Course 4: Physical Exam Flashcards by Mary Parianos

Benign Exam: Constitutional

Well developed, well nourished. No acute distress.

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Benign Exam: Eyes

PERRL, EOMI

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Benign Exam: ENT

Moist mucous membranes.

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Benign Exam: Neck

Supple, no lymphadenopathy.

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Benign Exam: Cardiovascular

Regular rate and rhythm. No murmurs, rubs, or gallops. Distal pulses intact.

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Benign Exam: Respiratory

No respiratory distress. Clear to auscultation bilaterally. No wheezes, rales, or rhonchi.

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Benign Exam: Abdominal

Soft. Non-tender. No guarding, rebound, or rigidity.

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Benign Exam: Extremities

No edema. Full ROM.

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Benign Exam: Skin

Warm, dry.

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Benign Exam: Neurological

Alert and oriented. Normal speech.

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Benign Exam: Psychiatric

Normal affect.

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If the physician examines the throat, they are looking for… (2)

pharyngeal erythema or exudates

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If the physician examines the inner-ear, they are looking for… (2)

TM erythema or bulging

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If the physician auscultates the abdomen, they are looking for…

hyperactive/hypoactive bowel sounds

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If the physician touches the wrist, they are looking for…

radial pulses

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If the physician squeezes the calf muscles, they are looking for…

calf tenderness

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If the physician pounds on the back, they are looking for… (2)

CVA tenderness

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General/Const. Normal Findings: (3)
NAD
Well developed, well nourished
Alert

Mild/Mod/Severe Distress
Cachectic/Emaciated/Malnourished
Somnolent (drowsy, respond to name), Obtunded (out of it, respond to pain), Unresponsive (neither)

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Head Normal Findings:

Atraumatic/Normocephalic (3)

Any signs of trauma
Sinus tenderness
Angioedema (swelling)

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Eyes Normal Findings:
Pupils are Equal, Round, Reactive to Light (PERRL)
Extra Ocular Movements Intact (EOMI)
Sclera are anicteric  (white)
Normal conjunctiva

Anisocoria (unequal pupils)
EOM entrapment
Scleral icterus (yellow)
Pale conjunctiva (anemia) or conjunctival infection

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Ears Normal Findings:
Normal TM (4)

TM erythema
TM bulging
TM dullness
TM obscured by cerumen (earwax)

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Nose Normal Findings:
Normal nares (4)

epistaxis
rhinorrhea
septal hematoma (raised area)
boggy turbinates (swollen inner nose)

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Mouth /Throat Normal Findings:
Moist mucous membranes
Oropharynx (back of throat) normal (7)

Dry mucous membranes (DMM)
Dental caries
edentulous (missing teeth)
pharyngeal erythema
tonsillar exudate (plaque on tonsil)
tonsillar hypertrophy (swollen)
peritonsillar abscess (PTA) (pus pocket)

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Neck/Cervical Spine Normal Findings:

Supple (5)

JVD
Carotid bruit
Cervical lymphadenopathy (swollen lymph nodes)
Vertebral point (midline) v paraspinal tenderness
thyromegaly (thyroid enlargement)

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Cardiovascular Normal Findings: | Regular rate and rhythm. Heart sounds normal. (6)

``` Tachycardia/Bradycardia Irregularly irregular rhythm murmur pleural rub gallop extrasystole (extra beat) ```

Perfusion Normal Findings: | Pulses are equal and symmetric. Capillary refill less than 2 seconds.

at risk for rupture

Pulmonary Normal Findings: | No resp distress. Clear to auscultation bilaterally. (7)

``` Mild/Mod/Severe Distress Tachypnea Accessory muscle use Diminished breath sounds Wheezes Rales Rhonchi ```

Abdominal Normal Findings: | Soft and non-tender. (4)

mild/mod/severe tenderness to palpitation (TTP) voluntary guarding rebound tenderness (feel pain when let go of area) rigidity (involuntary guarding)

Detailed Abd Normal Findings: | Normal bowel sounds. No organomegaly. No mass. (6)

``` absent/hypoactive/hyperactive bowel sounds organomegaly distended murphy's sign mcburney's point tenderness psoa's sign, obturators, rovsing's ```

Rectal Normal Findings: | normal rectal tone. heme neg. (5)

``` heme pos. abnormal stool color hemorrhoids rectal prolapse decreased rectal tone ```

``` Female Genital Normal Findings: Normal external genitalia Normal bimanual exam (3) Normal speculum exam Cervical os is closed No blood or discharge ```

``` sores, lesions, rashes cervical motion tenderness (CMT) uterine tenderness adnexal tenderness (ovaries) cervical os open blood in vaginal vault malodorous/thick white discharge ```

