Physical Exam

Question 1

General components of exam.

Answer 1

HEENT
Neck/Thyroid
Pulm
CV
Abdominal
Extremities
Neuro

Question 2

Components of HEENT exam.

Answer 2

Head - inspect, palpate
Eyes - inspect (sclera, conjunctiva), pupils, EOM, fundoscopy, acuity
Ears - external ear (inspect/palpate), TM, Weber, Rinne
Nose - palpate sinuses, inspect with light
Mouth/Throat - inspect with light/tongue depressor

Question 3

General components of exam.

Answer 3

HEENT
Neck/Thyroid/Nodes (head/neck/axillary/epitrochlear/inguinal)/Trachea
Pulm
CV
Abdominal
Neuro
Extremities/MSK

Question 4

Components of HEENT exam.

Answer 4

Head - inspect, palpate
Eyes - inspect (sclera, conjunctiva), pupils, EOM, fundoscopy, acuity
Ears - external ear (inspect/palpate), TM (otoscope), Weber, Rinne
Nose - palpate sinuses, inspect with light
Mouth/Throat - inspect with light/tongue depressor

Question 5

Components of CV exam.

Answer 5

Carotids - palpate, listen
Suprasternal notch (palpate)
JVD (45 degree angle)
Inspect
Palpate (PMI)
Auscultate
Pulses (carotid, femoral, dorsalis pedis, posterior tibial)
Edema

Question 6

Components of Neuro exam?

Answer 6

MSE
CN
Motor (passive ROM, active ROM, strength)
Reflexes
Sensory (sharp, dull, vibration, position sense)
Cerebellum (FNF, heel shin, rapid alternating movements, Romberg, gait)
Babinski
+/- meningeal signs (neck stiffness, Kernig, Brudzinski)

Question 7

Components of Abdominal exam.

Answer 7

Inspect
Auscultate
Palpate (rebound, liver edge, spleen tip, kidneys)
Percuss liver span
CVA tenderness
+/- obturator sign, psoas sign, Murphy sign

Question 8

Knee tests?

Answer 8

• Lachman test
• Anterior drawer test
• Posterior draw test
• McMurray test
• MCL/LCL stability

Question 9

Shoulder tests?

Answer 9

Adduction, internal rotation
Abduction, external rotation
Neer test
Hawkins test
Drop arm test
O'Brien test

Question 10

Wrist tests?

Answer 10

Tinel
Phalen
Dupuytren contracture
Heberden nodes

Question 11

Elbow exam?

Answer 11

Medial and lateral epicondylitis

Question 12

Hip exam?

Answer 12

Abduction, adduction, flexion, extension

Question 13

Lower back?

Answer 13

Leg raise test

Question 14

Lower back?

Answer 14

Leg raise test

Palpate/percuss spine/paravertebrals

Question 15

HEENT write-up with normal findings?

Answer 15

Head: normocephalic, atraumatic, no lesions/tenderness

Eyes: white sclera, pink conjunctiva, no discharge, EOMI, PERRLA
Fundoscopy: red reflex present, disc round, sharp margins, normal color, vessels normal caliber, no abnormal pigmentation, hemorrhages, exudates, edema, macula visualized

Ears: no lesions, masses, tenderness of external ear, auditory canal without redness, discharge, TMs gray, translucent, with normal light reflex

Nose: pink, no discharge, septum midline, normal turbinates

Mouth/Throat: teeth present and in good dentition, no tongue lesions, moist, no swelling, bleeding, infection, lesions of mucosa, no tonsillar or pharyngeal erythema, exudates, or enlargement

Question 16

Neck write-up with normal findings?

Answer 16

ROM: normal flexion, extension, lateral rotation, tilting
Trachea; midline, mobile
Thyroid: non-palpable or palpable, normal size and consistency, non-tender, no lesions or nodules
Suprasternal notch: no pulsation

Supple, no JVD, no cervical LAD

Question 17

Neck write-up with normal findings?

Answer 17

ROM: normal flexion, extension, lateral rotation, tilting
Trachea; midline, mobile
Thyroid: non-palpable or palpable, normal size and consistency, non-tender, no lesions or nodules
Suprasternal notch: no pulsation

Supple, no JVD, no cervical LAD

Question 18

Lung write-up with normal findings

Answer 18

Percussion: normal resonance to percussion
Auscultation: clear to auscultation bilaterally
No rales, rhonchi, wheezing
No tenderness to palpation
No egophony
Tactile fremitus WNL

Question 19

Heart write-up with normal findings?

Answer 19

No JVD at 45 degrees
Normal upstroke and amplitude bilaterally of carotids, no bruits
Inspection: no lifts, heaves, PMI not visible
Palpation: no parasternal impulses, thrills, PMI palpable in 5th ICS, MCL, normal size
Ausculation: S1 heard best at apex, normal intensity, S2 heard best at base, normal splitting A2>P2, no extra sounds (S3, S4), no murmurs, rubs, gallops, regular rate, rhythm

Question 20

Abdomen write-up with normal findings?

Answer 20

Soft, non-tender, non-distended, no guarding or rebound tenderness, no masses, bowel sounds present, no HSM

No scars, striae

Question 21

Neuro write-up with normal findings?

Answer 21

MS: awake, alert, oriented to person, place, time

CN II-XII grossly intact
Motor: normal tone 5/5 strength in all extremities
Sensory: normal light touch, position sense, vibration, sharp (normal)
Reflexes: 2/4
Negative Babinski
Gait and balance normal
FNF normal, rapid finger mvoements, tandem walking, Romberg etc.

Question 22

Mental status exam + scoring?

Answer 22

1. (5/5) - year, season, date, day, month
2. (5/5) - state, county, city, hospital, floor
3. (3/3) - name three unrelated objects clearly and slowly, ask the patient to repeat these (registration)
4. (5/5) - serials sevens or spell WORLD backwards
5. (3/3) - remembers 3 things (recall)
6. (2/2) - show two objects, name them
7. (1/1) - repeat the phrase “no ifs, ands, or buts”
8. (3/3) - take the paper in your right hand, fold it in half, and put it on the floor.
   9 (1/1) - Please read this and do what it says (“Close your eyes”)
9. (1/1) - Write a sentence about anything (noun and verb)
10. (1/1) Copy a picture (2 intersecting pentagons)