Course 4: Physical Exam COPY COPY Flashcards by Anna Gotsiridze

What is CVA tenderness?

Flank tenderness (costovertebral angle tenderness) -tenderness over the kidneys

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adj. Black stool color

Melanotic

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Motor strength: Very mildly weak

4/5

neurologic PE

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Pale skin

Pallor

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HSM

Hepatosplenomegaly

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Scleral icterus

Characterized by jaundice

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A frame of reference used to describe anatomy and movement

Anatomical Position

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Complete Benign Exam: Neurological

Alert and Oriented, Normal speech

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Make sure to document for Code Exam

“A full examination is unable to be obtained due to clinical condition”

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“Eardrum blocked by earwax”

TM obscured by cerumen

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Severity scale for Pitting Pedal Edema

Trace to 4+

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DDx: Induration

Cellulitis

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Absent sensation

Numbness

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What is the difference between laceration and abrasion?

Laceration: incision in the skin that typically need sutures Abrasion: scrape of the skin

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Extra Exam Findings: Examines the inner-ear

TM erythema or bulging

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Benign nose exam

Normal Nares (or naris)

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Contradiction: Normal Speech (2)

Aphasia (loss of ability to understand or express speech) vs. Dysarthria (slurred or slow speech that can be difficult to understand)

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MAE

Moves All Extremities

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Flap of skin

Avulsion

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Why is Midline bony tenderness “worse” than paraspinal tenderness?

Bony tenderness (aka vertebral point tenderness) points towards a spinal fracture and therefore concern for a spinal cord injury Paraspinal tenderness points towards muscle pain or strain

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Drooping of upper eyelid

Ptosis

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Contradiction: Cool/hot to touch

Warm

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What is the medical term for a nostril?

Naris

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Sucking in of skin around bones of chest between breathing (esp. pediatric)

Retractions

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What would you guess “TPP” means?

Tenderness to Palpation

Spell the medical term for “Hives”

Urticaria

Abdomen S and NT

Soft and Non-tender

Contradiction: Normal conjunctiva (2)

Pale conjunctiva, Conjunctival infection

Glasgow Coma Scale

1. Used to assess level of consciousness in trauma pts 2. (GCS \<15)

Without trauma

Atraumatic

Tenderness in RUQ sign

Murphy's sign

Benign Exam "No Touch": Cardiovascular

Well perfused

Swollen and inflamed veins in anus or rectum

Hemorrhoids

Sign seen when pt asked to hold arms outwards with palms facing upwards

Pronator Drift

DMM

Dry Mucous Membranes

Decreased sensation

Hypoesthesia

Contradiction: Flat/Odd affect, Tearful, Anxious, Depressed, Hypomanic, Poor eye contact

Normal affect

Name an instrument a physician may use to closely investigate the eyes\>

Slit Lamp Woods Lam Ophthalmoscope (aka fundoscopic exam)

A bruise

Ecchymosis

Cavities

Dental Caries

If a patient says their abdomen feels very painful, can you automatically document “abdominal tenderness” in the PE?

No. Subjective vs. Objective

When one eye does not move in concert with other

EOM palsy

Scale for Deep Tendon Reflexes (DTRs) (and normal)

0 to 4+ (2+ normal)

Fail test to stand with feet together and eyes closed

Positive Romberg

Blue color

Cyanotic

Drowsy

Somnolent

Contradiction: Regular Rhythm

Irregularly Irregular Rhythm

In the neurological exam what does “normal gait” mean?

Walking normally

Benign cardiovascular exam (2)

Regular Rate and Rhythm, Heart sounds nl

Like hematoma (Blood or bleeding under the skin due to trauma of any kind; typically black and blue at first, with color changes as healing progresses)

Contusion (a region of injured tissue or skin in which blood capillaries have been ruptured; a **bruise**.)

Extra Exam Findings: "Pounds" on the back

CVA tenderness

What is the medical term for “swollen lymph nodes”?

Lymphadenopathy

If you saw RRR written in the cardiac exam, what do you think it might mean?

Regular Rate and Rhythm

Enlarged liver

Hepatomegaly

What is bony tenderness a sign of?

