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Physical exam > Final > Flashcards

Final Flashcards

1
Q

what does pressure difference of 10-15 mmHg or more in UE suggest?

A
  • subclavian steal syndrome

- aortic dissection

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2
Q

what does HTN in UE and low BP in LE suggest

A
  • coarctation of aorta

- occlusive aortic disease

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3
Q

what happens if BP cuff is too narrow

A
  • BP reading is falsely high
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4
Q

what happens if BP cuff is too wide?

A
  • in small arm get low BP reading

- in large arm get high BP reading

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5
Q

CN I

A
  • olfactory N
  • Make sure both nasal passages are patent
  • Have pt close eyes, occlude one nostril
  • have pt smell and ID familiar substance
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6
Q

CN II

A
  • optic N
  • Test visual acuity- each eye separately and both eyes together
  • Inspect size of pupils
  • test visual fields
  • view with opthalmoscope
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7
Q

CN III, IV, VI

A
  • extra-occular movements
  • check 6 cardinal fields of gaze
  • convergence
  • nystagmus or ptosis
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8
Q

CN V

A
  • corneal reflexes, facial sensation, jaw movements
  • Motor function- clench jaw while palpating temporal and masseter muscles, move jaw from side to side
  • Sensory- use a sharp and dull object to test for sensation on forehead, cheeks and chin
  • if sensory loss check- temperature sensation
  • corneal reflex with wisp of cotton
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9
Q

CN VII

A
  • facial N

- raise both eyebrows, frown, close both eyes tightly, show upper and lower teeth, smile, puff out both cheeks

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10
Q

CN VIII

A
  • vestibulocochlear N
  • whispered voice test
  • weber and rinne if abnormal
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11
Q

CN IX and X

A
  • glossopharyngeal n and vagus n
  • swallowing and rise of palage, gag reflex
  • Listen for hoarseness
  • difficulty swallowing?
  • Ask patient to say “Ah” and watch movements of soft palate and pharynx
  • assess gag reflex
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12
Q

CN XI

A
  • spinal accessory n
  • Assess for atrophy or fasciculations
  • turn head against your hand
  • shrug both shoulders upwards against your hands
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13
Q

CN XII

A
  • hypoglossal n
  • tongue symmetry, position, and movement
  • Listen to articulation of patients words
  • Assess movement of tongue and look for atrophy or fasciculations
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14
Q

hyperopia

A
  • farsightedness
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15
Q

myopoia

A
  • nearsightedness
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16
Q

presbyopia

A
  • aging vision
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17
Q

scotoma

A
  • blind spot
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18
Q

diplopia

A
  • double vision

- causes: lesion in brainstem or cerebellum, weak/paralyzed muscles

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19
Q

ptosis

A
  • drooping of upper eyelid

- causes- Horner’s, weak muscles, congential

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20
Q

entropion

A
  • inward turn of eyelid
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21
Q

ectropion

A
  • outward turn of eyelid
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22
Q

lid retraction + exopthalmos

A
  • wide stare with protrusion of eyeball

- occurs in hyperthyroidism, graves, tumor

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23
Q

pinguecula

A
  • yellowing triangular nodule in conjunctiva next to iris

- due to aging

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24
Q

hordeolum

A
  • aka stye

- painful tender infection of gland at lid margin

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25
Q

xanthelasma

A
  • slightly raised, yellow, well demarcated plaque on nasal portion of eyelid
  • common in lipid disorders
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26
Q

chalazion

A
  • blocked meibomian gland

- points inside eyelid

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27
Q

episcleritis

A
  • localized inflammation of episcleral vessels

- occurs in RA, sjogrens, herpes zoster

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28
Q

dacryocystitis

A
  • inflammation of lacrimal sac
  • swelling between lower eyelid and nose
  • prominent tearing
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29
Q

arcus senilus

A
  • corneal acrus
  • thin grey circle close to edge of cornea
  • normal aging process
  • hyperlipoproteinemia
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30
Q

kayser- fleischer ring

A
  • Cu depositon
  • golden/ brown ring in periphery of cornea
  • occurs in wilson’s disease (mutation in chromosome 13)
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31
Q

corneal scar

A
  • greyish white opacity in cornea secondary to injury or inflammation
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32
Q

cataracts

A
  • opacity of lens through pupil

- due to old age, smoking, DM, steroids

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33
Q

pterygium

A
  • triangular thickening of bulbar conjunctiva growing outward toward cornea
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34
Q

peripheral cataract

A
  • spoke like shadows
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35
Q

