Physical Exam

Question 1

Abdominal Exam

Answer 1

wash hands

inspect and then feel for ventral, inguinal, and femoral hernias

ausculate for bowel sounds anywhere for 15 seconds

then listen one once above and lateral to umbilicus for bruee

light palpations in eight spots, looking for facial grimaces and asking if any tenderness

two hand rolling deeper palpation of eight locations, again looking and patient and asking if any tenderness

special palpations of liver with patient breathing deep, starting low in abdomen working way up

percuss the liver, starting at top of chest, moving down until not resonate

percuss for speen, starting low on abdomen, with patient breathing deep.

percuss four quadrants

femoral pulses, as times with radial pulse

CVA tenderness

special tests:
Murphy’s sign for gallbladder

Obturator sign for appendicitis - turn on side, extend hip

Rovsing’s sign: + RLQ pain on LLQ palpation

Psoas sign: + RLQ pain when flexing hip against resistance

Question 2

Cardiac Exam

Answer 2

wash hands

inspect

listen for closing snap for mechanical valve

are they ill , cyanosis to rest

capillary refill (2 seconds)

clubbing (hold fingers together)

splinter hemorrhages

tobocco

janeway palms

palpate radial pulse (rate and rhythm)

feel for collapsing pulse

brachial pulse in fold of arm

jvd

hepatic reflex

inspect face for xanthalesma

eyelids for anemia

mouth for central cyanosis and hygiene

cardiac pulses (look for slow rising pulse)

inspect chest for malformations and scars

feel for apex (5th space mid clavicular)

palpate for heaves on right sternal borders

palpage for thrills at each four locations

osculate the apex for both heart sounds

osculate each valvular area

listen for mitral stenosis with bell with patient lying on left hand side, then in axilla, with deep breaths

listen to carotids with diaphragm, holding breath

aortic regurge with bell with patient leaning forward, holding breath

auscultate lungs, deep breaths

sacral edema

ankle edema

Question 3

Lung Exam

Answer 3

wash hands

press on chest looking for pain

press on back looking for pain

look of symmetry of breathing from back with deep breaths

fremmetus (“toy boat”) four locations both heads

percuss back in 10 locations (under arm too)

auscultate 10 locations with deep breaths

pull out foot rest, lay patient down, drape legs, pull gown down, listen to top two locations

ask patient to hold breast up and do two more locations

fremitus two locations (“two boat”) on front

percuss four locations

measure jvd (with 2 measuring sticks)

check hepatojugular reflex

Question 4

EENT

Answer 4

wash hands

open and close eyes

look up and to right then up to left while shining light to look and conductive

pupilary reflexes, both direct and indirect

extraocular movements ( tell me if you see double) six locations

then to center and nose looking for accommodation

opthalomoscope, round circle aperture, + 10 diopters, power to 80%. , ask patient to look at spot on wall

otoscope - inspect behind ear, and pinnae, pull back gently on pinnae, hold it horizontally so you can brace with little tiger.

nasal exam with pin light while compressing the tip a little

oral exam - tongue blade in dominant exam, pin light in left hand. look at gums, soft palate, under tongue, tongue in cheek, look at sides, say ah,

Thyroid exam with swallowing

Question 5

Knee Exam

Answer 5

wash hands

look. have patient stand, expose knee, and rotate 90 degrees, four times. looking for scars, symmetry, deformities, baker’s cyst,

watch them walk, turn around, and walk back

lie down on bed

feels knees, temperature comparing both using back if hands

access for fluid. squish from top down above knee, then with other hand press for effusion

bend knee 45, palpate medial aspect then lateral aspects for pain, then behind knee

then check rom,

first active flexion, then passive flexion

hyperextension of knee by picking up leg at foot

anterior and posterior drawer

lateral ligament test

Question 6

Brief Torso Exam

Answer 6

Use for back pain, rash, depression, mental status change, fatigue, extremity problem(s)

Listen to four places on back

listen to four places on heart

retie gown

check bowel sounds (3 seconds)

palpate four quadrants

Question 7

Brief Neurological Exam

Answer 7

headache, mental status change, dementia, or head trauma ( feel free to leave stuff off)

• mental status (person, place, time)
• cranial nerves, 2,3,4,6,7,9,10,12, and 5. do 5 last, “clench your teeth”, then check 5th sensory with cotton ball
• sensory exam: tip of third finger both hands, and where great toe and second toe meet. check both sides at same time.
• motor strength - test both sides of upper extremity at once. “squeeze my fingers, pull me in, kick out.
• DTRs brachial and patellar only
• Cerebellar: Gait

Question 8

Mini Mental Status

Answer 8

• person, place, date
• remember 3 things (ball, flag, tree)
• count back from 100 subtracting 7 (93,88,
• spell world backwards (dlrow)
• say the three remembered things