Physical Exams Flashcards
(30 cards)
Knee
Inspection - Scars, erythema, swelling, atrophy, deformities (a rum/Valium)
Gait - antalgic, squat (overalll strength)
Palpation - Warmth, Effusion (bulge, ballottement), point tenderness
ROM - active then passive (crepitus)
Special Tests - Lachman’s/Anterior Drawer for ACL, Posterior drawer/sag for PCL, Varus stress for LCL, Valgus stress for MCL, McMurray/Appley’s Gring for menisci
Joint above and below
Adrenal Insufficiency
Vitals - orthostatic hypotension and tachycardia
Inspection - weight loss, pigmentation of oral mucosa, to Silas hypertrophic, auricular calcification, bitemporal hemianopia, EOM palsy, abdominal tenderness, splenomegaly, generalized hyperpigmentation, decreased axillary and pubic hair, vitiligo
Hip
Inspection - BMI, atrophy, scar, erythema, leg length, pelvic tilt, rotation, Trendelenburg sign
Gait - Antalgic, Compensated Trendelenburg, Gluteus Maximus gait (pelvic thrust)
Palpation - Bony Structures (pubic ramos, trochanter, Crest, ASIS/PSIS, isshial tuberosity), bursa
ROM - squat, active then passive, flexion 100-120, extension 20, abduction 45, addiction 30, external rotation 45, internal rotation 40
Special Tests - Thomas’ (hug knee, drop other leg), FABER, Ober’s (lie on side, knee flexed, hip abducted/extended, drop leg behind other (IT)), Tripod sign
Joint above and below
Shoulder
Inspection - scars, swelling, erythema, rounding, step deformities, scapular winging, atrophy
Palpation - SC joint, clavicle, AC joint, Cora oil process, greater tubercle, bicipital groove, tip of shoulder (supraspinatus), scapula
ROM - Active then passive, abduction 180, adduction, internal/external rotation, flexion 180
Special Tests - Rotator Cuff Tendinopathy (Lift-off, Hawkins (shoulder/elbow flexed 90, int rotation), Neer’s test, external rotation lag test (maintain external rotation), Rotator Cuff (Empty Can), Biceps Tendinopathy (Yergasons (resisted pronation), Speed’s (downward force shoulder flexion), Shoulder Instability (Apprehension, Relocation, Sulcus), Labral Tear (O’Briens, Biceps Load II)
Joint above and below
Pleural Effusion
Vitals - Febrile, Tachypneic, hypoxia, tachycardia, hypotension
Inspection - Chest expansion, concavity of intercostal spaces
Percussion - dull over effusion, auscultatory percussion (decreased resonance)
Palpation - tactile fremitus
Auscultation - decreased breath sounds, vocal fremitus, pleural rub
Lyles criteria - Fluid:Serum LDH > 0.6, Protein >0.5 LDH >2/3 ULN, only need 1 criteria
Obstructive Sleep Apnea
Risk Factors - Male, Obesity, Age, Alcohol, Black race, smoking
Vitals - Bradycardia, hypertensive, tachypneic, hypoxia
Inspection - Crowded pharynx, macroglossia, soft palate hypertrophy, elongated palate, high arched palate, micrognathia, hyomental distance <40mm, retrognathia >2mm, Crico-mental space <15mm, neck circumference F >40cm, M >43cm
Complications - HTN, HF, arrhythmia, PHTN, CAD, CVA
Epworth Sleepiness Scale 0 never, 3 high - Reading, TV, Meeting, Passenger >1h, lying down afternoon, talking, after lunch, stopped while driving, severe OSA 11-20
Thyroid
Inspection - lateral anterior bowing, tracheal deviation, distended neck veins, strider, coughing, hoarse voice, facial plethora, moves superior with swallowing
Palpation - Size (larger than patients thumbnail, consistency (normal, firm, rubbery, stony), shape, nodule, tenderness, mobility, cervical LAD,
Auscultation - bruit (Grave’s)
Pemberton’s Sign - abduct arms (facial plethora, neck vein distension, strider)
Thyroiditis
Vitals - Systolic HTN, Tachycardia
Inspection - Anxiety, scared fancies, fidgeting, weight loss, fine tremor, onycholysis (4th digit), thyroid acropachy (Grave’s), palmar erythema, sweaty palms, Vitiligo (AI disease), hyperpigmentation, pruritus (Grave’s), Pretibial myxedema (Grave’s), Thyroid stare, lid retraction, Lid lag, thyroid opthalmopathy (Grave’s), chemosis, corneal ulceration, optic atrophy, opthalmoplegia, Flow murmur (SEM LLSB), Means-Lerman scratch (mid systolic), bilateral crackles, pleural effusions, proximal muscle weakness, hyperreflexia
