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SWC Heep Lab MT

Survey of Western Clinical sciences, Heep, Lab midterm

How do you take Heart Rate: Taken at radial or carotid arteries. Note rate (bpm, calculated from 15 seconds of palpation) and rhythm (regular, irregular)
How do you take Respiratory Rate: Note rate, rhythm, depth, effort (use of accessory muscle). Count breaths for 30sec-1min
How do you take Temperature: Avoid food or drink for 15 minutes before measuring oral temperature
Inspection of Hair? Quality: Coarse and dry in Hypothyroidism Thin and fragile in anemia Quantity: thinning senile/hypothyroidism/ anemia Distribution: Alopecia
Inspection of Scalp: texture, color
Inspection of Skull: size, contour, lumps, tenderness
Inspection of Face: Inspect for symmetry, edema, masses
Evaluate facial expression: Smile, raise eyebrows (CN VII)
Palpate muscles of mastication: (CN V)
Inspection of eyebrows: Loss of lateral portion: Hypothyroidism Patchy loss: syphilis, alopecia
Inspection of CN VII: facial expression, smile, raise eyebrows.
Inspection of CN V: palpate muscles of mastication
Inspection of Eyes: Position and alignment Eyelids Edema Lesions: stye, chalazion Eyelashes Palpate lacrimal gland and sac Inspect conjunctiva for pallor or redness Lower: pale in anemia, red in HTN
Inspect sclera: clear, no jaundice, redness
Corneal reflection: ensures both eyes are looking forward
Inspection of Pupils: Pupillary reaction: direct and consensual (CN II & CN III) Accomodation
Inspection of CNII & CN III Pupillary reaction direct and consensual accomodation.
Inspection of Extra-ocular muscles (check CN III, CN IV, CN VI) Extra-ocular muscle movements “H” in space Lid lag Convergence
Inspection of CN III, CN IV, CN VI: Extra-ocular muscle movements “H” in space Lid lag Convergence
Inspection of Otitis externa: pull ear
Inspection of Otitis media: press tragus
Inspection of Mastoiditis: tap on mastoid
Inspection of Auditory acuity: (CN VIII): using “watch test” !
Inspection of CN VIII: Auditory acuity using watch test
Inspection of nose: Palpate: Frontal sinus: press on frontal part or press up from under bony orbit Maxillary sinus: press up from under cheek
Inspection of Lips: color (cyanosis), lumps, lesions (cancer), cracking
Inspection of Buccal mucosa: color (cyanosis), ulcer, white patches (leukoplakia, candida)
Inspection of Gums: inflammation, swelling, bleeding
Inspection of Tongue: lesions
Inspection of CN XII: if affected, tongue will point to one side
Inspection of Pharynx: Inspect tonsils: Patient say “ah”, press on tongue with tongue depressor – assess CN IX and X
Inspection of CN IX and X: Patient say “ah”, press on tongue with tongue depressor
Inspection of TMJ: Evaluate TMJ while opening and closing for alignment Palpate TMJ while opening and closing, feeling for crepitus, pain and tenderness
Inspection of Neck: Inspection: Symmetry, masses, scars Palpation: lymph nodes Tender node = inflammation Hard and fixed node = malignancy
What are the lymph nodes? pre-auricular; posterior auricular; occipital; tonsillar; submandibular; submental; Cervical: superficial cervical; posterior cervical and deep cervical Supraclavicular
What we use to measure BP? Proper blood pressure cuff (Sphygmomanometer) Stethoscope
Where do we measure it? Brachial artery and Popliteal artery
How do we measure it? Listen to Korotkoff sounds (turbulent and laminar flow) Use the bell of your stethoscope
Describe Inspection of Posterior Chest: AP/lateral diameter ratio – normal would be 1:2 – barrel chest in COPD (emphysema) Slope of ribs – flattening in COPD ICS retraction (sucking in of intercostals) – COPD or upper airway obstruction (indicated respiratory distress)
Describe Palpation of Posterior Chest: Check for masses Assess respiratory expansion Hands on the sides, make fold in middle and ask patient take deep breath in. Unilateral decrease: lung fibrosis, pleural effusion, pneumonia
How do you check for fremitus on Posterior Chest? Assess tactile fremitus (feel vibration) in 4 sites Decreased vibration with fluid in lung: pleural effusion, pneumothorax, emphysema, asthma and atelectasis Increased in consolidation in lungs like fibrosis or pneumonia
Describe Percussion on Posterior Chest: Tap twice in each of the 7 areas Identify percussive notes: flat, dull, resonant, hyper-resonant
Describe Auscultation of Posterior Chest: 7 areas – same as percussion Check for normal breath sounds: Tracheal, bronchial, broncho-vesicular, vesicular Check for abnormal sounds Crackles Wheezes Rhonchi
What do you check for in breathing patterns? Check for respiratory rhythm, depth,
Describe Inspect neck: Trachea in midline – no deviation Supra-clavicular retraction Contraction of SCM and scalenes Both indicate respiratory distress
Describe Inspect chest of Anterior Chest: Shape Asymmetry Impairment of respiratory movement
Describe Palpation of Anterior Chest: Tender areas Assess tactile fremitus in 3 areas
Describe Auscultation of Anterior Chest: 6 areas Identify breath sounds
Created by: bastyr41