OP Course 2: PE - Objective Flashcards by Noah Wenger

“Objective” refers to?

Factual information; comes from provider

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“Auscultation” refers to?

Listening w/ stethoscope

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“Palpation” refers to?

Pressing on an area

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“Chachetic” refers to?

emaciated; malnourished

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“Diffuse” refers to?

Widespread

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What are some normal terms you may see in the “general/constitutional” section of the physical exam?

No acute distress (NAD)

Well developed/nourished

Alert

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What are some abnormal terms you may see in the “general/constitutional” section of the physical exam?

Mild/moderate/severe distress

Cachectic/Emaciated/Malnourished

Somnolent, obtunded, unresponsive, C-collar, backboard, oxygenation 91% 10L O2 NC

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What is the normal term you may see in the “head” section of the physical exam?

Atraumatic/Normocephalic (AT/NC)

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What are some abnormal terms you may see in the “head” section of the physical exam?

Any signs of trauma

Sinus tenderness

Angioedema

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What does PERRL stand for?

Pupils equal, round, reactive to light

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What does EOMI stand for?

Extraocular movements intact

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What are some normal terms you may see in the “eyes” section of the physical exam?

PERRL or PERRLA

EOMI

Sclerae are anicteric

Normal conjunctiva

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What are some abnormal terms you may see in the “eyes” section of the physical exam?

Anisocoria (unequal pupils)

EOM entrapment

Scleral icterus (yellowing)

Pale conjunctiva (anemia) or conjunctival injection (conjunctivitis)

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What is a normal term you may see in the “ears” section of the physical exam?

Tympanic membranes normal (TMs normal)

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What are some abnormal terms you may see in the “ears” section of the physical exam?

TM erythema

TM bulging

TM dullness

TM obscured by cerumen (earwax)

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What are some normal terms you may see in the “mouth/throat” section of the physical exam?

Moist mucous membranes

Oropharynx (OP) normal

Normal dentition

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What are some abnormal terms you may see in the “mouth/throat” section of the physical exam?

Dry mucous membranes (DMM)

Pharyngeal erythema

Tonsillar exudate

Tonsillar hypertrophy

Edentulous

Dental caries

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What is a normal term you may see in the “neck & cervical spine” section of the physical exam?

Supple

No carotid bruit

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What are some abnormal terms you may see in the “neck & cervical spine” section of the physical exam?

Thyromegaly

Jugular venous distension (JVD)

Carotid bruit

Cervical lymphadenopathy

Limited ROM

Vertebral point vs. paraspinal tenderness

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What are some normal terms you may see in the “cardiovascular” section of the physical exam?

Regular rate

Regular rhythm

Heart sounds normal

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What are some abnormal terms you may see in the “cardiovascular” section of the physical exam?

Tachycardia/Bradycardia

Irregularly irregular rhythm (Afib)

Murmur, gallops or rubs

Extrasystoles

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What are the following values on the pulse grading scale? Which value is the normal value?

0 = ?

1+ = ?

2+ = ?

3+ = ?

4+ = ?

0 = absent

1+ = barely palpable

2+ = easily palpable

3+ = full

4+ = bounding/aneurysmal

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What are some normal terms you may see in the “perfusion” section of the physical exam?

Study These Flashcards

Pulses equal & symmetric

Capillary refill < 2 sec

What are some abnormal terms you may see in the “perfusion” section of the physical exam?

Study These Flashcards

Unequal pulses

Delayed capillary refill

What are "vesicular" breath sounds?

Normal breath sounds

What are some normal terms you may see in the "pulmonary" section of the physical exam?

No respiratory distress Normal respiratory rate Normal effort Breath sounds clear and equal Clear to auscultation bilaterally

What are some abnormal terms you may see in the "pulmonary" section of the physical exam?

Mild --\> severe respiratory distress Tachypnea Accessory muscle use Diminished (quiet) breathing Wheezes, rales, rhonchi

Label the following aspects of the abdomen: Epigastrium, R & L Flanks, Generalized, Suprapubic, Periumbilical, LLQ, RUQ, RLQ, LUQ

What are the three "peritoneal signs"?

