Exam 1 Flashcards
Health history
Is 90% of diagnosis ability
Should just confirm what you already know
See the world of the patient as that patient sees itE
Effective communication
Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, confirmation, confidentiality
Outline of the patient history
Chief complaint History of present illness Past medical history Family history Personal and social history Review of systems How much of each component helps determine the billing code Try to find 3 chief complaints
7 dimensions of chief complaint
LOCATES Location Other associated symptoms Character (quality) Alleviating or Aggravating factors Timing Environment/Setting Severity
Past medical history
Medical illnesses Immunizations Surgery Hospitalizations Injuries Allergies Current medications Past transfusions Recent screening tests Emotional status
Important immunizations to note in adults
Influenza, varicella, pneumonia, last tdap, meningococcal
Important allergies to note
Food, medications, latex, environment
Recent screening tests to note
Gynecological exam, eye exam, dental exam, pap, colonoscopy, DRE, PSA, A1C, FBS
Assessing family history
Assess 3 generations–children, siblings, parents or siblings, parents, grandparents
Identify family member, living status, age
Social History
Personal status Habits: smoking, alcohol, drugs, exercise Sexual history, preference, STIs Home conditions and safety Environmental hazards/occupation Military Religion Access to care
General constitutional symptoms
Weight loss/gain
Frequent/recurrent illness
Appetite
Fever, chills, malaise, fatigue, night sweats, sleep patterns
Skin, hair and nail history
Rash, moles, acne, texture or pigmentation change, sweating, abnormal nail or hair growth or loss, dryness, itching
Head and neck history
Head injuries, loss of consciousness, lymph nodes enlarged, neck pain or injury, snoring
Eyes history
Blurring, diplopia, phototobia, pain, discharge, infections, vision changes, glaucoma, eye medications, trauma, glasses
Ear history
hearing loss, pain, discharge, tinnitus, frequent ear infections
Nose history
Sense of smell, colds, obstruction, epistaxis, postnasal discharge, sinus pain
Throat/mouth history
Hoarseness/change in voice, sore throat, bleeding gums, tooth pain, soreness or ulcers, taste changes, history of tonsillectomy
CV history
Chest pain, palpitations, edema, varicosities, syncope, history of MI or Htn, exercise intolerance
Respiratory history
Pain, asthma, dyspnea, infections, cyanosis, wheezing, cough, sputum, hemoptysis, TB exposure, last chest x ray, orthopnea
GI history
Appetite, digestion, food intolerance, dysphagia, heartburn, N/V, hematemesis, incontinence, bowels, constipation, diarrhea, change in stool, hemorrhoids, jaundice, pain or cramping
GU history
Dysuria, pain, urgency, frequency, nocturia, hematuria, polyuria, hesistancy, dribbling, force of stream, passage of stone, edema, hernias
Musculoskeletal history
Joint stiffness, restriction of motion, swelling or redness, bony deformity, history of fractures, weakness, injuries
Neurologic history
Seizures, weakness, tremors, loss of memory, abnormalities of sensation or coordination, vertigo, headache, tingling or numbness, spine injury
Psych history
Depression, mood changes, difficulty concentrating, nervousness, tension, suicidal thoughts, sleep disturbances, anxiety
Endocrine history
Thyroid enlargement, heat/cold intolerance, weight change, polyphasia, polydipsia, polyuria, changes in facial or body hair, increased hat or glove size, skin striae
CAGE questionnaire for alcohol
Cutting down?
Annoyance by criticism?
Guilty feeling?
Eye-openers?–drinking in the morning
Domestic Violence: HITS
In the last year, how often did your partner: Hurt you physically? Insult or talk down to you? Threaten you with physical harm? Scream or curse at you?
Spirituality: FICA
Faith
Importance and Influence
Community
Address/action of care
Concluding history questions
Is there anything else you think I should know?
What problem concerns you the most?
What do you think is wrong?
What worries you the most?
