Duke PA Program Complete Physical Exam: PART ONE

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Yeah.
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Hello my name is vicky scott I've been a physician assistant for 22 years.
Today I'm going to be demonstrating a complete physical exam for you in your physical diagnosis course you'll be learning each of the components of the physical exam you see on this video at the end of the course you're going to be expected to demonstrate your skills for your instructor we hope that this video will provide you with an overview and introduction to the skills that you'll be learning over the next several months.
Mr. Allen.
Well my name is vicky scott i'm a physician assistant and we'll be doing a complete exam on you today good and you know if you have any questions as we go along feel free to to ask the group i'm just going to start with a set of vital signs I'm sure you've had that before so i'm going to do a blood pressure first and we're actually going to do to stay on this side.
Ok.
I'm just going to lift your arm up a little bit here.
That's good.
When 1276 and i'm just going to come over on the other side ok that's a monk.
Nice to know I'm symmetrical yes ok I'm just going to take take your pulse.
Ok i was also counting your respirations I was doing hey I'm going to kind of go from head to toe at this point so just take a look at your face and looking to see that it looks symmetric and now I just want to check your your pad your hair and I'm gonna ask you to do some face movements along with me to check the muscles in your face so can you wrinkle your forehead for me go great.
Excellent ok can you close your eyes really tight and keep them closed don't let me open them excellent very good okay you can open them and without your cheeks for me.
Okay smile ok good and can you drown.
Okay great excellent.
And I'm can you open your mouth for me open and close open and close.
Great ok I'm going to check the sensation in your face now and going to check a couple of different ways one is I'm going to touch you with a little bit of a sharp point and I want you to tell me if it feels sharp or dull.
Ok so if you close your eyes for me and you just say sharp or dull when you feel something sure ok sharp sharp sharp sure that was don't ok sure that ok and now i'm going to do the same thing just with a little little cotton wisp.
Ok so it's just gonna feel kind of like that and good you got your eyes closed and just say yes when you feel something yes yes yes yes yes yes good okay i'm going to do your ear and eye exam next ok and i just want to take a look at your ears and any any tenderness they are you know how about it.
Have it over here ok.
And i'm going to take a look in your ears.
It's my ancient otoscope that's good come around the other side.
I'm gonna check you're hearing now and i'm just going to cover up this year and can you hear this.
Tell me when you can't hear it anymore yeah okay.
Same thing on the other side can you hear this tell me when you can't hear it anymore no good okay now this is another little hearing test.
I'm going to place this on top of your head can you hear that mhm does sound about the same in both sides.
I think so yes ok now we're going to do the same thing that just behind your ear.
Can you hear that yes tell me when you can't hear it anymore No.
I can hear it now yes ok and do the same thing on the other side can you hear that tell me when you can't hear it anymore now.
Can you hear it now great ok now we're going to start with your eyes and I'm just taking a look at your brows and your your eyelids and i'm going to take a look at your the rest of your eyes here.
Ok and I want to just check your vision.
Do you normally wear glasses for reading okay so I want you to just hold us in whatever hand feels comfortable to you and hold it about that far away and can you read this line of numbers for me yes.
937 826.
Okay now I want you to cover one eye and can you read this line backwards six to six to eight seven three nine.
Okay good now cover the other I ok and read this line forward 937 826 good.
Okay i want you to just follow my finger with your eyes and keep your head still.
Very good.
Okay this time I want you to just look straight at me and i'm going to be wiggling my fingers and various places beside your head and as soon as you're able to see them on either side i want you to lift up your finger on that side ok show me that you can see it.
Ok so just look straight at me ok very good good very good okay we're just going to check your pupils now I want you to look right at my nose okay great.
And don't you just look straight ahead of me.
Great just gonna shine this light from the side.
All right i just want you to look at my finger and watch as it comes in toward you and make you cross-eyed.
Okay very good and now I'm like you to look at a point at the door over there and just focus on that and now look at my finger.
Very good and look back at the door okay great.
I'm just gonna check your tear glands there and here good all right.
Normally we would turn the lights off for this part of the exam but for purposes of demonstration we're going to leave them on.
Ok mr. Allen i would like you to just look at the distant . over there and I'm going to be shining this light in your eye just trying to hold your head still for me.
