physical exam Flashcards
what belongs and doesn’t belong in the physical exam?
Belongs: what the clinician inspected, what they saw, heard, felt, and smelled
Doesn’t belong: symptoms, (headache, nausea, etc), medical history (HTN, DM, etc), diagnoses (appendicitis, cellulitis, etc), anything not inspected
which of the following would the provider do to listen to the lungs?
palpate, auscultate, inspect, computate
auscultate
The clinician did not use a stethoscope during the exam. What does not belong in your physical exam?
alert, lungs clear to auscultation, awake, heart regular rate and rhythm, no distress
lungs clear to auscultation and heart regular rate and rhythm
do any patient complaints belong in the physical exam?
no
what is meant by palmar aspect and give an example
palm of the hand
ex. no rash on the palmar aspect of the right hand
what is meant by plantar aspect and give an example
sole of the foot
ex. pain present in the plantar aspect of the left foot
match the body systems with the PE findings
constitutional, neck, skin, gastrointestinal, respiratory, cardiovascular
alert and oriented, no wheezing, tachycardic, epigastric tenderness, warm and dry, no jugular vein distention
alert and oriented - constitutional
no wheezing - respiratory
tachycardic - cardio
epigastric tenderness - gastrointestinal
warm and dry - skin
no jugular vein distention - neck
what are the normal values for the following vital signs and what are the names of their abnormal conditions:
BP, Pulse Rate (PR or HR), Respiratory Rate (RR), Temp, oxygen saturation (SpO2)
BP: 120/80, hypertension and hypotension
PR/HR: 60-100 bpm, bradycardic and tachycardic
RR: 12-18, bradypneic and tachypneic
Temp: 98.6 F, hypothermic and febrile (>= 100.4F)
SpO2: >96%, hypoxic if low
describe what is being investigated in the constitutional BS, and the normal and abnormal findings you could expect to find
investigating the distress level and general appearance of the pt. investigated visually
normal: - no acute distress (NAD); - well developed, well nourished, - alert
abnormal: - mild/moderate/severe distress due to the pain or respiratory difficulty; - cachectic/emaciated/malnourished; - somnolent (sleepy), obtunded (blunt/dull to sensitivity), unresponsive
describe what is being investigated in eye portion of the PE, and the normal and abnormal finding you could expect to find
investigating pupils, sclera, conjunctiva and movement visually by either shining light on pt’s eye or pt tracks finger
normal: - PERRL; - EOMI; no nystagmus (shaking of eyes); - sclerae anicteric (white); - normal conjunctiva
abnormal: - fixed and dilated; - EOM entrapment; - nystagmus; - sclera icterus (yellow); - pale conjunctiva, conjunctival injection, or discharge/crusting
What does PERRL stand for
pupils equal, round, reactive to light
what does EOMI stand for
extraocular movements (EOM) intact
what are possible ddx for fixed and dilated pupils
stroke, tumor, brain injury, congenital
what are possible ddx for nystagmus
inner ear problems, alcohol or drugs, abnormal brain conditions
what is a possible reason for scleral icterus
yellowing of eye, common in liver failure
what is a cause of pale conjunctiva
anemia
what is a cause of conjunctival injection
conjunctivitis
what is being investigated in the ENT section of the PE
outer ear, inner ear (assess w ophthalmoscope), nares, dentition, oropharynx
describe a few normal and abnormal findings in the ear portion of the PE
normal: - tympanic membranes (TMs) normal; - no canal swelling or tenderness
abnormal: - TM: erythema, effusion, bugling, dullness, obscured by cerumen; - canal swelling or tenderness
what is a cause of TM erythema, effusion, bulging, or dullness
otitis media
what does erythema mean
redness or reddening of the skin
what is a possible reason for ear canal swelling or tenderness
otitis externa (swimmer’s ear)
describe the normal and abnormal findings possible in the PE for the nose
normal: - no discharge; - normal nasal mucosa; - no active bleeding
abnormal: - clear or yellow discharge; - boggy turbinates / swelling of the nasal mucosa; - site of bleeding identified
what are some possible abnormal findings in the oropharynx? what could cause them?