Adolescents: PACES
Parents/Peers Accidents/Alcohol/Drugs Cigarettes Emotional Issues School/Sexuality
General Appearance description
Apparent state of health, level of consciousness, signs of distress, skin color and obvious lesions, dress/grooming/personal hygiene, facial expressions, odors, posture/gait/motor activity
Height, weight, BMI
Rapid weight change over few days suggest
Changes in fluid, not fat tissue
Order of examination techniques
Inspection, palpation, percussion, auscultation
EXCEPT ABDOMEN: Inspection, auscultation, percussion, palpation
Tympany percussion
Loud, high, drumlike
Gastric bubble
Hyperresonance percussion
Very loud, low, booming
Emphysematous lungs
Resonance percussion
loud, low, hollow
Healthy lung tissue
Dullness percussion
Soft, moderate, thudlike
Over liver
Flatness percussion
Soft, high, dull
Over muscle
Order of percussion
From resonance to dullness
Amsler grid
Used to test for macular degeneration
Grid of perpendicular straight lines with central black dot as fixation point
Transilluminator
Light source used to distinguish whether a body cavity contains fluid, air or tissue
Goniometer
Determines degree of joint flexion and extension
Objective skin data
Color, temperature, moisture, texture, thickness, edema, mobility and turgor, vascularity and ecchymosis, lesions
Function of skin
Protection, prevents penetration, perception, temperature regulation, identification, communication, wound repair, absorption and excretion, production of vitamin D
Palpate skin surface for
Moisture, temperature, texture, turgor, mobility
Inspect hair for
Color, distribution, quantity
Inspect nails for
Pigmentation of nails and beds, length, symmetry, ridging/beading/pitting/peeling, redness, swelling, pain, exudate, warts/cysts/tumors
Fluid filled lesions with transillumination
Will transilluminate with a red glow; solid lesions will not
Where do dysplastic moles usually occur
Upper back in men and legs in women
Characteristics of skin lesions
size, shape, color, texture, elevation or depression, attachment at base, exudates, configuration (annular, grouped, linear, arciform), location and distribution
Helpful hints for assessing skin lesions
Are there associated symptoms such as pruritus?
What is the chronology of the appearance of these lesions?
Are they changing in morphology? Are they disappearing?
Associated variables of skin
Environmental exposures, injuries, infection, use of medications, diet, clothing, emotional factors, personal care items
Screening for melanoma
Asymmetry, border irregularity, color variations, diameter >6mm, evolving
Macule Patch Papule Plaque Vesicle Bulla
Macule: flat <1cm Patch: flat >1cm Papule: raised, <1cm, not fluid filled Plaque: raised, >1cm, not fluid filled Vesicle: raised, <1cm, fluid filled Bulla: raised, >1cm, fluid filled
Spider angioma
Normal and common on face and chest
Also seen in pregnancy and liver disease
Spider veins
most often in legs
Often accompanies increased pressure in superficial veins as in varicose veins
Cherry angioma
Normal; increase in size and number with aging
Ecchymosis
Blood outside the vessels
Secondary to bruising or trauma
Can be seen in bleeding disorders
Male pattern baldness
Frontal hairline regression and thinning of the posterior vertex
Alopecia Areata
Sudden onset of clearly demarcated, usually localized, round or oval patches of hair loss leaving smooth skin without hairs. No visible scaling or erythema
Tinea capitis
Round, scaling patches of alopecia
Paronychia
Superficial infection of the proximal and lateral nail folds adjacent to the nail plate
Often red, swollen and tender
usually due to staph aureus or strep
Clubbing of the fingers
Bulbous swelling of soft tissue at the nail base, with loss of normal angle between the nail and the proximal nail fold
Mechanism involves vasodilation with increased blood flow to the distal portion of the digits possibly due to hypoxia, changes in innervation, platelet derived growth factor
Seen in congenital heart disease, interstitial lung disease, lung cancer, IBS, malignancies
Stage 1 pressure ulcer
Reddened area that fails to blanch with pressure
Stage 2 pressure ulcer
Skin forms a blister or sore
Partial thickness skin loss of ulceration involving the epidermis, dermis, or both
Stage 3 pressure ulcer
Crater appears in the skin with full thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to muscle
Stage 4 pressure ulcer
Full thickness skin loss with destruction, tissue necrosis or damage to underlying muscle, bone and sometimes tendons and joints
Past medical history for head/neck
