PE Findings

Question 1

What would BP show in PCOS?

Answer 1

potentially elevated
HTN is a component of metabolic syndrome which is common in PCOS

Question 2

What would WC or W:H ratio show in PCOS?

Answer 2

WC:
<102 cm M OR < 88 cm F
W:H:
M cut off is 1 OR F is 0.85

Weight gain

Question 3

What would a dermatologic exam (hair, skin, nails) show in PCOS?

Answer 3

Face: acne, hirsutism, skin tags
Scalp: alopecia
Neck: Acanthosis nigricans, skin tags (IR)
Arms/chest: acne, hirsutism, acanthosis nigricans, skin tags, keratosis pillaris (↑ androgens), tuberous xanthomas
Abdomen/legs: hirsutism, acanthosis nigricans, tuberous xanthomas

Question 4

What would an external eye exam show in PCOS (2)?

Answer 4

Xanthomas
Corneal arcus (white line around eye)
both due to dyslipidmeia

Question 5

What would liver percussion + palpation show in PCOS?

Answer 5

signs of comorbid NAFLD (dyslipidemia)
- hepatomegaly
- firm liver (cirrhosis)

Question 6

What would a skin exam show for acne?

Answer 6

Papule: small raised sold circumscribed lesion < 1 cm
Nodule: palpable, raised, solid, circumscribed lesion > 1 cm

Pustule: small, circumscribed, inflamed, pus filled lesion

Comedo: dilated hair follicle filled w/ keratin, bacteria + sebum
Closed comedo: white head
Open comedo: black head

Question 7

What would vitals show in PMS/ PMDD?

Answer 7

Looking to rule out hypo/hyperthyroid in all Bp, Temp, HR, RR
Also HTN may contribute to sx such as headache, dizziness, faitgue
Also temp may rule out infection
Also body temp rises in luteal phase

Question 8

WC in PMS/PMDD?

Answer 8

Bloating & metabolic health assessment

Question 9

Skin exam in PMS + PMDD?

Answer 9

Acne - PMS/ PMDD

Periorbital edeam - rule out hypothyroid

Temp of skin (upper + lower extremities): may be colder in thyroid/ anemia but hotter in PMS/PMDD

Coarse dry skin for hypothyroid

Nutritional deficiency w/ dryness of skin associated with PMS/ PMDD

Question 10

NSE for PMS/ PMDD?

Answer 10

Nails: Koilonychia - rule out anemia/ nutritional defiencies
Also thin brittle nails (hypothyroid)

Hiar: hair loss + lateral 1/3 eyebrow loss (hypothyroid)

Pallor: rule out anemia

Question 11

Thyroid exam for PMS/PMDD?

Answer 11

Can rule out thyroid disease
Goiter, bogginess, nodules, tenderness

Question 12

DTRs in PMS/ PMDD?

Answer 12

if delayed (esp. achilles) - hypo

Question 13

Abdominal exam in dysmenorrhea

Answer 13

Suprapubic tenderness – primary/ secondary dysmenorrhea
Palpable masses (endometriosis, ovarian cysts, uterine masses) in secondary dysmenorrhea

Question 14

HR + RR in asthma?

Answer 14

HR: tachycardia or bradycardia (severe)
grade + rhythm

RR: Tachypnea or bradypnea (if severe)

Question 15

Nose exam in asthma?

Answer 15

Nasal secretion, mucosal swelling, pale/blue nasal turbinates = allergic asthma
Nasal polyps = seen in some forms of asthma (non-allergic) OR may cause obstruction themselves and contribute to breathing issues

Question 16

Inspection of thorax in asthma?

Answer 16

Anteroposterior diameter:
barrel chested - lung stadning Lund conditions or COPD

Chest deformity - pectus carinatum or pectus excavatum

Patient appears in distress with laboured breathing and use of accessory muscles.
Supraclavicular retraction observed on inspiration. Trachea deviated to the right side.
Costal angle 170 degrees, horizontal ribs with a 1:1 anteroposterior to lateral diameter.

Question 17

Lung percussion/ ausultation for asthma abnormal findings?

Answer 17

• percussion may be hyper resonant (air trapping)
• wheezing (but may be normal between attacks)

Question 18

External eye exam in allergy?

Answer 18

Conjunctivitis, allergic shiners, palpebral edema

Question 19

Nose + sinus exam in allergy?

Answer 19

Nasal salute
Assess for structural abnormalities (septal deviation, nasal ulcerations, polyps)
- polyps ↑ asthma suspicion, septal deviation, nasal ulcerations do not
- boggy, pale or bluish nasal turbinate’s due to venous engorgement ↑ suscipion
Cobblestoning of nasal mucosa, swelling + discharge
Mucosal swelling

Sinus palpation: may elicit tenderness in pts w/ chronic symptoms

Question 20

Oropharyngeal exam in allergy?

