Physical Examination Techniques Quiz
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Questions and Answers

What is the primary reason for conducting a physical examination from the patient’s right side?

  • To follow a sequence that minimizes patient movement and maintains privacy. (correct)
  • To reduce the risk of cross-contamination between different body regions during the examination.
  • To standardize the examination process for all healthcare providers involved.
  • To ensure the examiner's dominant hand is used for all palpation techniques.

    • Which physical examination technique involves assessing the density of underlying structures by emitting sound?

  • Percussion (correct)
  • Inspection
  • Palpation
  • Auscultation

    • When observing a patient, what aspect is included in the assessment of 'body habitus'?

  • The patient's orientation to time, place, and person.
  • The patient's current emotional state and expressed feelings during the interview.
  • The patient's ability to perform activities of daily living.
  • The patient's physical characteristics, such as build and posture. (correct)

    • Which of the following is the MOST appropriate use of palpation during a thorax examination?

    <p>To identify areas of tenderness or masses. (A)</p> Signup and view all the answers

    Which of the following examination steps is MOST closely associated with assessing a patient's mood?

    <p>Assessing affect and its appropriateness. (A)</p> Signup and view all the answers

    What does 'WDWN' indicate when assessing a patient's apparent state of health and appearance?

    <p>Well-developed, well-nourished (A)</p> Signup and view all the answers

    When palpating an arterial pulse, which characteristics are essential to assess?

    <p>Rate, strength, and regularity of the pulse (A)</p> Signup and view all the answers

    Which of the following conditions is most likely associated with a 'bounding' arterial pulse?

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

    During the inspection of respiration, what parameters should be evaluated besides the breaths per minute?

    <p>Pattern of breathing and use of accessory muscles (D)</p> Signup and view all the answers

    Which of the following respiratory patterns is most indicative of metabolic acidosis?

    <p>Deep breaths (B)</p> Signup and view all the answers

    What is the term for the absence of respiration?

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

    A patient presents with a respiratory rate of 10 breaths per minute. Which term best describes this?

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

    Which condition is least likely to be related to the use of accessory muscles during respiration?

    <p>Normal resting breathing (C)</p> Signup and view all the answers

    Which artery is typically palpated when assessing the arterial pulse?

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

    Beta-agonists can cause

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

    Flashcards

    Physical Examination

    A systematic process to assess a patient's health using observational skills and techniques.

    Four Fundamental Techniques

    The key methods used in physical assessment: Inspection, Percussion, Palpation, and Auscultation.

    Inspection

    A visual examination of the patient to gather health information based on their appearance and behavior.

    Auscultation

    Listening to sounds from the body using ear or devices to assess health conditions.

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    Posture and Gait Assessment

    Observing a patient's body position, movement, and physical characteristics to evaluate overall health status.

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    Apparent State of Health

    Observation of physical appearance indicating health level, such as well-nourished or ill-appearing.

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    Vital Signs (VS)

    Clinically measured indicators that reflect overall health, including BP, HR, RR, and Temp.

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    Palpation of Arterial Pulse

    Assessing pulse through feeling the radial artery for rate, strength, and regularity.

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    Bradycardia

    Abnormally slow heart rate, usually below 60 beats per minute.

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    Weak Pulse Causes

    Weak pulses can indicate heart failure or hypovolemia (low blood volume).

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    Deep Breaths

    Breathing patterns that are deeper than normal, indicative of metabolic acidosis.

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    Apnea

    A condition defined by the absence of respiration.

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    Inspection of Respiration

    Evaluating breathing rate and pattern by observing without interference.

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    Normal Respiratory Rate

    Standard breathing rate is between 12 to 20 breaths per minute.

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    Auscultation of Blood Pressure

    Listening to Korotkoff sounds via stethoscope while measuring BP with a sphygmomanometer.

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    Study Notes

    Physical Examination/Assessment

    • Typically performed on the patient's right side.
    • Follows a standard sequence to minimize position changes, respect privacy, and minimize discomfort.
    • The scope varies depending on the illness and severity, ranging from comprehensive to focused assessments.
    • Utilizes observational skills (sight, hearing, and touch) to identify health issues and assess drug therapy responses.
    • Components include a general survey of vital signs, head and neck, chest and lungs, cardiovascular system, breasts, axillae, abdomen, genitourinary system, musculoskeletal system, skin and extremities, and the neurologic system.

