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Physical Exam > Final Exam > Flashcards

Final Exam Flashcards

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1
Q

Bony landmarks of the shoulder

A

Acromioclavicular joint (superior)
Coracoid process of scapula
Greater tubercle of humerus (SITS muscles)

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2
Q

Shoulder joint anatomy

A

Glenohumeral joint, sternoclavicular joint, acromioclavicular joint

Subacromial bursa b/w acromion & humeral head

Long head of biceps tendon sits within bicipital groove

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3
Q

What does Neer impingement sign indicate?

A

Subacromial impingement

Rotator cuff tendinitis disorder

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4
Q

What does Hawkins impingement sign indicate?

A

Supraspinatus impingement

Rotator cuff tendinitis

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5
Q

What does external rotation lag test indicate?

A

Inability to maintain external rotation → supraspinatus/infraspinatus disorder

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6
Q

What does internal rotation lag test indicate?

A

Inability to hold hand behind back → subscapularis disorder

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7
Q

What does drop-arm test indicate?

A

Weakness abducting arm to 90 degrees → supraspinatus rotator cuff tear OR bicipital tendinitis

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8
Q

What does external rotation resistance test indicate?

A

Pain/weakness → Infraspinatus disorder

Limited → glenohumeral disease OR adhesive capsulitis

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9
Q

What does empty can test indicate?

A

Supraspinatus tear

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10
Q

How do you test CN I?

A

Smell

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11
Q

How do you test CN II?

A

Visual acuity
Visual fields by confrontation
Fundoscopic exam

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12
Q

How do you test CN III?

A

Extraocular movements

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13
Q

How do you test CN IV?

A

Extraocular movements - eye looks down and out

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14
Q

How do you test CN V?

A

Muscles of mastication

Sensation on face/corneal reflex

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15
Q

How do you test CN VI?

A

Extraocular movement - lateral movement

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16
Q

How do you test CN VII?

A

Facial expressions

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17
Q

How do you test CN VIII?

A

Whispered voice test

Rinne/Weber if abnormal

  • Rinne → conduction (AC > BC)
  • Weber → unilateral conductive (lateralizes to bad ear), unilateral sensorineural (lateralizes to good ear)
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18
Q

How do you test CN IX?

A

Hoarseness of voice

Gag reflex

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19
Q

How do you test CN X?

A

Rise of uvula and hard palate

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20
Q

How do you test CN XI?

A

Shoulder shrug

Turn head against resistancw

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21
Q

How do you test CN XII?

A

Stick out tongue

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22
Q

Findings associated with upper motor neuron lesion

A

Hypertonia
Hyperreflexia
NO fasciculations/atrophy
Positive Babinski sign (dorsiflexion)

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23
Q

Findings associated with lower motor neuron

A 
Hypotonia
Hyporeflexia
Fasciculations
Atrophy
Normal plantar reflex (negative Babinski)
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24
Q

