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HTH 310: Medical Interviewing a Physical Examination I
Course Content Guide
Physical Exam Overview and Appearance
1.
Define:
Pyrexia
Bradycardia
Tachycardia
Apnea
Tachypnea
Hyperpnea
Bradypnea
Korotkoff Sounds
Auscultatory Gap
Hypertension
Core temperature
Pulse pressure
Systolic pressure
Diastolic pressure
Toxic appearance
Cachexia
Morbidly obese
Extracorporeal
Hypothermia
Hypotension
2.
Describe the use of the following techniques of examination:
Inspection
Palpation
Percussion
Auscultation
Smell
3.
4.
List the areas that should be observed during the general survey of the patient.
Describe acceptable routes used to obtain body temperature. List the normal range for the three
routes and the length of time the thermometer should be in place for each route.
Describe the correct technique for obtaining the pulse. List
the arteries used to palpate the
pulse and normal pulse rate for adults.
Describe the technique used to obtain the patient's
respiratory rate. List the normal range for
respirations in the adult.
Describe the technique used to obtain the patient's blood pressure. List the normal range for blood
pressure in the adult. Identify common causes of error in measuring blood pressure.
5.
6.
7.
SKIN
1.
2.
3.
4.
5.
6.
7.
8.
List the layers of the skin, and describe each.
List the appendages of skin.
List the parts of the nail and their functions.
List the glands of the skin, their function and location.
List the cardinal characteristics of every skin lesion that must be assessed during examination.
Describe some of the changes that occur with aging of skin.
Define:
Pallor
Diaphoresis
Pruritis
Cyanosis
Turgor
Dermatographism
Hyperkeratinization
Define the following terms as they apply to skin lesions:
Macule
Venous spider
Patch
Papule
Petechiae
Plaque
Telangiectases
Rodule
Purpura
Tumor
Ecchymosis
Wheal
Spider Angioma
Scale
Ulcer
Fissure
Crust
Vesicle
Pustule
Bulla
Cyst
Atrophy
Erosion
HEAD, EYES, EARS, NOSE, ORAL CAVITY, THROAT
I. HEAD
1.
Identify the regions of the head.
2.
Describe the technique for examining the head (include hair, scalp, skull, face, and skin).
II. EYES
1.
Locate the following external structures:
a. Palpebral fissure
b. Upper and lower eyelid
c. Medial and lateral canthus
d. Cornea and Pupil
e. Limbus
f. Iris
f. Sclera and palpebral conjunction
g. Bulbar conjunction
h. Bony orbit and lacrimal gland
i. Punctum and lacrimal sac
2.
Identify the following internal (eyeball) structures:
a. Iris and Lens
b. Anterior chamber
c. Retina
d. Fovea centralis
e. Macula
f. Physiologic Cup
g. Optic Disc
h. Arteriole and Vein
3.
Diagram the visual pathways in terms of response to a stimulus (include both temporal and nasal
information from both left and right visual fields).
Describe and demonstrate the testing of visual fields by confrontation, and list the functions tested by
this maneuver.
Describe and demonstrate the correct use of the Snellen eye chart to check visual acuity.
Describe and demonstrate the techniques for inspection and examination of the eye: alignment,
conjunctiva and sclera, eyebrows and eyelids.
Describe and demonstrate the techniques for inspection of the cornea/lens, iris, and pupils.
Describe and demonstrate the pupillary reflexes to light and accommodation.
Describe and demonstrate functional testing of extraocular movements and evaluation and lid lag.
Describe and demonstrate correct technique for ophthalmoscopic examination of the eye, including
the structures listed above.
List the cranial nerves that can be assessed during the course of the eye examination.
4.
5.
6.
7.
8.
9.
10.
11.
IV. EARS
1.
Identify the following external ear structures:
a.
b.
c.
d.
d.
e.
2.
Auricle
Helix
External auditory canal
Tragus
Lobe
Mastoid process
Identify the following internal ear structures (tympanic membrane ):
a.
b.
c.
d.
e.
f.
g.
3.
4.
5.
Pars flaccida
Incus
Pars tensa
Umbo
Short process of malleus
Handle of malleus
Cone of light (light reflex)
Describe the inspection of the external ear structures listed
above.
Explain and demonstrate the proper technique for otoscopic examination of the ear canal and
tympanic membrane.
Demonstrate how to screen for auditory acuity.
V. NOSE
1.
Identify the following external nose structures:
a. Bridge
b. Columella
c. Naris
d. Ala nasi
e. Vestibule
2.
Identify the following internal nose structures:
a. Vestibule/mucous membrane
b. Turbinates
c. Paranasal sinuses
e. Septum
3.
4.
5.
6.
Demonstrate correct inspection and palpation of the nose including the test for nasal obstruction.
Demonstrate proper otoscopic examination of the nares.
Demonstrate correct technique for palpation of the sinuses.
Demonstrate olfactory testing.
VI.
Oral Cavity and Throat
1.
Identify the following structures of the mouth and pharynx:
a. Buccal and gingival mucosa
b. Opening of parotid ducts
c. Dorsum of tongue
d. Vallate papilla
e. Anterior pillars
f. Tonsils
g. Posterior pillars
h. Uvula
i. Posterior pharyngeal wall
j. Hard and soft palates
k. Opening of submandibular ducts
l. Frenum
m. Teeth
n. oropharynx
2.
3.
4.
