Physical Exam

Question 1

Hand hygiene

Answer 1

Alcohol: recommended for routine patient encounters

Soap + water: when hands are visibly dirty, or following exposure to spore-forming pathogens (i.e. C diff)

Question 2

Opthalmoscope

Answer 2

AKA a fundoscope.
For good patient encounters, look at the right eye of the patient with your right eye. This makes things less awkward.
Half-light= good for patients with cataracts
Blue light= good for monitoring corneal abrasions

Question 3

Otoscope

Answer 3

• Looking at the ear to visualize the tympanic membrane
• Kiddos < 12 mo: pull the outer ear down and back
• Kiddos > 12 mo: pull the ear up and back.

Kiddos less than 12 months old are short (down), adults are tall (up).

• Stop at any signs of pain

Question 4

Measuring blood pressure

Answer 4

Laminar flow= no resistance.
Turbulent flow= audible, this is what happens to blood when you add a BP cuff.

Ausculatory gap –> common with atherosclerosis.

Question 5

Falsely elevated BP

Answer 5

1) Brachial artery is below the heart

2) Cuff is too small or too large on a large arm.

Question 6

False hypotension

Answer 6

1) Brachial artery is above the heart

2) Cuff is too large on a small arm

Question 7

Integument exam

Answer 7

Skin: Color, uniformity, thickness, symmetry, hygiene, lesions, odor

Hair: Color, distribution, density, texture, hygiene, fragility

Nails: Pigmentation, length, symmetry, surface changes

Question 8

Gait cycle (classic terms)

Answer 8

1) Heel strike
2) Foot flat
3) Mid-stance
4) Heel off
5) Toe off
6) Midswing

Question 9

Gait cycle (new terms)

Answer 9

I Love Multiple Tiny Pizzas In My Tummy

1) Initial contact
2) Loading response
3) Midstance
4) Terminal stance
5) Preswing
6) Initial swing
7) Mid-swing
8) Terminal swing

Question 10

Fundoscopic exam

Answer 10

Uses opthalmoscope

Question 11

Weber-Rinne test

Answer 11

WEBER: place tuning fork on top of head and ask pt which ear it is loudest in.
Normal: heard in both ears equally.
Conductive loss: Sound will loudest in affected ear.
Sensorineural loss: Sound will be loudest in opposite ear.

RINNE: Place tuning fork perpendicular to ear (to test air conduction = AC), then place it on the skull above the ear (bone conduction).
BC>AC or BC=AC: Conductive hearing loss.
AC < BC: Sensorineural loss.

Question 12

Components of the patient-centered treatment model

Answer 12

1) Patient’s role is active, they ask the questions.
2) Patient is a partner in the tx plan (not the recipient of treatment)
3) Physician collaborates with the patient
4) Care is quality-of-life centered
5) Physician listens more and talks less
6) Patient is more likely to adhere to treatment plan

Question 13

Patient centered interviewing technique

Answer 13

1) Set the stage for the interview
2) Ask about the chief complaint and set an agenda for the visit
3) Ask open ended questions for the HPI
4) Continue the patient-centered HPI with focused, but open-ended questions to obtain more description (how would you describe the pain vs. is it sharp?)
5) transition to the clinician-centered process (summarize conversation to confirm you haven’t missed anything).

Question 14

Festinating gait

Answer 14

Seen in Parkinson’s. Patient is in the stance phase. Short quick steps. Flexed at trunk. Altered center of gravity.

Question 15

Lateral gravitational line

Answer 15

External auditory canal
Lateral head of the humerus
Third lumbar vertebrae
Anterior third of sacrum 
Greater trochanter of the femur
Lateral condyle of the knee
Lateral malleolus

Question 16

Limit of drinks each week

Answer 16

14 per week for men

7 per week for women

Question 17

A 21 year old trans-male presents to the clinic with complaints of abdominal pain. What should be on your differential?

Answer 17

This patient is female –> male transition… Need to think if they are still “biologically female”, because this can change your ddx.

Question 18

Dislocation vs. subluxation

Answer 18

Dislocation: Complete lack of contact between two articular surfaces

Subluxation: Residual contact between two articular surfaces.

Question 19

Questions re: alcohol use

Answer 19

CAGE:
Cut back
Annoyed when people talk about your drinking,
Guilty about drinking habits
Eye opening (that you need a drink in the am).

AUDIT: Alcohol use disorders identification test
More sensitive, but more time consuming.

Question 20

FICA

Answer 20

Faith: Do you consider yourself religous?
Importance: What importance does your spirituality have in your life.
Community: Are you part of a spiritual community.
Address in A/P: How would you like me, as your hc provider, to address these issues in your life?

Question 21

SAFE

Answer 21

Screening for domestic violence
Stress/safety
Afraid/abuse
Friends/family
Emergency plan

Question 22

Direct vs. consensual pupillary reflex

Answer 22

Direct: When light is shined in one eye, that eye constricts

Consensual: When light is shined in one eye, the other eye constricts.

Question 23

20/40 vision

Answer 23

This is bad (vision is ~ 50% of normal).

Patient can read something that is 20 feet away, while the average person can read it from 40 feet away.