    Four Fundamental Techniques

    • Inspection: Visual observation of the body.
    • Percussion: Tapping to evaluate underlying structures by listening to the resulting sounds (e.g., resonant, dull, tympanic, flat).
    • Palpation: Feeling areas of the body that can't be seen using fingertips, palm, or back of the hand, with varying depths (superficial vs. deep).
    • Auscultation: Listening to sounds produced by the body spontaneously using the ear or a device.

    Inspection of Appearance and Behavior

    • Observe patient posture, gait, clothing, personal grooming, body habitus, body position, affect, and appropriateness.
    • Examples: III appearing, muscular build, appears older than stated age, disheveled, resting comfortably, in moderate distress, following commands, and appears anxious, withdrawn, combative, or lethargic.

    Vital Signs (VS)

    • A set of clinical measurements that reflect a patient's overall health state.
    • Components include blood pressure (BP), pulse, temperature (T/Temp), respiratory rate (RR), and oxygen saturation (SpO2).
    • Examples include BP 155/81, Pulse 85, Temp 98.2°F (36.8°C), Resp 17, SpO2 97%

    Palpation of Arterial Pulse

    • Often uses the radial artery.
    • Measures rate, strength (normal, weak, or bounding), and regularity (regular, irregular, or irregularly irregular).
    • Normal rate is 60-100 beats per minute with a regular rhythm.

    Palpation of Arterial Pulse (Abnormal Findings and Causes)

    • Bradycardia: <60 beats/min (with symptoms) caused by medications (beta-blockers, calcium channel blockers, digoxin, opioids) or sinus node/AV node dysfunction.
    • Tachycardia: >100 beats/min caused by medications (beta-agonists, stimulants, epinephrine) or infection, anxiety, volume depletion, fever, exercise.
    • Weak pulse: caused by heart failure, hypovolemia
    • Bounding pulse: caused by anxiety, pain, hyperthyroidism
    • Irregular hear rate: caused by cardiac arrhythmias (e.g., atrial fibrillation)

    Inspection of Respiration

    • Unobtrusively observe complete respiratory cycles.
    • Assess rate, pattern, and use of accessory muscles (like sternocleidomastoid and abdominal muscles).
    • Normal rate is 12-20 breaths/min with evenly spaced inspirations and expirations.

    Inspection of Respiration (Abnormal findings and causes)

    • Deep breaths: caused by metabolic acidosis
    • Shallow breaths: caused by obstructive airway disease, asthma exacerbation, obstructive sleep apnea.
    • Use of accessory muscles: caused by obstructive sleep apnea
    • Apnea: absence of respiration caused by medications (opioids, benzodiazepines) or pain, anxiety, exercise, asthma exacerbation, COPD, pneumonia.
    • Bradypnea (<12 breaths/min): caused by medications (e.g., opioids)
    • Tachypnea (>20 breaths/min): caused by pain, anxiety, exercise, asthma exacerbation, COPD, or pneumonia.

    Auscultation of Blood Pressure

    • Palpate the brachial artery.
    • Use a stethoscope and sphygmomanometer.
    • Normal is systolic BP < 120 mmHg and diastolic BP < 80 mmHg.

    Inspection of Temperature

    • Body temperature is used to screen for illness and monitor therapy response.
    • Temperature varies by location (oral, rectal, tympanic, axilla, ear, temporal artery, central line, bladder)
    • Normal is 37°C or 98.6°F (97-99°F).
    • Abnormal findings and causes:
      • Hypothermia (<95°F): caused by cold exposure
      • Fever (≥100.4°F): caused by illness, infection, or drug-induced factors (antibiotics, antidepressants, MDMA).

    Anthropomorphic Measurements

    • Includes height, weight, and BMI.
    • BMI calculations: Metric (Weight / height^2) ; English (703 x Weight / height^2)
    • BMI classifications: underweight (<18.5), normal (18.5-24.9), overweight (25-29.9), class 1 obesity (30-34.9), class 2 obesity (35-39.9), and class 3 obesity (≥ 40).