Bone Deformity, Fracture or Injury

Enlarged spleen

Splenomegaly

Used to assess level of consciousness in trauma pts

GCS, Glascow Coma Exam

Document for female genital exam

"Female chaperone present"

Contradiction: Pulse/Sensory/Motor deficits

Distal CSMT intact

Complete Benign Exam: Skin

Dry, No rashes, Warm

Rectum extends outside body

Rectal Prolapse

Pulse on neck

Carotid Pulse

Sign tested by passively flexing foot backwards

1. Homan's sign—» listed in PE for DVT

Type of hernia seen in male genital exams

Inguinal Hernia

Complete Benign Exam: Constitutional

Well developed, well nourished, NAD (no acute distress)

What is scleral icterus and what does it indicate?

Yellowing of the eyes, indicates liver failure

3 Peritoneal Signs

Voluntary Guarding, Rebound Tenderness, Rigidity

Normal

Benign

Catheter left in the bladder

Indwelling Catheter

Affect

Feeling and emotion

Motor strength: slight contraction, no movement

1/5

Bleeding in the eye

Hyphema

DDx: Fluctuance

Abscess

Swollen lymph nodes

Cervical lymphadenopathy

Hives

Urticaria

What would you document “RUE strength 3/5” under the “neurological” or “Extremities” section of the exam?

Neurological

Orifice separating vagina and uterus

Cervical os

Match the following condition or disease that is associated with each physical exam finding. * psychiatric evaluation * meningitis * pyelonephritis * CHF * Bells Palsy * Abscess * DVT * CVA

Unequal pupils

Anisocoria

Yellow color

Jaundice

Tenderness

Pain felt on the release of pressure

Complete Benign Exam: Psychiatric

Normal affect

Rash of purple spots on skin

Purpura

If you documented “NAD” in the constitutional section would you be contraindicating yourself if you wrote “There is mild respiratory distress” in the pulmonary exam?

Yes

Benign Exam "No Touch": Neck

Supple

Contradiction: Murmurs, Rubs, Gallops, Extra Systoles

Heart Sounds Normal

Swelling of face (esp. with allergic reactions)

Angioedema

Condition of Difficulty speaking

Dysarthria

Atraumatic

Without trauma

Benign Exam "No Touch": Neurological

Alert and Oriented, Normal speech

Contradiction: Retinal detachment, Papilledema, Hyphema (2)

Clear anterior chamber, Sharp disc margins

Contradiction: Somnolent, Obtunded, Unresponsive

Alert

Contradiction: Scleral icterus

Sclera are anicteric

Not characterized by jaundice

Anicteric

Oropharynx

Motor Strength: Normal strength

5/5

Written as roman numerals

Cranial Nerves

Pulse in groin area

Femoral Pulse

Condition of Not able to speak

Aphasia

Contradiction: PERRL

Anisocoria

A mother states her child has been extremely tired and drowsy recently; based on that, can you document “Lethargic” in the child’s PE?

NAH

If you document “there is no pronator drift” in the neurological exam, can you also document “No focal neurological deficits”?

No because its a contraindication

Involuntary Guarding

Rigidity

Raised area of tissue with bruising

Contusion

DDx: decreased rectal tone

Spinal Cord Injury

Match the following condition or disease that is associated with each physical exam finding. * Asthma * Otitis Media * CHF * Afib * SBO * Diverticulitis * Pneumonia * Corneal Abrasion * cholelithiasis

Able to be comforted

Consolable

Extra Exam Findings: Examines the throat

Pharyngeal erythema or exudates

Benign Exam "No Touch": Respiratory

No respiratory distress

RRR

Regular Rate and Rhythm

Contradiction: Sinus tenderness, Angioedema, Any signs of trauma

Atraumatic/Normocephalic (AT/NC)

"loose ligaments"

Tendon Laxity

Complete Benign Exam: ENT

Moist mucous membranes

The flow of blood through the body's blood vessels

Perfusion

If a patient has pale conjunctiva what does that indicate?

Anemia

Benign Exam "No Touch": Psychiatric

Normal affect

Earwax

Cerumen

Extra Exam Findings: Squeezes the calf muscles

Calf tenderness

Contradiction: Tachypnea, Accessory Muscle Use

No respiratory distress

What is fluctuance a sign of?

Abscess

What does a Guaiac positive stool sample diagnose?