Okay very good now i'm going to do the same thing on the other side . same ..
Ok I'm going to examine your nose now and I want to check your sinuses first and just see if you have any tenderness when i press over these areas and that hurt you know how about when i press up here.
No it doesn't hurt ok and I want to just check and see if your nasal passages are open so if you just close off one nostril and breathe in.
Ok and the other side very good okay i'm going to test your sense of smell now and I've got a nice nice pleasant aroma is that I want you two to tell me what they are.
So again I want you to just close off one nostril and once you close your eyes for me too and just breathe in a little bit and tell me if you smell something and what it is like coffee.
Okay very good and now the other side.
Supposing soon.
Very good exactly right I'm just going to take a look inside your nose now.
Just tilt your head a little bit for me.
Good all right I'd like to just examine your mouth now and can you open up for me a little bit good.
Excellent can you lift up your tongue for me great.
Ok let's stick your tongue out and put it over to the side and the other side.
Good ok open up again and say ahh.
All ok sorry.
All right all right let me just check your neck now just looking at your thyroid gland and I want to check your trachea ok and I'm going to check your lymph nodes.
And check your thyroid now I want you to just hold on to that and i'm going to ask you to swallow a couple of times so why don't you just take a little water in your mouth don't swallow yet.
Ok swallow.
Great ok.
Alright that's fine.
Now we're going to just do some neck movements together okay so I want you to touch your chin to your chest.
Very good and all the way back and now back toward me and you're down to your shoulder and the other way.
Good now chin to your shoulder and the other side.
Excellent good I'm just checking the contour in the back there okay now I want you to just push against my hand push me away ok very good and the other side push me away.
Good shrug your shoulders up and just hold them up don't want to push them down.
Very good mr. Allen i'm going to take a look at your back now just under your down and let's just let that that down I'm just looking for symmetry looking at your breathing effort and take a nice deep breath in good and another one.
Very good hey i'm going to just push on your back and tell me if any of this hurts.
All feels okay yeah okay how about over here.
I don't feel so right ok just gonna pound on your back here for a second.
That hurt no it's good how about that yeah good i'm going to touch you at various points on your back and when you feel me touch you want you to say 99.
Ok just cross your arms in front for me that ok.
9999 working on very good ok now i'm going to tap on your back a little bit.
Going to check your diaphragms so what I'd like you to do is take a deep breath in and that all your air out and hold it ok so whenever you're ready it all out.
Ok you can go ahead and breathe it's gonna make a little mark on you here.
Okay now I want you to take a deep breath in and hold it ok you can breathe just going to measure that looks like it's just about five centimeters now I'm going to do the same thing on the other side.
So again I want to take a deep breath in and let it all out and hold it.
Great.
Ok you can breathe now take a ok you can breathe.
And again I'm going to measure that distance.
It's just under five centimeters okay very good.
Now i'm going to take a listen to your lungs.
So when you feel me touch you with the stethoscope everyone should just take a nice deep breath through your mouth in and out okay go ahead let me know if you get a little lightheaded.
Just one more.
Okay very good ok let's get you covered up again.
Mr. Allen I'm going to check the lymph nodes under your arms now ok so i'm i'm just going to let this down down again.
Don't mind and I want you to do is just just rest your arm on my shoulder and i'm going to reach up.
Really deep into your armpit here just try and relax your arm that's great.
Okay very good let's do the same thing on the other side just try and relax your arm okay good.
All right.
Let's put this back on and now I'm gonna have you lie down just going to get you covered up here.
Yeah we're going to lower this down again and again i'm just looking at your chest wall and once you take another deep breath for me.
And again.
Ok press on you tell me if this hurts.
That didn't hurt at all about when i press like this okay we're here here.
Ok again we're gonna I'm going to touch you in a few places and I want you to say 99 when i touch you.
Ninety-nine ninety-nine ninety-nine good and i'm going to just tap on you a little bit and take a listen.
So some nice deep breaths again your mouth open.
One more time.
Just going to shine a light now on your neck.
I'm just looking in this area your carotid pulse and Venus pulsations and try to measure these if they looked elevated and we would measure them just like that.
Going to check your carotid pulse.


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