November Practical Tips for Success
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| OLDCAARTS | Onset
Location
Duration
Character
Associated symptoms
Aggravating factors
Relieving factors
Temporal factors
Severity
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| MIIMASH | Medical illnesses (ask specifically)
Injuries
Immunizations
Medications
Allergies
Surgeries
Hospitalizations
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| SHORES | Safety of relationships
Habits: tobacco, EtOH, drugs (illegal, herbals), diet, exercise, sleep…)
Occupation
Religion
Environment
Sexual history
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| What do you evaluate for respiratory distress? (6) | Respiratory Rate
Body position
general appearance
accessory muscle use
color
mental status
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| How many spots to you auscultate on the back? | 4-6
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| How many lung fields need to be evaluated? | 6
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| What lung sound is heard at the left axilla? | lingula
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| What lung sound is heard at the right axilla? | right middle lobe
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| How many spots need to be auscultated for lung sounds on the front? | 4
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| How do you instruct patient to breath when listening to lung sounds? | Breath in and out thru the mouth
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| How do you compare lung sounds | compare sides bilaterally
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| What does increased fremetus indicate? | consolidation, fluid or mass
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| What does decreased fremetus indicate? | fat, air/fluid in chest wall, overexpansion of the lungs (emphysema)
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| What is fremetus? | palpable vibration on the human body
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| What is a positive test for fremitus? | increased or decreased fremitus
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| How do you test for fremitus? | Instruct the patient to say "99" as you palpate using either the karate chop or piano method
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| What is the karate chop method? | Examiner places ulnar side of hand against teh patient's chest wall. Palpate side to side, top to bottom on both front and back of teh chest while they say "99"
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| What is the piano test? | examiner places palmer surface of fingertips against patient's chest wall. Palpate side to side, top to bottom on both the front and back of the chest while the patient says "99"
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| What is diaphragmatic excursion? | tests for conditions that inhibit diaphragm from proper movement
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| What is a positive test for diaphragmatic excursion? | decreased excursion
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| How do you test for diaphragmatic excursion? | Stand behind patient and instruct them to inhale and hold it. Precuss to find the border of diaphragm.
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| What is normal diaphragmatic excursion? | 3-6 cm
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| What is bronchophony? | tests for lung consolidation
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| What is a positive bronchophony test? | louder and or clearer sounds
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| How do you perform bronchophony test? | instruct patient to say "99" as you auscultate on bare skin, bilaterally thru all lung fields.
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| What is whispered pectoriloquy? | tests for consolidation of lungs
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| What is lung consolidation? | area of the lung that, while previously collapsible, is now filled with a fluid
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| What is a positive test for whispered pectoriloquy? | Louder and/or clearer sounds
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| How do you perform whispered pectoriloquy test? | Instruct the patient to whisper "1,2,3" as you auscultate on bare skin, bilaterally thru all lung fields
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| What is egophony? | Tests for consolidation
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| What is a positive egophony test? | "EEEEE" to "AAAAA"
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| How do you perform an egophony test? | Have the patient say "EEEEE" as you auscultate on bare skin, bilaterally thru all lung fields
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| What do you inspect for in cardiovascular exam? (9) | Symmetry
edema
color
cyanosis
skin lesions
scars
tattoos
contour
venous pattern
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| Where do you auscultate the heart? | Aortic (R 2nd)
Pulmonic (L 2nd)
Erbs Point (L 3rd)
Tricuspid (L 4th)
Mitral (L 5th)
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| how do you evaluate the patient for aortic regurgitation? | Auscultate over the aortic valve while the patient is seated and leaning forward
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| How do you evaluate for mitral stenosis? | auscultate over mitral valve while the patient is in the left lateral recumbant position
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| What pulses do you palpate? (8) | Temporal
Carotid
Brachial
Radial
Femoral
Popliteal
Dorsalis Pedis
Posterior Tibial
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| Where do you examine for Bruits? (7) | ocular
temporal
carotid
abdominal aorta
renal
iliac
femoral
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| Where do you listen for renal bruits? | 2 fingers over and up from umbilicus
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| Where do you listen for iliac bruits? | 2 fingers over and down from umbilicus
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| What do you inspect for on the abdomen? | contour
skin lesions
color changes
venous patterns
symmetry
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| What is proper order of abdominal exam | AUSCULTATE, then palpate or percuss
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| Where do you ausculate the abdomen? | all 4 quadrants
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| Where do you examine for pitting edema? | Lower extremities
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| How do you percuss the span of the liver? | percuss from area of tympany on chest in the midclavicular line. the change to dullness indicates teh upper border of the liever. Then percuss upward from teh area of tympany in the right lower quadrant in mid-clavicular line until you reach dullness. The
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| What is the scratch test for the liver? | Place the diaphragm over the area of teh liver and then scratch parallel to teh costal margin until the sound intensity drops off marking the edge of the liver.
