Course 4: Physical Exam COPY COPY 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
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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
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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
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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
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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