CN III paralysis

A
  • dilated pupil is fixed
  • ptosis if eyelid
  • lateral deviation of eye
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36
Q

argyll robertson pupils

A
  • small, irregular pupils
  • accommodate light but do not react to it
  • d/t CNS syphilis
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37
Q

hypema

A
  • blood in anterior chamber
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38
Q

hypopyon

A
  • pus in anterior chamber
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39
Q

lagopthalmos

A
  • inablity to close eyelids

- CN VII issue

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40
Q

coloboma

A
  • cat eye
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41
Q

keratoconus

A
  • thinning of cornea
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42
Q

iritis

A
  • inflammation around iris

- marked photosensitivity

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43
Q

mydriasis

A
  • dilation of pupil
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44
Q

sensorineural hearing loss

A
  • issue in inner ear, nerve conduction to brain

- trouble understanding speech

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45
Q

conductive hearing loss

A
  • problem in middle/ external ear

- noise may help hearing

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46
Q

tinnitus

A
  • perceived sound with no external stimulus
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47
Q

rhinitis medicamentosa

A
  • drug induced rhinitis
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48
Q

epistaxis

A
  • nose bleed
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49
Q

goiter

A
  • enlarged thyroid

- assoc with increased or decreased function

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50
Q

vertigo

A
  • perception that pt or environment is spinning
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51
Q

lightheadedness

A
  • sx worse/ start when sitting or standing
52
Q

presycope

A
  • feeling of passing out
53
Q

disequilibrium

A
  • feeling unsteady or losing balance
54
Q

PE findings for glaucoma

A
  • crescent shadow suggests narrow angle glaucoma

- cup: disc ratio > 3:1

55
Q

normal IOP

A
  • 10-22 mmHg
56
Q

gold standard for IOP measurement

A
  • goldman applanation tonometer
57
Q

marcus gunn pupil

A
  • aka afferent pupillary defect
  • swinging light in abnormal eye -> partial dilation of both pupils
  • swinging light in normal eye -> consensual constriction
  • due to afferent and efferent stimuli reduction -> net dilation
58
Q

Adie’s tonic pupil

A
  • pupil is large, regular
  • unilateral
  • rxn to light is reduced/ slowed/ absent
59
Q

adventitious breath sounds

A
  • additional or superimposed breath sounds

- will not be heard if there is enough gas exchange

60
Q

crackles

A
  • brief

- aka rales

61
Q

wheezes

A
  • high pitched

- suggest narrow airways

62
Q

rhonci

A
  • low pitched
  • suggest large airways
  • usually heard on inspiration
63
Q

stridor

A
  • high pitched inspiratory noise from severe subglottic or tracheal obstruction
64
Q

what do transmitted breath sounds suggest?

A
  • air filled lungs have become airless/ consolidated
65
Q

when is tactile fremitus decreased

A
  • obstructed bronchus
  • COPD
  • pneumothorax
  • pleural effusion
  • fibrosis
  • tumor
66
Q

when is tactile fremitus increased

A
  • pneumonia
67
Q

when is percussion to thorax dull

A
  • consolidation/ pneumonia
  • atelectasis
  • pleural effusion
68
Q

when is percussion to thorax hyper-resonant

A
  • pneumothorax
  • COPD
  • asthma
69
Q

a wave

A
  • JVP corresponding to atrial contraction

- immediately precedes S1

70
Q

when is a wave increased

A
  • increased resistance to R atrial emptying
  • decreased RV compliance- RVH, COPD, restrictive CMP, pulm valve stenosis
  • tricuspid stenosis
71
Q

when is a wave absent

A
  • a fib

- junctional/ ventricular rhythms

72
Q

when is a wave intermittent

A
  • cannon a waves
  • AV dissociation
  • v tach
73
Q

grade 1 murmur

A
  • very faint
  • listener must be “tuned in”
  • may not be heard in all positions
74
Q

grade 2 murmur

A
  • quiet but immediately herad
75
Q

grade 3 murmur

A
  • moderately loud
76
Q

grade 4 murmur

A
  • loud with palpable thrills
77
Q

grade 5 murmur

A
  • very loud with thrill

- may be heard with stethoscope partially off chest

78
Q

grade 6 murmur

A
  • very loud with thrill

- may be heard with stethoscope entirely off chest

79
Q

aortic stenosis

A
  • systolic murmur
  • heard best when pt sits and leans forward
  • Location- 2nd and 3rd interspace
  • Radiation- carotid, down left sternal border and apex
80
Q

