Question 11

3 - 2

Answer 11

ABDOMEN AUSCULTATION 4 quadrants and epigastric
Diaphragm: “Bowel sounds are present in all 4 quadrants, not decreased, hyperactive, tinkling, or high pitched”
Bell: “No bruits heard in abdominal aorta, renal arteries, iliac arteries, or femoral arteries”

Question 12

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Answer 12

ABDOMEN PERCUSSION 4 quadrants and epigastric
“No remarkable hyper-resonance or dullness appreciated”
“Liver span is approximately 8 cm”

Question 13

3 - 4

Answer 13

ABDOMEN - Shifting Dullness
“If dullness is noted in dependent areas while patient is lying supine, I would have them roll on their side and percuss downward to until dullness is detected to confirm ascites”

Question 14

3 - 5

Answer 14

ABDOMEN PALPATION
“No masses or tenderness to light and deep palpation”
“Liver edge is not tender or firm, the spleen is not palpable”
“Abdominal aorta is palpable less than 3 cm”
“Femoral arteries are palpated - regular rate and rhythm 2+”

Question 15

3 - 6

Answer 15

“Rebound tenderness is negative in all 4 quadrants”
“Psoas sign is negative” - lift right knee against hand
“Obturator sign is negative”