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Internal Medicine > Physical Exams > Flashcards

Physical Exams Flashcards

1
Q

Knee

A

Inspection - Scars, erythema, swelling, atrophy, deformities (a rum/Valium)

Gait - antalgic, squat (overalll strength)

Palpation - Warmth, Effusion (bulge, ballottement), point tenderness

ROM - active then passive (crepitus)

Special Tests - Lachman’s/Anterior Drawer for ACL, Posterior drawer/sag for PCL, Varus stress for LCL, Valgus stress for MCL, McMurray/Appley’s Gring for menisci

Joint above and below

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2
Q

Adrenal Insufficiency

A

Vitals - orthostatic hypotension and tachycardia

Inspection - weight loss, pigmentation of oral mucosa, to Silas hypertrophic, auricular calcification, bitemporal hemianopia, EOM palsy, abdominal tenderness, splenomegaly, generalized hyperpigmentation, decreased axillary and pubic hair, vitiligo

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3
Q

Hip

A

Inspection - BMI, atrophy, scar, erythema, leg length, pelvic tilt, rotation, Trendelenburg sign

Gait - Antalgic, Compensated Trendelenburg, Gluteus Maximus gait (pelvic thrust)

Palpation - Bony Structures (pubic ramos, trochanter, Crest, ASIS/PSIS, isshial tuberosity), bursa

ROM - squat, active then passive, flexion 100-120, extension 20, abduction 45, addiction 30, external rotation 45, internal rotation 40

Special Tests - Thomas’ (hug knee, drop other leg), FABER, Ober’s (lie on side, knee flexed, hip abducted/extended, drop leg behind other (IT)), Tripod sign

Joint above and below

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4
Q

Shoulder

A

Inspection - scars, swelling, erythema, rounding, step deformities, scapular winging, atrophy

Palpation - SC joint, clavicle, AC joint, Cora oil process, greater tubercle, bicipital groove, tip of shoulder (supraspinatus), scapula

ROM - Active then passive, abduction 180, adduction, internal/external rotation, flexion 180

Special Tests - Rotator Cuff Tendinopathy (Lift-off, Hawkins (shoulder/elbow flexed 90, int rotation), Neer’s test, external rotation lag test (maintain external rotation), Rotator Cuff (Empty Can), Biceps Tendinopathy (Yergasons (resisted pronation), Speed’s (downward force shoulder flexion), Shoulder Instability (Apprehension, Relocation, Sulcus), Labral Tear (O’Briens, Biceps Load II)

Joint above and below

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5
Q

Pleural Effusion

A

Vitals - Febrile, Tachypneic, hypoxia, tachycardia, hypotension

Inspection - Chest expansion, concavity of intercostal spaces

Percussion - dull over effusion, auscultatory percussion (decreased resonance)

Palpation - tactile fremitus

Auscultation - decreased breath sounds, vocal fremitus, pleural rub

Lyles criteria - Fluid:Serum LDH > 0.6, Protein >0.5 LDH >2/3 ULN, only need 1 criteria

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6
Q

Obstructive Sleep Apnea

A

Risk Factors - Male, Obesity, Age, Alcohol, Black race, smoking

Vitals - Bradycardia, hypertensive, tachypneic, hypoxia

Inspection - Crowded pharynx, macroglossia, soft palate hypertrophy, elongated palate, high arched palate, micrognathia, hyomental distance <40mm, retrognathia >2mm, Crico-mental space <15mm, neck circumference F >40cm, M >43cm

Complications - HTN, HF, arrhythmia, PHTN, CAD, CVA

Epworth Sleepiness Scale 0 never, 3 high - Reading, TV, Meeting, Passenger >1h, lying down afternoon, talking, after lunch, stopped while driving, severe OSA 11-20

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7
Q

Thyroid

A

Inspection - lateral anterior bowing, tracheal deviation, distended neck veins, strider, coughing, hoarse voice, facial plethora, moves superior with swallowing

Palpation - Size (larger than patients thumbnail, consistency (normal, firm, rubbery, stony), shape, nodule, tenderness, mobility, cervical LAD,

Auscultation - bruit (Grave’s)

Pemberton’s Sign - abduct arms (facial plethora, neck vein distension, strider)