GI Bleed

Motor strength: Unable to overcome resistance

3/5

Benign neck and cervical spine exam

Supple

Feeling and emotion

Affect

Hesitant to talk/respond

Pressured Speech

Less serious tenderness left and right of spine

Paraspinal Tenderness

Pulse on wrist

Radial Pulse

Benign

Normal

Anisocoria

unequal pupils

CTA

Clear to Auscultation

Anatomical Position

A frame of reference used to describe anatomy and movement

3 descriptions of hemorrhoids

Internal, External, Thrombosed

Exam Findings: Palpating the Abdomen (4)

Soft, Non-tender, Non-distended, No guarding, rebound, or rigidity

Benign Exam "No Touch": Extremities

No edema

Blood in stool

Heme positive

Contradiction: Normal finger-to-nose, Normal heel-to-chin

Dysmetria (a lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye)

"Crunching" respiratory sound

Crepitus

Increased warmth

Calor

Perfusion

The flow of blood through the body's blood vessels

Benign Exam "No Touch": Gastrointestinal

Non-distended

Complete Benign Exam: Eyes

PERRL, EOMI

Blood coming out of ears

Hemotympanum

"Pus leaking"

Purulent Drainage

What does AT/NC mean?

Atraumatic/Normocephalic

Contradiction: Suicidal/Homicidal, Hallucinations, Flight of idea, Paranoid

Normal judgement

GCS

Glascow Coma Exam

What phrase do you have to document in the GU exam for every female pelvic exam performed by a male physician?

Female Chaperone Present

To describe a runny nose would the doctor use the word “epistaxis” or “rhinorrhea”?

Rhinorrhea

Contradiction: Alert

Somnolent

Benign Exam "No Touch": ENT

Moist mucosa

Scale for pulse (normal?)

0 to 4+ (2+)

Document for rectal exam

"Female/Male chaperone present"

What does DTR stand for?

Deep tendon reflex

Organ enlargement

Organomegaly

Organ enlargement

Pulse on side of foot

Posterior Tibialis (PT) Pulse

Contradiction: Mild/Moderate/Severe Tenderness To Palpation (TTP)

Soft and Non-tender

Swelling behind eye

Papilledema

Normal General Pediatric Physical Exam (6)

Alert, Interactive, Playful, Smiling, Crying with tears on exam, Quickly consolable

Collection of blood in pocket of nose

Septal hematoma

EOMI

Extraocular Movements Intact

Benign Exam "No Touch": General

Well developed, Well nourished, NAD

Purulent

Pus-like

Pulse on top of foot

Dorsalis Pedis (DP) Pulse

Complete Benign Exam: Extremities

No edema, Full ROM

Contradiction: Mild/Mod/Severe Distress

No Acute Distress

Do any patient complaints belong in the PE?

Contradiction: Normal Bimanual Exam (3)

Cervical motion tenderness (CMT), Uterine tenderness, Adnexal tenderness (Ovaries)

Icterus

Yellowing, also known as jaundice

If the doctor takes 1 finger and presses in a specific spot in the RLQ what is the name of the finding they are investigating?

McBurney’s point tenderness (Appendicitis)

Contradiction: Normal RAM (Rapid Alternating Movements)

Dysdiadochokinesia

Somnolent

Responsive to verbal

Used for external eye exam (2)

Wood's lamp, Fluorescein

Detailed/descriptive speech

Tangential Speech

Contradiction: Tachycardic, Bradycardic

Regular Rate

What does PERRL stand for?

Pupils are equal round and reactive to light

NAD

No Acute Distress

In the psychiatric exam, what do SI and HI stand for?

Suicidal and Homicidal Ideations

Abdomen very full

Distended

Contradiction: Denies illness/symptoms, Non-compliant with treatment

Normal insight

Benign mouth/throat exam (2)

Moist Mucous Membranes, OP Normal

Consolable

Able to be comforted

"swooshing" in neck artery

Carotid bruit

Contradiction: Jaundice

Normal color

DDx: Homan's sign/Palpable cords

DVT

"Loose associations"

Flight of ideas

CSMT

Circulation, Sensory, Motor, Tendon

adj. Lacking teeth

Edentulous

Neurological scale for trauma pts

Glawgow Coma Scale

Contradiction: Capillary Refill less than 2 seconds

Delayed capillary refill

Benign perfusion exam (2)

Pulses Equal and Symmetric, Capillary Refill less than 2 seconds

GCS scale

3-15

Erythema

Redness

What does NAD stand for?

No acute distress or disease

Inappropriately happy/energetic

Hypomanic

Rapid, repetitive, and involuntary movement of the eye

Nystagmus

Yellowing, also known as jaundice

Icterus

Complete Benign Exam: Respiratory

No respiratory distress, Clear to auscultation bilaterally, No wheezes, rales, or rhonchi

Instrument used for fundoycopic exam of the internal eye

Ophthalmoscope

Which of these 2 physical exam findings could a physician appreciate without auscultating the patients lungs: A. No respiratory distress B. No rales

No respiratory distress

Extra Exam Findings: Auscultates the abdomen

Hyperactive/hypoactive BS

PTA (not prior to arrival)

Peritonsillar Abscess (biggest concern for pt w/sore throat)

Name the rhythm that the physician would hear if the patient was in Afib?

