CLET Visceral

• 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

• 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

Noting nodules, tenderness, size, shape, configuration, consistency, & tenderness

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

• 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

• 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.

• 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

• Bell
• Temporal
• Carotid
• Subclavian
• Abdominal aorta
• Femoral

• Bell
• Ask pt to take breath & hold
• Epigastrum
• Base of neck

• 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

• 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)

• Apices of lungs
• Interscapular areas (arms crossed)
• Triangle of auscultation (arms raised)
• Medial base of lungs
• Lateral base of lungs

• 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

• 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

• 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

• Crackles
• Wheezes
• Rubs

• Diaphragm
• Listening anywhere, ask pt to say blue moon