Course 4.5 Flashcards
What are the 3 Peritoneal signs?
GRR..
- Voluntary guarding
- Rebound tenderness
- Rigidity (Involuntary guarding)
- —They indicate signs of a surgical abdomen
What is a normal abdomen PE ?
Soft and non-tender (S,NT)
What is an abnormal abdomen PE?
Guarding
rebound tenderness
rigidity
Mild/mod/severe tenderness to palpation (TTP)
What does TTP stand for and which PE does it belong to ?
Tenderness to palpation
Abdomen PE
What are some key details to consider during a normal abdominal PE?
Normal bowel sounds, No organomegaly, No mass
What are some key abnormal details to consider for an abdominal PE?
Absent/Hypoactive/Hyperative/Bowel Sounds
Organomegaly (Hepatomegaly, Splenomegaly) (HSM)
Distended
Murphy’s sign
McBurney point tenderness
Psoas sign, Obturator sign , rovsing sign
Define Hempatomegaly
Enlarged liver
Define splenomegaly
Enlarged splen
Define distended
bloated, swollen inside
What does a murphy’s sign indicate?
Cholelithiasis or Cholecystitis
What’s the difference between Cholelithiasis and Cholecystitis?
Cholelithiasis = Formation of gallstones Cholecystitis = inflammation of the gallbladder
What does McBurney’s point tenderness indicate?
Appendicitis
What are the 3 McBurney’s point of tenderness signs?
POR
Psoas sign
Obturator sign
Rovsing’s sign
A positive Psoas sign, Obturator’s sign and Rosing’s sign all indicate that the patient has……?
Appendicitis
What are some PE that requires a chaperone present?
Rectal, female and male genital exam
What is a normal rectal PE?
Normal rectal tone, Heme Negative
What does Heme negative mean?
No blood found in stool
What is a abnormal rectal PE ?
Blood: Heme positive
Abnormal stool color: Black/Melanotic, Red, Yellow, White, Bright red
Veins :Hemorrhoids (internal, external, thrombosed)
In or out of place: Rectal prolapse
Decreased rectal tone (spinal cord injury)
What does a decreased rectal tone indicate ?
spinal cord injury
Define Hemorrhoids
Swollen veins
What is a normal female genital PE?
Normal external genitalia Normal bimanual exam normal speculum exam cervical os is closed no blood or discharge
What is an abnormal female genial PE?
External: Sores, lesions, rashes
Internally: Cervical motion, tenderness (CMT).
Uterine tenderness, Adnexal tenderness (ovaries)
Internally: cervical os is open, blood in the vaginal vault, malodorous/thick white discharge
What does CMT stand for?
Cervical motion tenderness
What is a normal male genital PE
Normal genital exam
Circumcised/uncircumcised
What is an abnormal male genital PE?
Testicular tenderness epididymal tenderness Testicular Edema Testicular mass Urethral discharge inguinal hernia indwelling Catheter
What is a normal Musculoskeletal/Extremities PE?
Non-tender Full ROM (FROM) Distal CSMT (circulation sensory, motor, tendon) intact no edema no calf tenderness
What does CSMT stand for and which PE does it belong to?
C:Circulation S: Sensory M:Motor T:Tendon Belongs to the musculoskeletal/Extremities PE
What is an abnormal Musculoskeletal/Extremities PE?
Bony tenderness (Fracture) Soft tissue tenderness (contusion) Calf tenderness (DVT) Decreased ROM 2^o pain Pulse/sensory/motor deficits /Tendon Laxity Pitting pedal edema (trace to 4+) Palpable cord/Homan's sign (DVT)
What does Homan’s sign indicate?
DVT
What is a normal Musculoskeletal/back?
Non-tender Thoracic (T-Spine) and Lumbar spine (L-spine)
What is an abnormal Musculoskeletal/back?
Paraspinal tenderness (muscle pain) Vertebral point tenderness (spinal cord injury) Midline deformities/step-offs Costovertebral Angle (CVA) Tenderness
What is a normal integumentary/skin PE?
Warm (normal temp)
Dry, Normal color, no rash
What is an abnormal integumentary/skin PE?
Cool to touch/hot to touch Diaphoretic Jaundice (yellow) Cyanotic (Blue) Pallor Urticaria (Hives) Blood: Petechiae/Purpura
Define Cyanotic
The bluish coloration of the skin caused by lack of oxygenation of the blood
Define Urticaria
Hives
What is the medical term for hives
Urticaria
What is a normal skin PE?
No erythema, warmth or drainage
What are some indications of a skin infection?
Erythema increased warmth (calor) Induration (Cellulitis) Fluctuant (abscess) Purulent drainage (pus-like) Lymphangitis (Spreading infection)
What is the medical term for increased warmth?
Calor
The presence of induration indicates ?
cellulitis
The presence of fluctuant indicates?
abscess
What is the medical term for spreading infection ?
Lymphangitis
What a skin without trauma looks like?
Atraumatic, intact
What does a skin with trauma looks like?
Ecchymosis contusion abrasion laceration skin tear avulsion
State the difference between contusion, abrasion and laceration ?
Contusion is a bruise
Abrasion is a scrape to the skin
laceration is the deep cut/tear to the skin (often requires stitches
Define avulsion
pulling of the skin that results in its complete removal
define ecchymosis
discoloration of the skin caused by a bruise
What are normal findings for neurological PE?
Alert,
Oriented x 4
normal speech
nonfocal neuro exam
What are abnormal findings for neurological PE?
Somnolent Disoriented to person, place, time or situation Aphasis Dysarthria any abnormal findings
Define dysarthria
inability to speak due to motor malfunctions or neural weakness
Define aphasis
loss of ability to understand or express speech, caused by brain damage
What are common findings for someone who has abnormal levels of consciousness?
Somnolent Obtunded Responsive to voice responsive to painful stimuli unresponsive to both pain and voice does not follow commands confused
What are normal findings for motor and sensation ?
motor strength 5/5 and symmetric, sensation intact
What are abnormal findings for motor and sensation?
extremity weakness
pronator drift
Hypoesthesia
Numbness (absent of sensation)
What is the medical term for decrease sensation ?
Hypoesthesia
What are some ways physicians can test motor strength?
- pronator drift
- upper extremity strength “grip stength”
- lower extremity strength
What is the normal value for reflex?
2+ = normal
What are abnormal findings for cranial nerve exam?
-visual field loss
-anisocoria
-EOM palsy, rightward/leftward gaze
Tongue deviation
decreased gag reflex
facial droop, ptosis
Hypoesthesia
unequal shoulder shrug
Define ptosis
Drooping or falling of upper eyelid
What is an abnormal cerebellar exam?
ataxia, antalgic (walking to avoid pain) Nystagmus Dysmetria Positive Romberg Dysdiadochokinesia (DDK) tremor
Define dysmetria
inability to perform coordinated arm related task
What does a positive romberg indicate?
the person cannot maintain their balance while their eyes are closed
Define Dysdiadochokinesia
The inability to conduct rapid alternative movements
What is a normal cerebellar exam?
normal gait no nystagmus normal finger to nose, normal heel to shin negative romberg's normal RAM (rapid alternating movements) No tremor
What does normal RAM stand for
rapid alternative movements
