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HPE Patient Special Tests

HPE Patient Special Tests

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Published by MedShare
HPE Patient Special Tests
HPE Patient Special Tests

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Published by: MedShare on Apr 09, 2009
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History & Physical Exam Special TestsVersion: 09Apr2009 Page 1 of 8
Blood Pressure – Auscultatory Gap
* Ask about caffeine use in the past 30 minutes* Ask if patient has been sitting for 5 minutes* Ask if patient has any restrictions to taking BP in either arm* Align correctly sized cuff with brachial artery, palpate radial artery* Inflate until radial artery not palpable, add 20mmHg as starting point for auscultation* Orthostatic hypotension is defined as 20mmHg drop between patient positioning
Auditory Function – Rinne & Weber Tests
* Weber: Strike 512Hz and place handle on center of patient’s forehead* Ask patient which ear the sound can be heard best in or if it is equal* Rinne (said rin-na): Strike 512Hz and place handle on patient’s mastoid process* Have patient tell you when the sound stops (bone conduction), then move the tines infront of the ear (air conduction) and ask if they can hear the sound
Opthalmoscopic – Fundus Exam
* Dim room lights, use opthalmoscope with same eye as patient’s eye being examined* Hold patient’s head with other hand to gauge your distance, adjust to 0 diopters* Come toward patient’s eye at a 15-degree angle, looking for a vessel to cross* Follow vessels to cup and disk, measure ratio to compare with other eye* Examine for abnormalities (AV nicking, cotton wool spots, papillary edema)* Have patient look into light briefly to examine macula and fovea* Anterior chamber (perpendicular) lighting: crescent moon diming with glaucoma
History & Physical Exam Special TestsVersion: 09Apr2009 Page 2 of 8
Otoscope – Ear Canal Exam
* Palpate tragus and pinna for pain and examine for exudate* Retract pinna up, out, and back (adult) or down, out, and back (child)* Insert otoscope with inverted hold using backhand method or extended 5th digit* Examine canal (exudate, lesions, erythema, cerumen)* Examine tympanic membrane (color, light reflex, boney structure)* Insufflate for mobility of tympanic membrane
Neck – Auscultation & Thyroid
* Auscultate of carotid arteries and thyroid for bruits* Hold thyroid from the back of the patient* Have patient swallow (examine for nodules, thyroidmegaly)
Respiratory – Suspected Consolidation
* Bronchophony: sound transmitted louder at area of consolidation* Egophony: patient says “e” and sounds like “a” at areas of consolidation* Whispered pectoriloquy: whispered word sounds louder at area of consolidation
History & Physical Exam Special TestsVersion: 09Apr2009 Page 3 of 8
Respiratory – Clinical Scenarios
Scenario Tactile fremitus Percussion Pneumonia
Increased Decreased resonance
Decreased Increased resonance
 Pleural effusion
Decreased Decreased resonance
Meningitis – Brudzinski & Kernig Tests
* Brudzinski sign: Patient supine, passively flex patient’s neck * Positive Brudzinski sign is pain or restricted flexion* Kernig (K for Knee) sign: Patient supine, knees bend, extend lower leg* Positive Kernig sign is pain
Cardiac – Heart Sounds
* S1: closure of the AV valves, marks onset of systole* S2: closure of semilunar valves, aortic and pulmonic* S2 split: right side slightly delayed with decreased pressures (A2>P2)* Have patient exhale and hold to resolve physiologic split (not IHSS)* Ejection click: early systole (diseased aortic valve)* Opening snap: early diastole (mitral disease)* S3: rapid deceleration of blood (decreased compliance in adults)* S4: atrial kick against non-compliant ventricle* Crescendo/decrescendo murmur: aortic stenosis* Plateau murmur: mitral regurgitation, tricuspid regurgitation, septal defect* Radiation to neck (aortic stenosis) or axilla (mitral regurgitation)

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