Irregularly irregular rhythm

Point to the general area of your body that Cranial Nerves (CN) control?

Face

Pain felt on the release of pressure

Tenderness

Redness

Erythema

Enlargement of thyroid

Thyromegaly

White plaque on tonsils

Tonsillar Exudate

Name 2 “Peritoneal signs” in the abdominal exam?

1. Guarding 2. Rebound Tenderness 3. Rigidity

Is the Glascow Coma Scale (GCS) associated with trauma patients or medical patients?

Trauma

Contradiction: well developed, well nourished (3)

Cachectic, Emaciated, Malnourished

Moveable and compressible (on skin)

Fluctuance

Contradiction: Diminished breath sounds, Wheezes, Rales, Rhonchi

Clear to auscultation bilaterally

Extra Exam Findings: Touches the wrists

Radial pulses

Document for male genital exam

"Male chaperone present"

Benign Exam "No Touch": Skin

Dry, No rashes

What section of the neurological exam would you document “Normal Finger-Nose-Finer test” and “Normal-Heel-to-Shin”?

Cerebellar/Coordination

DDx: Bony tenderness

Fx (fracture)

Inflammation of walls of lymphatic vessels

Lymphangitis

Condition of spot hardening on skin

Induration

Jaw misalignment

Malocclusion

Normal Neurological Pediatric Physical Exam (3)

Alert, Appropriate for Age, Moves All Extremities x 4

Small red or purple spot ("tiny red rash")

Petechiae

Contradiction: Normal External Genitalia (3)

Sores, Lesions, Rashes

Alternative name for Heme Positive

Guaiac Positive

Pus-like

Purulent

Contradiction: Irregularly Irregular

Regular Rhythm

Benign Exam "No Touch": Eyes

PERRL

In which body system would you document “TM erythema and bulging”?

Ears

Exam Findings: Auscultating the Lungs (2)

Clear to auscultation bilaterally, No wheezes, rales, or rhonchi

If the physician checks the pulse on the right wrist and says “the pulses are fine” what would you document in the PE?

Right radial pulse is 2+

TTP

Tenderness To Palpation

Contradiction: Cachectic/Emaciated/Malnourished (2)

Well developed, Well nourished

Which of these is NOT a peritoneal sign? Guarding, Rebound, Tenderness, Rigidity

Tenderness

Mentally dulled, "out of it"

Obtunded

More serious tenderness on spine

Vertebral Point (Midline) Tenderness

DDx: calf tenderness

DVT

Motor strength: Unable to overcome gravity

2/5

Hard, thickened palpable vein

Palpable cords

Contradiction: alert (3)

Somnolent, Obtunded, Unresponsive

What abdominal exam is indicative of cholecystitis?

Murphy’s Sign

Exam Findings: Examining the Legs (2)

No edema, Distal pulses intact

1. McBurney's point tenderness 2. Rovsing's Sign 3. Obturator Sign

Like abrasion seen in elderly

Skin Tear

Complete Benign Exam: Abdominal

Non-distended, Soft, Non-tender, No guarding, rebound, or rigidity

Complete Benign Exam: Cardiovascular

Well perfused, RRR, No murmurs, rubs, or gallops, Distal pulses intact

Contradiction: Normal cornea (3)

Corneal abrasion, corneal ulcerations, fluorescein uptake

Swollen inner nose

Boggy turbinates

Contradiction: EOMI

EOM entrapment

Complete Benign Exam: Neck

Supple, No lymphadenopathy

Redness in back of throat

Pharyngeal Erythema

Decreased rectal tone

Rectal laxity

Bowel Sounds

Contradiction: Tangential/Pressure Speech

Normal speech

What procedure is associated with a laceration by not an abrasion?

Laceration Repair, Sutures

Obtunded

Responsive to pain

Contradiction: Sclera are anicteric

Scleral icterus

Contradiction: Dry

Diaphoretic

DDx: Soft tissue tenderness

Contusion

Motor strength: Flaccid, limp

0/5

Contradiction: Hypoesthesia, Numbness

Sensation intact

Swollen tonsils

Tonsillar Hypertrophy

Exam Findings: Auscultating the Heart (2)

RRR, No murmurs, rubs, or gallops