Grading of deep tendon reflexes

A 
0 - No reflex
1 - Diminished reflex
2 - Normal
3 - Brisker than average, may be normal
4 - Very brisk, hyperactive → +/- clonus
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25
What does clonus indicate?
Upper motor neuron lesion (corticospinal lesion)
26
What is a positive Babinski sign?
Dorsiflexion of foot during test → indicates corticospinal tract lesion (CNS) Can be accompanied by reflex flexion in hip/knee Can transiently occur in unconscious states d/t alcohol/drug intoxication and during postictal period following seizure
27
Where would you auscultate for the aortic area of the heart?
Right sternal border at 2nd ICS
28
Where would you auscultate for the pulmonic area of the heart?
Left sternal border at 2nd ICS
29
Where would you auscultate for Erb's point?
Left sternal border
30
Where would you auscultate for the tricuspid area?
Left sternal border at 5th ICS
31
Where would you auscultate for the mitral area of the heart?
Approx. midclavicular line at 5th ICS
32
What areas do you listen for heart sounds?
``` Aortic area Pulmonic area Erb's point Tricuspid area Mitral area ```
33
What does S1 represent?
Closure of mitral/tricuspid (AV) valves
34
What does S2 represent?
Closure of aortic/pulmonic valves
35
Grading of pulses
0 - absent 1+ - Weak 2+ - Normal, brisk 3+ - Bounding
36
Visceral pain findings
Stretch/distention of hollow abdominal organs (e.g. intestines, biliary tree) Difficult to localize Visceral periumbilical pain = early acute appendicitis (changes to RLQ parietal pain)
37
Parietal pain findings
Steady, aching pain usually more severe than visceral pain More precisely located over involved structure Aggravated by movement → pt prefers to lie still
38
Referred pain findings
Felt in more distant sites which are innervated at approximately the same spinal level May be palpated superficially or deeply but usually localized
39
What kind of pain is colicky pain from a renal stone?
Visceral - pt is constantly repositioning self
40
Exam findings consistent with splenomegaly
Positive general splenic percussion sign - change from tympany to dullness into Traube's space Positive splenic percussion sign - change in percussion note from tympany to dullness on inspiration
41
When would splenomegaly occur?
``` Portal HTN HIV Splenic infarct Hematoma Mononucleosis ```
42
How do you perform Murphy's sign? What does it test for?
Hook fingers under costal margin or under liver edge Ask pt to take deep inspiration → Pain indicates acute cholecystitis
43
Where is McBurney point? What's the purpose of it?
A point 2 inches from anterior superior spinous process of ilium in an imaginary line drawn right and down from umbilicus Tenderness = appendicitis
44
How do you test for Psoas sign? What does it indicate?
- Patient lies down on left side and extends right hip - Patient supine, tries to raise right leg against resistance Increased abdominal pain at either = appendicitis or peritonitis
45
How do you test for Rovsing sign? What does it test for?
Apply pressure to RLQ and LLQ Rebound tenderness indicates appendicitis
46
Where do you assess the abdominal aorta?
1cm above and 1cm to the left of the umbilicus
47
How wide is a normal aorta?
<3cm wide Aortic abdominal aneurysm if >3cm
48
What is asterixis? What does it indicate?
Sudden, brief, nonrhythmic flexion of hands/fingers followed by recovery Suggests metabolic encephalopathy in pts with impaired mental function Seen in liver disease, uremia, hypercapnia
49
What lung sounds do you hear in a normal pt?
None
50
What lung sounds do you hear in partial lobar obstruction/atelectasis?
None
51
What lung sounds do you hear in pleural effusion
None, possible pleural rub
52
What lung sounds do you hear in pneumothorax
None, possible pleural rub
53
What lung sounds do you hear in left-sided HF?
Late inspiratory crackles, with possible wheezes
54
What lung sounds do you hear in lobar pneumonia (consolidation)?
Late inspiratory crackles
55
What lung sounds do you hear in COPD?
None, crackles, wheezes, or rhonchi
56
What lung sounds do you hear in asthma?
Wheezes or crackles
57
What percussion notes do you hear in pleural effusion?
Dull
58
What percussion notes do you hear in pneumonia?
Dull
59
What percussion notes do you hear in chronic bronchitis?
Resonant
60
