CLET Visceral

  1. Palpation of hair texture
    • Palpate hairline behind ears & crown of head. Should be smooth, symmetrically distributed, & have no split or cracked ends.
    • Fine silky hair is associated w/ hyperthyroidism
  2. Palpating pt swallowing
    • Thyroid cartilage movement should be smooth, painless, symmetrical, & midline
    • Should be smooth & rhythmic. There should be no need to swallow twice
    • Difficulty in swallowing may be an enlarged thyroid gland or space occupying lesion in the anterior spine
  3. Palpate thyroid gland
    Noting nodules, tenderness, size, shape, configuration, consistency, & tenderness
  4. Tracheal tug
    Use the thumb & second finger to palpate each side of the trachea just below the thyroid isthmus. If a downward tug sensation is felt w/ a synchronous pulse, this is evidence of an aortic aneurysm
  5. Palpate lymph nodes
    • Size, consistency, mobility, condition
    • Occipital nodes @ base of skull
    • Postauricular nodes located superficially over the mastoid process
    • Preauricular nodes in front of the ear
    • Tonsillar nodes @ angle of mandible
    • Submandibular nodes halfway b/w angle & tip of mandible
    • Submental nodes in midline behind tip of mandible
    • Facial nodes across zygomatic arch
    • Anterior & posterior cervical chain @ A & P border of SCM
    • Supraclavicular nodes just above the clavicle
  6. Head & Neck auscultation
    • Temporal arteries for bruits (bell)
    • Over the eyes (bell) (say don't do)
    • Thyroid gland for bruits (bell) ask pt to take a breath & hold. If hypermetabolic state is present there will be an increase blood supply in the area.
  7. Palpating arterial pulses
    • For rate, rhythm, amplitude, & contour
    • Carotid
    • Subclavian
    • Brachial
    • Radial
    • Ulnar
    • Abdominal aorta (1" S & 1" to the L of the umbilicus
    • Femoral
    • Popliteal
    • Dorsalis pedis
    • Posterior Tibialis
  8. Vascular auscultation for bruits
    • Bell
    • Temporal
    • Carotid
    • Subclavian
    • Abdominal aorta
    • Femoral
  9. Auscultation for venous hum
    • Bell
    • Ask pt to take breath & hold
    • Epigastrum
    • Base of neck
  10. Respiratory excursion
    • Take tissue pull till thumbs almost touch SP at T8-T10 level.
    • Ask pt to take deep breath in & out through mouth
    • Repeat 3 times
    • Watch for symmetry. Lag indicates underlying lung pathology on that side
  11. Tactile fremitus
    • Use ball of hand & have pt say blue moon
    • Check for symmetry of vibrations
    • Apices of lungs
    • Interscapular areas (arms crossed)
    • Triangle of auscultation (arms elevated)
    • Medial base of lungs (ulnar side of hand)
    • Lateral base of lung (ulnar side of hand)
    • Decreased / absent = air in the lungs (emphysema, pleural thickening or effusion, massive pulmonary edema, bronchial obstruction)
    • Increased fremitus = fluid or solid mass within lungs (lung consolidation, heavy but non-obstructive bronchial secretions, compressed lung or tumor)
  12. Posterior chest percussion
    • Apices of lungs
    • Interscapular areas (arms crossed)
    • Triangle of auscultation (arms raised)
    • Medial base of lungs
    • Lateral base of lungs
  13. Diaphragmatic excursion
    • Ask pt to breathe deeply & hold
    • Percuss along scapular line until change in note from resonance to dullness is heard (lower border of diaphragm)
    • Mark & repeat on other side
    • Ask pt to take several breaths then exhale as much as possible
    • Percuss up from marked pt & make a mark at change from dullness to resonance
    • Normally 3 to 5 cm
    • Excursion limited by several types of lesions (pulmonary emphysema, abdominal - massive ascites, superficial painful - fractured rib)
    • Diaphragm innervated by C3, C4, C5, & phrenic nerve
  14. Chest & lung auscultation
    • Posterior: apices of lungs, interscapular area, triangle of ausculation, medial base of lung, lateral axillary area
    • Anterior: Above clavicle, above breasts, medial & lateral below breasts
    • Pt should breathe through mouth
    • Listen for pitch, intensity, duration
  15. Normal breath sounds
    • Vesicular: heard over most of lung fields, low pitch, short expirations, listen for abnormal audible breath sounds
    • Bronchovesicular: Heard over main bronchus area& over right upper right posterior lung field, medium pitch, expiration equals inspiration
    • Bronchial: heard only over trachea, high pitch, loud & long expirations
  16. Adventitious breath sounds
    • Crackles
    • Wheezes
    • Rubs
  17. Vocal Resonance
    • Diaphragm
    • Listening anywhere, ask pt to say blue moon
Card Set
CLET Visceral
CLET lab