- pharyngeal erythema: pharyngitis
- exudates (fluid released from BV into tissues, ie. pus): pharyngitis or tonsillitis
- tonsillar hypertrophy (swollen tonsils): tonsillitis
- tonsillar asymmetry: tonsillitis
- uvular shift: peritonsillar abscess
what are some possible abnormal dentition findings
- edentulous: no teeth
- dental caries: cavities
- gum tenderness or edema: infection
what can be a reason for dry mucous membranes?
dehydration
match the following abnormal eye findings with the common ddx
-conjunctivitis, anemia, liver damage/failure
-scleral icterus, pale conjunctiva, conjunctival injection
conjunctivitis–>conjunctival injection
pale conjunctiva –> anemia
scleral icterus –> liver failure/damage
what is being investigated in the neck portion of the PE
lymph nodes, thyroid, carotid artery, jugular vein, vertebrae, muscles
what is meant by a “supple” neck
the neck is easily bent
what is meningismus
nuchal rigidity (aka neck stiffness),
what are the 2 reasons for neck tenderness when palpated?
vertebral point = fracture of the spine
paraspinal tenderness = muscle strain
what is meant by cervical lymphadenopathy
lymphadenopathy is the swelling of the lymph nodes due to infection
what is jugular vein distention (JVD)
JVD refers to the bulging of the major veins in the neck, often caused by heart failure or circulatory problems
what is carotid bruit? what causes it? how is it investigated in the neck?
a vascular sound heard by auscultation of the neck with a stethoscope because of the turbulent (= not flowing smoothly), non-laminar blood flow through the carotid artery. carotid bruit can be a symptom of carotid artery stenosis
- normal for no carotid bruit
name the rhythm that the physician would hear if the patient was in Afib
irregularly irregular rhythm
what is RRR?
regular rate and rhythm (heart)
what are some examples of abnormal heart sounds and their ddx?
murmurs, rubs (ddx - pericarditis), gallops (ddx - ventricular failfure or hypertrophy), extrasystoles
what is the difference between tachycardia and bradycardia?
tachycardia = fast HR >100 bpm
bradycardia = slow HR <60 bpm
what is considered a normal capillary refill? abnormal?
normal - less than 2 seconds
abnormal - delayed, > 2 seconds
describe the scale used for intensity of pulse. what is considered normal? what are the pulse locations?
intensity is rated on a scale of 0-4. pulse can be found in specific locations such as carotid (neck), radial (wrist), femoral (groin), dorsalis pedis (top of foot), posterior tibial (back of ankle)
0 = absent pulse
1+ = barely palpable
2+ = NORMAL, easily palpable
3+ = full
4+ = bounding/aneurysmal
which of the following are contradictions?
A. neck supple and rigid
B. oropharynx is normal, mild tonsillar exudate
C. tachycardia and regular rate and rhythm
D. heart sounds normal with 2/6 murmur
E. pulses equal and easily palpable
a, b, c, d
what are some examples of abnormal auscultation breath sounds
diminished breath sounds, wheezes (COPD or asthma), rales/crackles (CHF), rhonchi (PNA)
what are some examples of abnormal respiratory function that can be observed visually
mild/moderate/severe respiratory distress, tachypnea (breathing too fast), accessory muscle use, pursed lip breathing (can be caused by emphysema)
what kind of abnormalities can be determined by palpating the abdomen?
rigidity, tenderness (mild/moderate/severe), peritoneal signs, organomegaly (enlarged organs) such as hepatomegaly or splenomegaly
what are the peritoneal signs
guarding, rebound, rigidity; signals inflammation of the peritoneum (inner abdomen)
what can palpating the RUQ indicate?
if accompanied by pain, can indicate positive Murphy’s sign which signals cholecystitis
what can palpating the RLQ indicate?
positive McBurney’s point (if tender) which points to appendicitis
what do providers listen for when they auscultate the abdomen?
normal bowel sounds. abnormal = absent/hyperactive/hypoactive bowel sounds
match the illness with the abdominal quadrant it belongs to:
RUQ, RLQ, epigastric
appendicitis, cholelithiasis, GERD
RUQ–>cholelithiasis
RLQ–>appendicitis
epigastric–>GERD
what can costovertebral angle (CVA) (flank)tenderness indicate?
the CVA is 90 degree angle formed between the curve of the 12th rib and the spine. tenderness here can mean renal calculi or pyelonephritis
what can palpating a specific area of the T-spine or L-spine indicate?
paraspinal tenderness (muscle injury) or vertebral point tenderness (spinal injury)
what is bony tenderness a sign of?
bone fracture, deformity, or injury
what is soft tissue tenderness a sign of?
contusion or strain
what can calf tenderness indicate?