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| Where do you percuss the spleen? | Start posterior to the midaxillary line on the left side beginning in a resonant lung field. There should be dullness from the 6th to 10th rib
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| How do you palpate the abdomen | use light, medium and deep pressure for general abdominal exam
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| How do you palpate the liver? | left hand under patient at 11th and 12th rib and press upward to elevate the liver. use your right hand to palpate where you know the leiver edge to be in the midclavicular line. If liver edge is felt, then palpate medially and laterally to assess liver c
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| How do you palpate the spleen? | Reach across the patient with your left hand and place it beneath the patient over the left costo-vertbral angle. Press upward to lift the spleen anteriorly. Have the patient take a deep breath and feel for teh spleen with the right hand below the costal
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| How do you palpate the kidney? | reach across the patient with your left hand under their flank. Place your right hand under the costal margin. Lift the flank while the patient inhales and press deeply with your right hand. Repeat on left.
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| What is the capture technique? | Place hands above and below patient while the patient is lying supine. Ask patient to take a deep breath and press fingers of both hands together. Ask patient to then exhale and slowly release your hand/finger pressure and feel for the kidney to slip thru
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| What is rebound tenderness? | Tests for peritoneal tenderness or irritation
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| What is positive rebound tenderness? | increased pain on release
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| What is iliopsas test? | tests for appendicitis
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| What is a positive iliopsoas test? | pain
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| how do you do a iliopsoas muscle test? | patient lies supine and then you place yoru hand over their lower right thigh. Patient flexes their hip while teh examiner resists
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| What is Aaron sign? | pain or distress occuring in the area of teh heart or stomach on palpation of McBurney's Point. Tests for appendicitis
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| What is Balance sign? | fixed dullness to perscussion in the left flank and dullness in right flank that disappears on position change. Tests for peritoneal irritation.
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| What is blumberg sign? | Rebound tenderness. Tests for periotoneal irritation and appendicitis.
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| What is Cullen sign? | bruising around the umbilicus. Tests for hemoperitoneum, pancreatitis and ectopic pregnancy.
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| What is dance sign? | absence of bowel sounds in right lower quadrant. Tests for intussusception
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| What is Grey Turner sign? | Bruising in the flanks. Tests for hemopertioneum and pancreatitis.
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| What is Kehr Sign? | abdominal pain radiating to left shoulder. Tests for spleen rupture, renal calculi, and ectopic pregnancy
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| What is Markle's Sign? | patient stands with straightened knees, then raises up on toes and allows heels to hit the floor. Tests for peritoneal irritaion and appendicitis
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| What is McBurney's Point? | Rebound tenderness and sharp pain when it is palpated. Tests for appendicitis.
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| Where is McBurney's Point? | 1/3 of the distance from the ASIS to the umbilicus
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| What is Murphy's Sign? | Abrupt cessation of inspriation on palpation of the gallbladder. Tests for Cholecystis
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| What is Rovsing Sign? | RLQ pain intensified by LLQ palpation. Indicates peritoneal irritation or appendicitis.
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| What is Romberg-Howship sign? | Pain down the medial aspect of the thigh to the knee. Indicates strangulated obturator hernia
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| What is the obturator muscle test? | Tests for ruptured appendix or pelvic abscess.
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| What is a positive obturator muscle test? | pain
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| How do you do an obturator muscle test? | flex teh patient's right hip and knee and then rotate the leg laterally and medially.
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