Guide to Physical Examination

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Questions and Answers

When performing a general physical examination, on which side of the patient should the examiner ideally stand?

  • Either side, as long as the lighting is adequate.
  • The patient's right side, as a standard practice. (correct)
  • The side with more space for equipment.
  • The patient's left side, to facilitate palpation with the dominant hand.

Why is it important to introduce yourself to the patient before starting a physical examination?

  • To establish trust and explain the examination process. (correct)
  • To ensure you remember their name throughout the examination.
  • To document the interaction for billing purposes.
  • To fulfill a legal requirement for medical procedures.

Before beginning a physical examination, what is the MOST important reason for ensuring you have the relevant equipment?

  • To impress the patient with your preparedness.
  • To adhere to hospital protocols and avoid penalties.
  • To minimize disruptions and maintain efficiency during the examination. (correct)
  • To prevent colleagues from borrowing your equipment.

Why is obtaining the patient's permission a crucial step before starting a physical examination?

<p>To respect patient autonomy and ensure they are comfortable with the procedure. (B)</p> Signup and view all the answers

In the context of a general physical examination, what is the PRIMARY purpose of performing hand hygiene?

<p>To prevent the spread of infections between the healthcare provider and the patient. (C)</p> Signup and view all the answers

During hand washing, what is the purpose of washing between fingers and knuckles?

<p>To prevent the spread of germs and bacteria that can reside between the fingers. (D)</p> Signup and view all the answers

Why is it important to wash the wrists during the hand washing process?

<p>To ensure complete removal of transient microorganisms from frequently exposed areas. (C)</p> Signup and view all the answers

What is the role of 'appearance of patient' in a general examination?

<p>Assessing general health status and potential underlying conditions based on visual cues. (C)</p> Signup and view all the answers

What aspect of a patient does 'corporation' refer to during a general physical examination?

<p>The patient's level of cooperativeness and willingness to participate in the examination. (D)</p> Signup and view all the answers

Why is assessing a patient's 'consciousness' an important part of a general examination?

<p>To determine the patient's level of awareness and responsiveness to stimuli. (D)</p> Signup and view all the answers

How does 'built' contribute to the overall assessment of a patient during a general examination?

<p>It evaluates the patient's overall body size, stature, and body mass, providing insights into their nutritional status and potential underlying conditions. (A)</p> Signup and view all the answers

What does 'decubitus' refer to in the context of a general physical examination?

<p>The presence and condition of pressure ulcers (bedsores). (A)</p> Signup and view all the answers

How is 'gait and posture' assessed during a general examination, and why is it important?

<p>By observing the patient's manner of walking and body position, which can reveal musculoskeletal or neurological issues. (B)</p> Signup and view all the answers

What is the significance of assessing a patient's 'vital signs' during a general examination?

<p>To measure fundamental physiological functions such as temperature, pulse, respiration, and blood pressure, indicating the patient's immediate health status. (D)</p> Signup and view all the answers

What does 'complexion' refer to in the context of a general physical examination?

<p>The patient's skin color and texture, which may indicate underlying health conditions. (A)</p> Signup and view all the answers

Why is head and neck examination important in a general physical examination?

<p>To evaluate cranial nerves, thyroid gland, lymph nodes, and other structures, potentially revealing neurological or endocrine disorders. (C)</p> Signup and view all the answers

What is the purpose of a 'upper and lower limb examination' in a general physical examination?

<p>To evaluate the patient's range of motion, strength, reflexes, and sensation, detecting musculoskeletal or neurological issues. (B)</p> Signup and view all the answers

Why is skin examination included in a general physical examination?

<p>To identify skin conditions, signs of systemic diseases, or evidence of injury or infection. (B)</p> Signup and view all the answers

What is the MAIN reason for performing a 'lymph node' examination during a general physical examination?

<p>To evaluate the lymphatic system for signs of infection, inflammation, or malignancy. (B)</p> Signup and view all the answers

What is the purpose of doing general examination?

<p>To identify any abnormalities or signs of disease that may require further investigation. (A)</p> Signup and view all the answers

How would you describe the appearance of a patient with a 'toxic' presentation?

<p>Displaying a flushed face, often due to infection or inflammatory processes. (D)</p> Signup and view all the answers

What does it mean when a patient is described as having an 'emaciated' or 'cachectic' appearance?

<p>The patient exhibits significant muscle and fat wasting, often associated with chronic diseases. (A)</p> Signup and view all the answers

What are the typical facial features associated with an 'Ape-like' appearance, as seen in acromegaly?

