Modified Leopolds Maneuvers

Fetus Weeks

These maneuvers are important adjuncts to palpation of the pregnant abdomen beginning at 28 weeks of gestation. They help determine where the fetus is lying in relation to the woman's back longitudinal or transverse , what end of the fetus is presenting at the pelvic inlet head or buttocks , where the fetal back is located, how far the presenting part of the fetus has descended into the maternal pelvis, and the estimated weight of the fetus. This information is necessary to assess the adequacy...

Auscultation Position For Aortic Regurgitation

Heart Sound

Auscultation of heart sounds and murmurs is a rewarding and important skill of physical examination that leads directly to several clinical diagnoses. In this section, you will learn the techniques for identifying S1 and S2, extra sounds in systole and diastole, and systolic and diastolic murmurs. Review the auscultatory areas on the next page with the following caveats 1 some authorities discourage use of these names since murmurs of more than one origin may occur in a given area and...

Normal Configurations Of The Hymen In Prepubertal And Adolescent Females

Hymen Prepubertal

15-month-old infant with annular hymenal orifice 15-month-old infant with annular hymenal orifice 7-year-old girl with a crescent-shaped hymenal orifice 2-year-old with an annular orifice, located offcenter, visible with labial traction 6-year-old with a septate hymen causing two orifices. Traction is needed to visualize the two openings. 9-year-old girl with redundant labial tissue. Greater traction or a knee-chest position would reveal a normal orifice. 12-year-old girl with annular-shaped...

Renal Bruit Auscultation Location

Renal Bruit Auscultation Location

Auscultation provides important information about bowel motility. Listen to the abdomen before performing percussion or palpation, since these maneuvers may alter the frequency ofbowel sounds. You should practice auscultation until you are thoroughly familiar with variations in normal bowel sounds and can detect changes suggestive of inflammation or obstruction. Auscultation may also reveal bruits, vascular sounds resembling heart murmurs, over the aorta or other arteries in the abdomen, which...

The Seven Attributes Of A Symptom

Where is it Does it radiate 3. Quantity or severity. How bad is it For pain, ask for a rating on a scale of C 1 to 10. 4. Timing. When did does it start How long did does it last How often did does it come Setting in which it occurs. Include environmental factors, personal activities, emotional reactions, or other circumstances that may have contributed to the illness. C 5. Remitting or exacerbating factors. Does anything make it better or worse T 7. Associated manifestations. Have...

TABLE 81 Visible Signs of Breast Cancer

Breast Cancer Skin Dimpling

As breast cancer advances, it causes fibrosis scar tissue . Shortening of this fibrotic tissue produces retraction signs, including dimpling, changes in contour, and retraction or deviation of the nipple. Other causes of retraction include fat necrosis and mammary duct ectasia. Look for this sign with the patient's arm at rest, during special positioning, and on moving or compressing the breast, as illustrated here. Edema of the skin is produced by lymphatic blockade. It appears as thickened...

Early And Late Childhood

Vaginal Trauma

After infancy, the labia majora and minora flatten out, and the hymenal mem- The appearance of pubic hair be-brane becomes thin, translucent, and vascular, with the edges easily identified. fore the age of 7 years should be considered precocious puberty and The genital examination is the same for all ages of children, from late infancy requires evaluation to determine until adolescence. Use a calm, gentle approach, including a developmentally the cause. appropriate explanation as you do the...

Extra Nipple On Areola

Areola Nipple

The breast is hormonally sensitive tissue, responsive to the changes of monthly cycling and aging. Glandular tissue, namely secretory tubu-loalveolar glands and ducts, forms 15 to 20 septated lobes radiating around the nipple. Within each lobe are many smaller lobules. These drain into milk-producing ducts and sinuses that open onto the surface of the areola, or nipple. Fibrous connective tissue provides structural support in the form of fibrous bands or suspensory ligaments connected to both...

