physical exam

Question 1

eyes- what do you inspect and for what?

Answer 1

Conjunctivae and sclerae for redness, discharge, jaundice

Question 2

what is accommodation for pupils

Answer 2

Accommodation (or “near”) reflex
1. initiated by shift gaze from far to near
2. three components- ocular convergence, pupillary constriction, lens thickening
3. Efferent limb: GSE and GVE of oculomotor
4. Afferent limb and central conditions
optic nerve–> optic tract–> lateral geniculat nucleu–> optic radiation–> primary visual cortex–> association visual cortex–> optic radiation–> br. of superior colliculus–> superior colliculus–> oculomotor nuclei–> oculomotor nerve

Question 3

what do you inspect when you look at the pupils?

Answer 3

Are they equal in size, are they round, do they react to light

Question 4

what is the swinging flashlight test and what are you looking for?

Answer 4

PERRLA
pupils
equal and
round
reactive to light
and accomodation

Question 5

what is argyll robertson pupil

Answer 5

constriction occurs as part of accommodation reflex, but not in response to light

Question 6

what is the whisper or finger rub test and how do you perform it?

Answer 6

1. whisper test
   -have patient cover opposite ear being tested
   -stand 1-2 ft behind patient and whisper
   -note patients ability to hear sound and repeat
2. watch tick test
   -patient cover opposite ear being tested
   hold ticking watch within 5 inches from ear
   observe patient ability to hear sound

Question 7

what to check for with neck mobility

Answer 7

flexion (head forward)
extension
hyper extension
rotation (to left or right)
lateral flexion

Question 8

what do you look for when inspecting heart

Answer 8

signs of distress
cyanosis, in lips and fingers
diaphoresis

Question 9

Ausculation of heart includes what

Answer 9

check heart rate, is it regular?
do you hear any sounds not normal?
listen to one more area

Question 10

where is aortic area, tricuspid area, pulmonic area, mitral area

Answer 10

aortic 2nd rib right side
tricuspid across from aortic
pulmonic lower than tricuspid
mitral lower and more lateral than pulmonic

Question 11

what to look for when you inspect abdomen

Answer 11

contour
scars
lesions
pulsations or other movement

when you auscultate- look for bowel sounds

Question 12

how to describe bowel sounds

Answer 12

Frequency
- absent, present, increased

Intensity
- normal, loud

Quality
- high pitched, musical, tinkling
-normal
-rumbling, gurgling rushes (borborygmi)

Question 13

when you palpate abdomen, what do you feel for?

Answer 13

tenderness
organomegaly- abnormal enlargement of organs

Question 14

for musculoskeletal exam, what do you inspect?

Answer 14

Gait
movement and activity
deformity
posture

Question 15

for neurologic exam, what do you inspect

Answer 15

Gait
balance
strength
tremors

Question 16

what does the cerebellum do? what are the 3 tests for it?

Answer 16

Assesses balance and coordiantion by:

Gait
walk the line (heel to toes)
romberg test- arms by side standing- will have little movement even with eyes closed for 20 seconds

Pronator drift- standing with eyes closed - hold arms out in front of you with palms up, then tap palms of hands- ok if patient cand hold balance

tandem balance- 1 foot whtout loosing balance (5 seconds) than hop 1x

finger to nose

rapid alternating movement

Question 17

how to test strength in neurologic exam

Answer 17

cross 2 fingers on each hand and have partner squeeze them tightly (crosssed fingers minimizes pain for examiner)

Question 18

how to test for tremors in neurologic exam

Answer 18

partner hold out hand- place piece of paper on lightly on hand and watch for paper vibrating or have them copy a spiral

Question 19

psycologic exam, what do you observe for?

Answer 19

alertness, mood and affect, hygiene, behavior

thought process- description of quality, tempo and form (logical coherence of thought)

thought content- describe patients delusions, overvalued ideas

perceptual distrubances- describe of disruption of ones organization, identification or interpretaion of sensory information

Question 20

how to test radial pulse

Answer 20

• Regular vs irregular
• If regular-count rate x 30 seconds, multiply x 2
• If unusually slow or fast-count for full 60 secs
• If irregular, listen and count at cardiac apex
• Normal HR (adult)= 60-100 beats per minute

Question 21

how to test respiratory rate and rhythm

Answer 21

• Count for 1 minute
  o visual inspection
• Observe effort of breathing for any distress
• Normal RR (adult) 12-20 breaths/minute

Question 22

Use medical terminology to describe your partner’s skin:

Answer 22

• Jaundice
• Lesions
• Bruising
• Trauma
• Signs of infection/inflammation
  o Erythema
  o Induration
  o Warmth
  Check skin turgor