PE- competency Flashcards
1
Q
HEENT exam
A
general inspection
otoscopic ear exam- Tympanic membrane
Gross hearing (finger rub)
weber, rinne
otoscopic nose examsinus palpation/percussion
oral exam
visual acuity
pupil light reflexes direct/inderirect
EOMI ("H") convergence and accommodation
Fundoscopic exam
Palpate lymph nodes, thryoid with swallow and tracheal position/mobility
2
Q
weber is
A
lateralization of sound using tuning fork
normal”weber is midline”
3
Q
rinne
A
put on mastoid until sound goes away then hold up next to ear and see if sound is still there
4
Q
weber vs rinne result interpretations
A
normal AC>Bone conduction
5
Q
Lung exam
A
inspect front and back palpate front and back excursion tactile fremitus- multiple spots on back percuss diaphragm excursion anterior 4 points, posterior 6 points, lateral 2 on each side auscultate open mouth 4:6:4 egophony bronchopony whispered pectoriloquy
6
Q
egophony
A
say ee. comes out ahh if consolidation
7
Q
bronchophony
A
say 99, if clear then consolidation
8
Q
whispered pecteriloquy
A
whisper 1,2,3
if loud and clear then consolidation
9
Q
Abdomen PE
A
inspect fully exposed auscultate 4 Q, aorta and renal aa percuss 4Q liver span and CVA palpate lightly 4Q deeply 4Q palpate: liver spleen kidneys aorta rebound tenderness rovsings, murphys fluid wave, whifting dullness
10
Q
rovsings:
A
deep palpation L LQ if when release pressure pain in RLQ
appendicitis test
11
Q
murphys
A
while deep inhale palpate gallbladder
if arrest inhalation from pain- galld bladder test
12
Q
fluid wave
A
have patient have hand down midline
ascites
CHF?
13
Q
shifting dullness
A
percuss on back then on side to look for ascites
14
Q
HEart Exam
A
inspect anterior chest wall, measure JVP palpate PMI, anterior wall for heaves or thrills carotid pulses (1 at a time) radial pulses dorsalis pedis pulses tibialis posterior pulses Ausculate 5 posts bell and diaphragm auscultate carotid aa
15
Q
auscultate with valsalva
A
auscultate valsalva at erbs
standing if louder than hypertrophic cardiomyopathy
squatting if louder then aortic stenosis
16
Q
what does a heave mean? thrill?
A
heaves is what you see
thrills you feel
17
Q
what is left lateral decubitus used for?
leaning forward
A
have them lay on left side and listen to mitral valve–mitral stenosis
leaning forward, they hold breathe and listen to aortic and pulmonic– aortic regurgitation
18
Q
Mental status exam
A
appearance/behavior affect/mood language perception/insight executive function short memory
19
Q
Cerebellar exam
A
disdiadakokinesia finger to nose tandem walk heel/toe rhomberg pronator drift heel down shin toe proprioception kernigs brudzinski
20
Q
kernigs test
A
flex patients hip to 90 then extending knee causes pain in neck or spine
meningeal pain
21
Q
brudzinski test
A
flexing patient neck causes flexion of hips and knees
reproduces meningitis HA
22
Q
rhomberg
A
proprioception(axial)
23
Q
pronator drift
A
proprioception (appendicular)
24
Q
CN exam
A
I olfactory II optic (light reflex and EOM) III oculomotor (EOMI) IV trochear EOMI V trigeminal, clench jar and move jaw and eyebrows. VI abducens EOMI VII facial facial expressions VIII hearing IX glossopharyngeal gag and uvula X vagus just say ah XI spinal accessory raise shoulders and resist head turn XII hypoglossal, stick out tongue
25
PNS
inspect, palpate involved area
soft sensation dermatomes and peripheral cutaneous
vibration, 2pt disc, toe proprio, temperature
DTR: biceps, triceps, brachioradial, patella, achilles
babinski
reinforce upper and lower
Strength: bicep, tricep forearm extensors hip flexor extensor
quads, hamstrings dorsi and plantar flexion
tinels phalens roos adsons straight leg
26
what are the ratings for DTR and strength testings
```
DTR
0absent
1hypoactive
2normal
3hyperactive
4hyperactive with clonus
Strength
0 none
1 barely