Peripheral Artery Disease
Inspection - colour, atrophy, hair, nails, wounds (arterial painful, tips, lateral malleolus) (Venous painless, medial malleolus)
Palpation - Temperature difference, pulses (femoral, popliteal, dorsalis pedis, posterior tibial)
Auscultation - bruits including iliac, Doppler of dorsalis pedis (3 arterial sounds)
Special Tests - Capillary refill >5 seconds, Buerger test (raise leg 90 (pallor not normal, lower until colour returns)), Venous fill time (raise leg 45 until veins collapse, lower leg >20s fill abnormal, ABI <0.9)
Mitral Regurgitation
Vitals - normal or tacky, normal or decreased BP
Inspection - respiratory distress, pale, (Ank spond, Marfans, RA), normal JVP, sharp upstroke, Previous sternotomy scar
Palpation - displaced PMI, diffuse, palpable S3, systolic thrill at apex, parasternal impulse
Auscultation - S1 soft, S2 widely split, loud P2 if PHTN, loud S2, S3, holosystolic, high pitched, radiates to axilla
Maneuvers - increases with afterload (handgrip, BP cuff), increases with preload (leg elevation/squatting), decreases with decreased preload (Valsalva/standing)
Surgical indications - symptomatic acute MR (pulm edema), severe sympomatic chronic MR (NYHA II-IV), MR with LVEF 30-60%, LVESD >40mm
Peritonitis
Vitals - tachycardia, hypotension, fever
Inspection - sit rigid, ascites, bulging flanks
Auscultation - normal bowel sounds
Percussion - tender, cough tenderness, fluid wave, shifting dullness
Palpation - guarding, rigidity, rebound tenderness,
Special Tests - Carnett test (palpation site maximal pain, partial sit-up, if pain decreases lower likelihood peritonitis)
Peripheral Dyslipidemia
Vitals - HTN
Inspection - obesity, periorbital xanthomas, corneal clouding, corneal Arcus, lipemia retinalis, pigmented retina, hypertrophied (yellow-grey) tonsils, tendinous xanthomas, eruptive xanthomas, palmar xanthomas, AS murmur, MR murmur (papillary muscle ischemia), HF, hepatosplenomegaly, pancreatitis, tendon xanthomas, peripheral artery disease, decreased proprioception, dysmetria, ataxia, spastic gait, mononeuritis multiplex
Chronic Liver Disease
Vitals - hypotension, tachypnea, fever (SBP)
Mental Status - confused/obtunded
Inspection - Temporal wasting, parotid enlargement, fetor hepaticas, jaundice, conjunctival pallor, Keiser-Fleischer rings, facial telangiectasias, pleural effusion, bulging flanks, shifting dullness, fluid wave, dilated veins, splenomegaly, umbilical hernia, muscle wasting, Terry’s nails, palmar erythema, clubbing, peripheral edema, Dupuytren’s contracture, ecchymosis, spider Angiomas, decreased body/pubic hair, gynecomastia, testicular atrophy, asterisks
Meningitis
General Appearance - Photophobia, altered LOC, Tripod position
Vitals - Fever, tachycardia, hypotension
Inspection - Meningismus, CN Paley (VI most common, V1-2), posterior throat, sinus, mastoid process, cervical LAN, orbital cellulitis, Jolt accentuation, respiratory consolidation, maculopapular rash, Kernig’s sign
Parkinson’s Disease
General Appearance - slowed movements, hypophonia, palilalia, MMSE
Vitals - Postural hypotension
Gait - rigidity, shuffling, diminished arm swing, festinating gait, postural instability
Balance - retropulsion
Inspection - mask like facies, decreased blinking, drooling, gaze paresis, glabellar tap, resting tremor, finger to nose test (bradykinesia), rigidity/cogwheeling, tapping fingers/feet, twiddling, writing (micrographics)
Cranial Nerve III
Inspection - Eye deviated down and out, pupil dilatation
Light reflex - RAPD no consensual response, follow fingers H,, convergence
Diabetic Screening Exam
