Respiratory Exam
As part of inspection, this is done posteriorly with both hands around the rib cage and the patient breathing slowly in and out.
Checking for symmetric lung expansion
What is the order of the abdominal exam?
Inspect, Auscultate, Palpate, Percuss
How many times do you wash your hands during an encounter?
3 times: when you first walk in, before the physical exam and after the physical exam
How can aortic regurgitation be assessed for on exam?
Listening to the left sternal edge (erb point) on expiration with patient leaning forward
What do we check at the hands? To look for ________
capillary refill, cyanosis, clubbing
Young african american woman with SOB and dyspnea and hilar lymphadenopathy on CXR. Name 2 other physical exam findings
erythema nodosum, uveitis, arthritis
(sarcoidosis)
During inspection, don't forget to check for ______ by asking the patient to look to the side and cough
Hernia
What do you offer the patient when you start the physical exam?
A drape
When is S3 heard?
Early diastole: just after S2 when the mitral valve opens, allowing passive filling of the left ventricle
What is the very first part of the patient encounter, before you even ask "what brings you in?" ?
General appearance (patient hygiene, breathing, positioning/posture, any noises during while speaking, behavior etc.)
Name 3 physical exam findings in a patient with lobar pneumonia.
diminished lung sounds, bronchial breath sounds, whisper pectiroliloquy, egophony, dullness to percussion, vocal fremitus, tactile fremitus
Young woman with RLQ pain and vomiting. Name 4 differentials!
ectopic pregnancy, ovarian torsion, ruptured ovarian cyst, appendicitis
What do you mention to the patient after you introduce yourself?
Their vitals and if they were normal or not
Heaves on palpation are associated with?
Pressure loaded RV (feels like lifting of the hand)
If you do anything on HEENT during the general survey, you better do these 2 things at minimum.
Check the conjunctiva/sclera and the oral cavity
Elderly male with a cough and chest pain. Name 3 differentials.
pneumonia, CHF, GERD, COPD, malignancy
What is Charcot's Triad?
right upper quadrant pain + jaundice + fever
This is very important do before the end of the encounter:
Summarize and ask for any corrections or questions
3 characteristics of typical chest pain (angina)?
(1) Retrosternal chest discomfort with a characteristic quality
(2) Provoked by exertion or emotional stress and
(3) pain is relieved by rest and/or nitroglycerin
This is a good thing to check after checking the dorsalis pedis pulses. (They are often overlooked and can be sign of good or bad hygiene).
The toes and toenails! (fungal infections often begin between toes or in toenails)
If a patient exhibits decreased air entry on auscultation, what differentials come to mind?
Emphysema, pneumothorax, pleural effusion, lung collapse
If you're suspecting a patient has GI outflow obstruction, you can check for ______ _______ by holding the patient's hips and shaking the abdomen from side to side.
Succussion splash (splashing sounds are audible in a stomach that's distended with a mix of fluid and gas; but this is often uncomfortable and should only be done when there's clinical suspicion of delayed gastric emptying)
What are the 3 things you ask for at the beginning of the encounter as part of introductions?
Ask patient to confirm name, age and pronouns.
Atypical chest pain (angina) is commonly seen in which 2 populations?
Women and diabetics (may be atypical in location and not strictly related to provoking factors).
*Atypical angina is only 2/3 characteristics of typical angina*
How many locations can you check for pulse during the general survey?
9 (Temporal, carotid, apical, brachial, radial, femoral, popliteal, posterior tibial, and dorsal pedal)