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8
Q

Thyroiditis

A

Vitals - Systolic HTN, Tachycardia

Inspection - Anxiety, scared fancies, fidgeting, weight loss, fine tremor, onycholysis (4th digit), thyroid acropachy (Grave’s), palmar erythema, sweaty palms, Vitiligo (AI disease), hyperpigmentation, pruritus (Grave’s), Pretibial myxedema (Grave’s), Thyroid stare, lid retraction, Lid lag, thyroid opthalmopathy (Grave’s), chemosis, corneal ulceration, optic atrophy, opthalmoplegia, Flow murmur (SEM LLSB), Means-Lerman scratch (mid systolic), bilateral crackles, pleural effusions, proximal muscle weakness, hyperreflexia

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9
Q

Peripheral Artery Disease

A

Inspection - colour, atrophy, hair, nails, wounds (arterial painful, tips, lateral malleolus) (Venous painless, medial malleolus)

Palpation - Temperature difference, pulses (femoral, popliteal, dorsalis pedis, posterior tibial)

Auscultation - bruits including iliac, Doppler of dorsalis pedis (3 arterial sounds)

Special Tests - Capillary refill >5 seconds, Buerger test (raise leg 90 (pallor not normal, lower until colour returns)), Venous fill time (raise leg 45 until veins collapse, lower leg >20s fill abnormal, ABI <0.9)

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10
Q

Mitral Regurgitation

A

Vitals - normal or tacky, normal or decreased BP

Inspection - respiratory distress, pale, (Ank spond, Marfans, RA), normal JVP, sharp upstroke, Previous sternotomy scar

Palpation - displaced PMI, diffuse, palpable S3, systolic thrill at apex, parasternal impulse

Auscultation - S1 soft, S2 widely split, loud P2 if PHTN, loud S2, S3, holosystolic, high pitched, radiates to axilla

Maneuvers - increases with afterload (handgrip, BP cuff), increases with preload (leg elevation/squatting), decreases with decreased preload (Valsalva/standing)

Surgical indications - symptomatic acute MR (pulm edema), severe sympomatic chronic MR (NYHA II-IV), MR with LVEF 30-60%, LVESD >40mm

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11
Q

Peritonitis

A

Vitals - tachycardia, hypotension, fever

Inspection - sit rigid, ascites, bulging flanks

Auscultation - normal bowel sounds

Percussion - tender, cough tenderness, fluid wave, shifting dullness

Palpation - guarding, rigidity, rebound tenderness,

Special Tests - Carnett test (palpation site maximal pain, partial sit-up, if pain decreases lower likelihood peritonitis)

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12
Q

Peripheral Dyslipidemia

A

Vitals - HTN

Inspection - obesity, periorbital xanthomas, corneal clouding, corneal Arcus, lipemia retinalis, pigmented retina, hypertrophied (yellow-grey) tonsils, tendinous xanthomas, eruptive xanthomas, palmar xanthomas, AS murmur, MR murmur (papillary muscle ischemia), HF, hepatosplenomegaly, pancreatitis, tendon xanthomas, peripheral artery disease, decreased proprioception, dysmetria, ataxia, spastic gait, mononeuritis multiplex

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13
Q

Chronic Liver Disease

A

Vitals - hypotension, tachypnea, fever (SBP)

Mental Status - confused/obtunded

Inspection - Temporal wasting, parotid enlargement, fetor hepaticas, jaundice, conjunctival pallor, Keiser-Fleischer rings, facial telangiectasias, pleural effusion, bulging flanks, shifting dullness, fluid wave, dilated veins, splenomegaly, umbilical hernia, muscle wasting, Terry’s nails, palmar erythema, clubbing, peripheral edema, Dupuytren’s contracture, ecchymosis, spider Angiomas, decreased body/pubic hair, gynecomastia, testicular atrophy, asterisks

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14
Q

Meningitis

A

General Appearance - Photophobia, altered LOC, Tripod position

Vitals - Fever, tachycardia, hypotension

Inspection - Meningismus, CN Paley (VI most common, V1-2), posterior throat, sinus, mastoid process, cervical LAN, orbital cellulitis, Jolt accentuation, respiratory consolidation, maculopapular rash, Kernig’s sign