Head trauma, radiation treatment, headaches (type), surgery for tumor or goiter, seizures, thyroid
Family history for head/neck
Headaches and thyroid function
Personal/social history for head/neck
Employment, stress, injury risks, nutrition, use of alcohol or drugs, sports played, new activities, weight training
Headache characteristics
Onset, duration, location, character, severity, visual prodrome, pattern, change in LOC, associated symptoms, precipitating factors, treatment, medications
Thyroid questions
Change in temperature preference, swelling of neck, change in texture of hair or skin or nails, change in emotional stability, exopthalmos, tachycardia or palpitations, change in menstrual flow, change in bowel habits, medications
Nodding movement of head may indicate
Aortic insufficiency
Assessment of bruits
Use bell of stethoscope
Could indicate cerebral aneurysm or temporal arteritis
Tracheal tugging suggest
Presence of aortic aneurysm
Auscultation of thyroid
In a hypermetabolic state, the blood supply is increased and a vascular bruit may be heard
Warning signs of headaches
Increasingly frequent over .3 months, sudden onset like thunderclap, new onset after age 50, aggravated or relieved by change in position, precipitated by vasalva maneuver, fever and night sweats and weight loss, presence of cancer or HIV or pregnancy, recent head trauma, change in pattern from past headaches, lack of a similar headache in the pass, associated with papilledema or neck stiffness or focal neurologic deficits
3 most important attributes of a headache
Severity, chronologic pattern, associated patterns
Red painless eye indicates
Subconjunctival hemorrhage
Red eye with gritty sensation indicates
Viral conjunctivitis
Red painful eye indicates
Glaucoma, herpes, foreign body, hyphema
Diplopia is seen in
Lesions in the brainstem and cerebellum and with weakness of one or more extraocular muscles
Sensorineural hearing loss
People have trouble understanding speech often complaining that people mumble; noisy environments make it worse
Problems in the inner ear, cochlear nerve or central connection to brain
Conductive hearing loss
Problems in external or middle ear
Noisy environments may help
if earache or pain in the ear ask about
Associated fever, sore throat, cough, concurrent upper respiratory infection, discharge from the ear
Clinical prediction for strep throat
Fever, tonsular exudates, swollen tender anterior cervical adenopathy, absence of cough
Causes of throat hoarseness
Voice overuse, acute viral laryngitis, environmental allergies, acid reflux smoking, alcohol, inhalation of fumes, talking a lot
Vertigo
False sense of motion
Benign paroxysmal vertigo–inner ear issue (room feels like it is spinning)
Nasal discharge HPI
Character and color, associated symptoms, seasonality, tenderness over sinuses, face pain and headache, time of onset and changes
Sinus pain HPI
Fever, malaise, cough, headache, maxillary toothache, eye pain, nasal congestion, colored nasal discharge, pain increased when bending forward, seasonal allergies
Hoarseness getting worse over time may indicate
Laryngeal lesion or cyst
Recurrent hoarseness could indicate
Allergic rhinitis
For adults, a history of frequent recurring HEENT infections may suggest
Primary immunodeficienc y problem
Alport syndrome
Hematuria, proteinsuria, frequently develop sensorineural hearing loss, eye abnormalities with mishhapen lenses
Weber test
Assesses unilateral hearing loss
Rinne test
Air heard longer than bone
Gag reflex tests which cranial nerves
9 (glossopharyngeal) and 10 (vagus)
Eustachian tube in infant vs adult
Infant is more horizontal–more risk for ear infections
Ear examination of child vs adult
Child: pull auricle down to view tympanic membrane
Adult: pull auricle up and out
Presbycusis
Sensorineural hearing loss
Due to the natural aging of the auditory canal and auditory bones; mostly affects the higher frequency sounds
Chronic illnesses that can affect vision
Hypertension, CAD, diabetes, glaucoma, IBS, thyroid dysfunction, autoimmune disease, HIV
Lymph nodes tenderness
The harder the node, the more likely the malignancy
The more tender the node, the more likely inflammation
Palpable supraclavicular node on the left is a clue to abdominal or thoracic malignancy
Macular degeneration
Common disease of aging
Results in central vision loss and is often bilateral
Meniere disease
Vertigo and tinnitus
Amblyopia
Lazy eye
Eye and brain are not in sync
Hordeolum
Stye
Localized swelling of eyelid caused mostly by staph aureus
Chalazion
Caused by noninfectious gland occlusion of the eye
Pterygium