2 active with no gravity
3 active against gravity
4 active with some R
5active against full R
```
27
tinels
tap on ventral side wrist for carpal tunnel
28
phalens
carpal tunnel
29
Roos
thoracic outlet
30
adsons
thoracic outlet, compression subclavian aa
31
straight leg raise
sciatica or piriformis
32
MSK neck
```
inspect
palpate
active or passive ROM
up down side side, side bending
muscle strength ACM and trapezius
```
33
MSK shoulder
```
insepct, palpate
active: flexion, extension, ADuction, ABduction
external/internal rotation (Apley)
supraspinatus
infraspinatus
subscapularis
```
34
supraspinatus test
empty can
35
infraspinatus test
resist patient pushing outward at 90 degree robot pose
36
subscapularis test
lift off
37
MSK elbow
```
inspection
palpation
ROM (active or pssive)
flexion/extension
pronation/supination
ulnar/radial deviation
```
38
MSK hand wrist
```
inspect
palpate
active or passive ROM: open close fist
flexion/extension
ADduction/ABduction
thumb opposition
finkelstein test
ulnar collateral lig test
first carpometacarpal grind test
```
39
first carpometacarpal grind
bones
40
ulnar collateral lig test
pull thumb backwards ish
41
finkelstein test
tenosynovitis of thumb abductors and extensors
42
MSK back
inspect spine
palpate
ROM active or passive: flexion/extension
sidebending
43
MSK LE- hips
```
inspect
palpate
flexion
internal/external rotations
ADduction/ABduction
trendelenburg
Thomas
Patrick fabere
```
44
trendelenberg
medius injury? opp side
| stand on one left than the other. if pelvis drops on raised leg side then standing leg affected
45
thomas hip test
bend legs laying supine,
| extend one leg should lay flat if doesn't then flexion contraction iliopsoas
46
patrick fabere
supine, cross legs to make a 4 and press knee down
| increased ROM SI pathology
47
MSK knee
```
inspect
palpate
flexion/extension
anterior/post drawers
lachmans
varus/valgus- collaterals
thessaly
mcmurray
apprehension
palpation for effusion
homans and thompson
```
48
lachmans
ACL flexed at 15 degree and externall rotated
49
thssaly
meniscal
50
apprehension
patella
| passively move medially laterally look for pain
51
What are homans and thompson tests for
homans-passivley dorsiflex and see it pain or discomfort
| thompsons- achilles rupture.squeeze calf and look for plantar flexion (lack of flexion indicates injury)
52
MSK-ankle
```
Inspect, palpate
dorsi/plantar flexion
inversion/eversion
anterior drawers
kleigers
```
53
klerigers ankle test
passively externally rotate foot and ankle
| + is pain at deltoid ligament
54
describe otoscopic exam normal findings
external auditory meatus, redness, swelling lesions etc
| TM- color, translcent, bulging or retraction?
55
describe nose exam
inspection, palpation
redness, septum midline,
mucous membrains pink
56
descirbe general oral exam results
```
mucosa description
teeth and gums
tongue
uvula no deviation
hard and soft palate colors, plaques?
```
57
S4 is heard when, means what
```
before S1(systole)
mitral stenosis
```
58
S3 is head when, means what
```
after S2(diastole)
aortic regurgitation
```
59
what does an aortic stenosis sound like
crescendo-decrescendo
60
what doesmitral regurg sound like
plateau murmur
| same intensity throughout
61
JVD? JVP
add 5
40 degree angle
want under 9
62
what are grades up murmurs
I- not even hear
II- lowintesnsity
III- medium intensity withouth thrill
IV medium intensity with thrill
V- loud with stethoscop on chest with thrill
VI- loudes audible w/o sthethoscope with thrill
63
crackles/rales
pneumonia, CHF fibrosis
| hear in inspiration- nonmusical sounds
64
wheezes
musical sounds expiration
| asthma, COPD bronchitis
65
rhonchi
lowered pitched, bubbly sounds
| secretions in large airways
66
pleural rub
gratins sound at end of inspiration or beginning of expiration
inflamed or thickened pathologic process
