Describe the technique/response to test for alertness (level of consciousness/arousal).
Speak to patient in normal tone of voice Response: opens eyes, looks at you, responds fully and appropriately
Describe the technique/response to test for lethargy (level of consciousness/arousal).
Speak to the patient in a loud voice Response: appears drowsy but opens eyes, looks at you, responds, falls asleep
Describe the technique/response to test for obtundation (level of consciousness/arousal).
Shake the patient gently as if awakening a sleeper Response: opens eyes, looks at you, responds slowly, is confused, alertness is decreased
Describe the technique/response to test for stupor (level of consciousness/arousal).
Apply a painful stimulus Response: arouses from sleep only after painful stimulus; verbal responses are slow/absent, minimal awareness of self/environment
Describe the technique/response to test for coma (level of consciousness/arousal).
Apply repeated painful stimuli Response: remains unarousable with eyes closed
What are the 12 major aspects of general appearance?
1. General state of health 2. Level of comfort 3. Respiratory effort 4. Development stage 5. Height/weight 6. Posture, motor activity, gait 7. Deformities or distinguishing characteristics 8. Characteristic facies 9. Dress, grooming, personal hygiene 10. Odors 11. Level of awareness/consciousnes 12. Skin color/hair distribution
What are some descriptors of general state of health?
Frail, chronically ill, robust, vigorous
What are some indicators of level of comfort?
Wincing/grimacing, crying, doubled over in pain, clutching chest, hand around neck, resting comfortably in bed
What is an important physical cue for emphysema?
Tripod position/leaning forward
What are some indicators of abnormal respiration?
Gasping for breath, labored breathing, coughing, unable to speak in sentences, use of accessory muscles of respiration (SCM, trapezius, scalenus), audible wheezing/stridor
What is the Dahl sign?
Clinical sign in which areas of darkened and thickened skin are seen on the lower thighs and elbows
What are two potential causes of unusual shortness?
1. Turner syndrome 2. Achondroplasia
What are two potential causes of unusual tallness?
1. Marfan syndrome 2. Gigantism/acromegaly
What are some physical signs of Turner's syndrome?
Short stature, webbed neck, increased carrying angle, swelling of feet
What are some physical signs of Marfan syndrome?
Tall, thin, disproportionate, chest deformity, thumbs stick out past the side of the hand when making a fist, can wrap hand around wrist and cross finger and thumb
What are the BMI ranges of underweight, overweight, obese, and morbidly obese?
Underweight: less than 18 Overweight: 25-29 Obese: 30-39 Morbidly obese: 40+
What is a weight-related sign of Cushing's?
Buffalo hump, central obesity with thin limbs
What are some aspects to look for in posture/motor activity?
1. Kyphosis 2. Scoliosis 3. Need arms to get out of a chair 4. Ambulation aids 5. Anxious/fidgeting 6. Sitting up (left sided heart failure) 7. Leaning forward sitting up (COPD)
What is a noticeable gait in Parkinson disease?
What is hemiplegic gait?
Circumduction of the paralyzed limb with the ball of the great toe touching the ground as it sweeps around; upper limb is flexed and internally rotated
What does stamping gait occur in?
Tabes dorsalis (proprioception loss)
What is scissor gait and when does it occur?
One leg crosses in front of the other as the patient walks; spastic paraplegia (cerebral palsy)
What are some possible deformities or distinguishing characteristics?
1. Amputees 2. Scars 3. Piercings/tattoos
What is moon face associated with?
What is prognathism associated with?
What is a stare associated with?
What are myxedema, loss of lateral 1/3 of eyebrows, puffy face, dry/dough skin, and brittle hair associated with?
What are masked faced, hunched posture, resting tremor, no arm swing with walking, and minimal blinking associated with?
What is a butterfly rash associated with?
What are some physical signs of Down syndrome?
Epicanthal folds, increased space between 2 digits of feet, shorter 5th finger, crease across palm, small ears
What might untied shoes indicate?
What might cut holes in shoes indicate?
Bunions or gout
What are some important odors to pay attention for?
1. Alcohol 2. Fruity odor (ketoacidosis) 3. Fecal odor (anaerobic infection) 4. Urine 5. Tobacco
What is yellow skin color associated with?
What is blue skin associated with?
Cyanosis, silver ingestion
What is red skin associated with?
Sunburn, rash, allergy
What is alopecia?
Loss of hair
What is hirsutism?
Increased hair growth
What does yellow skin with a white sclera indicate?
What might circumduction of the leg and/or a flexed upper limb indicate?
What is acute otitis media?
Acute inflammation of the middle ear (red, bulging)
What is serous otitis media?
Fluid in the middle ear (can see an air-fluid level)
What is hemotympanum?
Blood behind the eardrum (bulging, black/red)
What is tympanosclerosis?
Scar tissue on the ear drum (white)
What is a tympanic membrane perforation?
Partial hole, can see into the inner ear
What is cholesteatoma?
Keratin debris in the middle ear behind the ear drum
What is otitis externa and how is it treated?
External auditory canal infection; wick (steroid and antibiotic drops funneled into the EAC)
What is serumen?
What will you see in allergic rhinitis?
Swelling, serous fluid
What will a CT scan look like in sinusitis?
Areas that should be black (air filled) are grey
What does the nose look like when the septum collapses?
What happens in a peritonsillar abscess?
Red bulging, can't see tonsils, uvula deviates to contralateral side, muffled speech
What is a ranula?
Sublingual gland cyst
What is parotitis?
Inflammation of the parotid gland
80% of tumors in major salivary glands are ___. 80% of tumors in minor salivary glands are ___.
This cyst moves up and down when a patient sticks out their tongue
Thyroglossal duct cyst
Lateral neck swelling anterior to the SCM might be indicative of a ___.
Branchial cleft cyst
The part of the eardrum above the malleus is the ___; everything else is the ___.
Pars flaccida; pars tensa
What is bullous myringitis?
Painful hemorrhagic vesicles appear on the tympanic membrane, the ear canal, or both
What are the 5 steps to the eye exam?
1. Visual acuity/fields 2. Pupils 3. External eye exam 4. Extra-ocular muscles 5. Fundus exam
Bitemporal hemianopia is commonly seen with a ___.
What is ptosis?
What is entropion?
Lid turning in
What is ectropion?
Lid sagging out
Which CN control which extra-ocular muscles?
LR6, SO4, all else 3
What is esotropia?
Turning in of the eye
What is exotropia?
Turning out of the eye
What happens in paretic strabismus
Paralysis of an extra-ocular muscle
___ leads to increased cupping and atrophy of optic nerve cells.
If you see "cotton wool spots" in the retina, what is this a sign up?
What causes a horizontal defect in the eye?
Occlusion of a branch of the central retinal artery
What causes blindness in the right eye?
Lesion of the right optic nerve
What causes bitemporal hemianopsia?
Lesion at the optic chiasm
What causes homonymous left superior quadrantic defect?
Partial lesion of the right optic radiation
What causes left homonoymous hemianopsia?
Lesion of the right optic radiation
Draw the optic tracts.
What will the physical exam show with CN III paralysis?
Dilated pupil fixed, ptosis of upper eyelid, lateral deviation of eye
What will the physical exam show in Horner's syndrome?
Ptosis of eyelid