physical exam part 5

Anterior Cervical Lymphadenopathy

Swollen lymph nodes under jaw and along anterior neck area

Carotid Bruit

Abnormal flow of blood through the carotid artery

Cervical Vertebral Tenderness

Pain along cervical spine

Jugular Vein Distension (JVD)

Swelling of the jugular vein (usually seen in heart failure patients)

Meningismus

Patient has neck stiffness, photophobia, and headache which may suggest meningitis

No Step-offs or crepitus

No misalignment of the vertebral bodies (spinous processes) as the spine is palpated

Nuchal Rigidity

Neck stiffness with neck movement

Peritonsillar Abscess

Deep abscess adjacent to infected tonsils (collection of pus/swelling which is usually only visible if drained)

Pharyngeal Erythema

Redness of the throat

Pharyngeal Exudate

Pus seen on the posterior throat

Trachea Midline

No deviation of trachea from its usual location

Uvula Midline

No deviation of the uvula to one side or another

Bradycardia

Slow heart rate; less than 60 beats per minute

Diastolic Murmur

Heart murmur heard during diastole (rest/active filling)

Distant Heart Sounds

Faint-sounding heart beat

Gallops

Extra/abnormal heart sounds (should only hear 2 distinct sounds, but you hear 3 or 4 sounds)

Murmur

An abnormal sound heard when listening to the heart

Rubs

Coarse sounds produced when the heart 'rubs' on inflamed pericardium (heart tissue) during contractions

Systolic Murmur

Heart murmur heard during systole (active pumping)

Tachycardia

Fast heart rate; greater than 100 beats per minute

Costovertebral Angle Tenderness (CVAT)

Angle in back where kidneys are (HCP taps); left, right and bilateral - if pain then possible kidney pathology

Midline Tenderness

Tenderness directly over spine

No Step-offs

No misalignment of thoracic/lumbar spine

Paraspinal Muscle Tenderness

Tenderness in muscles adjacent to spine

Saddle Anesthesia

Loss of sensation around buttocks area

Straight Leg Raise

If pain, indicative of herniated disk

Apnea

Temporary absence or cessation of breathing

Accessory Muscle Use

Using extra muscles to breathe (you can usually see an emphasis on use of diaphragm and intercostal muscles)

Bradypnea

Abnormally slow breathing

Prolonged Inspiratory Expiratory Phase

Increased time between inspiratory and expiratory phases

Intercostal Retractions

Use of intercostal muscles with breathing (indicates severe respiratory distress/work of breathing) - sunken intercostal muscles (can see ribs)

Rales

Wet, crackling sound with respirations (aka crackles)

Rhonchi

A whistling or snoring sound heard on auscultation of the chest when air channels are partially obstructed; plural of rhonchus

Stridor

Harsh or high-pitched respiratory sound, caused by an obstruction of the air passages

Tachypnea

Abnormally rapid breathing

Wheezes

Difficult breathing with a whistling sound resulting from narrowing of the lumen of the respiratory passageways