Course 4: Physical Exam Flashcards
What is CVA tenderness?
Flank tenderness (costovertebral angle tenderness) -tenderness over the kidneys
adj. Black stool color
Melanotic
Motor strength: Very mildly weak
4/5
neurologic PE
Pale skin
Pallor
HSM
Hepatosplenomegaly
Scleral icterus
Characterized by jaundice
A frame of reference used to describe anatomy and movement
Anatomical Position
Complete Benign Exam: Neurological
Alert and Oriented, Normal speech
Make sure to document for Code Exam
“A full examination is unable to be obtained due to clinical condition”
“Eardrum blocked by earwax”
TM obscured by cerumen
Severity scale for Pitting Pedal Edema
Trace to 4+
DDx: Induration
Cellulitis
Absent sensation
Numbness
What is the difference between laceration and abrasion?
Laceration: incision in the skin that typically need sutures Abrasion: scrape of the skin
Extra Exam Findings: Examines the inner-ear
TM erythema or bulging
Benign nose exam
Normal Nares (or naris)
Contradiction: Normal Speech (2)
Aphasia (loss of ability to understand or express speech) vs. Dysarthria (slurred or slow speech that can be difficult to understand)
MAE
Moves All Extremities
Flap of skin
Avulsion
Why is Midline bony tenderness “worse” than paraspinal tenderness?
Bony tenderness (aka vertebral point tenderness) points towards a spinal fracture and therefore concern for a spinal cord injury Paraspinal tenderness points towards muscle pain or strain
Drooping of upper eyelid
Ptosis
Contradiction: Cool/hot to touch
Warm
What is the medical term for a nostril?
Naris
Sucking in of skin around bones of chest between breathing (esp. pediatric)
Retractions
What would you guess “TPP” means?
Tenderness to Palpation
Spell the medical term for “Hives”
Urticaria
Abdomen S and NT
Soft and Non-tender
Contradiction: Normal conjunctiva (2)
Pale conjunctiva, Conjunctival infection
Glasgow Coma Scale
- Used to assess level of consciousness in trauma pts
- (GCS <15)
Without trauma
Atraumatic
Tenderness in RUQ sign
Murphy’s sign
Benign Exam “No Touch”: Cardiovascular
Well perfused
Swollen and inflamed veins in anus or rectum
Hemorrhoids
Sign seen when pt asked to hold arms outwards with palms facing upwards
Pronator Drift
DMM
Dry Mucous Membranes
Decreased sensation
Hypoesthesia
Contradiction: Flat/Odd affect, Tearful, Anxious, Depressed, Hypomanic, Poor eye contact
Normal affect
Name an instrument a physician may use to closely investigate the eyes>
Slit Lamp Woods Lam Ophthalmoscope (aka fundoscopic exam)
A bruise
Ecchymosis
Cavities
Dental Caries
If a patient says their abdomen feels very painful, can you automatically document “abdominal tenderness” in the PE?
No. Subjective vs. Objective
When one eye does not move in concert with other
EOM palsy
Scale for Deep Tendon Reflexes (DTRs) (and normal)
0 to 4+ (2+ normal)
Fail test to stand with feet together and eyes closed
Positive Romberg
Blue color
Cyanotic
Drowsy
Somnolent
Contradiction: Regular Rhythm
Irregularly Irregular Rhythm
In the neurological exam what does “normal gait” mean?
Walking normally
Benign cardiovascular exam (2)
Regular Rate and Rhythm, Heart sounds nl
Like hematoma (Blood or bleeding under the skin due to trauma of any kind; typically black and blue at first, with color changes as healing progresses)
Contusion (a region of injured tissue or skin in which blood capillaries have been ruptured; a bruise.)
Extra Exam Findings: “Pounds” on the back
CVA tenderness
What is the medical term for “swollen lymph nodes”?
Lymphadenopathy
If you saw RRR written in the cardiac exam, what do you think it might mean?
Regular Rate and Rhythm
Enlarged liver
Hepatomegaly
What is bony tenderness a sign of?
Bone Deformity, Fracture or Injury
Enlarged spleen
Splenomegaly
Used to assess level of consciousness in trauma pts
GCS, Glascow Coma Exam
Document for female genital exam
“Female chaperone present”
Contradiction: Pulse/Sensory/Motor deficits
Distal CSMT intact
Complete Benign Exam: Skin
Dry, No rashes, Warm
Rectum extends outside body
Rectal Prolapse
Pulse on neck
Carotid Pulse
Sign tested by passively flexing foot backwards
- Homan’s sign—» listed in PE for DVT
Type of hernia seen in male genital exams
Inguinal Hernia
Complete Benign Exam: Constitutional
Well developed, well nourished, NAD (no acute distress)
What is scleral icterus and what does it indicate?