Pinkish, triangular tissue growth on the cornea–surfers eye
Papilledema
Increased pressure in the brain
Can be associated with visual disturbances, headaches, vomiting or combination
Optic nerve in glaucoma
Enlarged
Drusen bodies in eye
Can be an early sign of dry age-related macular degeneration
Cotton wool bodies
Fluffy white patches on the retina seen with DM, hypertension, AIDS
At what age can you start snellen vision test
at 3 years
Disorders of the lymph system are present with 3 physical signs:
Enlarged lymph nodes, red streaks in the skin, lymphedema
Angle of Louis
Sternal angle
5cm below the sternal notch
First 7 ribs
Articulate with the sternum
Inferior tip of the scapula
Landmark for the level of the 7th rib or interspace
Most protruding spinous process when neck flexed forward
Usually C7
Location of trachea bifurcation
Levels of sternal angle anteriorly anteriorly and T4 spinous process posteriorly
SOB history
Onset, pattern, position most comfortable and number of pillows used at night, relate to extent of exercise, certain activities, time of day and eating, is it harder to inhale or exhale, severity, associated symptoms, efforts to treat
5 A’s for tobacco cessation
Ask about smoking at each visit Advise patients regularly to stop smoking Assess patient's readiness Assist patients to set stop dates Arrange for follow up visits
Normal AP diameter of chest
1:2 of posterior: anterior
AP diameter for barrel chest
1:1
Chest retractions
When the chest wall seems to cave in at the sternum, between the ribs, at the suprasternal notch, above the clavicles, and at the lowest coastal margins
Suggests an obstruction to inspiration at any point in the respiratory tract
Paradoxic breathing
On inspiration, the lower thorax is drawn in and on expiration, the opposite occurs
Crepitus
Crackly or crinkly sensation that can be both palpated and heard
Indicates air in the subcutaneous tissue due to rupture somewhere in the respiratory system or infection with a gas producing organism
Friction rub
Palpable, coarse, grating vibration, usually on inspiration
Fremitus
Palpable vibratory sensation to the chest wall
Can be detected by placing ulnar aspects of hands against each side of chest while patient says “ninety nine”
Abnormal fremitus could mean
Lung consolidation due to fluid or tissue usually due to pneumonia
Could also indicate obesity, COPD, effusion, tumor or fibrosis
Hyperresonance of lung
Hyperinflation of lungs
Normal percussion sound of lung
Resonant
Dullness of percussion of lung
When fluid or tissue replaces air containing lungs or occupies pleural space
Breath sounds are markedly decreased in
Emphysema
Vesicular breath sounds
Soft and low pitched
Heard over most of both lungs
Broncho-vesicular Breath sounds
Intermediate intensity and pitch
Heard over the 1st and 2nd interspaces anteriorly, and between the scapulae
Bronchial breath sounds
Louder and higher in pitch
Heard over the manubrium
Tracheal breath sounds
Very loud and high pitched
Heard over the trachea
Bronchial breath sounds distally suggests
Consolidation and cavitation
Alveolar atelactasis
Decreased or absent breath sounds over atelecatasis
Fine crackles may be present
Rhonchi and wheezes
Continuous, musical, prolonged
Wheezes: high pitched (due to asthma, COPD or bronchitis)
Rhonchi: low pitched like snoring (due to secretions in large airways)
Rales or crackles
Discontinuous–fine or coarse
CHF, fibrosis, pneumonia or bronchiectasis
Stridor
Present entirely or predominantly on inspiration louder in the neck than over the chest wall
Indicates partial obstruction of trachea or larynx
Friction rub breath sounds
Occurs outside the respiratory tree
Dry, crackly, grating, low pitched sound and is heard in both expiration and inspiration
Caused by inflamed, roughened surfaces rubbing together
Mediastinal crunch
Found with mediastinal emphysema
Variety of sounds: loud crackles, clicking and gurgling sounds are synchronous with the heartbeat and not particularly so with respiration
Bronchophony, egophony, pectoriloquy
May be present in any condition that consolidates lung tissue
Increased vocal resonance
Decreased vocal resonance
Due to loss of tissue within respiratory tissue as in barrel chest of emphysema
Bronchophony
Spoken words louder and clearer on auscultation
Lobar pneumonia
Egophony
Spoken “ee” heard as “ay” on auscultation
Lobar pneumonia
Pectoriloquy
Whispered words louder and clearer on auscultation
Lobar pneumonia
Respiratory findings with consolidation or atelactasis
Dull percussion
Increased fremitus
Bronchial breath sounds
Crackles present
