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Physical Examination Guide
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Physical Examination Guide
Physical Examination Guide
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1
Question
What are key aspects to assess in a general patient appearance during examination?
Answer
Stable or unstable condition, level of consciousness (conscious/unconscious), alertness or sleepiness, orientation to time/place/person, cooperation, mood, and memory status (intact or not for recent, immediate, and remote events).
2
Question
How is body build described in a general physical examination?
Answer
Body build is described as average, underweight, or overweight. The patient's posture and comfort lying flat or sitting are also noted, along with any preferred position.
3
Question
What skin/color conditions should be noted in an inspection?
Answer
Look for pallor, jaundice, cyanosis, any skin rashes, scars, pigmentation, and signs of dehydration or respiratory distress.
4
Question
What is the importance of assessing pulse during cardiovascular examination?
Answer
Pulse assessment includes rate, rhythm (regular or irregular), volume (average, large, or small), symmetry (symmetrical or asymmetrical), capillary refill time, presence or absence of radio-femoral delay, vessel condition, and any special pulse characters like water hammer or pulsus paradoxus.
5
Question
How is respiration evaluated during physical examination?
Answer
By assessing the rate (breaths per minute), rhythm (regular or irregular), depth (average, deep, or shallow), type (abdomino-thoracic or thoraco-abdominal), and noting any special breathing patterns such as Kussmaul or Cheyne-Stokes.
6
Question
What are common special pulse characters to identify?
Answer
Water hammer pulse, pulsus tardus, pulsus bisferiens, pulsus alternans, pulsus bigeminus, and pulsus paradoxus.
7
Question
Describe the method and significance of abdominal inspection.
Answer
Inspection checks abdominal contour (flat, distended, scaphoid), movement with respiration, skin condition (scars, rash, pigmentation), the umbilicus position and condition, presence of hernias, and signs of abdominal wall abnormalities. It helps to assess underlying pathology and general abdominal health.
8
Question
What are the key findings in abdominal palpation?
Answer
Look for tenderness, guarding, rigidity, swelling, enlarged organs, abdominal masses, and skin temperature. Palpate liver and spleen size, consistency, borders, tender spots, and presence of masses.
9
Question
How is liver size and location normally assessed?
Answer
Liver size is normally about 12 cm, measured from the 5th right intercostal space to near the costal margin. It occupies the right hypochondrium and epigastric area, with specific anatomical borders and normal span.
10
Question
What are the normal auscultatory findings over the abdomen?
Answer
Normal bowel sounds are intermittent, occurring every 5 to 10 seconds, with medium pitch and gurgling quality. No arterial bruit or venous hum should be present.
11
Question
What percussion notes are expected normally over the abdomen?
Answer
Tympanic sounds over most of the abdomen except dullness over the liver area; Traube's area is tympanic; bladder is tympanic unless full, when it is dull.
12
Question
What abnormalities might be noted during chest inspection?
Answer
Abnormalities include barrel chest, flat chest, pigeon chest, funnel chest, unilateral retraction or bulge, limited chest expansion, skin rash, scars, pigmentation, gynecomastia, or tracheal deviation.
13
Question
Explain the importance of assessing chest expansion and tracheal position.
Answer
Chest expansion should be symmetrical and full during respiration; asymmetric or limited expansion may indicate lung pathology. Tracheal position should be central or slightly deviated to the right; significant deviation can indicate mediastinal shift or pathology.
14
Question
What are normal percussion and auscultation findings in the chest examination?
Answer
Percussion reveals resonance over lung fields, dullness over the heart, and typical dullness over liver area. Auscultation reveals vesicular breath sounds without adventitious sounds like wheezes, crackles, or pleural rub.
15
Question
What clinical positions can patients be placed in to assist diagnosis of respiratory or cardiac conditions?
Answer
Squatting (praying Muslim position), lateral decubitus (trepopnea), semi-sitting (orthopnea), opisthotonus (arched back), and tripod position. Each helps alleviate symptoms associated with specific conditions like pericardial effusion or severe COPD.