DVT
what is a possible cause of edema in the extremities
CHF
what is the purpose of palpating distally to a specific concern area
to check the distal CSMT (circulation, sensory, motor, tendon) of the area
describe some visual skin abnormalities that can be observed during a physical exam
diaphoretic (sweating), color, urticaria/wheals/maculopapular rash (hives), petechiae (pinpoint, red spots rash resulting from bleeding), induration, fluctuance, purulent drainage
what does purulence mean
purulence is used to describe pus-like as in an abscess
describe the different types of skin discoloration
jaundice - yellow, caused by liver failure/damage
cyanotic - blue, caused by hypoxia (low O2)
pallor - pale, caused by anemia
match the finding with the pathology
- cellulitis, dehydration, abscess, CHF, fracture, allergic rxn
- urticarial rash, dry mucous membranes, induration, bilateral pedal edema, bony tenderness, fluctuance
cellulitis–>induration
dehydration–>dry mucous membranes
abscess–>fluctuance
CHF–>bilateral pedal edema
fracture–>bony tenderness
allergic rxn–>urticarial rash
what does A&Ox4 mean? how is it investigated?
alert and oriented to person, place, time, and situation; conversing with pt and asking the questions: what’s your name? where are you? what year is it? why are you here?
what are some examples on non-alert patients
somnolent (drowsy), confused, responsive to voice or painful stimuli, unresponsive to voice and pain
what are some abnormal speech patterns observed in the PE
aphasia (expressive or receptive) (inability to understand speech), dysarthria (difficulty speaking due to inability to control facial muscles) both result of brain damage
how can a provider determine the status of cranial nerves 2-12?
varies, provider will specify. examples include visual field loss, unequal pupils, facial droop, EOM palsy, or facial hypoesthesia (loss of sensation)
how is motor strength measured in a PE
grip or lower extremity strength is felt by the clinician and rated out of 5
5/5 = normal, 4/5 = very mildly weak, 3/5= unable to overcome resistance, 2/5 = unable to overcome gravity, 1/5 = slight contraction, no movement, 0/5 = flaccid, limp
what is pronator drift
pt closes their eyes and extends their arms anteriorly to 90 degrees with palms facing up. they hold this position for 20-30 seconds and neurological function is observed based on the position of the arms after the 30 seconds. if they remain equal and unchanged, then neuro function is normal. if one or both arms drift down, then pronator drift is present and there is neurological dysfunction
how are reflexes tested in a PE
clinician uses a rubber mallet to strike different points on the body and observes response. points include tricep, bicep, brachioradialis, patellar, achilles. measured on scale of 0-4
0 = absent, 1+ = hypoactive, 2+ = normal, 3+ = increased, 4+ = unsustained clonus
what is characteristics are measured when the physician asks the patient to walk
observing gait (walking stride). ataxia = uncoordinated; antalgic = walking to avoid pain
true or false: nystagmus is only observed and documented in the eye exam
false, also documented in the neurological - cerebellar exam
what is dysmetria? How is it investigated in a PE?
an inability to control the distance, speed, and ROM necessary to perform smoothly coordinated movements. tested by finger-to-nose and heel-to-shin
what is Romberg’s test
a test used to determine balance issues by standing with arms outstretched and eyes closed. if an swaying occurs then there is a balance issue
what does AT/NC mean?
atraumatic/normocephalic
in which body system would you document “TM erythema and bulging”
Ears
to describe a ‘runny nose’ would the doctor use the word “epistaxis” or “rhinorrhea”?
rhinorrhea
why is midline bony tenderness “worse” than paraspinal tenderness?
because it likely means an injury or fracture to the vertebral column and spinal cord injury, paraspinal tenderness points towards a muscle sprain or strain
If the physician checks the pulse on the right wrist and says “the pulses are fine”, what would you document in the PE:
a. wrist pulse 5/5, right
b. radial pulse OK
c. right wrist pulse is fine
d. right radial pulse is 2+
d. right radial pulse is 2+
bc in the pulse scale, 2+ is a normal rating, 5/5 is used to measure muscle strength
what abdominal exam sign is indicative of cholecystitis?
murphy’s sign
what is fluctuance a sign of?
abscess
how do you document normal reflexes?
reflexes are 2+
what section of the neurological exam would you document “normal Finger-nose-finger test” and “normal heel-to-shin”?
cerebellar/coordination
what general area of the body do cranial nerves CN control
face
what is normal GCS
glascow coma scale, 15 is normal
how do you document normal strength?
on a scale of 5/5
what would you guess “TTP” means (ie. TTP in the RUQ)
tender to palpation
what is the medical term for swollen lymph nodes?
lymphadenopathy
if you document “there is right pronator drift” in the neurological exam, can you also document “no FNDs”?
no, contradiction
