Head to Toe
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Head Inspection | Hair distribution, shape/contour of skull
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| Head Palpate | Hair, skull for lumps/bumps/depressions occiput moving down to face, look for symmetry, involuntary facial mvmts, lesions, scarring
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| Head Palpate (cont) | temporal pulse/artery, temporomandibular joint (TMJ) - open/close, max/frontal sinus - pressure/pain
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| Eye Inspection | eyebrows/eyelashes - symmetry, sclera - white, no yellow, jaundice, Conjunctivae - pull down lower lid, pink, clear
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| Opthalmascope Exam | Obliquely - look at lens for foreign bodies/symm/color diff. Look for reflex in pupil - symm. Light across pupils - PERRLA with direct and consensual - both constrict and individually
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| Fundoscopic Exam | Set dial to '0" (adjust if blurry). Come in at angle L to L, R to R. Look for red reflex which is light shining in pupil, move and adjust. See blood vessels. optic disc, move nasal to see macula & filvia
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| Visual Field | Confrontation testing (CNII) - peripheral, post/sup view. Cardinal Views of gaze (6) - test EOM (CN 3,4,6). Convergence Test - 5cm-15cm move finger to bridge of nose- look for constriction too. Near Test - look at finger, then object far. Constrict w/ near
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| Ear Inspection | Placement, s/s infection/inflam, drainage, damage. Tug test - pull pinna back/down, auricle too, check b4 scope for tenderness.
Whisper test - occl ear, whister "apple", pt repeat
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| Otoscope | Adult - pinna up/back. Child - pinna down/back. Look at TM, bony prominence malleus/umbo, light reflex. Look for inf/redness/bulging
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| Tuning Fork Weber Test & Rhinne Test | Weber - for conduciton of ear/lateralization. Strike, top of crown - which ear feel/hear (should be both).
Rhinne - AC> BC, strike, back of ear lobe - ask when no longer hear, then place front of ear - should hear vibration.
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| Nose inspection | symm (CN 7), ala for deformities. Shine light look for polyps, abn discharge, mucosa, turbinates, septum for deviation
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| Mouth Inspection | cracks, sores, lesions. Shine light in mouth, tongue out "Ahh" - view tonsils, pillars, uvula (rise, midline), hard/soft palate, dentition, mucosa. Test gag (CN 9, 10)
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| Mouth Palpate | Gloves: feel mucosa for masses, under tongue, submandibular/sublingual glands/ducts
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| Neck Inspection | trachea alignment, no masses/lesions, torticollus (twisting of head)
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| Neck Palpation | Lymph nodes - pea size or + (mobile/nontender), pre/post auricular (front/back ear), tonsilar, submandibular, submental, ant/post cervical (front neck), deep clavicle (turn head push into sternoclidoid muscle), supra/infraclavicular (above/below), occipital (behind neck)
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| Neck Palpation (cont) | Trachea
Ant thyroid (displace to one side, midline)
Posterior thyroid: hands below isthmus, cricoid. Pt swallow (should rise, smooth) no masses, enlarged
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| Neck Palpate (cont) | ROM/muscle strength - head forward/back, side/side, shoulder shrug (CN 2) against resistance
Listen for bruit first - Carotid pulse. Palpate (never both at same time)
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| Chest Inspection | Anterior - skin, breathing rate, effort, symm, intercostal muscle use
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| Chest Palpation | Ant - crepitus, tactile fremitus - "99" side/side, feel vibrations
Post - spinous processes, symmetric expansion, tactile fremitus
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| Chest Percussion | Post - apices to bases, side/side, resonance, no hyperresonance/dull
Diaphragmatic Excursion: observe insp/exp diaphragm, Pt inhale & hold - percuss down til snd change. Mark.
Pt exhale & hold - percuss from spot down to change to dull. Mark. Do other side. Equal is 3-5cm. Abn can mean fluid or atelectasis of LL.
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| Chest Auscultation | Post - (diaphragm) start above clavicle , side/side to rib 6. Mostly lower lobe and vesicular.
Bronchophony: "99" (consolidation=clr/distinct)
Egophony: "eee" (consol. = "AAA")
Whispered Pectoriloquy: "1,2,3" (distinct/clr)
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| Chest Auscultation (cont) | Ant - supraclavicular area down to 6th rib, side/side & full respiration, BV - near sternum, V - lung fields,
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| Upper Extremities Inspection | ROM/strength - hands(cap refills)/arms/shoulders
[Pt lay down flat]
Stand on right, pt turn head to left, jugular venous pressure (JVP) - find highest pulsating point
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| Upper Extremities Palpation | Carotid pulses - 1 side at a time, Listen for bruits(bell & diaphragm), feel for thrills.
Radial Pulses, brachial pulses
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| Cardio Inspection | precordium for vent pulsations (if see Point of maximal inpulse PMI @ 5th ICS midclavicular)
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| Cardio Palpation | Start at sternal border @ 2nd ICS, move to L 2nd ICS, then down 3rd, 4th, 5th ICS. (feel for thrills, heaves, lifts/pulsations)
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| Cardio Markers | 1. Aortic area: R sternal border, 2nd ICS
2. Pulmonic: L 2nd ICS
3. Erb's Point: 3rd, 4th, 5th, ICS
Tricuspid: sternal border 5th ICS
4. Mitral (PMI, apex): 5th ICS midclavicular
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| Cardio Auscultation | Diaphragm then Bell 1-5
[Pt Sit Up] or [Decubitus or Left lateral position]
L Erb's Point
[Pt lean forward]
L 2nd ICS for murmurs
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| Peripheral Vascular Inspection | [Pt supine]
abdomen for aortic pulsations
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| Peripheral Vascular Auscultate | for bruits Bell/Diaphragm - above umbilicus
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| Peripheral Vascular Palpate | above umbilicus - then separate to feel iliac, renal, femoral pulses
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| Abdomen Inspection | [Pt flex knees to relax abd muscles] Inspect skin, contour, peristalsis, pulsation of aorta, distension, massess, hernias (raise head)
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| Abd Auscultation | Diaphragm, all 4 quadrants (5 min. for "absent")
Bell - aorta for bruits
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| Abd Percussion | Percuss 4 quadrants, then percuss for size of liver, should be bn 6-12cm
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| Abd Palpation | 4 quads lightly/deeply. then palpate for liver, spleen, L/R kidneys, aorta [Pt take in deep breath]
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| Abd palpation | Femoral pulses and hernia and nodes. Auscultate for femoral bruits.
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| Lower Extremities Inspection | symmetry, hair distribution, warmth, lesions, redness, swelling, hair on calves/toes (none = bad), varicose veins, between toes
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| Lower Ext Palpation | Edema, popliteal (use both hands), dorsalis pedis (ant foot), post tibialis (medial malleolus)
Holman Sign - flexion of foot + squeeze calf for pain, Babinski sign, coord/sensa, ROM hips/knees/ankles/ft
[SIT ON SIDE AND DANGLE LEGS]
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| Neuro | (hammer) tendon reflexes: biceps/tri/brachioradialis, patellar, achilles
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| Neuro (cont) | MEND - finger to nose, count fingers, sens
[STAND/WALK]
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| Neuro (cont) | Walk, walk on tiptoes, Romberg, knee bends, touch toes, inspect spine, stabilize pelvis, ROM hyperextends, rotates, laterally bends
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Created by:
palmerag
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