Rebound tenderness Rigidity Voluntary guarding

What are some normal terms you may see in the "abdominal" section of the physical exam?

Soft Non-tender **No peritoneal signs** Normal bowel sounds Nondistended

What are some abnormal terms you may see in the "abdominal" section of the physical exam?

Rigid (involuntary guarding) Mild --\> severe tenderness Peritoneal signs (Rebound tenderness, rigidity, voluntary guarding) Absent/hypoactive/hyperactive bowel sounds Organomegaly Distended

What does a positive murphy's sign refer to?

gallbladder

What does "Positive McBurney's point" refer to?

Appendix

What does a positive Psoas sign refer to?

Appendix

What does a positive obturator sign refer to?

Appendix

What does a positive Rovsing's sign refer to?

Appendix

What are some normal terms you may see in the "musculoskeletal/extremities" section of the physical exam?

Non-tender Full ROM Distal circulation, sensory, motor, tendon (CSMT) intact

What are some abnormal terms you may see in the "musculoskeletal/extremities" section of the physical exam?

Bony tenderness (fracture) Soft tissue tenderness (contusion) Decreased ROM 2° pain Pulse/sensory/motor deficits Tendon laxity Pitting edema (trace to 4+) Calf tenderness, palpable cords/Homan's sign (DVT)

What are some normal terms you may see in the "back" section of the physical exam?

Non-tender thoracic and lumbar spine

What are some abnormal terms you may see in the "back" section of the physical exam?

Paraspinal tenderness (muscular) Vertebral point tenderness (spinal injury) Costovertebral angle (CVA) tenderness

What are some normal terms you may see in the "integumentary" section of the physical exam?

Warm Dry Normal color No rash Atraumatic No erythema, warmth, or drainage

What are some abnormal terms you may see in the "integumentary" section of the physical exam?

Cool or hot to touch diaphoretic Jaundice, cynotic, pallor Any signs of rash Any signs of trauma Any signs of infection

What are some normal terms you may see in the basic neurological exam?

Alert Oriented x4 Normal speech Nonfocal neuro exam

What are some abnormal terms you may see in the basic neurological exam?

Somnolent, obtunded, unresponsive Disoriented to person, place, time, or situation (x4) Aphasia (expressive or receptive) dysarthria Any abnormal findings

What are some normal terms you may see in the motor & sensation part of the neurological section of the physical exam?

Motor strength 5/5 and symmetric Sensation intact

What are some abnormal terms you may see in the motor & sensation part of the neurological section of the physical exam?

Extremity weakness (\_/5) Pronator drift Hypoesthesia (decreased sensation) Numbness

What do the following strength values correspond to? 5/5 = ? 4/5 = ? 3/5 = ? 2/5 = ? 1/5 = ? 0/5 = ?

5/5 = normal strength 4/5 = very mildly weak 3/5 = unable to overcome resistance 2/5 = unable to overcome cravity 1/5 = slight contraction, no movement 0/5 = flaccid/limp

What is a normal Babinski reflex (in an adult)?

Downgoing toes

What is an abnormal Babinski reflex?

Upgoing toes

What do the following values for Deep Tendon Reflexes (DTRs) represent? 0 = ? 1+ = ? 2+ = ? 3+ = ? 4+ =?

0 = absent 1+ = hypoactive 2+ = normal 3+ = increased 4+ = unsustained clonus

What are some normal terms you may see on the "psychiatric" section of the physical exam?

Normal affect Normal judgment Normal insight Normal speech

What are some abnormal affects that you may see in the "psychiatric" section of the physical exam?

flat affect odd affect tearful depressed hypomanic poor eye contact

What are some abnormal "judgments" that you may see in the "psychiatric" section of the physical exam?

Suicidal or homicidal Hallucinations Flight of ideas (loose association) Paranoid

What are some abnormal "insights" that you may see in the "psychiatric" section of the physical exam?

Denies illness/symptoms Noncompliant with treatment

What are some abnormal "speech patterns" that you may see in the "psychiatric" section of the physical exam?

Tangential speech Pressured speech

What constitutes a complete physical exam?

9 body systems (and 18 total findings)

OP Course 2: PE - Objective Flashcards

(56 cards)