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Physical Exam > Final Exam > Flashcards

Final Exam Flashcards

1
Q

Bony landmarks of the shoulder

A

Acromioclavicular joint (superior)
Coracoid process of scapula
Greater tubercle of humerus (SITS muscles)

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2
Q

Shoulder joint anatomy

A

Glenohumeral joint, sternoclavicular joint, acromioclavicular joint

Subacromial bursa b/w acromion & humeral head

Long head of biceps tendon sits within bicipital groove

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3
Q

What does Neer impingement sign indicate?

A

Subacromial impingement

Rotator cuff tendinitis disorder

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4
Q

What does Hawkins impingement sign indicate?

A

Supraspinatus impingement

Rotator cuff tendinitis

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5
Q

What does external rotation lag test indicate?

A

Inability to maintain external rotation → supraspinatus/infraspinatus disorder

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6
Q

What does internal rotation lag test indicate?

A

Inability to hold hand behind back → subscapularis disorder

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7
Q

What does drop-arm test indicate?

A

Weakness abducting arm to 90 degrees → supraspinatus rotator cuff tear OR bicipital tendinitis

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8
Q

What does external rotation resistance test indicate?

A

Pain/weakness → Infraspinatus disorder

Limited → glenohumeral disease OR adhesive capsulitis

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9
Q

What does empty can test indicate?

A

Supraspinatus tear

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10
Q

How do you test CN I?

A

Smell

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11
Q

How do you test CN II?

A

Visual acuity
Visual fields by confrontation
Fundoscopic exam

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12
Q

How do you test CN III?

A

Extraocular movements

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13
Q

How do you test CN IV?

A

Extraocular movements - eye looks down and out

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14
Q

How do you test CN V?

A

Muscles of mastication

Sensation on face/corneal reflex

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15
Q

How do you test CN VI?

A

Extraocular movement - lateral movement

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16
Q

How do you test CN VII?

A

Facial expressions

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17
Q

How do you test CN VIII?

A

Whispered voice test

Rinne/Weber if abnormal

  • Rinne → conduction (AC > BC)
  • Weber → unilateral conductive (lateralizes to bad ear), unilateral sensorineural (lateralizes to good ear)
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18
Q

How do you test CN IX?

A

Hoarseness of voice

Gag reflex

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19
Q

How do you test CN X?

A

Rise of uvula and hard palate

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20
Q

How do you test CN XI?

A

Shoulder shrug

Turn head against resistancw

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21
Q

How do you test CN XII?

A

Stick out tongue

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22
Q

Findings associated with upper motor neuron lesion

A

Hypertonia
Hyperreflexia
NO fasciculations/atrophy
Positive Babinski sign (dorsiflexion)

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23
Q

Findings associated with lower motor neuron

A 
Hypotonia
Hyporeflexia
Fasciculations
Atrophy
Normal plantar reflex (negative Babinski)
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24
Q

Grading of deep tendon reflexes

A 
0 - No reflex
1 - Diminished reflex
2 - Normal
3 - Brisker than average, may be normal
4 - Very brisk, hyperactive → +/- clonus
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25
Q

What does clonus indicate?

A

Upper motor neuron lesion (corticospinal lesion)

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26
Q

What is a positive Babinski sign?

A

Dorsiflexion of foot during test → indicates corticospinal tract lesion (CNS)

Can be accompanied by reflex flexion in hip/knee

Can transiently occur in unconscious states d/t alcohol/drug intoxication and during postictal period following seizure

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27
Q

Where would you auscultate for the aortic area of the heart?

A

Right sternal border at 2nd ICS

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28
Q

Where would you auscultate for the pulmonic area of the heart?

A

Left sternal border at 2nd ICS

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29
Q

Where would you auscultate for Erb’s point?

A

Left sternal border

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30
Q

Where would you auscultate for the tricuspid area?

A

Left sternal border at 5th ICS

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31
Q

Where would you auscultate for the mitral area of the heart?

A

Approx. midclavicular line at 5th ICS

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32
Q

What areas do you listen for heart sounds?

A 
Aortic area
Pulmonic area
Erb's point
Tricuspid area
Mitral area
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33
Q

What does S1 represent?

A

Closure of mitral/tricuspid (AV) valves

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34
Q

What does S2 represent?