16
Question
What are common facial features that could indicate systemic diseases?
Answer
Ape-like face, myxedema face, thyrotoxic face, moon face, senile (monkey) face, toxic face, Hippocratic face, leonine face, tetanic face, mask-like face, earthy-colored face, and Mongolian face.
17
Question
What signs should be noted when examining the eyes during physical examination?
Answer
Examine eye position, symmetry, exophthalmos or enophthalmos, eyelid abnormalities (ptosis, retraction, puffiness), conjunctival color (pallor, redness), sclera color (jaundice, blue), cornea clarity, presence of petechiae, and unusual spots like Kayser-Fleischer ring.
18
Question
What features are important to note when inspecting the mouth?
Answer
Lips (pallor, dryness, angular stomatitis), gums (bleeding, hypertrophy), teeth (hygiene, discoloration, caries), tongue (size, fissures, ulcers, color), buccal mucosa (pigmentation, ulcers), palate (cleft, high arch), tonsils (hypertrophy, exudates), and abnormal odors.
19
Question
How are peripheral extremities assessed during examination?
Answer
Examine temperature, sweating, swelling, edema, cyanosis, pulse and blood pressure differential, nail changes (clubbing, pallor, onycholysis), ulcers, trophic changes (hair loss, muscle wasting), deformities, and venous issues such as varicosities.
20
Question
What is the significance of detecting shifting dullness in abdominal percussion?
Answer
Shifting dullness helps detect ascites by noting changes in dullness when the patient changes position, indicating free fluid in the abdomen.
21
Question
Why assess hernial orifices during abdominal examination?
Answer
To detect presence of hernias via inspection and palpation, including any impulse on coughing and any masses in the hernial areas.
22
Question
What are five common signs of dehydration?
Answer
1. Loss of skin elasticity 2. Sunken eyes 3. Dry mouth 4. Delayed capillary refill 5. Cyanosis
23
Question
List four signs of respiratory distress.
Answer
1. Tachypnea (rapid breathing) 2. Working alae nasi (flaring of nostrils) 3. Intercostal retraction (pulling in of muscles between ribs) 4. Grunting
24
Question
What are causes of pallor even when the complete blood count (CBC) is normal?
Answer
- Shock or congestive heart failure - Toxemia (e.g., infective endocarditis) - Edema of the face (e.g., nephrotic syndrome) - Racial pallor (common in Far East populations) - Albinism - Myxedema - Lymphedema
25
Question
Which arrhythmias are causes of irregular pulse?
Answer
1. Atrial fibrillation 2. Multiple extrasystoles 3. Ventricular fibrillation
26
Question
What causes a regular irregular pulse?
Answer
1. Pulsus bigeminy (every other beat is premature) 2. Pulsus trigeminus (every third beat is premature)
27
Question
Identify two causes of small pulse volume.
Answer
1. Small stroke volume (low cardiac output) 2. Shock, characterized by a thready, weak, and rapid pulse
28
Question
What are common causes of central cyanosis?
Answer
1. Asphyxia 2. Pulmonary arteriovenous fistula 3. Lung diseases such as COPD, fibrosis, collapse, massive consolidation 4. Fallot's tetralogy 5. Eisenmenger's syndrome (right to left shunt) 6. Polycythemia
29
Question
What are some causes of peripheral cyanosis?
Answer
1. Polycythemia 2. Marked decrease in systemic blood flow 3. Venous congestion (right ventricular failure and cardiac tamponade) 4. Localized decrease in blood flow such as cold temperature and peripheral circulation disturbances like Raynaud's, Buerger's disease, venous thrombosis, and arterial occlusion
30
Question
Name causes of big pulse volume.
Answer
1. Arteriovenous fistula 2. Aortic regurgitation 3. Bradycardia in congenital heart block 4. Hyperkinetic state (e.g., fever, anemia)