HOCM

A
  • systolic murmur
  • heard best with squatting and valsalva
  • Location- left 3rd and 4th interspaces
  • Radiation- down left sternal border to apex
81
Q

mitral regurg

A
  • holosystolic murmur
  • doesn’t change with inspiration
  • can have S3
  • Location- ape
  • Radiation- L axilla
  • If loud associated with apical thrill
82
Q

pulmonic stenosis

A
  • crescendo-decrescendo systolic murmur
  • can have thrill
  • Location- left 2nd and 3rd interspaces
  • Radiation- if loud towards L shoulder and neck
83
Q

tricuspid regurg

A
  • holosystolic murmur
  • increases with inspiration
  • Lower L sternal border
  • if RV pressure is high and V is enlarged murmur is loudest at apex and may be confused for mitral regurgitation
  • Radiation- R sternum, xiphoid area, L midclavicular line
84
Q

VSD

A
  • holosystolic murmur
  • usually with thrill
  • Location- left 3rd, 4th and 5th interspaces
  • Radiation- usually wide
  • Smaller defect= louder murmur
85
Q

aortic regurg

A
  • decrescendo diastolic
  • heard best leaning forward with exhalation
  • Location- L 2nd to 4th interspaces
  • Radiation- if loud, to apex
86
Q

mitral stenosis

A
  • decrescendo diastolic
  • opening snap after S2
  • use bell
  • heard best in LLD with hand grips and exhalation
  • Location- usually limited to apex
  • Radiation- none
87
Q

venous hum

A
  • continuous humming murmur
  • loudest in diastole
  • listen with bell
  • Location- above medial third of clavicles especially on right
  • Best heard when pt is sitting, disappears in supine
  • Radiation- left 1st or 2nd interspaces
88
Q

pericardial friction rub

A
  • sounds close to the stethoscope
  • best with pt leaning forward with exhalation
  • Location- usually heard best in 3rd interspace next to sternum
  • Radiation- minimal
  • Quality- scratchy, scraping, grating
89
Q

PDA

A
  • machine like
  • sometimes with thrill
  • Location- 2nd left interspace
  • Radiation- L clavicle
90
Q

S3 sounds

A
  • ventricular gallop
  • brief mid-diastolic
  • physiologic in kids, young adults, and in 3rd trimester
91
Q

S4 sounds

A
  • atrial gallop
  • right before systolic apical beat
  • marks atrial contraction
  • due to increased resistance to filling
92
Q

L sided causes for S4

A
  • HTN heart disease
  • myocardial ischemia
  • aortic stenosis
  • CMP
93
Q

R sided causes for S4

A
  • pulm HTN

- pulmonic stenosis

94
Q

special tests for ascites

A
  • shifting dullness
  • fluid wave
  • ballottement
95
Q

shifting dullness

A
  • percuss for dullness while pt is supine
  • have pt to turn on side, percuss and mark borders of dullness
  • In pt with ascites → tympany shifts to top
96
Q

fluid wave

A
  • ascites test
  • pt press side of hand on midline of abdomen
  • tap one flank and feel opposite flank for impulse
97
Q

ballottement

A
  • test for ascites
  • straighten and stiffen fingers, make brief jabbing motion
  • will displace fluid
98
Q

special tests for appendicitis

A
  • McBurney’s point tenderness
  • Rosving’s sign
  • psoas sign
  • obuterator sign
99
Q

McBurney’s point tenderness

A
  • for appendicitis
  • 2in from ASIS
  • check for guarding, rigidity, rebound tenderness
100
Q

