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PROPER SKILLS Flashcards

(85 cards)

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1
Q

When should auscultation be performed during an examination?

A

Before palpation and percussion

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2
Q

Why should auscultation be done before palpation and percussion?

A

To avoid false interpretation of bowel sounds

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3
Q

Where are bowel sounds best appreciated?

A

Right lower quadrant at ileocecal valve

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4
Q

What is the significance of bowel sounds being normally present in the ileocecal valve area?

A

Indicates normal gastrointestinal activity

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5
Q

How is absent bowel sound defined?

A

No sounds heard within 5 minutes

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6
Q

What characterizes hypoactive bowel sounds?

A

4 or fewer sounds heard

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7
Q

How are hyperactive bowel sounds defined?

A

Bowel sounds occur every < 2 seconds

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8
Q

What defines normoactive bowel sounds?

A

5-30 low pitched sounds per minute

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9
Q

What is the typical character of bowel sounds?

A

Low pitched, gurgling, intermittent sounds

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10
Q

Which part of the stethoscope is best for hearing bowel sounds?

A

Diaphragm of the stethoscope

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11
Q

Where should vascular sounds be assessed?

A

Aorta, renal, iliac, and femoral arteries

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12
Q

What is a venous hum?

A

An innocent murmur with medium pitch

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13
Q

What happens to a venous hum with jugular venous compression?

A

It disappears with compression

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14
Q

What are normal auscultation findings?

A

Normoactive bowel sounds, 10/minute

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15
Q

What is the initial step in palpation?

A

Ask the patient to identify pain area

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16
Q

What does palpation aim to determine about the abdomen?

A

Softness, firmness, rigidity, tenderness

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17
Q

How deep is light abdominal palpation?

A

About 1 cm deep

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18
Q

What technique is used in light abdominal palpation?

A

Gentle rotatory motion with fingers

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19
Q

What is the purpose of deep abdominal palpation?

A

To delineate organs and masses

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20
Q

What is the single-handed technique in deep palpation?

A

Push down 5-8 cm with one hand

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21
Q

What is reinforced palpation?

A

A two-handed technique for better pressure

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22
Q

How is bimanual palpation performed?

A

One hand on each side of the mass

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23
Q

How is the liver edge palpated using the general technique?

A

Push under the right costal margin

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24
Q

What should be felt during liver palpation?

A

The liver edge bumping fingertips

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25
What is the hooking technique for liver palpation?
Hook fingers over the right costal margin
26
How is the spleen palpated using the primary technique?
Push under the left costal margin
27
What is the alternative technique for spleen palpation?
Roll the patient on their right side
28
What should be felt during spleen palpation?
No firm mass should be felt
29
What is the purpose of ballottement?
To assess freely movable masses
30
How is the liver edge palpated using the general technique?
Push under the right costal margin
31
What should be felt during liver palpation?
The liver edge bumping fingertips
32
What is the hooking technique for liver palpation?
Hook fingers over the right costal margin
33
How is the spleen palpated using the primary technique?
Push under the left costal margin
34
What is the alternative technique for spleen palpation?
Roll the patient on their right side
35
What should be felt during spleen palpation?
No firm mass should be felt
36
What is the position of the right kidney in relation to the left kidney?
The right kidney is lower than the left kidney.
37
What is the first step in palpating the right kidney?
Place the right hand in a duckbill position.
38
What should the examiner do while palpating the right kidney?
Press two hands together firmly and ask the patient to breathe deeply.
39
What findings can be noted during right kidney palpation?
No change or feel a round, smooth mass.
40
How does the left kidney's position compare to the right kidney?
It usually sits 1 cm higher than the right kidney.
41
Why is the left kidney not normally palpable?
It is usually not palpable due to its position.
42
What is the technique for palpating the left kidney?
Reach left hand across abdomen and push right hand deeply.
43
What should be felt during left kidney palpation with inhalation?
No change should be felt with inhalation.
44
Where should the aortic pulsation be palpated?
In the upper abdomen, slightly left of midline.
45
What is the normal width of the aorta in adults?
2.5 - 4 cm wide.
46
In which direction does the aorta pulsate?
In the anterior direction.
47
What is percussion useful for in abdominal examination?
General orientation, identifying air, measuring organs.
48
What should be assessed during light percussion of the abdomen?
General proportions and distribution of tympany and dullness.
49
What is the procedure for percussion of the liver span?
Percuss upwards from tympany to dullness.
50
Where is the lower border of liver dullness typically found?
Near the right costal margin.
51
What is the upper border of liver dullness usually located?
Near the 5th intercostal space (ICS).
52
What is Traube's space?
A crescent-shaped space where the spleen is located.
53
How is the height of liver dullness measured?
In cm, measuring the vertical span.
54
What indicates splenomegaly during percussion of Traube's space?
Space becomes dull or obliterated.
55
What is Castell's method used for?
Identifying splenic enlargement.
56
What happens to the percussion note when the spleen is enlarged?
It becomes dull when enlarged.
57
What are the key findings to report after abdominal examination?
Tympanitic on all quadrants ## Footnote Liver span is 10 cm Traube’s space is intact
58
What is the first palpation maneuver for right upper quadrant pain?
Direct tenderness on RUQ
59
How do you perform Murphy's sign?
Hold finger under liver, ask to inspire
60
What indicates a positive Murphy's sign?
Sharp pain and stopped inspiration
61
What is the second palpation maneuver for right lower quadrant pain?
Rebound tenderness
62
How is rebound tenderness tested?
Press and suddenly withdraw fingers
63
What does a positive rebound tenderness indicate?
Presence of pain upon release of pressure
64
What is the psoas sign test procedure?
Lift right leg, push down on thigh
65
What indicates a positive psoas sign?
RLQ pain when pushing down
66
How is the obturator sign performed?
Flex right leg and rotate internally
67
What does a positive obturator sign indicate?
RLQ pain during leg rotation
68
What is Rovsing's sign?
Pain in RLQ when pressing LLQ
69
What is the cough sign used to elicit?
RLQ pain upon coughing
70
What is assessed for flank pains or urinary symptoms?
Costovertebral angle tenderness
71
How is CVA tenderness tested?
Tamp hand over 12th rib with fist
72
What indicates a positive CVA tenderness test?
Patient feels pain at CVA
73
What is the succussion splash used to assess?
Gastric outlet obstruction with vomiting
74
How is the succussion splash performed?
Shake abdomen with stethoscope at LUQ
75
What indicates a positive succussion splash?
Very loud splash sound
76
What is the puddle sign used to detect?
Small amount of ascites
77
How is the puddle sign performed?
Flick flank while listening with stethoscope
78
What indicates a positive puddle sign?
Sound becomes louder at puddle edge
79
What are the two maneuvers for suspected ascites?
1. Fluid wave 2. Shifting dullness
80
How is the fluid wave test performed?
Strike left flank while blocking midline
81
What indicates a positive fluid wave test?
Distinct tap felt on left hand
82
How is shifting dullness tested?
Percuss abdomen, mark tympanic to dull
83
What happens when the patient is turned onto the right side during shifting dullness?
Fluid gravitates to dependent side
84
What sound change indicates the presence of fluid during shifting dullness?
Change from tympany to dullness
85
Where does the level of dullness rise when fluid is present?
Higher towards the umbilicus

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