Pictures Of Enlarged Liver

Child Palpate Enlarged Liver

Place your left hand behind the patient, parallel to and supporting the right 11th and 12th ribs and adjacent soft tissues below. Remind the patient to relax on your hand if necessary. By pressing your left hand forward, the patient's liver may be felt more easily by your other hand. Place your right hand on the patient's right abdomen lateral to the rectus muscle, with your fingertips well below the lower border of liver dullness. Some examiners like to point their fingers up toward the...

Inspection And Palpation

Apical Impulse Normal Conditions

Careful inspection of the anterior chest may reveal the location of the apical impulse or point of maximal impluse PMI , or less commonly, the ventricular movements of a left-sided S3 or S4. Tangential light is best for making these observations. Use palpation to confirm the characteristics of the apical impulse. Palpation is also valuable for detecting thrills and the ventricular movements of an S3 or S4. Be sure to assess the right ventricle by palpating the right ventricular area at the...

The Anus Rectum and Prostate Multiple Choice

A 28-year-old bus driver presents to the emergency room for pain and drainage from an area at the bottom of her spine. This has never occurred before. On examination of the rectum, a small opening is identified in the midline superficial to the lower sacrum. There is a surrounding halo of erythema. It is tender to palpation and purulent material is expressed. Your most likely diagnosis of this condition is (D) Thrombosed external hemorrhoid 2. A 24-year-old housewife and mother presents to the...

Asthma exacerbation most likely diagnosis

Most people with acute asthma present with a constellation of symptoms consisting of cough, dyspnea, and wheezing. These typically occur simultaneously. Acute attacks are set of by some type of stimulant, and the patient has been exposed to some type of stimulant, which has produced an allergic response. An asthma exacerbation may or may not be accompanied by fever, depending on the initiating trigger. This patient is most likely having an acute asthma exacerbation, given her symptoms of...

Bilateral Visual Field Obliteration

A 26-year-old woman presents for evaluation of hair loss. She also has noticed increased weight loss and diarrhea. You diagnose Graves' disease hyperthyroidism . On physical examination of the hair, what would you expect to find 2. A 25-year-old swim instructor presents to your clinic complaining of an itchy scalp. You diagnose seborrheic dermatitis. What physical findings are most consistent with this diagnosis C Dry, flaking areas on the scalp 3. A 55-year-old construction worker presents...

Natomy And Physiol

Physical Examination

Review the anatomy of the male genitalia. Review the anatomy of the male genitalia. The shaft of the penis is formed by three columns of vascular erectile tissue the corpus spongiosum, containing the urethra, and two corpora cavernosa. The corpus spongiosum forms the bulb of the penis, ending in the cone-shaped glans with its expanded base, or corona. In uncircumsized men, the glans is covered by a loose, hoodlike fold of skin called the prepuce or foreskin where smegma, or secretions of the...

Newborn And Early Infancy

Does Angel Kiss Baby Eyelids Fade

The newborn infant's skin has a unique characteristic texture and appearance. The texture is soft and smooth because it is thinner than the skin of older children. Within the first 10 minutes after birth, a normal newborn progresses from generalized cyanosis to pinkness. In lighter-skinned infants, an erythematous flush, giving the skin the appearance of a boiled lobster, is common during the first 8 to 24 hours, then the normal pale pink coloring predominates. Cutis marmorata is prominent in...

Jugular Venous Pressure and Pulsations

Tekanan Vena Jugular

Estimating the JVP is one of the most iportant and frequently used skills of physical examination. At first it will seem ficult, but with practice and supervision you will find that the JVP provides aluable information about the patient's volume status and cardiac function. you have learned, the JVP reflects pressure in the right atrium, or central venous pressure, and is best assessed from pulsations in the right internal jugular vein. Note, however, that the...

Epitrochlear And Brachial

Epitrochlear Nodes

Assessment of the peripheral vascular system relies primarily on inspection of the arms and legs, palpation of the pulses, and a search for edema. See Chapter 3 for a method of integrating these techniques into your examination of the limbs. Additional techniques may be useful when you suspect an abnormality. Inspect both arms from the fingertips to the shoulders. Note Their size, symmetry, and any swelling The color of the skin and nail beds and the texture of the skin Lymphedema of arm and...

