Physical exams Flashcards
McMurray test
knee is held by one hand, which is placed along the joint line, and flexed to complete flexion while the foot is held by the sole of the foot with the other hand. The examiner then places one hand on the medial side of the knee to pull the knee towards varus position,[2] pulling the knee laterally (bow legged). The other hand rotates the leg internally while extending the knee.[3] If pain or a “click” is felt, this constitutes a “positive McMurray test” for a tear in the lateral meniscus.
Lachman test
See online
anterior and posterior drawer test
see online
knee exam
Anterior and posterior drawer tests
Lachman Test
McMurray test
normal JVP
6-8cm
pulses grading
0 - absent
1 - weak/thready
2 - normal
3 - full, firm pulse
reflexes grading
1+ = slow 2+ = normal 3+ = very brisk
appendicitis exam
psoas sign
obturator sign
Mcburney’s point
headache exam
Vital signs; inspection and palpation of entire head; ENT inspection; complete neurologic exam, including funduscopic exam.
confusion exam
Vital signs; complete neurologic exam, including mini-mental status exam and gait;
loss of vision history
Acute vs. chronic, progression, ability to see light; associated symptoms (eye pain, discharge, itching, tearing, photophobia, redness, headache, weakness, numbness, floaters, sparks); history of cardiac, rheumatic, thrombotic, autoimmune, or neurologic disorders; jaw claudication, medications, trauma.
depressed mood exam
documentation of appearance, behavior, speech, mood, affect, thought process, thought content, cognition (measured by the 30-point mini-mental status exam), insight, and judgment.
weber test
In an affected patient, if the defective ear hears the Weber tuning fork louder, the finding indicates a conductive hearing loss in the defective ear. In an affected patient, if the normal ear hears the tuning fork sound better, there is sensorineural hearing loss on the other (defective) ear.
chest pain exam
complete cardiovascular exam (JVD, PMI, chest wall tenderness, heart sounds, pulses, edema); lung and abdominal exams; lower extremity exam (inspection for signs of DVT).
hypothyroid symptoms
weight gain
constipation
skin changes
hair changes
nail changes
slow mental activity with poor memory(1), slow physical activity
apathy
weakness, lethargy, fatigue(1)
muscle weakness(1), muscle cramps, arthralgias
cold intolerance(1) (may also have heat intolerance due to impaired sweating)
constipation(1)
weight gain(1) (usually < 10% of total body weight) despite decreased appetite (although some patients have weight loss due to anorexia)
dry coarse skin (ichthyosis) and hair loss
menstrual irregularities (menorrhagia, dysfunctional uterine bleeding, infertility)(1, 7)
rarely voice changes such as hoarse voice (laryngeal myxedema)(7), slow speech
hearing loss(1) (middle ear myxedema)
decreased libido
chest pain physical exam
- palpate chest wall for reproducible tenderness
- look and palpate for apical impulse
- auscultation
- inspect for symmetrical expansion
- tacile vocal fremitus
- percussion
- auscultation
- inspect for JVD
- peripheral pulses
- calves for swelling, tenderness
how to inspect visual acuity
Ask patient to cover left eye and read smallest possible line on chart. Check both eyes.
rinne test
place vibrating tuning fork on mastoid process. when patient no longer hears it, move to external ear and determine if patient can still hear the vibration.
how to assess for lymphadenopathy
Use three middle fingers and palpate in a circular motion.
thyroid exam
skin hair reflex myxedema tremor
auscultating for carotid bruits
Use bell or diaphragm and auscultate just lateral to Adam’s apple
Tinel’s sign
Lightly tap over center of wrist, ask patient if he-she feels any tingling sensation.
Phalen’s sign
30 seconds, ask pt if he-she feels any numbness-tingling
mental status exam
Orientation
Concentration
Memory
how to assess concentration
ask patient to spell world backwards
Cranial nerve exam
kaplan page 73
biceps reflex testing
- patient’s arm should be partially flexed at elbow with palm down
- place thumb or finger over biceps tendon
triceps reflex testing
flex patient’s arm at elbow and pull it slightly across the chest
- strike the triceps tendon above the elbow
achilles reflex
dorsiflex foot at ankle, strike achilles tendon
sensation testing
crude touch – tell patient to close eyes, tell me when you feel my hand
position – use big toe, ask pt to close eyes, and report whether toe is up or down
vibration – use first metatarsal joint of each foot
kernig sign
with patient lying supine flex a knee, extend the leg on the thigh, positive test is flexion of the neck as you extend the leg
brudzinski sign
gently flexing the neck results in flexion of both knees
assessing tactile fremitus
put palms of fingers on chest wall and have patient repeat “99”
how to percuss chest wall
Lay nondominant hand over left lung apex; apply pressure and using dominant middle finger, tap on middle finger of nondominant hand
pulmonary auscultation
6 regions on back
4 on front
how to examine for JVD
Place table at a 30 degree angle, turn head to left, shine a light source obliquely over area of EJ on right side
assessing for hepatomegaly
ask patient to take a deep breath, palpate inferior to costal margins
where to listen for abdominal aorta bruit (concern for partial rupture of AAA)
xyphoid process to superior and left of umbilicus
how to start off physical exam
always include general appearance (NAD)
vitals format
- write WNL if all normal
- include height and weight if relevant
thyroid documentation
Nontender, NL size, no nodules, trachea midline.
normal CV exam documentation
RRR, apical impulse not displaced, no RMG, no JVD, clubbing, or edema. No carotid artery bruits. Peripheral arterial pulses palpable in lower limbs.
abdominal exam documentation
ABD: symmetric appearance, BS present, no bruits heard, no HSM, no abdominal mass, no tenderness.
neurologic exam documentaton
AOx3, CN2-12 intact. Sensation to light touch, position sense, and vibration sense intact in all 4 extremities. Coordination intact. No dysmetria or dysdiaochokinesia. Motor 5-5, DTR 2-4, B-L all 4 ext. Gait WNL.
psych exam documentation
Patient appears well-groomed, alert and oriented to person, place, and time, speech fluid and goal-directed, recent and remote memory intact, attention and concentration unimpaired, mood euthymic, affect c-w mood; no abnormal perceptions: hallucinations, delusions, or paranoia; no suicidal-homicidal ideation or intact.
diagnostic workup for liver concern
AST-ALT, not LFTs
LIQOR-AAA for pain
Location Intensity Quality Onset Radiation Associations Aggravating factors Alleviating factors
