Case 24: Better Exam

 

Sorry, something non-mysterious again this month.  If you want a mystery though, case 25 is up, but you’ll have to wait till December for the answer.

We all learned how to do a physical exam in med school, PA school, nursing school, etc., but most of us have learned our own little “tricks” along the way that increase the speed, sensitivity or palatability of our exams.  Here are some of my favorites.  Please submit your own in the comment section below.

Spine Palpation: Most people use their fingertips.  Instead…

Lung Auscultation: Save the $300 for an electric stethoscope.  It’s much more useful to … 

Cardiac Auscultation: Ask your patient to stick out their tongue.  This does two things… 

Knee Effuision: To sensitively check for a knee effusion have the patient …

DON’T FORGET TO SUBMIT YOUR OWN EXAM TRICKS IN THE COMMENTS SECTION BELOW.

Scroll down for case answer

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ANSWERS

Spine Palpation: Most people use their fingertips.  Do this bluntly with the ulnar side of your fist and you should have improvements in both sensitivity and specificity for detecting fractures.

Lung Auscultation: Save the $300 for an electric stethoscope.  It’s much more useful to tell your patient “breath like this” and then demonstrate what you want. 

Cardiac Auscultation: Ask your patient to stick out their tongue.  This does two things.  First, they stop talking and breath slower, which minimizes the extraneous noise.  Second, by looking at their tongue you can simultaneously check  hydration status

Knee Effuision: To sensitively check for a knee effusion have the patient maximally flex their knee and palpate for fluid anteriorly, comparing to the other knee for reference.

DON’T FORGET TO SUBMIT YOUR OWN EXAM TRICKS IN THE COMMENTS SECTION BELOW.

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