Respiratory findings with emphysema
Hyperresonant percussion Decreased fremitus Decreased breath sounds Decreased voice transmission Absent crackles
Respiratory findings with pneumothorax
Hyperresonant percussion Decreased fremitus Decreased breath sounds Decreased voice transmission Absent crackles
Respiratory findings in pleural effusion
Dull percussion, decreased fremitus, decreased breath sounds, decreased voice transmission, absent crackles
Breathing in infants
Coughing rare, sneezing and hiccups frequent
Breathing primarily diaphragmatic and use of intercostal muscles is gradual
Paradoxic breathing–chest wall collapses as the abdomen distends on inspiration
When do children use the intercostal (thoracic) musculature for respiration
By the age of 6 or 7
Mucoid sputum
Translucent, white or gray
Seen in viral infections and cystic fibrosis
Purulent sputum
Yellow or green
Often accompanies bacterial infection
Foul smelling sputum
Present in anaerobic lung abscess
Fever + productive cough usually signifies
Pneumonia
Chest pain, dyspnea and orthopnea usually indicates
Acute coronary syndromes
Crackles that clear after coughing or position change suggests
Secretions seen in bronchitis or atelactasis
Crackles of heart failure best heard
Posterior inferior lung fields
Barrel chest
increased AP diameter–often accompanies COPD
Flail chest
Moves inward with inspiration and outward with expiration
Pigeon chest
Congenital abnormality in which the sternum is displaced anteriorly
Pectus Carinatum
Thoracic kyphoscoliosis
Abnormal spinal curvatures and vertebral rotation
Base/Apex of the heart
Base: Flat part on top of the heart
Apex: tip facing downward and left
Anterior surface of the heart
Right ventricle is most of it
The most likely part to be harmed by external force or trauma
S1
Closure of mitral/tricuspid valves
S2
Closure of aortic/pulmonic valves
Physiologic splitting of S2
With respiration
RV filling is delayed causing the audible split
Paradoxical split of S2
On end expiration
Significant for delay in closure of aortic valve–left bundle branch block
S3 heart sound
Vibration from ventricular filling
Fluid overload states such as CHF or pregnancy
S4 heart sound
Atrial gallop
Occurs at end-diastole (pre-systole) as atria contract and try to bush blood into a resistant ventricle
Left ventricular hypertrophy, restrictive cardiomyopathy, MI, chronic hypertension
Indications of heart disease during pregnancy
Progressive or severe dyspnea, progressive orthopnea, paroxysmal nocturnal dyspnea, hemoptysis, syncope with exertion, chest pain related to effort or emotion
Inspection of heart
Apical impulse, pulsations, heaves or lifts
Apical impulse
Should be visible at the midclavicular line in the 5th left intercostal space
Should not be seen in more than one space
Obscured by obesity, large breasts or muscularity
Thrill
A fine, palpable, rushing vibration, a palpable murmur
Acronym for heart sounds
Aortic valve Pulmonic valve Erb's point Tricuspid valve Mitral valve
Aortic valve location
2nd right intercostal space
Pulmonic valve location
2nd left intercostal space
Erb’s point location
3rd left intercostal space
Listen for murmurs
Tricuspid valve location
4th left intercostal space
Mitral valve location
5th left intercostal space at midclavicular line
PMI
Assess for what characteristics of murmurs
timing and duration, pitch, intensity, pattern, quality, location, radiation, variation with respiratory
Apical pulse in pregnant woman
Shifts up and laterally
HPI for leg pain/cramps
Onset and duration, character, continuous burning in toes, pain in thighs or buttocks, skin changes, limping, waking at night with leg pain
Palpate arteries and note
Rate and rhythm, pulse contour, amplitude, symmetry, obstructions, variations
Amplitude of pulse
0: absent
1: diminished
2: normal
3: full and increased
4: bounding and aneurysma
Bruits could indicate
Radiation of murmurs or obstructive arterial disease
4 P’s for assessment of peripheral artery disease occlusion
Pain, pallor, pulselessness, paresthesia
Claudication
Dull ache, muscle fatigue and cramps, usually appears during sustained exercise such as walking a distance or climbing stairs
Rest usually relieves
Conditions that make JVP inspection difficult
Severe right heart failure, severe volume depletion and obesity
Abnormal JVP
> 8-9cm
S/S for venous obstruction and insufficiency
Swelling and tenderness over the muscles, engorgement of superficial veins, erythema and/or cyanosis
Homan sign
Calf pain with passive dorsiflexion of foot
Sign of venous insufficiency
PMI in patients with COPD