Yellowing of the eyes, indicates liver failure
3 Peritoneal Signs
Voluntary Guarding, Rebound Tenderness, Rigidity
Normal
Benign
Catheter left in the bladder
Indwelling Catheter
Affect
Feeling and emotion
Motor strength: slight contraction, no movement
1/5
Bleeding in the eye
Hyphema
DDx: Fluctuance
Abscess
Swollen lymph nodes
Cervical lymphadenopathy
Hives
Urticaria
What would you document “RUE strength 3/5” under the “neurological” or “Extremities” section of the exam?
Neurological
Orifice separating vagina and uterus
Cervical os
Match the following condition or disease that is associated with each physical exam finding.
- psychiatric evaluation
- meningitis
- pyelonephritis
- CHF
- Bells Palsy
- Abscess
- DVT
- CVA
Unequal pupils
Anisocoria
Yellow color
Jaundice
Tenderness
Pain felt on the release of pressure
Complete Benign Exam: Psychiatric
Normal affect
Rash of purple spots on skin
Purpura
If you documented “NAD” in the constitutional section would you be contraindicating yourself if you wrote “There is mild respiratory distress” in the pulmonary exam?
Yes
Benign Exam “No Touch”: Neck
Supple
Contradiction: Murmurs, Rubs, Gallops, Extra Systoles
Heart Sounds Normal
Swelling of face (esp. with allergic reactions)
Angioedema
Condition of Difficulty speaking
Dysarthria
Atraumatic
Without trauma
Benign Exam “No Touch”: Neurological
Alert and Oriented, Normal speech
Contradiction: Retinal detachment, Papilledema, Hyphema (2)
Clear anterior chamber, Sharp disc margins
Contradiction: Somnolent, Obtunded, Unresponsive
Alert
Contradiction: Scleral icterus
Sclera are anicteric
Not characterized by jaundice
Anicteric
OP
Oropharynx
Motor Strength: Normal strength
5/5
Written as roman numerals
Cranial Nerves
Pulse in groin area
Femoral Pulse
Condition of Not able to speak
Aphasia
Contradiction: PERRL
Anisocoria
A mother states her child has been extremely tired and drowsy recently; based on that, can you document “Lethargic” in the child’s PE?
NAH
If you document “there is no pronator drift” in the neurological exam, can you also document “No focal neurological deficits”?
No because its a contraindication
Involuntary Guarding
Rigidity
Raised area of tissue with bruising
Contusion
DDx: decreased rectal tone
Spinal Cord Injury
Match the following condition or disease that is associated with each physical exam finding.
- Asthma
- Otitis Media
- CHF
- Afib
- SBO
- Diverticulitis
- Pneumonia
- Corneal Abrasion
- cholelithiasis
Able to be comforted
Consolable
Extra Exam Findings: Examines the throat
Pharyngeal erythema or exudates
Benign Exam “No Touch”: Respiratory
No respiratory distress
RRR
Regular Rate and Rhythm
Contradiction: Sinus tenderness, Angioedema, Any signs of trauma
Atraumatic/Normocephalic (AT/NC)
“loose ligaments”
Tendon Laxity
Complete Benign Exam: ENT
Moist mucous membranes
The flow of blood through the body’s blood vessels
Perfusion
If a patient has pale conjunctiva what does that indicate?
Anemia
Benign Exam “No Touch”: Psychiatric
Normal affect
Earwax
Cerumen
Extra Exam Findings: Squeezes the calf muscles
Calf tenderness
Contradiction: Tachypnea, Accessory Muscle Use
No respiratory distress
What is fluctuance a sign of?
Abscess
What does a Guaiac positive stool sample diagnose?