A

Closure of aortic/pulmonic valves

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35
Q

Grading of pulses

A

0 - absent
1+ - Weak
2+ - Normal, brisk
3+ - Bounding

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36
Q

Visceral pain findings

A

Stretch/distention of hollow abdominal organs (e.g. intestines, biliary tree)

Difficult to localize

Visceral periumbilical pain = early acute appendicitis (changes to RLQ parietal pain)

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37
Q

Parietal pain findings

A

Steady, aching pain usually more severe than visceral pain

More precisely located over involved structure

Aggravated by movement → pt prefers to lie still

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38
Q

Referred pain findings

A

Felt in more distant sites which are innervated at approximately the same spinal level

May be palpated superficially or deeply but usually localized

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39
Q

What kind of pain is colicky pain from a renal stone?

A

Visceral - pt is constantly repositioning self

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40
Q

Exam findings consistent with splenomegaly

A

Positive general splenic percussion sign - change from tympany to dullness into Traube’s space

Positive splenic percussion sign - change in percussion note from tympany to dullness on inspiration

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41
Q

When would splenomegaly occur?

A 
Portal HTN
HIV
Splenic infarct
Hematoma
Mononucleosis
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42
Q

How do you perform Murphy’s sign?

What does it test for?

A

Hook fingers under costal margin or under liver edge

Ask pt to take deep inspiration → Pain indicates acute cholecystitis

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43
Q

Where is McBurney point?

What’s the purpose of it?

A

A point 2 inches from anterior superior spinous process of ilium in an imaginary line drawn right and down from umbilicus

Tenderness = appendicitis

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44
Q

How do you test for Psoas sign?

What does it indicate?

A
  • Patient lies down on left side and extends right hip
  • Patient supine, tries to raise right leg against resistance

Increased abdominal pain at either = appendicitis or peritonitis

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45
Q

How do you test for Rovsing sign?

What does it test for?

A

Apply pressure to RLQ and LLQ

Rebound tenderness indicates appendicitis

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46
Q

Where do you assess the abdominal aorta?

A

1cm above and 1cm to the left of the umbilicus

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47
Q

How wide is a normal aorta?

A

<3cm wide

Aortic abdominal aneurysm if >3cm

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48
Q

What is asterixis?

What does it indicate?

A

Sudden, brief, nonrhythmic flexion of hands/fingers followed by recovery

Suggests metabolic encephalopathy in pts with impaired mental function

Seen in liver disease, uremia, hypercapnia

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49
Q

What lung sounds do you hear in a normal pt?

A

None

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50
Q

What lung sounds do you hear in partial lobar obstruction/atelectasis?

A

None

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51
Q

What lung sounds do you hear in pleural effusion

A

None, possible pleural rub

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52
Q

What lung sounds do you hear in pneumothorax

A

None, possible pleural rub

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53
Q

What lung sounds do you hear in left-sided HF?

A

Late inspiratory crackles, with possible wheezes

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54
Q

What lung sounds do you hear in lobar pneumonia (consolidation)?

A

Late inspiratory crackles

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55
Q

What lung sounds do you hear in COPD?

A

None, crackles, wheezes, or rhonchi

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56
Q

What lung sounds do you hear in asthma?

A

Wheezes or crackles

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57
Q

What percussion notes do you hear in pleural effusion?

A

Dull

58
Q

What percussion notes do you hear in pneumonia?

A

Dull

59
Q

What percussion notes do you hear in chronic bronchitis?

A

Resonant

60
Q

What percussion notes do you hear in normal pt?

A

Resonant

61
Q

What percussion notes do you hear in COPD?

A

Hyperresonant

62
Q

What percussion notes do you hear in pneumothorax?

A

Hyperresonant

63
Q

What is paresthesia?

A

Pins/needles

64
Q

What is dysesthesia?

A

Distorted sensations

E.g. burning pain occurs in painful sensory neuropathies like diabetets

65
Q

When does sensory loss in stocking-glove distribution occur?

A

Polyneuropathies, esp. from diabetes

66
Q

Causes of syncope

A

Seizures

Neurocardiogenic conditions - vasovagal syncope, postural tachycardia syndrome, carotid sinus syncope, orthostatic hypotension, arrhythmias (v-tach, bradyarrythmia)

Stroke/subarachnoid hemorrhage unlikely unless involves both hemispheres

67
Q

What is the most common cause of syncope

A

vasovagal syncope - prodrome of nausea, diaphoresis, pallor triggered by fearful/unpleasant event

68
Q

What findings are associated with syncope from arrythmias?

