Physical Exam Lecture Flashcards
What are the 7 vital signs, according to the Diff Dx Physical Exam lecture?
Pulse Respirations Pulse oximetry Blood pressure Core body temperature Skin temperature Pain
What is one looking for when conducting inspection and palpation?
Texture, mobility or movement Location, size, position, alignment Color Shape, contour, symmetry Tenderness Temperature
What are the palpation depths for light and deep palpation?
Light = up to ½ inch
Deep = up to 1 inch
What does the “5 students and 5 teachers around the CAMPFIRE” stand for (Could only find 6 students and 3 teachers online)
Site, Size, Shape, Surface, Skin, Scar Tenderness, Temperature, Transillumination Consistency Attachment Mobility Pulsation Fluctuation Irreducibility Regional lymph nodes Edge
What does pallor mean and what might it indicate?
pale; decreased pigmentation;
possibly from blood abnormality or liver
disease
What does cyanosis mean and what might it indicate?
Blue skin from decreased oxygen delivery
What does jaundice mean and what might it indicate?
Yellow, orange, or green skin; excess billirubin
What does rubor mean and what might it indicate?
Dusky red from arterial insufficiency from
PVD
What does hyperpigmentation mean and what might it indicate?
Darkened skin; Addison’s disease, pregnancy
What additional considerations might one have to make when assessing dark skin?
Observe palms of hands and soles of feet;
tongue, lips and gum; sclera and conjunctiva
of eyes
Pallor may present as yellow or ashen-gray
Skin rashes – check for texture changes
Edema may lighten skin
Inflammation – check temperature
Normal oral mucosa may appear freckled
Petechiae – check areas with lighter skin such
as abdomen, gluteal area, volar aspect of
forearm
Differentiate petechiae from erythema
Pressure causes erythema to blanch but no
change in skin if petechiae or bruising
How are benign and malignant skin lesions different in terms of shape?
Benign: Symmetric
Malignant: Asymmteric
How are benign and malignant skin lesions different in terms of borders?
Benign: Distinct/smooth
Malignant: Indistinct/irregular
How are benign and malignant skin lesions different in terms of color?
Benign: Uniform
Malignant: Varied/black
How are benign and malignant skin lesions different in terms of size?
Benign: < 6 mm
Malignant: > 6 mm
How are benign and malignant skin lesions different in terms of consistency?
Benign: Soft to firm
Malignant: Firm to hard
How are benign and malignant skin lesions different in terms of friability?
Benign: None
Malignant: Often
How are benign and malignant skin lesions different in terms of ulceration?
Benign: Seldom
Malignant: Often
How are benign and malignant skin lesions different in terms of mobility?
Benign: Mobile
Malignant: Mobile or non-mobile
How are benign and malignant skin lesions different in terms of rate of change?
Benign: Slow
Malignant: Slow or rapid
Which aspects of skin lesions are most important?
Irregular borders more important than size
Spot of blood may be basal or squamous
cell
Describe a spider angioma
fiery red, radiating “legs”; small up to 2 mm; associated with liver disease,
pregnancy, estrogen therapy
Describe a cherry angioma
fiery red, round, smooth borders; small up 3 mm
Describe a xanthoma
Benign fatty fibrous yellow plaques or nodules in subcutaneous layer; intracellular accumulation of cholesterol Occur with: Aging Disorders of lipid metabolism: primary biliary cirrhosis uncontrolled diabetes May occur with leukemia, lymphoma, or myeloma
What are the risk factors for melanoma?
Prolonged sun exposure Pre-malignant skin lesions Family history Previous history of melanoma Caucasian – fair skin, blond hair, red hair, blue eyes
What are the risk factors for basal cell carcinoma?
Family history Immunosuppression Prolonged sun exposure Characteristics – depressed center surrounded by raised, firm border
What are the risk factors for squamous cell carcinoma?
Prolonged sun exposure Pre-malignant skin lesions Radiation therapy Local exposure to tar and oil Characteristics – scaling, crusty nodules or plaques
What follow-up questions should be asked if a concerning skin lesion is found?
Is patient aware of it? Any associated signs and symptoms? How long present? Has it changed? Is doctor aware? Has doctor seen it?