What percussion notes do you hear in normal pt?
Resonant
61
What percussion notes do you hear in COPD?
Hyperresonant
62
What percussion notes do you hear in pneumothorax?
Hyperresonant
63
What is paresthesia?
Pins/needles
64
What is dysesthesia?
Distorted sensations E.g. burning pain occurs in painful sensory neuropathies like diabetets
65
When does sensory loss in stocking-glove distribution occur?
Polyneuropathies, esp. from diabetes
66
Causes of syncope
Seizures Neurocardiogenic conditions - vasovagal syncope, postural tachycardia syndrome, carotid sinus syncope, orthostatic hypotension, arrhythmias (v-tach, bradyarrythmia) Stroke/subarachnoid hemorrhage unlikely unless involves both hemispheres
67
What is the most common cause of syncope
vasovagal syncope - prodrome of nausea, diaphoresis, pallor triggered by fearful/unpleasant event
68
What findings are associated with syncope from arrythmias?
Sudden onset/offset - reflects loss/recovery of cerebral perfusion
69
Grade 1 murmur
Grade 1 - very faint, heard only after listener has "tuned in"; may not be heard in all positions
70
Grade 2 murmur
Grade 2 - quiet, but heard immediately after placing stethoscope on chest
71
Grade 3 murmur
Grade 3 - Moderately loud
72
Grade 4 murmur
Grade 4 - Loud with palpable THRILL
73
Grade 5 murmur
Grade 5 - Very loud, w/ THRILL; may be heard when stethoscope is partly off chest
74
Grade 6 murmur
Grade 6 - Very loud, w/ thrill; may be heard with stethoscope entirely off chest
75
What is a normal difference in BP measurements on diff. arms?
5-10 mmHg difference is normal
76
What would be an abnormal BP finding b/w arms?
>10-15 mmHg difference → indicates subclavian syndrome or aortic dissection
77
What does it mean if there is higher BP measurement in arms than legs?
Coarctation of aorta or occlusive aortic disease Systolic pressure should be 5-10mm Hg higher in legs than arms in normal pt
78
How would you assess position sense? What would an abnormal result indicate?
Joint position of toe Loss of position sense is seen in tabes dorsalis, MS, Vitamin B12 deficiency
79
Exam findings associated with peripheral neuropathy
Loss of vibration sense & loss of position sense
80
Dermatome at axilla
T1
81
Dermatome at nipple
T4
82
Dermatome at umbilicus
T10
83
Dermatome at groin
L1
84
Dermatome at knee
L4
85
Exam findings associated with Guillan Barre syndrome
Subacute onset of LE weakness
86
What does analgesia/hypalgesia/hyperalgesia mean?
absent/decreased/increased sensation of pain
87
What does o Anesthesia/hypesthesia/hyperesthesia mean?
absence/decreased/increased sensation of touch
88
What is the first sensation lost in peripheral neuropathy?
Vibration sense
89
When would vibration sense be lost?
Diabetes Alcoholism Posterior column disease (tertiary syphilis, B12 deficiency)
90
Why would you test vibration sense on trunk?
To identify level of cord lesion
91
When would you see loss of position sense?
Tabes dorsalies Multiple sclerosis Vitamin B12 deficiency Diabetic neuropathy
92
Common musculoskeletal causes regarding lordosis
Paravertebral spasm | Metastatic malignancy
93
S3 heart sound
- "Kentucky", ventricular gallop → right after S2 - Normal in children & up to age 40 - Pathologic in >40 y/o → decreased myocardial contractility, HF, ventricular volume overload from aortic/mitral regurgitation, left-to-right shunts
94
S4 heart sound
"Tennessee", atrial gallop → just before S1 Occasionally normal in trained athletes & older age groups but usually d/t resistance during ventricular filling (ventricular hypertrophy or fibrosis)
95
Sequence for proper fundoscopic exam
- Darken room - Switch light on & turn lens disc to see large round beam of white light - Shine on back of hand to check/adjust - Turn lens disc to 0 diopter - Hold scope in right hand & use right eye when examining pt's right eye - Tell pt to look slightly up and over your shoulder at wall - Place self ~15 in. away at 15 degrees lateral to pt's line of vision - Look for red reflex in pupil (fundus)
96
Broncophony
Loud/distinct "ninety-nine"
97
Whispered pectoriloquy
Loud/cleaer whisper
98
Egophony
E to A
99
Another term for airless lung tissue
consolidation
100
Marcus Gunn pupil
Swinging flashlight test - dilation of both eyes when light is on affected eye, bilateral constriction when light is on normal eye Impairment of optic nerve - relative afferent pupillary defect