Rosving’s sign

A
  • for appendicitis

- press in LLQ → RLQ pain if positive

101
Q

Psoas sign

A
  • for appendicitis
  • place your hand above R knee → pt raise thigh against resistance
  • OR
  • turn pt on L side → extend R leg at hip →
  • Positive: abdominal pain
102
Q

obturator sign

A
  • test for appendicitis
  • flex pt R hip with knee bent then internally rotate hip
  • Positive: R hypogastric pain
103
Q

murphys sign

A
  • for cholecystitis
  • hook fingers under costal margin
  • ask pt to take deep breath
  • Positive: sharp increase in tenderness and sudden stop of inspiration
104
Q

visceral pain

A
  • Distension/ stretching of hollow abdominal organs
  • Typically palpable near midline
  • Varying quality- gnawing, burning, cramping, aching
  • Sweating, pallor, n/v, restlessness when severe
105
Q

parietal pain

A
  • a/w inflammation, parietal inflammation
  • Steady, aching pain- usually worse than visceral
  • More precisely localized over structures
  • aggravated by movement or coughing
  • prefers to lie still
106
Q

referred pain

A
  • Felt in distant sites that are innervated at roughly the same spinal level
  • May be felt superficially or deeply, usually localized
  • Pain in abdomen may be referred from chest, spine, or pelvis
107
Q

traube’s space

A
  • left lower anterior chest wall, from the border of cardiac dullness at the 6th rib to the anterior axillary line and down to the costal margin
108
Q

RTC tendinitis

A
  • repeated shoulder motion that can cause edema & hemorrhage followed by inflammation
  • usu supraspinatus tendon
  • PE: tenderness just below the tip of the acromion
109
Q

RTC tear

A
  • usu from fall, trauma, repeated impingement
  • most common clinical problem of the shoulder
  • complete tear normally has impaired active abduction and forward flexion
  • pos drop arm test
110
Q

apley scratch test

A
  • Testing overall shoulder rotation
  • Touch opposite scapula from top (ER) and bottom (IR)
  • Pain suggest a rotator cuff disorder
111
Q

painful arc test

A
  • Fully adduct pt’s arm from 0-180 degrees
  • Positive: shoulder pain from 60-120 degrees
  • subacromial impingement/ rotator cuff tendinitis disorder
112
Q

neer impingement sign

A
  • Raise pt’s arm while pressing on the scapula to prevent movement
  • compresses greater tuberosity against the acromion
  • Positive: pain
  • subacromial impingement/ rotator cuff tendonitis disorder
113
Q

hawkins impingement sign

A
  • Flex pt’s shoulder & elbow to 90 with palm facing down
  • rotate arm internally
  • compresses the greater tuberosity against the supraspinatus tendon & the coracoacromial ligament
  • Positive: pain
  • supraspinatus impingement/ rotator cuff tendinitis
114
Q

drop arm test

A
  • abduct arm to 90 and lower it slowly
  • pos- weakness
  • supraspinatous tear
115
Q

empty can test

A
  • Elevate arms to 90 & IR arms w/ thumbs pointing down
  • pt resist as you push arms down
  • Positive: inability for pt to hold the arms fully abducted at shoulder level or control lowering of arm
  • supraspinatus rotator cuff tear
116
Q

what is the most common type of knee bursitis

A
  • pes anserine
117
Q

when is babinski transiently positive

A
  • unconscious states from drug or alcohol intoxicatino

- postictal periods following seizures

118
Q

upper motor neuron lesions

A
  • hypertonia
  • hyperreflexia
  • no fasciculations
  • no atrophy
    • babinski
119
Q

lower motor neuron lesions

A
  • hypotonia
  • hyporeflexia
  • fasciculations
  • atrophy
  • normal plantar reflex
120
Q

guiding questions for neuro exam

A
  • is mental status intact?
  • are your findings symmetric?
  • where is lesion? central vs. peripheral vs. both
121
Q

don’ts assoc with assessment of comatose pt

A
  • dont dilate pupils- single most important clue for underlying cause of coma
  • dont flex neck
122
Q

facial paralysis due to peripheral lesion

A
  • paralyze entire half of face including forehead
  • only half of forehead wrinkles
  • eyebrows dont raise
  • eyes no dont close and eyeballs roll up
  • i.e. bells palsy
123
Q

facial paralysis due to central lesions

A
  • paralyze lower face but cortical innervation to forehead is preserved
  • entire forehead wrinkles
  • eyebrows raise
  • eyes close but with weakness
  • i.e. cerebral infarction
124
Q

components of NS

A
  • mental status
  • cranial nerves
  • motor system
  • sensory system
  • deep tendon, abdominal, and plantar reflexes
  • coordination
125
Q

normal 2 point discrimination in fingertips

A
  • 2- 5 mm
126
Q

dysdiadochokinesis

A
  • Abnormal rapid alternating movement where finger tips touch thumb

Physical exam (3 decks)

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