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15
Q

Parkinson’s Disease

A

General Appearance - slowed movements, hypophonia, palilalia, MMSE

Vitals - Postural hypotension

Gait - rigidity, shuffling, diminished arm swing, festinating gait, postural instability

Balance - retropulsion

Inspection - mask like facies, decreased blinking, drooling, gaze paresis, glabellar tap, resting tremor, finger to nose test (bradykinesia), rigidity/cogwheeling, tapping fingers/feet, twiddling, writing (micrographics)

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16
Q

Cranial Nerve III

A

Inspection - Eye deviated down and out, pupil dilatation

Light reflex - RAPD no consensual response, follow fingers H,, convergence

17
Q

Diabetic Screening Exam

A

Vitals - BMI, waist circumference

Inspection - body habits, amputations, glasses, pigmentation, acanthosis nigricans, CNIII palsy, Argyll Robertson pupil (accommodate don’t react to light), cataracts, exudate/haemorrhages on fundoscopy, CV exam including bruits, injection sites, muscle atrophy, skin changes of PAD, DFU, necrobiosis lipoidica, palpation pulses/temperature, neuro power/reflexes, vibration, proprioception

18
Q

Cranial Nerve V

A

V1 - sensory forehead
V2 - sensory face and upper lip
V3 - sensory and motor lower jaw, masseter, temporalis, pterygoid

Inspection - muscle wasting, Herppes zoster (tip of nose Hutchison’s sign), dull/sharp sensation, light touch

Motor - clench jaw (palpation masseter), open jaw (petrygoid, deviates to weak side)

Reflexes - corneal reflex (afferent V1, efferent VII), jaw jerk

19
Q

Cranial Nerve VII

A

Inspection - facial asymmetry, external auditory canal (HSV/Ramsey-Hunt), Bell’s phenomenon, red eyes, dental caries

Motor - Frontalis (raise eyebrows), orbicluaris oculi (close eyes), orbicularis oris (puff cheeks), Buccinator (show teeth), Platysma (neck muscles), Stapedius (hyperacusis)

Sensation - Taster anterior 2/3 tongue, over mastoid

Reflexes - corneal reflex (efferent orbicularis oculi),

Parasympathetic - lacrimal gland (Schirmer test >15mm moisture in 5 min), Salivary gland

20
Q

Dysphagia

A

Phases Swallowing - Oral predatory phase, buccal phase (CN V, VII, XII), pharyngeal phase (CN V, IX, X, XII), Esophageal phase

Initial testing - Pa (CN VII), Ta (CN XII), Ga (CN IX/X), MMSE

CN V - deviation of jaw to weak side, open/close against resistance, palpation temporalis/masseter, jaw jerk reflex

CN VII - facial asymmetry, show teeth, puff cheeks

CN IX/X - dysarthria, hoarseness, uvula midline, gag reflex, tonsillitis, test swallow with liquid (wet voice, decreased O2)

CN XII - inspect tongue (wasting/fasciculation), dysarthria, protrude tongue (towards lesion)

Mechanical obstruction - palpation neck for masses

21
Q

Median Nerve

A

Inspection - thenar wasting, deformity at wrist, hand diagram of parenthesis

Sensation - palm, digits 1 to lateral aspect of 4

Motor - Pronator teres, flexor carpi radialis (flex/abduct), flexor digitorum profundus I and II (flex DIP, fixed PIP (digits 2+3)), 1st lumbrical (extend PIP, hyperextend MCP), flexor pollicus longus (flex distal phalanx), abductor pollicis brevis (abduct), opponens pollicis

Reflexes - none

Special tests - Oschner’s clasp (unable to flex 2nd/3rd digits), Tinel’s sign, Phalen’s sign

22
Q

Peripheral Thyroid

A

Vitals - Systolic HTN, Tachycardia (A fib)

Inspection - Anxiety, scared facies, fidgeting, weight loss, tremor, onycholysis (4th digit), thyroid acropatchy, palmar erythema, sweating, vitiligo, hair thinning, hyperpigmentation (ACTH), pruritus, urticaria, pretibial myxedema, thyroid stare, lid retraction, lid lag, exophthalamos, thyroid bruit

