Physical Exams (FA) Flashcards
HEENT:
Head:
- Inspect the head for signs of trauma and scars.
- Palpate the head for tenderness or abnormalities.
Eyes:
- Inspect the sclerae and conjunctivae for color and irritation.
- Check the pupils for symmetry and reactivity to light
- Check the extraocular movements of the eyes.
- Check visual acuity with the Snellen eye chart.
- Perform a funduscopic exam.
Ears:
- Conduct an external ear inspection for discharge, skin changes, or masses.
- Palpate the external ear for pain (otitis externa); do the same for the mastoid.
- Examine the ear canal and the tympanic membrane using an otoscope.
- Conduct the Rinne and Weber tests.
Nose:
- Inspect the nose.
- Palpate the nose and sinuses.
- Inspect the nasal turbinates and the nasal septum with a light source.
Mouth and throat:
1. Inspect with a light.
2. Look for mucosal ulcers, and inspect the uvula and under the tongue for
masses.
Cardiovascular exam
Listen to the carotids for bruits.
Look for JVD. Remember to raise the head of the bed to 45 degrees.
Palpate the chest for the PMI, retrosternal heave, and thrills.
Listen to at least two of the four cardiac areas. (Listen to the mitral area with the patient on his left side.)
Listen to the base of the heart with the patient leaning forward.
Check for pedal edema.
Check the peripheral pulses.
Pulmonary Exam
Inspect: Examine the shape of the chest, respiratory pattern, and deformities.
Palpate: Look for tenderness and tactile fremitus.
Percuss.
Auscultate for egophony, wheezes, and crackles.
Examine both the front and the back of the chest.
Abdominal Exam
Inspect. Auscultate Percuss. Palpate: Start from the point that is farthest from the pain; be gentle on the painful area, and don’t try to reelicit the pain. Check for rebound tenderness, CVA tenderness, the obturator sign, the psoas sign, and Murphy’s sign. Check the liver span.
Neurological Exam
Mental status examination: Orientation, memory, concentration.
Cranial nerves:
1. II: Vision.
2. III, IV, VI: Extraocular movements.
3. V: Facial sensation, muscles of mastication.
4. VII: “Smile, lift your brows, close your eyes and don’t let me open them.”
5. IX, X: Symmetrical palate movement, gag reflex.
6. XI: “Shrug your shoulders.”
7. XII: “Stick out your tongue.”
Motor system:
1. Passive motion.
2. Active motion: Arms—flexion (“pull in”), extension (“push out”);
wrists—flexion (“push down”), extension (“pull up”).
3. Hands: “Spread your fingers apart; close your fist.”
4. Legs: Knee extension (“kick out”), knee flexion (“pull in”).
5. Ankles: “Push on the gas pedal.”
Reflexes: Biceps, triceps, brachioradialis, patellar, Achilles, Babinski.
Sensory system: Sharp (pin)/dull (cotton swab), vibration, position sense.
Cerebellum: Finger-to-nose, heel-to-shin, rapid alternating movements,
Romberg’s sign, gait.
Meningeal signs: Neck stiffness, Kernig’s sign, Brudzinski’s sign.
Joint Exam (general)
Inspect and compare the joint with the opposite side.
Palpate and check for joint tenderness.
Check for joint effusion.
Check for crepitus.
Check joint range of motion both by having the patient move the joint (ac- tive) and by having the examiner move it (passive).
Check for warmth, swelling, and redness.
Check for instability.
Check gait.
Joint Exam (Knee)
Conduct a Lachman test, an anterior drawer test, a posterior
drawer test, and McMurray’s test, and check the stability of the medial and
lateral collateral ligaments.
Joint Exam (Shoulder)
Check adduction and internal rotation, abduction and ex-
ternal rotation, Neer’s test, Hawkins’ test, the drop arm test for supraspinatus
tears, and O’Brien’s test.
Joint Exam (Wrist)
Check for Tinel’s sign, Phalen’s sign, signs or symptoms of Du-
puytren’s contracture, and Heberden’s nodes.
Joint Exam (Elbow)
Check for lateral and medial epicondylitis.
Joint Exam (Lower back)
Conduct a leg raise test.