GI Bleed
Motor strength: Unable to overcome resistance
3/5
Benign neck and cervical spine exam
Supple
Feeling and emotion
Affect
Hesitant to talk/respond
Pressured Speech
Less serious tenderness left and right of spine
Paraspinal Tenderness
Pulse on wrist
Radial Pulse
Benign
Normal
Anisocoria
unequal pupils
CTA
Clear to Auscultation
Anatomical Position
A frame of reference used to describe anatomy and movement
3 descriptions of hemorrhoids
Internal, External, Thrombosed
Exam Findings: Palpating the Abdomen (4)
Soft, Non-tender, Non-distended, No guarding, rebound, or rigidity
Benign Exam “No Touch”: Extremities
No edema
Blood in stool
Heme positive
Contradiction: Normal finger-to-nose, Normal heel-to-chin
Dysmetria (a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye)
“Crunching” respiratory sound
Crepitus
Increased warmth
Calor
Perfusion
The flow of blood through the body’s blood vessels
Benign Exam “No Touch”: Gastrointestinal
Non-distended
Complete Benign Exam: Eyes
PERRL, EOMI
Blood coming out of ears
Hemotympanum
“Pus leaking”
Purulent Drainage
What does AT/NC mean?
Atraumatic/Normocephalic
Contradiction: Suicidal/Homicidal, Hallucinations, Flight of idea, Paranoid
Normal judgement
GCS
Glascow Coma Exam
What phrase do you have to document in the GU exam for every female pelvic exam performed by a male physician?
Female Chaperone Present
To describe a runny nose would the doctor use the word “epistaxis” or “rhinorrhea”?
Rhinorrhea
Contradiction: Alert
Somnolent
Benign Exam “No Touch”: ENT
Moist mucosa
Scale for pulse (normal?)
0 to 4+ (2+)
Document for rectal exam
“Female/Male chaperone present”
What does DTR stand for?
Deep tendon reflex
Organ enlargement
Organomegaly
Organomegaly
Organ enlargement
Pulse on side of foot
Posterior Tibialis (PT) Pulse
Contradiction: Mild/Moderate/Severe Tenderness To Palpation (TTP)
Soft and Non-tender
Swelling behind eye
Papilledema
Normal General Pediatric Physical Exam (6)
Alert, Interactive, Playful, Smiling, Crying with tears on exam, Quickly consolable
Collection of blood in pocket of nose
Septal hematoma
EOMI
Extraocular Movements Intact
Benign Exam “No Touch”: General
Well developed, Well nourished, NAD
Purulent
Pus-like
Pulse on top of foot
Dorsalis Pedis (DP) Pulse
Complete Benign Exam: Extremities
No edema, Full ROM
Contradiction: Mild/Mod/Severe Distress
No Acute Distress
Do any patient complaints belong in the PE?
No
Contradiction: Normal Bimanual Exam (3)
Cervical motion tenderness (CMT), Uterine tenderness, Adnexal tenderness (Ovaries)
Icterus
Yellowing, also known as jaundice
If the doctor takes 1 finger and presses in a specific spot in the RLQ what is the name of the finding they are investigating?
McBurney’s point tenderness (Appendicitis)
Contradiction: Normal RAM (Rapid Alternating Movements)
Dysdiadochokinesia
Somnolent
Responsive to verbal
Used for external eye exam (2)
Wood’s lamp, Fluorescein
Detailed/descriptive speech
Tangential Speech
Contradiction: Tachycardic, Bradycardic
Regular Rate
What does PERRL stand for?
Pupils are equal round and reactive to light
NAD
No Acute Distress
In the psychiatric exam, what do SI and HI stand for?
Suicidal and Homicidal Ideations
Abdomen very full
Distended
Contradiction: Denies illness/symptoms, Non-compliant with treatment
Normal insight
Benign mouth/throat exam (2)
Moist Mucous Membranes, OP Normal
Consolable
Able to be comforted
“swooshing” in neck artery
Carotid bruit
Contradiction: Jaundice
Normal color
DDx: Homan’s sign/Palpable cords
DVT
“Loose associations”
Flight of ideas
CSMT
Circulation, Sensory, Motor, Tendon
adj. Lacking teeth
Edentulous
Neurological scale for trauma pts
Glawgow Coma Scale
Contradiction: Capillary Refill less than 2 seconds
Delayed capillary refill
Benign perfusion exam (2)
Pulses Equal and Symmetric, Capillary Refill less than 2 seconds
GCS scale
3-15
Erythema
Redness
What does NAD stand for?
No acute distress or disease
Inappropriately happy/energetic
Hypomanic
Rapid, repetitive, and involuntary movement of the eye
Nystagmus
Yellowing, also known as jaundice
Icterus
Complete Benign Exam: Respiratory
No respiratory distress, Clear to auscultation bilaterally, No wheezes, rales, or rhonchi
Instrument used for fundoycopic exam of the internal eye
Ophthalmoscope
Which of these 2 physical exam findings could a physician appreciate without auscultating the patients lungs: A. No respiratory distress B. No rales
No respiratory distress
Extra Exam Findings: Auscultates the abdomen
Hyperactive/hypoactive BS
PTA (not prior to arrival)
Peritonsillar Abscess (biggest concern for pt w/sore throat)
Name the rhythm that the physician would hear if the patient was in Afib?