    Inspection & Palpation of Head

    • Assessment of skull size, contour, shape, trauma, presence of lumps, bumps, and tenderness.
    • Includes hair inspection for texture, lesions, scalp conditions.
    • Includes face assessments regarding expression, symmetry, movement, lesions, and edema.
    • Includes assessments of mouth, including lips, teeth, gums, palate, tonsils, and tongue for lesions, color, and symmetry.

    Inspection of Face (Abnormal findings and causes)

    • Asymmetry: caused by stroke or drug-induced factors
    • Round "moon" face: caused by Cushing's syndrome or drug-induced corticosteroid use.
    • Hirsutism: caused by Polycystic ovarian syndrome (PCOS) or drug-induced factors (e.g., cyclosporine).

    Inspection of Mouth (Abnormal findings and causes)

    • Gingival hyperplasia: caused by drug-induced factors (phenytoin, tacrolimus, calcium channel blockers) or immunosuppressant use (HIV or drug-induced corticosteroids).
    • Oral candidiasis (thrush): caused by immunosuppression (HIV or drug-induced corticosteroids).

    Inspection of Eyes (Assessment and abnormalities)

    • Extraocular muscles: Evaluate eye movement (EOMI: extra ocular muscles intact).
    • Eyelids and lashes: Color, lesions, edema, condition of lashes.
    • Sclera and conjunctiva: Color, lesions, edema.
    • Cornea and pupils: Size, shape, symmetry, PERRLA (pupils equal, round, reactive to light and accommodation).
    • Abnormal Findings and Causes:
      • Nystagmus: Stroke, multiple sclerosis, drug-induced (e.g., phenytoin).
      • Exophthalmos: Hyperthyroidism and/or Graves' disease.
      • Scleral icterus: Cirrhosis.
      • Conjunctivitis: Infection or allergies.
      • Conjunctival pallor: Anemia.
      • Mydriasis: Drug-induced (e.g., drugs with anticholinergic properties or opioids)
      • Miosis: Drug-induced (e.g., opioids or benzodiazepines).

    Inspection & Palpation of Ear

    • External ear: Inspect lesions, trauma, size, contour. Palpate nodules.
    • Ear canal and tympanic membranes: Inspect canal, discharge, edema and foreign bodies (insects, toys) with otoscope. Inspect tympanic membrane, observe color, bulging, perforation, and air-fluid level. Normal finding is clear tympanic membranes.
    • Abnormal findings and causes:
      • Bulging tympanic membrane: Acute otitis media
      • Cloudy/white/yellow tympanic membrane: Acute otitis media
      • Purulent otorrhea (pus-like drainage): Acute otitis media

    Inspection & Palpation of Nose & Sinuses

    • Nose and nasal cavity: Inspect for symmetry, inflammation, lesions, bleeding.
    • Sinuses: Inspect using transillumination. Palpate for tenderness or swelling.
    • Normal: Nasal mucosa is pink, septum is midline, and transillumination shows a glowing red appearance.
    • Abnormal findings and Causes:
      • Rhinorrhea (excessive nasal discharge): Allergic rhinitis or infection.
      • Epistaxis (nosebleed): Trauma, drug-induced (e.g., anticoagulants like warfarin or apixaban).

    Inspection & Palpation of Neck

    • Neck: Inspect for symmetry, masses, and enlargement of parotid and submaxillary glands. Note the position of the sternomastoid muscles, carotid arteries, and trachea.
    • Thyroid gland: Inspect and palpate for size, shape, symmetry, tenderness, and nodules. Normal is non-tender and not enlarged.
    • Lymph nodes: Inspect and palpate for size, shape, mobility, and tenderness.
    • Abnormal findings and causes:
      • Lymphadenopathy: Infection or cancer.
      • Goiter: Thyroid cancer, Hashimoto's disease, Graves' disease.

    Auscultation of Neck

    • Thyroid gland (bruit): Auscultate for a thyroid bruit if the thyroid gland is enlarged.
    • Carotid arteries (bruit): Auscultate for carotid artery bruits.
    • Abnormal findings and causes:
      • Thyroid bruit: Hyperthyroidism.
      • Carotid bruit: Atherosclerosis.