Steps For Palpating The Thyroid Gland

Inspect Puncta

Ask the patient to flex the neck slightly forward to relax the sternomastoid muscles. Place the fingers of both hands on the patient's neck so that your index fingers are just below the cricoid cartilage. Ask the patient to sip and swallow water as before. Feel for the thyroid isthmus rising up under your finger pads. It is often but not always palpable. Displace the trachea to the right with the fingers of the left hand with the right-hand fingers, palpate laterally for the right lobe of the...

Physical Examination Multiple Choice

An 83-year-old woman presents to the ER the afternoon of Thanksgiving complaining of severe abdominal pain. She states it was at first cramping around her navel but has now radiated to the rest of her abdomen. She also complains of some vomiting and bloody diarrhea. About 1 hour before the pain started, she had a large traditional holiday meal. She states she generally only eats about half a sandwich and some soup at meals. She denies any earlier history of similar pain. Her past medical...

Subxiphoid Cardiac Impulse

Subxiphoid Cardiac Impulse

If an impulse is palpable, assess its location, amplitude, and duration. A brief systolic tap of low or slightly increased amplitude is sometimes felt in thin or shallow-chested persons, especially when stroke volume is increased, as by anxiety. A marked increase in amplitude with little or no change in duration occurs in chronic volume overload of the right ventricle, as from an atrial septal defect. An impulse with increased amplitude and duration occurs with pressure overload of the right...

Women Anus Rectum Picture

Digital Rectal Examination Female

MEDIAN SECTION VIEW FROM THE LEFT SIDE MEDIAN SECTION VIEW FROM THE LEFT SIDE The anal canal is demarcated from the rectum superiorly by a serrated line marking the change from skin to mucous membrane. This anorectal junction, often called the pectinate or dentate line, also denotes the boundary between somatic and visceral nerve supplies. It is readily visible on proctoscopic examination, but is not palpable. Above the anorectal junction, the rectum balloons out and turns posteriorly into the...

Locations For Percussion And Auscultation

Percussing Liver Span

In a woman, to enhance percussion, gently displace the breast with your left hand while percussing with the right. The dullness of right middle lobe pneumonia typically occurs behind the right breast. Unless you displace the breast, you may miss the abnormal percussion note. Alternatively, you may ask the patient to move her breast for you. Identify and locate any area of abnormal percussion note. With your pleximeter finger above and parallel to the expected upper border of liver dullness,...

The Gastrointestinal Tract

Pain Intestine And Bladder Fistula

How is your appetite is a good starting question and may lead into other important areas such as indigestion, nausea, vomiting, and anorexia. Patients often complain of indigestion, a common complaint that refers to distress associated with eating, but patients use the term for many different symptoms. Find out just what your patient means. Possibilities include Anorexia, nausea, vomiting in many gastrointestinal disorders also in pregnancy, diabetic ketoacidosis, adrenal insufficiency,...

Beginning the Physical Examination General Survey and Vital Signs Multiple Choice

A 15-year-old high-school student presents to your office for a sports physical He is 65 inches in height and weighs 250 pounds. His BMI falls in which category 2. A 16-year-old sophomore presents to the clinic for a sports physical she is accompanied by her mother. She is involved in gymnastics and has been since age 5. In addition to training for the gymnastics team, she runs 10 miles per day. She is proud of her athleticism and states that she is still too fat and wants to lose more...

All About Torus Palatinus

Diphtheria Pharyngitis

Normal tonsils may be large without being infected, especially in children. They may protrude medially beyond the pillars and even to the midline. Here they touch the sides of the uvula and obscure the pharynx. Their color is within normal limits. The white marks are light reflections, not exudate. This red throat has a white exudate on the tonsils. This, together with fever and enlarged cervical nodes, increases the probability of roup A streptococcal infection, or infectious mononucleosis....