Irregularly irregular rhythm
Point to the general area of your body that Cranial Nerves (CN) control?
Face
Pain felt on the release of pressure
Tenderness
Redness
Erythema
Enlargement of thyroid
Thyromegaly
White plaque on tonsils
Tonsillar Exudate
Name 2 “Peritoneal signs” in the abdominal exam?
- Guarding 2. Rebound Tenderness 3. Rigidity
Is the Glascow Coma Scale (GCS) associated with trauma patients or medical patients?
Trauma
Contradiction: well developed, well nourished (3)
Cachectic, Emaciated, Malnourished
Moveable and compressible (on skin)
Fluctuance
Contradiction: Diminished breath sounds, Wheezes, Rales, Rhonchi
Clear to auscultation bilaterally
Extra Exam Findings: Touches the wrists
Radial pulses
Document for male genital exam
“Male chaperone present”
Benign Exam “No Touch”: Skin
Dry, No rashes
What section of the neurological exam would you document “Normal Finger-Nose-Finer test” and “Normal-Heel-to-Shin”?
Cerebellar/Coordination
DDx: Bony tenderness
Fx (fracture)
Inflammation of walls of lymphatic vessels
Lymphangitis
Condition of spot hardening on skin
Induration
Jaw misalignment
Malocclusion
Normal Neurological Pediatric Physical Exam (3)
Alert, Appropriate for Age, Moves All Extremities x 4
Small red or purple spot (“tiny red rash”)
Petechiae
Contradiction: Normal External Genitalia (3)
Sores, Lesions, Rashes
Alternative name for Heme Positive
Guaiac Positive
Pus-like
Purulent
Contradiction: Irregularly Irregular
Regular Rhythm
Benign Exam “No Touch”: Eyes
PERRL
In which body system would you document “TM erythema and bulging”?
Ears
Exam Findings: Auscultating the Lungs (2)
Clear to auscultation bilaterally, No wheezes, rales, or rhonchi
If the physician checks the pulse on the right wrist and says “the pulses are fine” what would you document in the PE?
Right radial pulse is 2+
TTP
Tenderness To Palpation
Contradiction: Cachectic/Emaciated/Malnourished (2)
Well developed, Well nourished
Which of these is NOT a peritoneal sign? Guarding, Rebound, Tenderness, Rigidity
Tenderness
Mentally dulled, “out of it”
Obtunded
More serious tenderness on spine
Vertebral Point (Midline) Tenderness
DDx: calf tenderness
DVT
Motor strength: Unable to overcome gravity
2/5
Hard, thickened palpable vein
Palpable cords
Contradiction: alert (3)
Somnolent, Obtunded, Unresponsive
What abdominal exam is indicative of cholecystitis?
Murphy’s Sign
Exam Findings: Examining the Legs (2)
No edema, Distal pulses intact
- McBurney’s point tenderness
- Rovsing’s Sign
- Obturator Sign
Like abrasion seen in elderly
Skin Tear
Complete Benign Exam: Abdominal
Non-distended, Soft, Non-tender, No guarding, rebound, or rigidity
Complete Benign Exam: Cardiovascular
Well perfused, RRR, No murmurs, rubs, or gallops, Distal pulses intact
Contradiction: Normal cornea (3)
Corneal abrasion, corneal ulcerations, fluorescein uptake
Swollen inner nose
Boggy turbinates
Contradiction: EOMI
EOM entrapment
Complete Benign Exam: Neck
Supple, No lymphadenopathy
Redness in back of throat
Pharyngeal Erythema
Decreased rectal tone
Rectal laxity
BS
Bowel Sounds
Contradiction: Tangential/Pressure Speech
Normal speech
What procedure is associated with a laceration by not an abrasion?
Laceration Repair, Sutures
Obtunded
Responsive to pain
Contradiction: Sclera are anicteric
Scleral icterus
Contradiction: Dry
Diaphoretic
DDx: Soft tissue tenderness
Contusion
Motor strength: Flaccid, limp
0/5
Contradiction: Hypoesthesia, Numbness
Sensation intact
Swollen tonsils
Tonsillar Hypertrophy
Exam Findings: Auscultating the Heart (2)
RRR, No murmurs, rubs, or gallops
