Physical Exam Mentionables

Question 1

General Appearance

Answer 1

general health, consciousness, affect, distress level

Question 2

BMI classifications

Answer 2

<18.5, 18.5-24.9, 25-29.9, >30

Question 3

BP recommendations

Answer 3

Calm and comfortable (at rest for a few minutes) in a seated position with the back supported and legs uncrossed. No recent caffeine, tobacco, or exercise. Arm at heart level with restrictive clothing removed. Correct cuff size should be used. All recommendations improve accuarcy.

Question 4

Which arm should we check BP on?

Answer 4

Both

Question 5

Why is the bell side of stethoscope recommended for BP?

Answer 5

Bell is better at picking up lower tones. Korotkoff sounds are low pitched.

Question 6

Utility of palpating radial artery

Answer 6

Estimate systolic BP and minimize patient discomfort with overinflating the cuff or with several measurements.

Question 7

Symptoms of orthostatic hypotension

Answer 7

Fainting, dizziness, light-headedness, and confusion that is associated with transitions to a standing position

Question 8

Orthostatic Hypotension clinical definition

Answer 8

Reduction in BP: >20 mmHg Systolic, >10 mmHg Diastolic or an increase in pulse >20 between sitting BP and standing BP (within 3 minutes of transition)

Question 9

Normal pulse range

Answer 9

60-100 BPM

Question 10

Other components of pulse to monitor

Answer 10

rate and rhythm

Question 11

What to do if pulse is irregular

Answer 11

Listen to heart sounds at cardiac apex

Question 12

Normal respiratory rate

Answer 12

12-20 breaths/minute

Question 13

questions to ask if patient is in pain

Answer 13

OLD CARTS (Onset, location, duration; Characteristics, aggravating/relieving factors, treatments, severity). How is the pain impacting activities of daily living

Question 14

How to ask about pain with children

Answer 14

Range of faces on card

Question 15

Skin inpection

Answer 15

Jaundice, pallor, cyanosis. Injury: Lesions, trauma, bruising, and infection/inflammation. Could also observe temperature, turgor, and moisture

Question 16

Eyes inspection

Answer 16

Pupils (Equal in size and in reactivity to light. Pupils are both round [PERRLA]. Also inspection of the conjuctivae and sclerae for jaundice, redness or discharge

Question 17

Ears evaluation

Answer 17

form assessment during general conversation. If concerned, perform whisper and finger rub test to identify gross frequencies of loss.

Question 18

Heart evaluation

Answer 18

Auscultate at 4 locations, listening to rate, rhythm, and for any abnormal sounds such as murmurs, clicks, rubs, or other extra sounds

Question 19

Lungs inspection

Answer 19

Observe general rate and rhythm of breathing pattern (labored, SOB, distress, and retractions) Check for cyanosis around fingertips and lips

Question 20

Lungs auscultation

Answer 20

Listen for abnormal sounds such as wheezing, crackles, or rhonchi

Question 21

Abdominal inspection

Answer 21

contour, lesions, scarring

Question 22

Abdominal auscultation

Answer 22

listen to bowel sounds for abnormalities

Question 23

Abdominal palpation

Answer 23

palpate each quadrant for tenderness and organomegaly

Question 24

Musculoskeletal inspection

Answer 24

Abnormal gait pattern (shuffling, imbalance), slow/quick or unsteady chair transitions. Inspection for deformities, posture deficiencies

Question 25

Neurological inspection

Answer 25

assessment of balance, strength, reflexes, and signs of tremor

Question 26

Psychologic eval

Answer 26

During the encounter, I am grossly assessing the patient’s alertness, mood/affect, hygiene, overall behavior, and thought patterns.

Question 27

Order of Physical Exam

Answer 27

wash hands, introduce self, general appearance, vitals (BMI, BP, OH, Pulse, RR), pain, Skin, eyes, ears, heart, lungs, abdomen, MSK, Neuro, psych