Vitals - BMI, waist circumference
Inspection - body habits, amputations, glasses, pigmentation, acanthosis nigricans, CNIII palsy, Argyll Robertson pupil (accommodate don’t react to light), cataracts, exudate/haemorrhages on fundoscopy, CV exam including bruits, injection sites, muscle atrophy, skin changes of PAD, DFU, necrobiosis lipoidica, palpation pulses/temperature, neuro power/reflexes, vibration, proprioception
Cranial Nerve V
V1 - sensory forehead
V2 - sensory face and upper lip
V3 - sensory and motor lower jaw, masseter, temporalis, pterygoid
Inspection - muscle wasting, Herppes zoster (tip of nose Hutchison’s sign), dull/sharp sensation, light touch
Motor - clench jaw (palpation masseter), open jaw (petrygoid, deviates to weak side)
Reflexes - corneal reflex (afferent V1, efferent VII), jaw jerk
Cranial Nerve VII
Inspection - facial asymmetry, external auditory canal (HSV/Ramsey-Hunt), Bell’s phenomenon, red eyes, dental caries
Motor - Frontalis (raise eyebrows), orbicluaris oculi (close eyes), orbicularis oris (puff cheeks), Buccinator (show teeth), Platysma (neck muscles), Stapedius (hyperacusis)
Sensation - Taster anterior 2/3 tongue, over mastoid
Reflexes - corneal reflex (efferent orbicularis oculi),
Parasympathetic - lacrimal gland (Schirmer test >15mm moisture in 5 min), Salivary gland
Dysphagia
Phases Swallowing - Oral predatory phase, buccal phase (CN V, VII, XII), pharyngeal phase (CN V, IX, X, XII), Esophageal phase
Initial testing - Pa (CN VII), Ta (CN XII), Ga (CN IX/X), MMSE
CN V - deviation of jaw to weak side, open/close against resistance, palpation temporalis/masseter, jaw jerk reflex
CN VII - facial asymmetry, show teeth, puff cheeks
CN IX/X - dysarthria, hoarseness, uvula midline, gag reflex, tonsillitis, test swallow with liquid (wet voice, decreased O2)
CN XII - inspect tongue (wasting/fasciculation), dysarthria, protrude tongue (towards lesion)
Mechanical obstruction - palpation neck for masses
Median Nerve
Inspection - thenar wasting, deformity at wrist, hand diagram of parenthesis
Sensation - palm, digits 1 to lateral aspect of 4
Motor - Pronator teres, flexor carpi radialis (flex/abduct), flexor digitorum profundus I and II (flex DIP, fixed PIP (digits 2+3)), 1st lumbrical (extend PIP, hyperextend MCP), flexor pollicus longus (flex distal phalanx), abductor pollicis brevis (abduct), opponens pollicis
Reflexes - none
Special tests - Oschner’s clasp (unable to flex 2nd/3rd digits), Tinel’s sign, Phalen’s sign
Peripheral Thyroid
Vitals - Systolic HTN, Tachycardia (A fib)
Inspection - Anxiety, scared facies, fidgeting, weight loss, tremor, onycholysis (4th digit), thyroid acropatchy, palmar erythema, sweating, vitiligo, hair thinning, hyperpigmentation (ACTH), pruritus, urticaria, pretibial myxedema, thyroid stare, lid retraction, lid lag, exophthalamos, thyroid bruit
Chest - SEM LLSB flow murmur, Means-Lermann scratch, pleural effusions
Neuro - proximal muscle weakness, hyperreflexia
Ulnar Nerve
Inspection - hypothenar/intrinsic muscles of hand wasting, ulnar claw
Palpation - ulnar groove
Sensation - ulnar aspect of hand, 5th digit, medical aspect of 4th
Motor - Flexor carpi ulnaris, flexor digitorum profundus III and IV (flexion DIP, fixed PIP 4+5), Abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, 3rd/4th lumbricals (hyperextend PIP), dorsal interossei, palmar interossei
Special Tests - Tinel’s, Provocative pressure test, Froment sign (grip paper between thumb and palm (adducted))
Radial Nerve
Inspection - Wrist drop, atrophy, scars, swelling
Sensation - posterior cutaneous nerve of arm and forearm, web space of thumb and 1st digit
Motor - Triceps, Brachioradialis, Extensor carpi radialis longus, Supinator, Extensor carpi ulnaris, extensor digitorum, abductor pollicis longus, extensor pollicis longus and brevis
Reflexes - Brachioradialis (C5-6), Triceps (C7-8)
