Physical Exams Flashcards
Overview of Steps: General appearance
- Development
- Nutrition
- Body Habitus
- Deformities
- Attention to Grooming
Overview of Steps: Skin
1) Inspect under good light and palpate.
2) Look and feel for changes in color, moisture (scaly and flaking versus moist), temperature
(use backs of fingers to assess; get general skin temperature sense as well as temperature of
erythematous areas), and texture (rough or smooth).
3) Check skin turgor.
4) Examine any lesions: distribution and anatomic location, arrangement (linear, clustered,
annular, etc.), and types (macule, papule, etc.)
5) Examine nails for color changes, lesions, and ingrown nails.
6) Inspect and palpate hair for quantity, distribution, and texture.
Overview of Steps: Head
1) Inspect and palpate hair for areas of hair loss or thinning, different textures, and the presence of dandruff or lice.
2) Examine the scalp for lesions, scaling, or lumps.
3) Palpate the skull for bumps, deformity, or tender areas.
4) Examine the face and facial expressions, as well as for lesions or swelling.
5) Examine the skin as above.
Overview of Steps: Eyes
1) Visual acuity with Snellen chart
2) Visual fields by confrontation: This is the thing with the waggling fingers.
3) Look at position and alignment of eyes. Look from above if eyes protrude.
4) Look at eyebrows for thinning or flaking.
5) Look at eyelids for edema or rash, as well as eyelash loss.
6) Examine conjunctiva and sclera; patient looks up as you pull down lower lid.
7) Look at iris and pupils (size, symmetry). Test pupillary reaction to light (direct and
consensual: shine into same eye and then opposite eye to watch for constriction). Then check
for accommodation (bring pen light in toward nose and watch eyes cross).
8) Extraocular muscles: H and X in space.
9) Fundoscopic exam with ophthalmoscope. Look at three different vessel crossings and at cup
to disc ratio, as well as the macula.
Overview of Steps: Ears
1) Inspect auricle, then palpate it and ask if anything is tender.
2) Ear speculum exam: Look at external canal, TM, and ossicles. Check for fluid behind the
TM, loss of landmarks, bulging or retraction of the TM, or cerumen.
3) Auditory acuity: Gross hearing test (fingers flicking and going farther away), air versus bone conduction: Weber test (hit tuning fork and put on head) Rinne test (hit tuning fork and place on mastoid bone).
Overview of Steps: Nose and Sinuses
1) Look at external nose.
2) Use speculum to look inside each nostril. Check for discharge, erythema/injection, swelling,
or blood. Check for deviated septum or other problems with the septum. Check for polyps or
ulcers.
3) Palpate and percuss maxillary and frontal sinuses.
4) Transilluminate sinuses.
Overview of Steps: Mouth and Throat
1) Look at lips.
2) Look at oral mucosae (with tongue blade).
3) Look at teeth, gums, and tongue, as well as palate and floor of mouth.
4) Look at posterior pharynx: “Aah” thing. Look at tonsils.
Overview of Steps: Neck
1) Look at neck for bulges or rash.
2) Palpate nodes: preauricular, posterior auricular, occipital, tonsillar, submandibular, submental,
superficial cervical, posterior cervical, deep cervical, and supraclavicular.
3) Look for tracheal deviation.
4) Visualize and palpate thyroid.
Overview of Steps: Respiratory
1) While taking vitals, watch rate of respiration, breathing pattern, and effort of breathing (accessory muscle use, obvious dyspnea). Listen for obvious wheezing or rough breathing. Make sure patient is not in acute respiratory distress.
2) Check if patient appears cyanotic.
3) Look at the shape of the patient’s chest from behind and laterally (for deformities or
asymmetry, increased A-P diameter, intercostal retractions, or impairment in respiratory
movement on one or both sides).
4) Assess respiratory expansion.
5) Palpate any areas that patient reports is painful (costochondritis?)
6) Tactile fremitus: Put hand on lung area and feel vibration as patient says “99”
7) Percuss lung fields. Also percuss diaphragmatic dullness.
8) Auscultate lung fields (patient crosses arms and breathes at normal rate through mouth; listen
through an entire breath in each spot). You can do egophony and whispered pectoriloquy
here.
9) Repeat these steps (inspection, respiratory expansion, palpation, percussion, and auscultation)
on the anterior chest with patient lying down.