101
Adie pupil
aka tonic pupil - pupil is dilated at rest; reaction to light is severely reduced/slowed Impaired parasympathetic innervation to iris
102
Grading of muscle strength
0 - no contraction 1 - barely detectable contraction 2 - active movement without gravity 3 - active movement against gravity 4 - active movement against gravity & some resistance 5 - active movement full resistance w/out evident fatigue (normal)
103
Dont's when assessing comatose pt
DON'T dilate pupils - single most important clue to underlying cause of coma DON'T flex neck (clearance of C-spine)
104
Significance of auscultatory gap
Silent interval that may be present b/w systolic & diastolic pressures - associated with arterial stiffness & atherosclerotic disease Unrecognized gap may lead to underestimation of SBP or overestimation of DBP
105
Corneal arcus
Thin, grayish white arc/circle on corneal edge Normal aging process or in young adults (esp. A.A.) May indicate hperlipoproteinemia in young adults Benign
106
Kayser-Fleischer ring
Golden/red-brown ring from copper deposition Associated with Wilson disease
107
Corneal abrasion/ulcer
Superficial grayish-white opacity in cornea
108
Cataract
opacity of lens only through pupil
109
Entropion
Inward turning of eyelid, common in elderly Lower lashes can turn inward & irritate conjunctiva/cornea
110
Ectropion
outward turning of lower lid margin, common in elderly
111
Exophthalmos
protrusion of eye ball, common in Graves’ disease
112
Pinguecula
yellowish triangular nodule on side of iris
113
Xanthelasma
yellow, raised cholesterol filled plaques near eyelids; common in hyperlipidemia
114
HSV keratitis
Dendritic ulcer under fluorescein
115
Near reaction vs. convergence
Near reaction - pupils constrict when gaze is shifted to nearby object Convergence - physical converging of eyeballs
116
Findings associated with Weber test
Unilateral hearing loss Conductive hearing loss - lateralizes to bad ear Sensorineural hearing loss - lateralizes to good ear
117
Findings associated with Rinne test
Normal AC > BC
118
Arteries vs. veins in ophthalmic exam
``` Arteries = light red, smaller, bright light reflex Veins = dark red, larger, absent light reflex ```
119
Target organs affected by HTN
Eyes Kidneys Brain Heart
120
Pulsating tonsillar node significance
Carotid artery - i.e. not a node
121
Small, hard tender tonsillar node b/w mandible & SCM - signficance?
Probably styloid process - i.e. not a node
122
Enlargement of supraclavicular node on left side - signficance?
Possible metastasis from thoracic or abdominal malignancy
123
Normal IOP
10-22mmHg
124
What is the 5th vital sign?
Pain
125
What percentage of adults are overweight/obese?
69%
126
Nociceptive pain
Linked to tissue damage to skin, MSK system, or viscera BUT sensory nervous system is intact Can be acute or chronic Mediated by afferent A-delta and C-fibers of sensory system
127
Neuropathic pain
Direct consequence of lesion/disease affecting somatosensory system May become independent of inciting injury, may persist even after healing of injury ("neuronal plasticity")
128
Central sensitization
Alteration of CNS processing of sensation, leading to amplification of pain signals
129
Psychogenic pain
Psychiatric conditions that influence pt's report of pain
130
Idiopathic pain
Unidentifiable etiology
131
BMI categories
``` 25-29.9 = overweight 30-34.9 = obese, class I 35-39.9 = obese, class II 40+ = extreme obesity, class III ```
132
Most important part of physical exam
General appearance of pt & vital signs
133
What are the vital signs (4)
BP RR HR Temp.
134
"True blood pressure"
Avg. BP in several office visits or at home in a 1 week period
135
How to select BP cuff
Width of inflatable bladder should be 40% arm circumference Length of inflatable bladder should be 80% arm circumference
136
Which side of the stethoscope do you listen to BP with
Bell b/c Kortkoff sounds are low in pitch
137
Indication for Wong-Baker FACES pain rating scale
Children & pts w/ language barriers or cognitive impairment
138
Where is S1/S2 loudest on heart?
S1 is loudest at apex | S2 is loudest at base
139
When is "a" wave absent?
Atrial fibrillation
140
How many clicks/gurgles is normal in abdomen auscultation?
5-34/minute

Physical Exam (1 decks)

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