A

Sudden onset/offset - reflects loss/recovery of cerebral perfusion

69
Q

Grade 1 murmur

A

Grade 1 - very faint, heard only after listener has “tuned in”; may not be heard in all positions

70
Q

Grade 2 murmur

A

Grade 2 - quiet, but heard immediately after placing stethoscope on chest

71
Q

Grade 3 murmur

A

Grade 3 - Moderately loud

72
Q

Grade 4 murmur

A

Grade 4 - Loud with palpable THRILL

73
Q

Grade 5 murmur

A

Grade 5 - Very loud, w/ THRILL; may be heard when stethoscope is partly off chest

74
Q

Grade 6 murmur

A

Grade 6 - Very loud, w/ thrill; may be heard with stethoscope entirely off chest

75
Q

What is a normal difference in BP measurements on diff. arms?

A

5-10 mmHg difference is normal

76
Q

What would be an abnormal BP finding b/w arms?

A

> 10-15 mmHg difference → indicates subclavian syndrome or aortic dissection

77
Q

What does it mean if there is higher BP measurement in arms than legs?

A

Coarctation of aorta or occlusive aortic disease

Systolic pressure should be 5-10mm Hg higher in legs than arms in normal pt

78
Q

How would you assess position sense?

What would an abnormal result indicate?

A

Joint position of toe

Loss of position sense is seen in tabes dorsalis, MS, Vitamin B12 deficiency

79
Q

Exam findings associated with peripheral neuropathy

A

Loss of vibration sense & loss of position sense

80
Q

Dermatome at axilla

A

T1

81
Q

Dermatome at nipple

A

T4

82
Q

Dermatome at umbilicus

A

T10

83
Q

Dermatome at groin

A

L1

84
Q

Dermatome at knee

A

L4

85
Q

Exam findings associated with Guillan Barre syndrome

A

Subacute onset of LE weakness

86
Q

What does analgesia/hypalgesia/hyperalgesia mean?

A

absent/decreased/increased sensation of pain

87
Q

What does o Anesthesia/hypesthesia/hyperesthesia mean?

A

absence/decreased/increased sensation of touch

88
Q

What is the first sensation lost in peripheral neuropathy?

A

Vibration sense

89
Q

When would vibration sense be lost?

A

Diabetes
Alcoholism
Posterior column disease (tertiary syphilis, B12 deficiency)

90
Q

Why would you test vibration sense on trunk?

A

To identify level of cord lesion

91
Q

When would you see loss of position sense?

A

Tabes dorsalies
Multiple sclerosis
Vitamin B12 deficiency
Diabetic neuropathy

92
Q

Common musculoskeletal causes regarding lordosis

A

Paravertebral spasm

Metastatic malignancy

93
Q

S3 heart sound

A
  • “Kentucky”, ventricular gallop → right after S2
  • Normal in children & up to age 40
  • Pathologic in >40 y/o → decreased myocardial contractility, HF, ventricular volume overload from aortic/mitral regurgitation, left-to-right shunts
94
Q

S4 heart sound

A

“Tennessee”, atrial gallop → just before S1

Occasionally normal in trained athletes & older age groups but usually d/t resistance during ventricular filling (ventricular hypertrophy or fibrosis)

95
Q

Sequence for proper fundoscopic exam

A
  • Darken room
  • Switch light on & turn lens disc to see large round beam of white light
  • Shine on back of hand to check/adjust
  • Turn lens disc to 0 diopter
  • Hold scope in right hand & use right eye when examining pt’s right eye
  • Tell pt to look slightly up and over your shoulder at wall
  • Place self ~15 in. away at 15 degrees lateral to pt’s line of vision
  • Look for red reflex in pupil (fundus)
96
Q

Broncophony

A

Loud/distinct “ninety-nine”

97
Q

Whispered pectoriloquy

A

Loud/cleaer whisper

98
Q

Egophony

A

E to A

99
Q

Another term for airless lung tissue

A

consolidation

100
Q

Marcus Gunn pupil

A

Swinging flashlight test - dilation of both eyes when light is on affected eye, bilateral constriction when light is on normal eye

Impairment of optic nerve - relative afferent pupillary defect

101
Q

Adie pupil

A

aka tonic pupil - pupil is dilated at rest; reaction to light is severely reduced/slowed

Impaired parasympathetic innervation to iris

102
Q

Grading of muscle strength

A

0 - no contraction
1 - barely detectable contraction
2 - active movement without gravity
3 - active movement against gravity
4 - active movement against gravity & some resistance
5 - active movement full resistance w/out evident fatigue (normal)