Chest - SEM LLSB flow murmur, Means-Lermann scratch, pleural effusions

Neuro - proximal muscle weakness, hyperreflexia

23
Q

Ulnar Nerve

A

Inspection - hypothenar/intrinsic muscles of hand wasting, ulnar claw

Palpation - ulnar groove

Sensation - ulnar aspect of hand, 5th digit, medical aspect of 4th

Motor - Flexor carpi ulnaris, flexor digitorum profundus III and IV (flexion DIP, fixed PIP 4+5), Abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, 3rd/4th lumbricals (hyperextend PIP), dorsal interossei, palmar interossei

Special Tests - Tinel’s, Provocative pressure test, Froment sign (grip paper between thumb and palm (adducted))

24
Q

Radial Nerve

A

Inspection - Wrist drop, atrophy, scars, swelling

Sensation - posterior cutaneous nerve of arm and forearm, web space of thumb and 1st digit

Motor - Triceps, Brachioradialis, Extensor carpi radialis longus, Supinator, Extensor carpi ulnaris, extensor digitorum, abductor pollicis longus, extensor pollicis longus and brevis

Reflexes - Brachioradialis (C5-6), Triceps (C7-8)

25
Q

Comatose Patient

A

Vital signs - HTN (ICH, encephalopathy), hypotension (shock, drugs, Addisons), Hyperthermia (sepsis, heat stroke, anticholinergic), Hypothermia (cold exposure, hypothyroid, sepsis, Addisons, drugs, EtOH)

Ventilation - Cheyenne Stokes, Kussmaul, Tachypnea, Agonal

GCS

Inspection - Trauma, Fundoscopy, pupillary light response, CN testing for EOM, nystagmus, occulocephalic reflex, caloric testing, gag reflex (IX/X), cough reflex (auctioning)

Motor and Reflexes

26
Q

Femoral Nerve

A

L2-L4

Inspection - Quadriceps wasting, stand up, squat, gait (swing outward)

Sensation - anterolateral thigh to medial malleolus

Motor - Quadriceps femoris, iliopsoas, rectus femoris

Reflexes - patellar tendon

27
Q

HIV Exam

A

Inspection - wasting, lipodystrophy, lipoatrophy, candida plaques, angular stomatitis, aphthous ulcers, tongue ulceration, oral hairy leukoplakia, parotid enlargement, sinus tenderness, lymphadenopathy, fundoscopy (retinitis), tachypnea, cough, crackles, onycholysis, epitrochlear LAN, IVDU track marks, organomegaly, rectal ulcers, tender prostate, painless chancres (syphilis), chancroid (haemophilus), HSV vesicles, LGV, dementia, meningismus, focal neuro deficits, mononeuritis multiplex, maculopapular rash, herpes zoster, molloscum contagiosum, candidiasis, impetigo, Kaposi sarcoma

28
Q

Peroneal Nerve

A

L4-S1

Inspection - trauma (fibulae head), muscle wasting anterior and lateral, foot drop

Palpation - tenderness over fibulae head and anterior compartment

Sensation - lateral leg, Dorsum foot, web space 1st/2nd toes

Motor - Tibialis anterior, extensor digitorum longus, extensor digitorum brevis, extensor hallucis longus, peroneus tertius

29
Q

Blood Transfusion Counselling

A 
Urticaria (1/100)
Fever (1/300)
TACO (1/700)
Delayed hemolytic transfusion (1/7000)
TRALI (1/10000)
Acute hemolytic transfusion reaction (1/40000)
Anaphylaxis

Infection - Bacterial (1/250000), Viral (HBV 1/150000, HCV 1/2.3 million, HTLV 1/4.3 million, HIV 1/7.8 million)

30
Q

Anticoagulation Counselling

A

A fib - CHADS

Bleeding - HASBLED (HTN, abnormal liver/renal, Stroke, bleeding, labile, elderly >65, drugs)

Indications - VTE, Afib, valve

Interactions - antimicrobials, amiodarone, EtOH, citalopram, sertraline, fish oil, omeprazole, anabolic steroids, diet

Monitoring - daily initially

Complications - bleeding

Reverse - Vit K, FFP

Pregnancy - avoid in T1

Internal Medicine (6 decks)

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