Term
Cardiac Exam (4 steps) (Supine)
(6 locations for palpation & 5 auscultation) |
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Definition
Wash Hands
1. Measure the PMI (from midsternal line to pmi)
2. Palpate the Precordium (aortic, pulmonic, Erb's point, tricuspid, mitral, subxiphoid) - both bell & diaphragm
3. Percuss left cardiac border (T3-6)
4. Auscultate heart (aortic, pulmonic, Erb's point, tricuspid, mitral)
Exam points:
1. Use tangental lighting to see the PMI better. You can use your pen light for this lighting technique.
2. Palpation: palpate the same places that you auscultate. , including Erb's point (3 ICS) and the subxiphoid (deep/under the xiphoid, NOT inferior) which is where the R ventricle would be felt if it were enlarged. |
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Term
| Vascular Exam (4 steps, auscultate 5, palpate 6) (Supine) |
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Definition
Wash Hands
1. Inspect Neck
2. Auscultate carotid arteries, aorta, renal arteries, iliac artery & femoral arteries (diaphragm)
3. Palpate carotid, brachial, femoral, popliteal, tibial, and pedal pulses
4. Check for pedal, tibial, and pre-tibial edema (hold pressure 3 seconds)
Exam points:
1. Palpate the popliteal pulses with the patient supine first, and then if you cannot feel the pulse, you can ask the patient to sit up.
2. Edema palpation: top third of the anterior tibia, superior to the ankle at the bottom of the tibia from the anterior side, and top of foot are the three locations. |
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Term
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Definition
Wash Hands
1. Check Oral Temperature
2. Palpate, compare, count radial pulse
3. Count Respiratory Rate
4. Measure Blood Pressure
5. Inspect Skin (moisture, temp, texture, turgor) & Nails (shape, texture, color)
Exam point: patient needs to be sitting in a chair with a back, and both feet need to be flat on the ground. |
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Term
| Lymphatic Exam (3 - 10, 6, 2) (Seated/Supine) |
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Definition
Wash Hands
Still Must Name All Nodes (or points will be lost)
1. Palpate cervical lymph nodes - 10 groups (occipital, posterior auricular, posterior cervical, superficial cervical, deep cervical, supraclavicular, preauricular, tonsillar, submandibular, submental)
2. Palpate axillary and epitrochlear nodes - 6 groups (central, pectoral, lateral, subscapular, infraclavicular & epitrochlear)
3. Palpate inguinal nodes and femoral pulse - 2 groups (horizontal & vertical groups) |
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Term
Musculoskeletal Exam (Supine & Seated/Standing)
3 steps
8 bottom to top
3 top down
4 top down |
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Definition
Wash Hands
1. Inspect and palpate joints bilaterally (feet, ankles, knees, hips, fingers, hands, elbows, shoulders)
2. Test AROM of lower extremity bilaterally - hips (flexion, abduction, adduction, internal rotation, external rotation), knees (flexion, extension, internal rotation, external rotation), ankles (dorsiflexion, plantar flexion, inversion, eversion)
2. Test AROM of upper extremity bilaterally - shoulders (flexion, extension, abduction, adduction, internal rotation, external rotation), elbows (flexion, extension, supination, pronation, wrists (flexion, extension, radial deviation, ulnar deviation), fingers (flexion, extension, abduction, adduction) |
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Term
| Respiratory Exam (8) (Seated) |
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Definition
Wash Hands
1. Inspect Posterior and lateral Chest (movement, accessory muscles, shape)
2. Palpate Posterior and lateral chest - level of 10th rib (respiratory expansion, tenderness)
3. Percuss posterior and lateral chest - 7 sites bilaterally
4. Auscultate posterior and lateral chest - 7 sites bilaterally (use diaphragm & have patient breath mouth open)
5. Inspect anterior chest (movement accessory muscles, shape)
6. Palpate anterior chest (respiratory expansion, tenderness)
7. Percuss anterior and lateral chest - 6 sites bilaterally
8. Auscultate anterior and lateral chest - 6 sites bilaterally (diaphragm w/ mouth open again)
Exam Points:
1. During auscultation please clearly ask patient to breathe deeply in and out of his/ her open mouth.
2. Be sure to let patient know to stop if he/ she gets dizzy or uncomfortable. |
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Term
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Definition
Wash Hands
Patient is supine.
Have the patient put their legs up.