List two important signs of disease which can be detected by observation of lip color.
Demonstrate appropriate inspection technique of the above listed structures.
List the cranial nerves which can be tested in this assessment.
VI.
Neck
1.
2.
3.
4.
5.
6.
7.
List the structures to be evaluated during examination of the neck.
Identify the anterior and posterior triangles and the occipital area the neck, and the
structures dividing them.
Identify the following midline structures:
a. Hyoid bone
b. Thyroid cartilage
c. Cricoid cartilage
d. Tracheal cartilages
e. Thyroid isthmus
f. External jugular vein
g. Carotid artery
Demonstrate correct inspection /palpation of the neck, including symmetry, masses, scars,
and enlargement of parotid/maxillary glands.
List the lymph nodes of the head and neck and demonstrate proper palpation technique of
same.
Demonstrate correct inspection/palpation technique for examination of the trachea and
thyroid gland.
Identify:
a.
Sternornastoid muscle
b.
Trupezius muscle
c.
Cervical spine
d.
Supraclavicular fossar
THORAX AND LUNGS
I.
1.
Anatomy
Identify the following bony landmarks:
a. Suprasternal notch
b. Sternal angle (angle of Louis)
c. Intercostal spaces (2nd-6th anteriorly)
d. Posterior 11th & 12th ribs
e. Inferior angle of scapula
f. Vertebra prominens (C7)
g. Clavicles
h. xiphoid process
2.
Describe the location of these "imaginary lines":
a. Midclavicular line
b. Axillary lines (anterior, midaxillary and posterior)
c. Scapular line
d. Midvertebral line
e. midsternal line
3.
Identify the locations of these areas:
a. Supraclavicular
b. Infraclavicular
c. Interscapular
d. Infrascapular
4.
Describe the bony landmarks for the following lung borders:
a. Apices
b. Inferior borders - anterior, posterior, and lateral
c. Oblique (major) fissures (anteriorly and posteriorly)
d. Minor fissures of the right lung
e. Bifurcation of the trachea (anteriorly and posteriorly)
5.
8.
9.
Locate the mediastinum and list its contents.
Describe the process of breathing. What muscles are used with normal respiration and with
increased effort?
Describe the changes in lung function and in the thorax that occur with age.
III.
1.
2.
3.
Physical Examination
List the four parts of a thorax/lung exam.
List items that should be noted during inspection.
Demonstrate assessment of respiratory expansion and tactile fremitus.
a. List causes for decreased fremitus.
b. List causes for increased fremitus.
4.
Briefly describe & practice the following percussion notes; list where "normal" example locations and
pathologic examples are found.
a. Flatness
b. Dullness
c. Resonance
d. Tympany
5.
6.
What is the purpose of chest percussion?
Know the proper technique for percussion of the chest and how to determine diaphragmatic
excursion.
Describe the three categories of normal breath sounds and tracheal breath sounds and when and
where they are normally heard.
What is the purpose of lung auscultation?
Define and know how to identify the following:
a. Tachypnea
b. Bradypnea
c. Pectus excavatum
d. Pectus carinatum
e. Kyphosis
7.
8.
9.
OBJECTIVES: CARDIOVASCULAR SYSTEM
I.
1.
2.
Anatomy
Describe the structures that surround the heart.
Locate the bony landmarks for the following:
a. Right ventricle
b. Left ventricle
c. Aorta
d. Superior Vena Cava
e. Pulmonary Artery
f. Base of heart
g. Apical pulse
3.
Name and describe the location of the atrioventricular valves and the semilunar valves.
II.
1.
2.
Cardiac Cycle
Describe the electrical events that occur during the cardiac cycle.
Discuss the events that occur during systole and diastole including pressure changes and valve
opening/closing.
III.
1.
2.
3.
Heart Sounds
Discuss the components of S1 and S2 and where these heart sounds are best heard.
Describe what actions create the above heart sounds when they are heard.
Give the bony landmarks for the following areas recommended for cardiac auscultation:
a. Aortic
b. Pulmonic
c. Tricuspid
d. Mitral
3.
Venous pressures
a. What does jugular venous pressure reflect?
b. Briefly discuss the following elevation and troughs of jugular venous pressure and what
they represent:
1) a wave
2) c wave
3) v wave
VI.
1.
Cardiovascular Changes with Age
Briefly discuss the following changes that may occur with aging and
significance.
VII.
1.
2.
Physical Examination
Define the apical impulse and describe its relationship to the carotid pulse.
Describe the correct method for assessing carotid and radial pulses including inspection, palpation
and auscultation
Compare and contrast jugular and carotid
pulsations.
Briefly describe the proper positioning of a patient during a
cardiac exam.
Demonstrate proper technique for inspection and palpation of the precordium and explain the
purpose for doing this.
Demonstrate the proper technique for auscultation of the heart:
a. Tell when to use the bell and when to use the diaphragm.
b. What areas should be auscultated?
c. What does one listen for at each site?
d. When will you hear the following heart sounds?
1) S1, S2, S3, S4
2) Split S2, closed (non split)S2
3.
4.
5.
6.
8.
9.
Define and describe the etiology of the following:
Bruit
murmur
Heave
splitting
Thrill
venus hum
explain their etiology and
innocent murmur
mammary souffle
Be familiar with the following cardiac rhythms:
a.
normal sinus rhythm
b.
sinus arrhythmia
c.
Physiologic vs. Pathologic splitting of S1 and S2