Overview of Steps: Cardiovascular
1) While taking vitals, palpate the radial pulse for rate and rhythm. You can also palpate carotid for thrills (vibrations).
2) Inspect chest/heart area.
3) Palpate PMI.
4) Auscultation: Carotids (bruits), pulmonic area, aortic area, tricuspid area, and mitral
area/apex. Use both diaphragm and bell. Ask female patient to displace breast superiorly and medially. You may have to repeat auscultation with patient sitting up, lying on left side, or
with Valsalva.
5) Jugular venous pressure: measure highest point of pulsation with two rulers.
Overview of Steps: Gastrointestinal
1) Inspection: Stand at right side of exam table. Look at abdomen for contour (flat, protuberant), scars, dilated veins, rashes and lesions, and umbilical problems. Look for peristalsis or pulsatile areas.
2) Auscultate bowel sounds in all four quadrants.
3) Auscultate for bruits in aorta and renal, iliac, and femoral arteries.
4) Percuss abdomen. Also percuss liver size and do splenic percussion sign.
5) Do light and deep palpation. Palpate liver edge. Palpate kidneys. Palpate aorta.
6) Kidney punch, if indicated.
7) You may need to test for an ascitic fluid wave.
Overview of Steps: Males
- Examination of the scrotal contents (e.g., hydrocele, spermatocele, tenderness of cord, testicular mass)
- Examination of the penis
- Digital rectal examination of prostate gland (e.g., size, symmetry, nodularity, tenderness)
Overview of Steps: female
• Pelvic examination (with or without specimen collection for smears and cultures), including:
- Examination of external genitalia (e.g., general appearance, hair distribution, lesions)
and vagina (e.g., general appearance, estrogen effect, discharge, lesions, pelvic
support, cystocele, rectocele)
o Examination of urethra (e.g., masses, tenderness, scarring) o Examination of bladder (e.g., fullness, masses, tenderness) o Cervix (e.g., general appearance, lesions, discharge)
• Uterus (e.g., size, contour, position, TNbility, tenderness, consistency, descent or support)
• Adnexa/parametria (e.g., masses, tenderness, organomegaly, nodularity)
Overview of Steps: Peripheral Vasculature
1) Inspection: Look at veins of extremities for size, symmetry, pattern, color of skin and nail beds, and problems like mottling, cyanosis, bronzing, or varicosities. Look for one extremity being thicker/more swollen than another and for any dependent edema.
2) Palpate pulses: radial, brachial, femoral, dorsalis pedis, posterior tibial, and popliteal.
3) Check for pretibial pitting edema.
4) With varicose veins, check for pressure wave—compress distal area of vein and feel for a
wave proximally.
5) Special tests include Trendelenburg’s for valvular incompetence and Allen’s test for
insufficiency of the radial or ulnar arteries. For arterial insufficiency, have patient lie down and raise legs to drain of blood, then sit up and hang legs down. Check for return of color and filling of the foot veins.
Overview of Steps: Musculoskeletal
1) Inspect for swelling, asymmetry, muscle atrophy, joint swelling and erythema, deformities, and whether problems are unilateral or bilateral and symmetrical.
2) Range of motion: active, passive, resisted.
3) Listen for crepitus as patient moves around.
4) Test integrity of motor, sensory (both dermatomal distribution and particular muscles), and
reflex components.
5) Specific tests, such as Phalen’s sign, Tinel’s tap, etc.
6) Check for stability of ligaments at affected joints (drawer sign, valgus/varus stress, etc.)
Overview of Steps: Neurological
1) Watch patient’s gait and movements. Look for any weakness or paralysis. Watch facial expressions. Look for tremors and atrophy.
2) Cranial nerve examination: pupillary and extraocular movements, sensory of face, motor of face (expressions), corneal reflex, hearing, swallowing, shrug shoulders, stick out tongue.
3) M, R, S tests (#4 for musculoskeletal). Include Babinski.
4) Rapid alternating movements (flipping hands on thighs), point-to-point (finger to nose and
patient’s finger to your finger, heel sliding down shin).
5) Pronator drift and Romberg’s.
6) Test light touch, sharp/dull, and vibration senses.
7) Two-point discrimination: Use bobby pin or compass.
8) Position sense: Dorsiflex big toe.
9) Stereognosis: patient identifies object by touch with eyes closed; write numbers or letters on
skin.
10) Mental status exam.