1. Inspect Abdomen (skin, contour)
2. Auscultate abdomen for bowel sounds.
3. Percuss abdomen (tympani/dullness)
4. Palpate abdomen (clockwise light and deep)
LEGS UP
5. Palpate bimanually for liver (contour, tenderness)
6. Palpate bimanually for spleen
Normal finding is "scattered tympani."
Exam point: the doctor position for the entire GI exam is on the right side of the patient. |
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Term
| Head Face & Eyes (5) (Seated) |
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Definition
Wash Hands
1. Inspect and palpate the hair, scalp, skull (quantity/distribution of hair, skin quality, tenderness)
2. Inspect face (expression, symmetry, contours)
3. Inspect eyes (position/alignment, lids, eyebrows, lacrimal apparatus, conjunctiva, sclera) – includes asking patient to look up/down/left/right to inspect the sclera (this can be combined with pulling the lower lid down to inspect palpebral conjunctiva if desired)
4. Inspect cornea, lens, pupil & iris (corneal reflections, PERRLA)
5. Fundoscopic exam (optic cup, disc, arteries/veins, retinae, macula, fovea) – includes pivoting to examine retina in each direction and ending lateral on macula/fovea |
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Term
| Ears, Nose, Sinuses, Mouth, Throat & Thyroid (8) (Seated) |
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Definition
Wash Hands
1. Inspect & palpate external ears, including auricle, tragus, mastoid (tenderness)
2. Otoscopic exam (canal, light reflex, malleus, incus, membrane) – includes ear pull
3. Inspect nasal passages (mucosa, septum, inferior & middle turbinate) – includes insertion of speculum a short way into each nostril
4. Palpate sinuses (frontal & maxillary)
5. Inspect lips, tongue, teeth, buccal and labial mucosa, palatine tonsils, posterior pharynx – use light and tongue blade, include ALL listed structures
6. Palpate tongue, buccal and labial mucosa, palate, floor of mouth (tenderness) – include ALL listed structures
7. Inspect thyroid (visibility/size) – includes use of tangential light from midline either from below or above, patient neck extended
8. Palpate thyroid (size, texture, tenderness) – includes use of one of the methods to assist in palpating lobes (deviating trachea, shifting SCM anteriorly, turning head), patient neck slightly flexed |
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Term
| Spine & Cranial Nerves (11) (Seated/Standing for spine, Seated for cranial nerves) |
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Definition
Wash Hands
1. Inspect the spine (symmetry, curvature) – includes view from posterior AND lateral
2. Percuss the spine and renal angles (tenderness) – renal angle starts at level of scapula and extends inferiorly to superior border of pelvis
3. Test AROM of cervical spine (flexion, extension, side-bending, rotation) – ALL AROM includes instructing patient to “go as far as they can” in all movements or something equivalent
4. Test AROM of lumbar spine (flexion, extension, side-bending, rotation) – includes stabilizing patient pelvis/hips to isolate lumbar spine if patient is standing
5. Check visual acuity (CN II) – includes instructing patient to cover opposite eye
6. Test EOM (CN III, IV, VI) and convergence
7. Check strength of temporalis and masseter (CN V – palpate muscles with teeth clenched)
8. Check facial muscles (CN VII – at least one test each of the upper face & lower face)
9. Check auditory acuity (CN VIII – by finger rub) – includes instructing patient to close eyes, cover/plug opposite ear, and state when sound stops
10. Check phonation, uvula, tongue (CN IX, X, XII – open mouth, stick out tongue, say “ah” – observing tongue, uvula, soft palate and phonation) – includes use of penlight to illuminate uvula
11. Check strength of SCM and trapezius (CN XI) – includes using two hands to stabilize head/neck during testing of SCM |
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Term
| Neurologic Extremity Exam (5) (Seated & Standing) |
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Definition
Wash Hands
1. Check muscle strength of biceps (C5 C6), triceps (C6 C7 C8), wrist extension (C6 C7 C8), finger flexion (C7 C8 T1), and finger abduction (C8 T1) – ALL muscle strength testing includes asking the patient to “resist” or “hold” against the clinician’s pressure
2. Check muscle strength of psoas major (L2 L3 L4), quadriceps (L2 L3 L4), ankle dorsiflexion (L4 L5 S1), toe extension (L5 S1) plantar flexion (S1)
3. Check deep tendon reflexes at biceps (C5-C6), triceps (C6-C7), patellar (L2-L4), Achilles (S1)
4. Check sensory with sharp and light touch on face (CNV), upper extremities (C5-T1) & lower extremities (L2-S1) – includes testing bilaterally and using specific extremity locations described in class
5. Check gait (stability, coordination) |
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