SPs SIMULATION OF PHYSICAL FINDINGS

Question 1

Abdomen:

Answer 1

1. Tenderness.
2. Rigidity ==> Pt will contact his abdominal muscles when you try to palpate the abdomen.
3. Rebound tenderness.
4. CVA tenderness.

Question 2

Chest:

Answer 2

1. SOB.
2. Wheezing ==> whistling.
3. Decreased resp sounds.
4. Increased fremitus ==> Pt will say 99 in a coarse voice.

Question 3

Nervous system:

Answer 3

1. Confusion.
2. Dementia.
3. Extensor plantar response (Babinski).
4. Absent or hyperactive tendon reflexes (stroke, DM).
5. Tremor (resting, intentional).
6. Facial paralysis.
7. Hemiparesis.
8. Gait abnl.
9. Ataxia — chorea.
10. Hearing loss.
11. Tinel — Phalen.
12. Nuchal rigidity — Kernig — Brudzinski.

Question 4

Eyes:

Answer 4

1. Visual loss (central, peripheral). In a young pt, this may be due to MS.
2. Photophobia ==> Dim the light!
3. Lig lag.
4. Nustagmus.

Question 5

Muscles and joints:

Answer 5

1. Muscle weakness.
2. Rigidity.
3. Spasticity.
4. Parkinsonism ==> Shuffling gait (difficulty initiating and stopping ambulation, small steps, no swinging of the arms), resting tremor, masked facies, rare blinking, cogwheel rigidity.
5. Restricted ROM of joints.

Question 6

Bruits and murmurs:

Answer 6

1. Renal artery stenosis.
2. Thyroid bruit.
3. Carotid bruit — hush hush.
4. Heart murmur — hush hush.

Question 7

Skin:

Answer 7

Artificial skin discoloration (eg painful red spots on the shin for erythema nodosum in a patient with sarcoidosis).

Question 8

Real physical exam findings:

Answer 8

1. C-section, appendectomy, cholecystectomy, or other scares.
2. Real nevus (mole). Ask the pt and adivse him to check it routinely.
3. Skin lesions such as pytiriasis rosea, seborrheic dermatitis, or acne vulgaris.
4. Real heart murmur.
5. Pt w/ sore throat may present with enlarged tonsils.