<p>A large jaw, tongue, nose, and ears. (A)</p> Signup and view all the answers

What is the characteristic facial appearance associated with Cushing's syndrome?

<p>A moon face. (A)</p> Signup and view all the answers

What is the primary purpose of using the AVPU scale in a clinical setting?

<p>To quickly and simply evaluate a patient's level of consciousness. (C)</p> Signup and view all the answers

In the AVPU scale, what does 'V' stand for?

<p>Responds to Voice. (C)</p> Signup and view all the answers

What does 'P' indicate on the AVPU scale?

<p>Patient responds to painful stimuli. (A)</p> Signup and view all the answers

What does 'U' stand for in the AVPU scale?

<p>Unresponsive (D)</p> Signup and view all the answers

What is the total score range of the Glasgow Coma Scale (GCS)?

<p>3 to 15 (A)</p> Signup and view all the answers

What does a GCS score of 13-15 indicate?

<p>Minor brain injury (C)</p> Signup and view all the answers

What elements are included in the measurement of 'built' during a general physical examination?

<p>Overall body size, stature, and body mass (B)</p> Signup and view all the answers

When measuring height, from which points should the measurement be taken?

<p>From the top of the head to the heel (A)</p> Signup and view all the answers

What does 'span' refer to in the context of body measurements?

<p>The distance between the distal phalanges of middle fingers in both extended arms (C)</p> Signup and view all the answers

Which of the following is NOT typically part of a clinical nutritional assessment?

<p>Electrocardiogram (ECG) (B)</p> Signup and view all the answers

What is the formula for calculating Body Mass Index (BMI)?

<p>$BMI = \frac{weight \ in \ kg}{height \ in \ m^2}$ (B)</p> Signup and view all the answers

According to BMI classifications, what range indicates a person is overweight?

<p>25-29.9 (A)</p> Signup and view all the answers

Flashcards

General Physical Examination

A systematic evaluation of a patient's body to detect signs of disease.

Right Approach

An important rule is to stand always at the patient's right hand side.

Preparing for Physical Exam

Introduce yourself, shake hands, ensure you have the right equipment, ensure privacy, and ask permission.

Appearance of Patient

Evaluates the patient's overall presentation including physical condition and mental state.

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AVPU scale

Rapid assessment using Alert, Voice, Pain, Unresponsive to quickly gauge the level of consciousness.

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Glasgow Coma Scale

Uses eye-opening, verbal, and motor responses to score consciousness on a scale of 3-15.

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Built

Assessment of a person's overall body size, including stature and body mass.

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Height measurement

Measured from head to heal.

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Span Measurement

Distance between distal phalanges of middle fingers in both extended arms

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Nutrition Assessment

Clinical assessment using BMI, skin fold thickness, mid-arm circumference, and assessing vitamin deficiency signs.

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Body Mass Index (BMI)

Weight in kilograms divided by height in meters squared.

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Skin Fold Thickness

Anthropometric measurement to identify fat.

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Mid-Arm Circumference (MUAC)

Measurement of muscle and subcutaneous fat in the upper arm using a non-stretchable tape.

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Waist Circumference

Associated with visceral fat and a clinical risk factor, with elevated risk at >102 cm (men) and >88 cm (women).

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Signs of Vitamin Deficiency

Nutritional edema, anemia, peripheral neuropathy, stomatitis, desquamated rash, and bleeding gums.

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Orthopnea

Dyspnea (shortness of breath) when lying down, relieved by sitting up.

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Platypnea

Dyspnea relieved by lying down

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Professorial attitude

Patient stands supporting his extended arms on a table.

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Prayer's position

Patient prefer to lean forward.

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Study Notes

  • A general physical examination is conducted.
  • Always stand at the patient's right-hand side during an examination.

Preparing a Physical Examination

  • Introduce yourself.
  • Shake hands.
  • Use the relevant equipment.
  • Ensure patient privacy.
  • Take permission.
  • Wash your hands

Hand Washing Steps

  • Wash palms and fingers
  • Wash back of hands
  • Wash fingers and knuckles
  • Wash your thumbs
  • Wash your fingertips
  • Wash your wrists

General Examination:

  • Appearance of the patient.
  • Corporation.
  • Consciousness.
  • Build and nutrition assessment.
  • Decubitus.
  • Gait and posture.
  • Vital signs.
  • Complexion.
  • Head and neck examination.
  • Upper and lower limb examination.
  • Skin.
  • Lymph node.
  • Other system examination.

