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Questions and Answers
What does scleral jaundice indicate when observed during a physical examination?
What is the implication of observing conjunctival pallor in a patient?
What health risk is associated with the presence of xantholasma?
What does central cyanosis suggest in a physical examination?
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Which physical sign is commonly associated with Marfan's syndrome?
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What is a normal jugular venous pressure measurement during an examination?
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What does the presence of carotid bruits signify?
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What condition can result from poor dental hygiene according to physical examination signs?
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Which of the following steps is NOT part of the WIPE process?
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What could indicate a patient has experienced mitral stenosis based on their color?
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What does finger clubbing typically signify in a patient?
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Which of the following is NOT an indicator of ineffective endocarditis?
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What is a common symptom of increased work of breathing (WOB)?
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Which lesion is associated with bacterial ineffective endocarditis?
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What does increased WOB typically imply about a patient's respiratory state?
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Which finding would most likely indicate a patient has ineffective endocarditis?
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What does a radio-radial delay indicate?
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What could a firm, spongey feeling in the liver during palpation indicate?
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What is indicated by an apex beat at the 5th intercostal space?
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What difference in blood pressure readings indicates orthostatic hypotension?
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What does the auscultation of all four points help identify?
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Which symptom might suggest the presence of ascites?
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What is suggested if no previous scars are found on the chest?
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What measurement do radial pulses assess?
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What physical examination finding is associated with severe right heart failure?
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Which symptom indicates potential peripheral vascular disease?
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What is a potential diagnosis for dull percussion sounds in the lower lobes?
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Calf tenderness is a potential sign of what condition?
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What would be a sign of congestive heart failure in physical examination?
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What does percussion produce in the abdomen of a patient with right heart failure?
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What is indicated by the presence of pitting edema in the ankles?
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What procedure involves the removal of a blood vessel for coronary artery bypass grafting?
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Study Notes
WIPE
- Establish a rapport with the patient, gain consent for the examination
- Position the patient comfortably and appropriately for the examination
- Expose the relevant areas for examination
- Explain what the examination involves
- Wash hands before and after the examination
General Impression
- Note any bedside medications, such as GTN (nitroglycerin)
- Look for surgical scars, indicating previous procedures
- Observe for shortness of breath or an increase in work of breathing (WOB)
- Assess skin colour for cyanosis (bluish tint), pallor (pale skin), or malar flush (reddish blush around cheeks), a sign of mitral stenosis
Hands
- Inspect for finger clubbing, where fingertips and knuckles appear swollen and rounded. This is associated with congenital heart disease and ineffective endocarditis.
- Look for Janeway lesions – small, painless, red-purple spots on the palms or soles of the feet, suggesting bacterial endocarditis.
- Observe for splinter hemorrhages, small, linear, dark lines under the nails. These are an indicator of ineffective endocarditis.
Face
- Check for scleral jaundice (yellowing of the whites of the eyes) by lifting the eyelid, hinting at cardiovascular disease (CVD).
- Assess for conjunctival pallor (pallor in the eye membrane) suggesting underlying anemia.
- Note xanthomas – small, yellow bumps under the skin, particularly around the eyelids, indicating high cholesterol and an increased risk of heart attacks.
- Look for central cyanosis, bluish discoloration of the lips and tongue, indicating inadequate oxygenation.
- Observe dental hygiene, poor dental hygiene is a possible sign of infective endocarditis.
- Note a high-arched palate, a high and narrow palate in the mouth, which is associated with Marfan's syndrome, a genetic disorder that may lead to heart defects.
Neck
- Assess jugular venous pressure (JVP) by observing the internal jugular vein. The venous pulsation should fluctuate twice with each heartbeat, with the JVP being less than 4cm above the sternal angle.
- Listen for carotid bruits – abnormal sounds heard over the carotid arteries during auscultation, which may suggest arterial occlusive pathology and hence a stroke risk.
Arms
- Palpate the radial pulses, noting their rate and rhythm.
- Observe for radio-radial delay – a delay in the radial pulse on one side compared to the other. This may indicate narrowing of the aorta, a condition called atherosclerosis.
- Feel for the brachial pulse, noting its rate, rhythm, and strength.
- Compare blood pressure measurements taken while sitting and standing. If the difference is more than 15 mmHg, it may suggest orthostatic hypotension.
Chest
- Look for scars, implying previous surgeries or procedures.
- Locate the apex beat, the point where the heart's apex touches the chest wall, usually in the fifth intercostal space. Displacement suggests ventricular hypertrophy (enlargement of the heart's ventricles).
- Auscultate the chest, listening for heart sounds at all four anatomical positions.
Abdomen
- Palpate the liver, checking for a firm, spongey feeling, indicating potential right heart failure or tricuspid regurgitation.
- Note ascites – fluid accumulation in the abdomen, a possible sign of right heart failure.
- Percuss the abdomen, the sound should be resonant (hollow) until the rib cage is reached.
Back
- Check for scars from previous surgeries.
- Auscultate the lungs over the six lung fields, including the areas around the scapula for any abnormal sounds.
- Percuss the lower lobes of the lungs, a dull sound may suggest pleural effusion, often a consequence of cardiac failure.
- Palpate the sacral area for edema, which is a sign of severe right heart failure.
Legs
- Inspect for peripheral cyanosis, bluish discoloration of the extremities, indicating peripheral vascular disease.
- Feel for pitting edema – swelling in the ankles that leaves an impression when pressed, suggestive of congestive heart failure.
- Assess for calf tenderness, a possible sign of deep vein thrombosis, a significant complication of CVD.
- Look for signs of saphenous vein harvesting – a small incision above the knee, representing the removal of a blood vessel used in coronary artery bypass grafting, a procedure performed for coronary heart disease.
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Description
This quiz covers essential patient examination techniques including establishing rapport, observing general impressions, and inspecting hands for specific signs of health issues. Enhance your understanding of how to effectively communicate and carry out clinical assessments.