Answer 20

• Enlarged tonsils (if present not allergic rhinitis – other infectious cause) – Grade 0-4

To increase suspicion of allergic rhinitis:
- Mucous accumulation in the back of throat (postnasal drip)
- erythema/ swelling

Question 21

Skin exam in allergy?

Answer 21

Inspection of face + eyes:
- Allergic shiners. Nasal salute, watery eyes, swollen conjunctiva

Inspection of skin:
- urticaria, eczema, contact dermatitis
- don’t say eczema or dermatitis state the finding (xerosis, erythema etc)
- signs of concurrent dermatitis (atopic triad)

Question 22

Orthostatic HTN for dizziness?

Answer 22

Positive findings: a decline of 20+ mmHg in systolic or 10+ mmHg in diastolic bp within 3 minutes of standing.
- HR increase of ≥ 30 bpm may suggest hypovolemia

Question 23

Dix-hallpike maneuver in dizziness?

Answer 23

(+): nystagmus
If (+): ↑ suspicion that dizziness may be caused by benign positional paroxysmal vertigo (BPPV)

Question 24

HINTS exam (head impulse, nystagmus, skew deviation) in dizziness?

Answer 24

Head impulse test: presence of saccade

Nystagmus: presence of nystagmus + type

Skew deviation: presence of skew

Indicates either central (stroke) or peripheral pathology (vestibular neuritis)

Peripheral pathology: saccade + no nystagmus/ unidirectional + no skew

Central: no saccade, bidirectional/ vertical nystagmus + vertical skew

Question 25

Gait in dizziness?

Answer 25

The gait is unsteady, with difficulty maintaining balance. This suggests that the dizziness may be contributing to impaired coordination or postural instability, potentially indicating a vestibular or neurological issue (peripheral/ central)

Question 26

CVIII hearing assessment (whisper, weber, rinne) for dizziness?

Answer 26

If (+) for sensorineural hearing loss then ↑ suspicion that dizziness may be caused by vestibular disorder (Meniere’s disease) Sensorineural: Whisper: unable to repeat in affected ear Weber: lateralized to unaffected ear Rinne: AC > BC (bilaterally) Sensorineural hearing loss typically suggests a peripheral cause of dizziness, as it reflects inner ear involvement.

Question 27

Otoscopic exam for dizziness?

Answer 27

If abnormal: increase suspicion of middle ear related dizziness (otitis media, infection) -redness, bulging of TM, fluid behind TM, pus, discharge, cerum blockage, TM perforation, growth/ mass (cholesteatoma), retraction (Eustachian tube dysfunction)

Question 28

Occiput to wall distance for osteopenia?

Answer 28

(+) test: > 2 cm abnormal  kyphosis - can indicate osteoporosis (common in menopausal W)

Question 29

Rib- Pelvis distance in osteopenia?

Answer 29

(+) test: ≤ 2 finger breadths = kyphosis due to occult lumbar vertebral fracture (frequently caused in osteoporosis, common in menopausal W)

Question 30

Pelvic exam in menopause?

Answer 30

Signs of baginal atrophy + vaginal prolapse

Question 31

Vitals in menopause?

Answer 31

temp = hot flashes Bp: higher CVD risk in menopause, may see HTN HR + RR = pt can experience HR variability + changes in respiratory function, if vasomotor sx are occurring HR palpitations

Question 32

Heart auscultation in menopause?

Answer 32

Hormonal changes in menopause cause higher CVD risk: normal findings decrease suspicion of heart disease in menopause Abnormal findings increase suspicion of CVD in menopause (S3, S4, murmurs)

Question 33

Height + weight in menopause?

Answer 33

Obesity can exacerbate CVD risk so good to monitor

Question 34

Bp in LUTS/ ED?

Answer 34

CVD+ ED (which can present with LUTS) HTN indicates an increased CVD risk + can cause LUTS sx (effect on kidney function on vascular health) HTN increases CVD risk and may contribute to ED/ LUTS via effects on vascular function.

Question 35

Abdominal bruits & LUTS/ED?

Answer 35

Abnormal: turbulent flow indicating vascular pathology (atherosclerosis or stenosis) – CVD risk + may contribute to LUTS Abdominal bruits suggest vascular pathology such as atherosclerosis, increasing suspicion for CVD-related LUTS. Abdominal bruits suggest vascular disease, which may impair blood flow to pelvic organs and increase my suspicion of vascular ED

Question 36

Peripheral Pulses & LUTS/ ED?

Answer 36

Abnormal: weak or absent peripheral pulses may indicate PVD , associated with poor circulation + atherosclerosis + CVD risk + may contribute to LUTS Abnormal peripheral pulses increase suspicion for vascular insufficiency, which is associated with ED Diminished peripheral pulses may indicate PVD disease, which is associated with poor circulation and may contribute to LUTS