1.1. Introduction and Instruments

Question 1

What are the 5 aspects of a physical exam?

Answer 1

1. Inspect (look)
2. Auscultation (listen)
3. Palpation (Touch)
4. Olfaction (smell)
5. Percussion (tap area to differentiate air, fluid, or solid)
   - Compare bilateral

Question 2

what are the 4 aspects of general appearance?

Answer 2

1. Apparent state of health
2. Level of consciousness
3. Signs of distress
4. Skin color and obvious lesions

Question 3

What is an Ophthalmoscope used for?

Answer 3

Visualize inner eye aspect- retina, vascular supply, optic n.

Question 4

How to perform an eye exam w/ ophthalmoscope?

Answer 4

1. Lens selector and select “o”
2. Turn on light
3. Ask patient to pick a spot and look over shoulder
4. Look through aperture
5. Approach patient
6. Hand on patient forehead
7. Use your right eye to examine their right eye
8. Start 15 degrees from center laterally
9. Identify red reflex

Question 5

What size light should you use for pupil size

Answer 5

Small = constricted, light room
Medium = normal
Large = dilated

Question 6

When is a half light used?

Answer 6

Patient with cataracts to prevent light reflection

Question 7

When is red free light used?

Answer 7

Visualize vessels and hemorrhages in better detail by improving contrast
-Setting makes retina look black and white

Question 8

When is slit beam used?

Answer 8

Observe corneal abrasions and ulcers after fluoresceine staining
-Good for abrasions

Question 9

When is grid used?

Answer 9

Make rough approximations for lens lesions

Question 10

What hand should you use for an otoscope exam?

Answer 10

• Same hand as ear you are viewing (right hand, right ear)
• Free hand should pull outer ear up and back to open canal
• <12 month old: pull down and back

Question 11

What are the two neuro tests performed with the tuning fork?

Answer 11

1. Gross hearing for CN
   - Air conduction is longer than bone
   - Hold fork in front of external auditory meatus
2. Vibration sense (placing handle on knee cap

Question 12

What are the 3 upper extremity deep tendon reflexes?

Answer 12

1. Biceps (hammer strikes your thumb)
2. Triceps
3. Brachioradialis

Question 13

What are the 2 deep tendon reflexes for LE?

Answer 13

1. Patellar

2. Achilles

Question 14

What is the reflex scale and what would be considered normal?

Answer 14

0 (absent) - 4 (hyper-reactive), 2/4 is normal

Question 15

What is the bell (smaller portion) used for?

Answer 15

Low pitched sounds (bruits)

Question 16

What is the diaphragm of the stethoscope used for?

Answer 16

High pitched sounds (breathing and heart tones)

Question 17

How do you choose correct BP cuff size for patient?

Answer 17

Length should be 80% of UE circumference and width of cuff should be 40% length of upper arm

Question 18

How far above cubital fossa should you place cuff?

Answer 18

1 inch

Question 19

How high should you inflate cuff?

Answer 19

180 mmHg or 30 higher than estimated systolic

Question 20

What is the 1st knocking sound you hear called?

Answer 20

Korotkoff (systolic)

Question 21

What should you be cautious of to avoid errors in BP monitoring?

Answer 21

• Pt should avoid smoking, caffeine and exercise 30 mins prior
• Pt feet should be on floor for 5 mins prior
• Arm free of clothing, dialysis fistulas, cut down scars and lyphedema

Question 22

What user error can lead to a false high BP?

Answer 22

• Brachial a. below heart (heart is roughly 4th rib space)
• Cuff too small (narrow)
• Cuff too large (wide)

Question 23

What is the scaling for pulses?

Answer 23

0 (absent)-+3(bounding), +2 is normal

Question 24

What are the 4 tenants of Osteopathic medicine?

Answer 24

1. Body is unit
2. Body has self-regulatory mechanisms
3. Structure and function are reciprocally related
4. rational therapy is based upon understanding that body is a unity, self-regulating, and there is an interrelationship with structure