What are Terry’s nails?
Nail bed is white for more than 2/3 of its length
Common with cirrhosis and hypoalbuminea
What is Spoon nail?
Refers to a concavity in the fingernail itself, resulting in a depression in the nail that gives an appearance of a spoon shape to the entire nail. The spooning is typically such that a water droplet may be placed and held in the depression within the nail.
Found in pt’s with iron deficiency
What condition is relatively common if nail bed pitting is observed?
Psoriasis - found in 50% of these pt’s
What are Mee’s lines?
A white discoloration of the nail plate that form transverse lines across the nail.
Found in patients after arsenic poisoning, also found in renal failure, heart disease, pneumonia
What are half-and-half nails?
White proximal portion with a brownish distal portion, the latter being more than one third of the nail plate.
Indicates chronic renal failure
What does the term clubbing mean with respect to nail inspection?
Broadening of the distal appendage with an increased Lovibond’s angle
What are Beau’s lines?
Transverse depressions in the nail
Found in pt’s with a severe systemic issue - high fever, infection, renal disease, hepatic disease
What are key facts to remember when examining lymph nodes?
Normally not visible or easily palpable (pea
size)
Enlarged >1 cm due to: Infections, allergies, viruses, allergies, THA, cancer
Hard, immovable, and tender = concern for
cancer
Palpate lightly
What is the appropriate sequence for abdominal exam activities?
Inspect
Auscultate
Percuss
Palpate
What would a flat percussive sound indicate?
solid, dense tissues like anterior thigh
What would a dull percussive sound indicate?
solid organs such as liver, heart, diaphragm, spleen
What would a resonating percussive sound indicate?
lung when clear, dull if congested or mass; hyperresonance with emphysemic lung
What would a tympanic percussive sound indicate?
gastric bubble, bowel
What is the Patellar-pubic percussion test?
A form of Osteophony or auscultatory percussion which is used in the assessment of bone integrity by analyzing its vibrations through the use of a stethascope and bony prominence percussion. The patient is positioned in supine and the bell of the stethascope is placed on the pubic symphysis, held in place by the patient. The patient’s legs are positioned symmetrically and extended while the clinician percusses each patella. The clinician stabilizes the patella, insuring that the leg being tested remains in the neutral position. The clinician compares the sounds from each leg for differences in pitch and loudness. These sounds should be equal in the case of normal bony structure. If there is a bony disruption, the affected side will have a duller, more diminished sound when compared to the unaffected side.
How useful are the results of a Patellar-pubic percussion test?
High Sp (0.86) and Sn (0.96) A positive test warrants advanced imaging
Above stats with respect to a study looking for occult femoral neck fx
What is the fulcrum test?
for femoral shaft stress fractures; pt sitting PT forearm under area of thigh pain, gentle dorsal pressure on distal femur
What is the axial percussion test?
for compression fracture; finger or reflex hammer tapping of spinous process (except if suspect fracture there)
What is asterixis?
liver flap; have patient extend arm, spread fingers, extend wrist; positive if hand flaps
What is Murphy’s percussion?
Direct or indirect, ulnar surface of fist over kidney area; vibration reproduces pain
What is Murphy’s sign?
Hook fingers around right anterior lower rib cage, patient inspires; exquisite tenderness = possible acute cholecystitis
What is Blumberg’s sign?
rebound tenderness; palpate deeply and slowly away from suspected area, remove quickly; pain experienced on side of inflammation
What is the pinch-an-inch test?
Alternate less provocative test; if negative do rebound tenderness
What is McBurney’s point?
pain from appendicitis or peritonitis; half way between R ASIS & umbilicus; palpated legs straight vs iliopsoas hooklying position; 11th thoracic nerve
What are the tests for psoas or obturator abscess from peritonitis
Heel tap – supine, tap heel; positive if
reproduces lower abdominal pain
Hop test – unable & clutches abdomen
Iliospoas muscle test – abdominal pain
reproduced w/ hip flexion
Passive hip extension – abdominal pain
reproduced
Obturator muscle test – flex hip and knee
rotate hip - abdominal pain reproduced
Iliopsoas muscle palpation – abdominal pain
reproduced
