Physical Exam Flashcards
Do any patient complaints belong in the PE?
No
If a patient says their abdomen feels very painful, can you automatically document “abdominal tenderness” in the PE? Why or Why Not?
No. it is subjective.
Which of these two physical findings could a physician appreciate without auscultating patient lungs:
a) No respiratory distress
b) No rales
a) No respiratory distress
What does PEERL stand for?
Pupils are equal, round, and reactive to light
What does NAD stand for?
No acute distress
What does AT/NC mean?
atraumatic/normocephalic
If a pt has pale conjunctiva, what does that indicate?
GI Bleed
What is scleral icterus, and what does it indicate?
yellow sign of liver failure
Name an instrument a physician may use to closely investigate the eyes.
Ophthalmoscope
In which body system would you document “TM erythema and bulging”?
ENT
What is the medical term for nostril?
Nares
To describe a “runny nose” would the doctor use the word “epistaxis” or “rhinorrhea”
Rhinorrhea
What would dry mucous membranes indicate?
dehydration
Why is midline body tenderness “worse” than paraspinal tenderness?
Bony tenderness (aka vertebral point tenderness) points toward a spinal fracture and therefore concern for spinal cord injury. paraspinal tenderness points toward a muscle sprain or strain
If you saw “RRR” written in the cardiac exam, what do you think it might mean?
Regular Rate & Rhythm
If the physican checks the pulse on the right right wrist and says “The pulses are fine”, what would you document in the physical exam?
Right Radial pulse is 2+
Name the rhythm that the physical would hear if the patient was in Afib
Irregularly Irregular
Name two “Peritoneal signs” in the abdominal exam
- Voluntary Guarding
- Rebound Tenderness
- Rigidity (Involuntary Guarding)
What abdominal exam sign is indicative of Cholecystitis
Murphy’s Sign
If a doctor takes 1 finger and presses in a specific spot in the RLQ, what is the name of the finding they are investigating
McBurney’s point tenderness
Which of these findings is NOT a peritoneal signs?
Guarding, Rebound, Tenderness, Rigidity
Tenderness
What would a “Guaiac positive” stool sample diagnose
GI Bleed
What phrase do you have to document in the GU exam for every female pelvic exam performed by a male physician?
Female Chaperone Present
What is bony tenderness a sign of?
Bone deformity, fracture, or injury
What is CVA tenderness?
Flank tenderness (costovertebral angle tenderness). Tenderness over the kidneys
What is fluctuance a sign of?
Abscess
What is the difference between a laceration and abrasion
Laceration-incision in the skin that typically need sutures
Abrasion-scrape of the skin
What procedure is associated with a laceration, but not an abrasion?
Laceration Repair, Sutures
What does A & Ox3 mean?
Alert and oriented to person, place, and time
What section of the neurological exam would you document “Normal Finger-Nose-Finger test” and “Normal Heel to Shin”?
Cerebellar/Coordination
What does DTR stand for?
Deep Tendon Reflex
Point to the general area of your body that Cranial Nerves control.
Face
In the Neurological exam, what does “Normal gait” mean?
Walking normally
In the psychiatric exam, what do SI and HI stand for?
Suicidal and Homicidal ideations
is the Glascow Coma Scale associated with Trauma its or Medical patients
Trauma
Would you document “RUE strength 3/5” under the Neurological or Extremities section of the exam
Neurological
What would you guys TTP means?
Tender to palpation
A mother states her child has been extremely tired and drowsy recently; based on that, can you document “Lethargic” in the child’s physical exam?
No!
Spell the medical term for Hives (allergic reaction rash)
Urticaria
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 focal neurological deficits”?
No. Contradiction
If you documented “NAD” in the constitutional section, would you be contradicting yourself if you wrote “There is mild respiratory distress” in the pulmonary exam?
Yes
