Basic points when conducting my first examination

I am lucky enough to be conducting my 1st medical next week, can anybody help me with basic points on listening to the heart, where should i start, bell or diaphram etc.

Am very keen to learn from some of you experts out there as I want to make the exam as authentic as possible

Should listen to the heart in various positions. start by listening to the heart in the sitting position, then have your patient lean forward, then have your patient lie down and finally with your patient lying down have him / her roll on their left side. use both the diaphragm and bell of the stethoscope in each position.

First get a used book on physical diagnosis on amazon. That's where I found a book on how to do physicals. Inspection, palpation, auscultation is three step program. Know the heart anatomy too. Most of heart is on the left. There isn't too much to see on the chest exam, although one might feel the heart beat near left nipple. Percussion: Practice by putting fingers on right chest and thumping with fingertips of the other hand. U hear a hollow sound, over the lung filled with air. Now try on the left chest, above the nipple line. U hear a different, dull sound. That's not air, but the heart. Now start at the level of the nipple, left side, at the edge of the chest, thumping. Move a little closer to mid-line until the sound changes. That's how big the heart is. On the right chest it's just to the right of the sternum. Bell hears low pitch, and diaphragm hears high pitch. Since ur not a real doctor, and don't know what ur listening for it doesn't matter. To look cool, use one, then the other. Correct sequence is to listen high and to the right, about level of 3rd rib, then to the left, then down the 6th rib on the left side, and then out to the area of the nipple (in a man) or that level in a woman. Other areas to listen: in the neck, front, 2 1/2 inches either side of midline: carotid arteries. Swishing or pffft sound is bad news. Same over the groin where one can feel the artery. Listen over the abdomen for bowel sounds.

Thanks for those replies, any advise when I ausculate her lungs, I have seen on videos that docs ask patients to say 99, Why is that?

Doctorsteth. There is a huge amount of information available on the internet all you need do is search, please take a look a the link below. "Say 99" is a check for vocal fremitus. I wish you good luck with your forthcoming examination.

http://www.osceskills.com/e-learning/subjects/respiratory-examination/

Thanks for that Rockdoc! That makes it a lot clearer! There was also a section on the location of heart valves and where to listen, So hopefully I will be as realistic as possible!

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I am lucky enough to be conducting my 1st medical next week, can anybody help me with basic points on listening to the heart, where should i start, bell or diaphram etc. Am very keen to learn from some of you experts out there as I want to make the exam as authentic as possible

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bratwurst and Rockdoc make very good points about researching with a book or on the internet - but you've only got 7 days!

I'll be very frank and say that my early forays into being a playdoc, dating from 25 years ago, had many areas where I bluffed my way through. No one was endangered by my bluffing because I only made 'appropriate' comments, that 'everything seemed to be fine there'. I've learned since then and now I know what and where to check but it's not something that can be explained here.

Unless your 'patient' is more knowledgeable than you, you aren't going to reveal your inexperience. But that doesn't mean you should stop at being inexperienced and you should use the time between the examination you conduct next week, and the next one etc; to arm yourself with more knowledge.

It's assumed you have a stethoscope and what better than researching on yourself, using charts etc from the internet and books, to listen to your own heartbeat, respiration etc. Then you can be more authoritative as you gain knowledge. This can be extended over time to other areas of the body. I've always believed in carrying out procedures on myself, especially more advanced and probably invasive procedures, before working or at least being authoratitive on others. About the only thing I've never used on myself is the vaginal speculum, lol!

The main thing is to go slowly and carefully. The purpose of a play examination is pleasure and if you and your patient get safe pleasure from it then that's all that's required. When you become more knowledgeable you might actually identify problems. Don't ever attempt to diagnose them - just advise the patient sees a real doc!

Have a nice time!

Thanks for that everyone, will hopefully post details of my 1st examination next weeend

There are too many things that can be diagnosed by hearing; cardiologists go to school too many years to learn that. Some things are easy. If the rhythm, the heart beat, is normal, you should comment on that. Sometimes the heartbeat/pulse is NOT regular. In that case see a real doc. Even if you don't know a murmur from a thrill tell your patient you 'can't hear any murmurs' 'The valves are normal' or you could listen to the right sternum, high, and tell the patient 'the aortic valve sounds okay' move to the left, high and say the pulmonary valve is ok, lower down left, next to sternum : 'the tricuspid valve is ok and out near nipple 'the mitral valve is ok"

Such a lot to remember for my 1st medical,think I will concentrate on her heart this time and like you say take some time listening to my own over this weekend. Thanks everyone

BTW... there are apps for that. For example this one: http://www.imedicalapps.com/2011/09/cardiac-murmurs-medical-app-hipposoft-heart-murmur-pro/

Continuing this topic have done a little homework on the ausculating, hopefully I will pass with a tiny bit of knowledge and be able to give her a realistic experience. My next question is breast exam, which will follow the steth! Can anybody give some basic advise, have watched a couple of videos but obviously if anyone can add from experience I would really appreciate your comments

Just one tip doctorsteth.

Your hands and the patients skin will be moist - not sure which will be most moist, lol.

Take along a talc dispenser and shake a litle onto your enquiring fingers. This will help your hands slide over the breasts easily and gently.

Have a good day!

Thanks for that BIGK! as a matter of interest I would like to post details of how the examination goes (good or bad) would it be the correct place here or should i go to a different section??

Think we'd like to see your report here doctor steth

Big K if you are waiting for my report i am afraid you will be waiting a little while longer, I have gone down with a stinking cold... oh well just means I have to wait a few more weeks

Appointment rebooked for Thursday.. report to follow

I had my first play medical last week and wanted to describe my experience. I met the Doctor in a hotel room with a huge circular bed and a floor to ceiling mirror. He asked me to sit on the edge of the bed as he asked me some medical questions and checked my neck glands. The feel of his hands made my clit tingle....and seeing the steth round his neck ready to use was such a massive turn on! I was told he needed to listen to my heart and proceeded to slide the cold steth inside my blouse. He then asked me to open my blouse so he could have a thorough listen. I had a long steth session in all positions, sitting, standing and lying down. It was bliss.The Doctor then asked me to remove my bra. Each breast was thoroughly examined and the nipples rubbed and manipulated....mmmmm! I was then asked to lie down and unbutton my skirt. The doctor seemed to like my stockings and suspenders! It was so erotic seeing his eyes looking at my now wet black silky knickers. I was asked to remove them, pull my legs up and let my knees fall apart. The doctor could now see my wet creamy labia. He put his latex gloves on, dripped lube on my pussy and pushed his fingers inside. He had a really good feel. I was then asked to get on all fours for a rectal exam. Lube was added and i felt his middle finger enter my anus. It took all my self control not to climax! I shall be looking forward to my next medical!!

Very jealous Nurse Bosmere as I was meant to have my first exam on Friday but I have an awful cold so it has been postponed. Glad you had a great time.

Thank you for sharing your play medical experience Nurse Bosmere. It would appear the examination was just what you wanted.

Thank you! It was a fantastic and just as i hoped it would be. Lots of stething....perfect!

Basic points are

1) keep the Patient Happy

2) keep the Patient Warm

3) have a good time

4) go slowly and carefully

5) tell the patient what you intend to do as yo go through the Exam

6) post exam chat with coffee