103
Q

Dont’s when assessing comatose pt

A

DON’T dilate pupils - single most important clue to underlying cause of coma

DON’T flex neck (clearance of C-spine)

104
Q

Significance of auscultatory gap

A

Silent interval that may be present b/w systolic & diastolic pressures - associated with arterial stiffness & atherosclerotic disease

Unrecognized gap may lead to underestimation of SBP or overestimation of DBP

105
Q

Corneal arcus

A

Thin, grayish white arc/circle on corneal edge

Normal aging process or in young adults (esp. A.A.)
May indicate hperlipoproteinemia in young adults
Benign

106
Q

Kayser-Fleischer ring

A

Golden/red-brown ring from copper deposition

Associated with Wilson disease

107
Q

Corneal abrasion/ulcer

A

Superficial grayish-white opacity in cornea

108
Q

Cataract

A

opacity of lens only through pupil

109
Q

Entropion

A

Inward turning of eyelid, common in elderly

Lower lashes can turn inward & irritate conjunctiva/cornea

110
Q

Ectropion

A

outward turning of lower lid margin, common in elderly

111
Q

Exophthalmos

A

protrusion of eye ball, common in Graves’ disease

112
Q

Pinguecula

A

yellowish triangular nodule on side of iris

113
Q

Xanthelasma

A

yellow, raised cholesterol filled plaques near eyelids; common in hyperlipidemia

114
Q

HSV keratitis

A

Dendritic ulcer under fluorescein

115
Q

Near reaction vs. convergence

A

Near reaction - pupils constrict when gaze is shifted to nearby object

Convergence - physical converging of eyeballs

116
Q

Findings associated with Weber test

A

Unilateral hearing loss

Conductive hearing loss - lateralizes to bad ear
Sensorineural hearing loss - lateralizes to good ear

117
Q

Findings associated with Rinne test

A

Normal AC > BC

118
Q

Arteries vs. veins in ophthalmic exam

A 
Arteries = light red, smaller, bright light reflex
Veins = dark red, larger, absent light reflex
119
Q

Target organs affected by HTN

A

Eyes
Kidneys
Brain
Heart

120
Q

Pulsating tonsillar node significance

A

Carotid artery - i.e. not a node

121
Q

Small, hard tender tonsillar node b/w mandible & SCM - signficance?

A

Probably styloid process - i.e. not a node

122
Q

Enlargement of supraclavicular node on left side - signficance?

A

Possible metastasis from thoracic or abdominal malignancy

123
Q

Normal IOP

A

10-22mmHg

124
Q

What is the 5th vital sign?

A

Pain

125
Q

What percentage of adults are overweight/obese?

A

69%

126
Q

Nociceptive pain

A

Linked to tissue damage to skin, MSK system, or viscera BUT sensory nervous system is intact

Can be acute or chronic

Mediated by afferent A-delta and C-fibers of sensory system

127
Q

Neuropathic pain

A

Direct consequence of lesion/disease affecting somatosensory system

May become independent of inciting injury, may persist even after healing of injury (“neuronal plasticity”)

128
Q

Central sensitization

A

Alteration of CNS processing of sensation, leading to amplification of pain signals

129
Q

Psychogenic pain

A

Psychiatric conditions that influence pt’s report of pain

130
Q

Idiopathic pain

A

Unidentifiable etiology

131
Q

BMI categories

A 
25-29.9 = overweight
30-34.9 = obese, class I
35-39.9 = obese, class II
40+ = extreme obesity, class III
132
Q

Most important part of physical exam

A

General appearance of pt & vital signs

133
Q

What are the vital signs (4)

A

BP
RR
HR
Temp.

134
Q

“True blood pressure”

A

Avg. BP in several office visits or at home in a 1 week period

135
Q

How to select BP cuff

A

Width of inflatable bladder should be 40% arm circumference

Length of inflatable bladder should be 80% arm circumference

136
Q

Which side of the stethoscope do you listen to BP with

A

Bell b/c Kortkoff sounds are low in pitch

137
Q

Indication for Wong-Baker FACES pain rating scale

A

Children & pts w/ language barriers or cognitive impairment

138
Q

Where is S1/S2 loudest on heart?

A

S1 is loudest at apex

S2 is loudest at base

139
Q

When is “a” wave absent?

A

Atrial fibrillation

140
Q

How many clicks/gurgles is normal in abdomen auscultation?

A

5-34/minute

Physical Exam (1 decks)

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