    Inspection of Skin

    • Inspect skin color (pallor, cyanosis, redness, yellowness), lesions, trauma, and other abnormalities.
    • Note distribution, amount, and texture of body hair.
    • Describe lesions based on location, type, color, shape, size, grouping, and pattern.

    Inspection of Skin Color (Abnormal findings and causes)

    • Pallor: Anemia.
    • Cyanosis: End-stage COPD, opioid overdose, skin and soft tissue infections, sunburn, deep vein thrombosis.
    • Erythema: Skin and soft tissue infections, sunburn, deep vein thrombosis.
    • Jaundice: Cirrhosis, gallstones.

    Inspection of Skin Lesions (Abnormal findings and causes)

    • Petechiae (<2 mm), Ecchymosis (>1cm): Hemorrhage (bleeding) under the skin.
    • Wheal (hive, urticaria): Allergic reactions.
    • Ulcer: Pressure sore, peripheral vascular disease, diabetes.

    Palpation of Skin

    • Palpate skin for turgor (hydration), moisture, temperature (warm or cool), texture (rough or smooth), thickness (thick or thin), and mobility (immobile, mobile, or hypermobile).
    • Abnormal findings and causes:
      • Decreased turgor (tenting): Dehydration or drug-induced (e.g., diuretics)
      • Dry skin: Hypothyroidism
      • Oily skin: Acne
      • Warmth: Fever, hyperthyroidism, heart failure, inflammation, infection, deep vein thrombosis.
      • Coolness: Hypothyroidism, heart failure.
      • Edema: Heart failure, renal or hepatic disease (fluid overload), deep vein thrombosis, drug induced (e.g., dihydropyridine calcium channel blockers, NSAIDs, corticosteroids).

    Inspection of Nails

    • Inspect nails and nail beds for clubbing, cyanosis, trauma, and abnormalities.
    • Abnormal findings and causes:
      • Clubbing: Cirrhosis, COPD, pulmonary fibrosis, drug-induced pulmonary fibrosis (amiodarone).
      • Cyanosis: End-stage COPD.
      • Koilonychias: Iron deficiency anemia.

    Correlating Physical Exam Findings with Diseases

    • Matching physical exam findings (e.g., hypotension, bradycardia, goiter, dry skin, cool skin, warm skin, exophthalmos, etc.) to potential diseases such as hypothyroidism and hyperthyroidism.
    • Matching findings (e.g., hypotension, tachycardia, tachypnea, rashes, fever, etc.) and diseases/drug-induced causes (e.g., opioid overdose, infection/sepsis, heart failure).
    • Matching findings (e.g., pallor, conjunctival pallor, koilonychias (iron deficiency), jaundice, scleral icterus, clubbing of nails, edema, etc.) with diseases like anemia and cirrhosis.

    Example Patient Case 1 (Vitals and Physical Exam Findings)

    • Includes vital signs (BP, HR, RR, Temp, Ht, Wt, BMI).
    • Includes general observations (e.g., WDWN, male, in NAD).
    • Includes skin & nail findings (e.g., dry and cold to touch, decreased turgor).
    • Includes HEENT findings (e.g., NCAT, EOMI, sclera white, conjunctiva erythema).
    • Includes neck findings (e.g., supple, non-tender, thyroid non-enlarged, non-tender).
    • Includes cardiovascular and pulmonary findings.
    • Includes neurologic findings (e.g., A&O x3).

    Example Quiz/Exam Questions

    • Learning Objective 1: Fundamental PE techniques (inspection, percussion, palpation, auscultation) and the role of percussion.
    • Learning Objective 2: Appropriate techniques to assess skin (inspection of skin color and temperature, palpation of skin for turgor and edema).
    • Learning Objective 3: Normal and abnormal HEENT and vital sign findings.
    • Learning Objective 4: Definitions of physical assessment terms, abbreviations, and acronyms (e.g., NCAT, EOMI, PERRLA, clubbing, cyanosis, koilonychias, etc.).
    • Learning Objective 5: Interpreting patient cases, correlating findings with diseases/drug causes, and applying knowledge to patient scenarios.

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    Physical Examination PDF

    Description

    Test your knowledge on various physical examination techniques and assessments. This quiz covers topics such as palpation, respiration, and body habitus evaluations. Perfect for medical students and health practitioners looking to reinforce their understanding of clinical assessments.

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