Male Genital Normal Findings: | circumcised/uncircumcised

``` testicular tenderness testicular edema epididymal tenderness testicular mass urethral discharge inguinal hernia indwelling catheter ```

``` Musc./Extremities Normal Findings: non-tender (3) full ROM distal CSMT intact (2) no edema no calf tenderness ```

``` bony tenderness (fracture) soft tissue tenderness (contusion) calf tenderness (DVT) decreased ROM pulse/sensory/motor deficits tendon laxity pitting pedal edema palpable cords/homan's sign ```

Musc. /Back Normal Findings: | non-tender thoracic and lumbar spine

CVA tenderness paraspinal tenderness vertebral point tenderness midline deformities/step offs

``` Skin Normal Findings: Warm (2) dry normal color (3) no rashes (2) ```

``` cool to touch hot to touch diaphoretic jaundice (yellow) cyanotic (blue) pallor urticaria (hives) petechiae/ purpura ```

Skin Infection Normal Findings: | no erythema, warmth or drainage (6)

``` erythema increased warmth induration (firmness) fluctuance purulent drainage lymphangitis (spreading infection) ```

Skin Trauma Normal Findings: | atraumatic, intact

``` ecchymosis contusion (bruise w swelling) abrasion laceration skin tear avulsion (flap of skin) ```

``` Neuro Normal Findings: alert oriented x4 normal speech (2) non-focal neuro exam ```

``` somnolent disoriented to (x4) aphasia dysarthria (slurred speech) any abnormal findings ```

Neuro LOC Normal Findings: | A&O x4

Somnolent obtunded unresponsive

Neuro Motor and Sensation motor strength 5/5 and symmetric (2) sensation intact (2)

extremity weakness pronator drift hypoesthesia (dec sensation) numbness (absent sensation)

Neuro Reflexes Normal Findings: 2+ deep tendon reflexes Babinksi downgoing toes

upgoing toes

Pediatric Normal PE: General

non-toxic, alert, interactive, playful, smiling, crying with tears on exam, quickly consolable

Pediatric Normal PE: Head

flat fontanel (

Pediatric Normal PE: Eyes

PERRL. No scleral icterus.

Pediatric Normal PE: Ears

Nml TMs

Pediatric Normal PE: Throat

Moist mucous membranes

Pediatric Normal PE: Neck

Supple. No meningismus

Pediatric Normal PE: Cardiac

Regular rate and rhythm

Pediatric Normal PE: Respiratory

No distress. Clear and equal

Pediatric Normal PE: Abdominal

Soft, no crying or grimacing with palpation

Pediatric Normal PE: Genital

Nml external, testicles descended

Pediatric Normal PE: Extremities

FROM

Pediatric Normal PE: Skin

Warm, dry, no rash

Pediatric Normal PE: Neuro

Alert. Appropriate for age. Moves all 4 extremities (MAE x4)

Pediatric Abnormal PE: General

lethargic, inconsolable, febrile

Pediatric Abnormal PE: Head

Sunken fontanel, bulging fontanel

Pediatric Abnormal PE: Eyes

scleral icterus

Pediatric Abnormal PE: Ears

TM erythema, bulging

Pediatric Abnormal PE: Throat

pharyngeal erythema

Pediatric Abnormal PE: Neck

lymphadenopathy

Pediatric Abnormal PE: Cardiac

Murmur, tachycardia

Pediatric Abnormal PE: Respiratory

Wheezes, stridor, retractions, nasal flaring

Pediatric Abnormal PE: Abdominal

Crying with abd pain

Pediatric Abnormal PE: Genital

erythema

Pediatric Abnormal PE: Extremities

Ecchymoses in various stages of healing

Pediatric Abnormal PE: Skin

rash (diaper rash, eczema)

Pediatric Abnormal PE: Neuro

post-ictal, somnolent

``` Neuro Cranial Nerves Normal Findings: visual field intact PERRL EOMI tongue midline normal gag reflex facial symmetry facial sensation intact normal shoulder shrug ```

``` visual field loss unequal pupils EOM palsy, rightward/leftward gaze tongue deviation decreased gag reflex facial droop, ptosis hypoesthesia, numbness unequal shoulder shrug ```

``` Neuro Cerebellar Exam Normal Findings: Normal gait no nystagmus normal finger to nose normal heel to shin negative Bromberg's normal RAM (rapid alt movements ) no tremor ```

ataxia (off balance), antalgic (painful walking) nystagmus (shaking eyes) dysmetria positive romberg (stand with feet together) dysdiadochokinesia tremor