Physical Exam by Organ System

Question 1

HEENT

Answer 1

• Inspect scalp and head for trauma
• Pupils
• EOM, follow finger near
• V1-V3 facial sensation
• Muscles of facial expression
• Ear exam, pull tragus
• Ea nostril
• Palpate sinuses
• Pharyngeal exam; say “ahhh”
• SCM / trap shrug
• LN’s
• Palpate thyroid
• Neck ROM
• Poss fundoscopy (right hand, right eye, right eye)

Question 2

Cardiac

Answer 2

• JVD (45 degrees)
• Palpate carotids and listen for bruit
• Inspect chest wall
• Palpate PMI
• Listen in 4 areas
• Listen to base of heart with pt leaning forward

Question 3

Pulm

Answer 3

• Chest wall expansion
• Percussion bilat
• Listen in front / lateral / back
• “99” bronchophony
• “ee” egophpny
• whispered pectoriloquy
• Axillary LN’s

Question 4

Abdominal

Answer 4

• Listen in 4 quads
• Listen to ab aorta
• Palpate light then deep (ask about pain)
• CVA tenderness
• Liver span with percussion or feel edge

Question 5

MSK

Answer 5

• Pulses
• Edema
• Palpate joints for effusion or tenderness
• Passive ROM
• Active ROM
• Strength
• Reflexes
• Palpate whole spine
• Straight leg test

Question 6

Neuro

Answer 6

• CN
• Oriented x 4 (self, place, time, situation)
• WORLD backwards
• 3/3 recall + clock
• Reflexes (tricep, bicep, brachioradialis, pat, ankle)
• Strength (deltoids, biceps, triceps, hands, quads, hamstrings)
• Sensory - sharp v dull, vibration, movement of fingers/toes
• Babinski
• Romberg
• Gait
• Finger to nose OR rapid alternating movements
• Tremors

Question 7

Psych (mental status exam)

Answer 7

• Alert, orientation
• Appearance
• Behavior
• Affect
• Mood
• Thought process
• Thought content (SI or homicidal ideation)
• Speech (rate)

Question 8

Weber v. Rinne

Answer 8

Weber - place tuning fork in center of head, normal if heard equally, if lateralizes to “bad side” by Rinne then conductive hearing loss, if lateralizes to “good side” by Rinne then sensorineural loss in other ear

Rinne - ask which is louder (air v. bone); want AC > BC

Question 9

Appendicitis

Answer 9

Obturator - pain with R leg internal rotation

Psoas - pain with R hip hyper-extension or flexion

Rovsing - LLQ palpation

Question 10

Special Knee Tests

Answer 10

• Ant / posterior Lachman (stabilize femur and pull tibia forward and backward)
• McMurray - test lateral meniscus with flex/ext knee while internally rotated; test medial meniscus with flex/ext knee while externally rotated

Question 11

Special Shoulder Tests

Answer 11

All for Impingement

• Hawkins - internally rotate shoulder with elbow flexed
• Neer - internally rotate humerus while arm is straight up in air by ear
• Empty Can