PE- competency Flashcards
HEENT exam
general inspection
otoscopic ear exam- Tympanic membrane
Gross hearing (finger rub)
weber, rinne
otoscopic nose examsinus palpation/percussion
oral exam
visual acuity
pupil light reflexes direct/inderirect
EOMI ("H") convergence and accommodation
Fundoscopic exam
Palpate lymph nodes, thryoid with swallow and tracheal position/mobilityweber is
lateralization of sound using tuning fork
normal”weber is midline”
rinne
put on mastoid until sound goes away then hold up next to ear and see if sound is still there
weber vs rinne result interpretations
normal AC>Bone conduction
Lung exam
inspect front and back palpate front and back excursion tactile fremitus- multiple spots on back percuss diaphragm excursion anterior 4 points, posterior 6 points, lateral 2 on each side auscultate open mouth 4:6:4 egophony bronchopony whispered pectoriloquy
egophony
say ee. comes out ahh if consolidation
bronchophony
say 99, if clear then consolidation
whispered pecteriloquy
whisper 1,2,3
if loud and clear then consolidation
Abdomen PE
inspect fully exposed auscultate 4 Q, aorta and renal aa percuss 4Q liver span and CVA palpate lightly 4Q deeply 4Q palpate: liver spleen kidneys aorta rebound tenderness rovsings, murphys fluid wave, whifting dullness
rovsings:
deep palpation L LQ if when release pressure pain in RLQ
appendicitis test
murphys
while deep inhale palpate gallbladder
if arrest inhalation from pain- galld bladder test
fluid wave
have patient have hand down midline
ascites
CHF?
shifting dullness
percuss on back then on side to look for ascites
HEart Exam
inspect anterior chest wall, measure JVP palpate PMI, anterior wall for heaves or thrills carotid pulses (1 at a time) radial pulses dorsalis pedis pulses tibialis posterior pulses Ausculate 5 posts bell and diaphragm auscultate carotid aa
auscultate with valsalva
auscultate valsalva at erbs
standing if louder than hypertrophic cardiomyopathy
squatting if louder then aortic stenosis
what does a heave mean? thrill?
heaves is what you see
thrills you feel
what is left lateral decubitus used for?
leaning forward
have them lay on left side and listen to mitral valve–mitral stenosis
leaning forward, they hold breathe and listen to aortic and pulmonic– aortic regurgitation
Mental status exam
appearance/behavior affect/mood language perception/insight executive function short memory
Cerebellar exam
disdiadakokinesia finger to nose tandem walk heel/toe rhomberg pronator drift heel down shin toe proprioception kernigs brudzinski
kernigs test
flex patients hip to 90 then extending knee causes pain in neck or spine
meningeal pain
brudzinski test
flexing patient neck causes flexion of hips and knees
reproduces meningitis HA
rhomberg
proprioception(axial)
pronator drift
proprioception (appendicular)
CN exam
I olfactory II optic (light reflex and EOM) III oculomotor (EOMI) IV trochear EOMI V trigeminal, clench jar and move jaw and eyebrows. VI abducens EOMI VII facial facial expressions VIII hearing IX glossopharyngeal gag and uvula X vagus just say ah XI spinal accessory raise shoulders and resist head turn XII hypoglossal, stick out tongue
PNS
inspect, palpate involved area
soft sensation dermatomes and peripheral cutaneous
vibration, 2pt disc, toe proprio, temperature
DTR: biceps, triceps, brachioradial, patella, achilles
babinski
reinforce upper and lower
Strength: bicep, tricep forearm extensors hip flexor extensor
quads, hamstrings dorsi and plantar flexion
tinels phalens roos adsons straight leg
what are the ratings for DTR and strength testings
DTR 0absent 1hypoactive 2normal 3hyperactive 4hyperactive with clonus Strength 0 none 1 barely 2 active with no gravity 3 active against gravity 4 active with some R 5active against full R