Displaced to epigastric area due to right ventricular hypertrophy
PMI >2.5cm
evidence of left ventricular hypertrophy from hypertension or aortic stenosis
Displacement of PMI lateral to midclavicular line
Occurs in left ventricular hypertrophy or ventricular dilation due to MI or heart failure
Heart murmurs
Distinct heart sounds distinguished by their pitch and longer duration; attributed to turbulent blood flow and are usually diagnostic of valvular heart disease
Can occur in regurgitation or stenosis of valves
ECG waves
P: atrial depolarization
QRS: ventricular depolarization
T: ventricular repolarization
Periorbital puffiness and right rings
Nephrotic syndrome
Enlarged waistline could indicate
Ascites dur to liver failure
Routine screenings for CVD
Every 5 years if low risk
Every 2 years if high risk
Every 3 years if diabetic
Causes of decreased carotid pulse
Decreased stroke volume from shock or MI, local atherosclerotic narrowing or occlusion
Bell vs diaphragm for heart
Diaphragm: high pitched sounds of S1 + S2; murmurs of aortic and mitral regurgitation and pericardial friction rubs
Bell: low pitched sounds of S3 and S4; murmurs of mitral stenosis
Systolic murmur
Falls between S1 and S2
Coincide with the carotid upstroke
Diastolic murmur
Falls between S2 and S1
Grade 1 murmur
Very faint, may not be heard in all positions
Grade 2 murmur
Heard immediately
Grade 3-6 murmur
Increasingly louder with a palpable thrill
Pulmonary hypertension and PMI
Results in right ventricular hypertrophy and displaces PMI medially
Hair loss over the anterior tibiae points to
Decreased arterial perfusion
PAD warning signs
fatigue, aching, numbness and pain that limits walking
Any poorly healing or non healing wounds of legs/feet, pain present when at rest in lower leg, abdominal pain after meals associated with food fear and weight loss, first degree relatives with an aortic aneurysm
Ankle-brachial index
Ratio of blood pressure in the foot and arm
Values <0.9 abnormal
Risk factors for aortic abdominal aneurysm
Older age, male, smoking, family history
Asymmetric blood pressures in arms
Coarctation of aorta and dissecting aortic aneurysm
Unilateral calf and ankle swelling suggests
Venous thromboembolic disease from DVT, chronic venous insufficiency or incompetent venous valves
Bilateral edema of legs seen in
Heart failure, cirrhosis, nephrotic syndrome
Structures present in RUQ
Right lobe of liver, gallbladder, bile duct, part of transverse colon, ascending colon
Structures present in RLQ
Cecum, appendix
Structures present in LUQ
Stomach, left lobe of liver, spleen, pancreas, descending colon, part of transverse colon
Stuctures present in LLQ
Rectum, anus
Order for abdominal examination
Inspection, auscultation, percussion, palpation
Hirschsprung disease
Developmental disorder characterized by the absence of ganglia in the distal colon, resulting in functional obstruction
Increased bowel sounds may occur with
Gastroenteritis, early intestinal obstruction or hunger
High pitched tinkling bowel sounds
Suggest intestinal fluid and air under pressure, as in early obstruction
Decreased bowel sounds occur with
Peritonitis and paralytic ileus
Friction rubs in abdomen
Indicate inflammation of the peritoneal surface of the organ from tumor, infection, or infarct
Normal liver span
6-12cm
Measure height of liver in right midclavicular line
Usual spot of liver dullness when going down from lungs
5th intercostal space on right side midclavicular line
Where is spleen dullness usually percussed
From 9th-11th intercostal space just behind left midaxillary line
McBurney’s point
Corresponds to the most common location of the base of the appendix
Pain on release may indicate appendicitis
Murphy sign
Palpate right and left midclavicular, breath in, pain on palpate may be sign of gall bladder issues
Grey turner sign
Bruising of the flanks
Sign of retroperitoneal hemorrhage or bleeding behind the peritoneum
Cullen sign
Can predict acute pancreatitis
Bruising around umbilicus
Rovsing sign
Palpating LLQ can elicit referred pain to RLQ
Can indicate appendicitis
Cotton wisp on face is measuring what CN
5
Keeping eyes closed on resistance, raising eyebrows, grown and smile is measuring what CN
7
Extra ocular movements is measuring what CN
2, 4, 6
Pupillary response is measuring what CN
3
Visual acuity is measuring what CN
2
Whisper test is measuring what CN
8
Psoas sign
Hand on right thigh/knee, have patient raise leg against resistance
Pain in RLQ may indicate peritonitis
Obturator sign
Patient on left side; flex hip and knee and internally rotate
Pain in RLQ may indicate peritonitis