Appearance of the Patient:

  • Normal appearance will be noted.
  • Toxic appearance indicates the face is flushed due to the effect of infection.
  • Emaciated/Cachectic appearance indicates wasting of face muscle and fat, as seen in LCF.
  • Ape-like appearance as in acromegaly due to a large jaw, tongue, nose, and ears.
  • Moon face appearance as in Cushing's syndrome.

Consciousness Assessment

  • Rapid assessment of a patient's conscious level can be made using the AVPU scale or Glasgow Coma Scale (GCS).

AVPU Scale:

  • AVPU scale is a simplified score used in rapid assessment of consciousness.
  • The AVPU scale often used by non-specialist nurses when monitoring a patient's conscious level
    • A = Alert.
    • V = Responds to Voice.
    • P = Responds to Pain.
    • U = Unresponsive.

GCS (Glasgow Coma Scale):

  • GCS provides an objective score of consciousness.
  • Total score ranges from 3 to 15

Glasgow Coma Scale Scoring

  • Eye Opening Response:
    • Eyes open spontaneously: 4 points.
    • Eyes open to verbal command, speech, or shout: 3 points.
    • Eyes open to pain (not applied to face): 2 points.
    • No eye opening: 1 point.
  • Verbal Response:
    • Oriented: 5 points.
    • Confused conversation, but able to answer questions: 4 points.
    • Inappropriate responses, words discernible: 3 points.
    • Incomprehensible sounds or speech: 2 points.
    • No verbal response: 1 point.
  • Motor Response:
    • Obeys commands for movement: 6 points.
    • Purposeful movement to painful stimulus: 5 points.
    • Withdraws from pain: 4 points.
    • Abnormal (spastic) flexion, decorticate posture: 3 points.
    • Extensor (rigid) response, decerebrate posture: 2 points.
    • No motor response: 1 point.
  • Minor brain injury is 13-15 points.
  • Moderate brain injury is 9-12 points.
  • Severe brain injury is 3-8 points

Body Build

  • Build = measure of overall body size, including stature and body mass.

Measurements

  • Height = measured from head to heal.
  • Span = distance between distal phalanges of middle fingers in both extended arms.

Clinical Nutritional Assessment

  • Includes BMI
  • Includes Fat and skin fold thickness(SFT)
  • Includes Protein and Mid-arm circumference(MAC)
  • Includes Vitamins and signs of deficiency

Calculating Body Mass Index

  • BMI = weight in kg / height in m².

BMI Values:

  • Underweight = less than 18.5.
  • Normal = 18.5-24.9.
  • Overweight = 25-29.9.
  • Obese = 30-39.9.
  • Morbidly obese = greater than 40.

Anthropometric Measurements:

  • Skin fold thickness (indicator of fat).
  • Mid-arm circumference (indicator of muscle mass); normally, it is 25cm.
  • Patient's waist circumference.

Skin Fold Thickness Measurement

  • Skin fold thickness is an indicator of fat and requires special equipment.
  • Triceps skinfold of less than 5 mm almost always reflects low body fat stores.
  • Detection sites:
    • a,b -arms
    • c,d,e -torso
    • h,i- legs

Mid-Arm Circumference (MUAC):

  • MUAC measures the sum of muscle and subcutaneous fat in the upper arm.
  • Use a non-stretchable insertion tape to assess MUAC and arm length; tapes are graduated in millimeters.

Waist Circumference:

  • Waist circumference is highly correlated with visceral fat and is a clinical risk factor.
  • Waist circumferences greater than 102 cm (40 in) in men.
  • Waist circumferences greater than 88 cm (35 in) in women are suggestive of elevated risk

Signs of Vitamin Deficiency:

  • Nutritional edema (d.t. hypoalbuminemia).
  • Anemia (d.t. iron or vitamin B12 deficiency).
  • Peripheral neuropathy (d.t. vitamin B complex deficiency).
  • Sulpher granules & angular stomatitis (in vitamin B2 riboflavin deficiency).
  • Brown desquamated rash in butterfly area of the face & neck lace area and dementia and diarrhea (in vitamin B3 niacin deficiency {Pellagra}).
  • Bleeding gums & delayed wound healing (in vitamin C deficiency Scurvy).

Decubitus and Gait Posture

  • Orthopnea: dyspnea on lying down relieved by sitting upright.
  • Platypnea: dyspnea on upright position relieved by lying down

Body posturing and attitude

  • Professorial attitude: patient stands supporting extended arms on a table.
  • Prayer position: patient prefers to lean forward.
  • Squatting position.
  • Clenching of the fist.
  • Finger pointing.

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