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
tinels
tap on ventral side wrist for carpal tunnel
phalens
carpal tunnel
Roos
thoracic outlet
adsons
thoracic outlet, compression subclavian aa
straight leg raise
sciatica or piriformis
MSK neck
inspect palpate active or passive ROM up down side side, side bending muscle strength ACM and trapezius
MSK shoulder
insepct, palpate active: flexion, extension, ADuction, ABduction external/internal rotation (Apley) supraspinatus infraspinatus subscapularis
supraspinatus test
empty can
infraspinatus test
resist patient pushing outward at 90 degree robot pose
subscapularis test
lift off
MSK elbow
inspection palpation ROM (active or pssive) flexion/extension pronation/supination ulnar/radial deviation
MSK hand wrist
inspect palpate active or passive ROM: open close fist flexion/extension ADduction/ABduction thumb opposition finkelstein test ulnar collateral lig test first carpometacarpal grind test
first carpometacarpal grind
bones
ulnar collateral lig test
pull thumb backwards ish
finkelstein test
tenosynovitis of thumb abductors and extensors
MSK back
inspect spine
palpate
ROM active or passive: flexion/extension
sidebending
MSK LE- hips
inspect palpate flexion internal/external rotations ADduction/ABduction trendelenburg Thomas Patrick fabere
trendelenberg
medius injury? opp side
stand on one left than the other. if pelvis drops on raised leg side then standing leg affected
thomas hip test
bend legs laying supine,
extend one leg should lay flat if doesn’t then flexion contraction iliopsoas
patrick fabere
supine, cross legs to make a 4 and press knee down
increased ROM SI pathology
MSK knee
inspect palpate flexion/extension anterior/post drawers lachmans varus/valgus- collaterals thessaly mcmurray apprehension palpation for effusion homans and thompson
lachmans
ACL flexed at 15 degree and externall rotated
thssaly
meniscal
apprehension
patella
passively move medially laterally look for pain
What are homans and thompson tests for
homans-passivley dorsiflex and see it pain or discomfort
thompsons- achilles rupture.squeeze calf and look for plantar flexion (lack of flexion indicates injury)
MSK-ankle
Inspect, palpate dorsi/plantar flexion inversion/eversion anterior drawers kleigers
klerigers ankle test
passively externally rotate foot and ankle
+ is pain at deltoid ligament
describe otoscopic exam normal findings
external auditory meatus, redness, swelling lesions etc
TM- color, translcent, bulging or retraction?
describe nose exam
inspection, palpation
redness, septum midline,
mucous membrains pink
descirbe general oral exam results
mucosa description teeth and gums tongue uvula no deviation hard and soft palate colors, plaques?
S4 is heard when, means what
before S1(systole) mitral stenosis
S3 is head when, means what
after S2(diastole) aortic regurgitation
what does an aortic stenosis sound like
crescendo-decrescendo
what doesmitral regurg sound like
plateau murmur
same intensity throughout
JVD? JVP
add 5
40 degree angle
want under 9
what are grades up murmurs
I- not even hear
II- lowintesnsity
III- medium intensity withouth thrill
IV medium intensity with thrill
V- loud with stethoscop on chest with thrill
VI- loudes audible w/o sthethoscope with thrill
crackles/rales
pneumonia, CHF fibrosis
hear in inspiration- nonmusical sounds
wheezes
musical sounds expiration
asthma, COPD bronchitis
rhonchi
lowered pitched, bubbly sounds
secretions in large airways
pleural rub
gratins sound at end of inspiration or beginning of expiration
inflamed or thickened pathologic process
