ED Course 4: Physical Exam

Define erythema

redness

Define edema

swelling

Exam findings are categorized in the charting system by __

Body system

Auscultate

To listen to the body with a stethoscope

Palpate

To touch/feel

Inspect

To visualize

Physical Exam findings are considered ____ information

Objective

Providers use what senses when examining patients?

Vision, Touching, Hearing, and Smelling

T/F A diagnosis can be documented in exam if the provider knows the dianosis by looking at it

False; diagnoses do not go on exam; you would need supporting documentation on exam describing why thats the correct dianosis

Example:

(WRONG way) Cellulitis to the right leg

(RIGHT way): There is induration, erythema, and increased warmth to the right leg.

T/F Something not examined by the provider can still be included on the exam.

False; if they did not do it then do not include it!

What exam findings require a stethoscope?

Heart rate, heart rhythm, heart sounds, Lung sounds,Bowel sounds, Carotid bruit

What is PERRL?

Normal eye exam that notes pupils are equal, round, and reactive to light

What is EOMI?

Normal eye exam that notes extraocular movements intact

what abnormal exam findings would indicate CHF?

Bilateral pedal edema/BLE edema on Musculoskeletal exam, JVD on neck exam, rales/Crackles on lung exam

What does paraspinal tenderness indicate?

Muscle injury like a strain

What does vertebral point tenderness indicate?

Bony injury like a fracture

What does costovertebral angle tenderness indicate?

Kidney issue like a pyelonephritis or nephrolithiasis

What abnormal exam findings indicate liver failure?

scleral icterus on eye exam.Jaundice on skin exam

What abnormal exam findings indicate anemia?

Pale conjunctiva on eye exam. Pallor on skin exam

What abnormal exam findings indicate meningitis?

Nuchal rigidity and Meningimus found on the neck exam

What are the peritoneal signs?

Abnormal abdominal exam findings of Guarding, rebound, and/or rigidity

The pulse in the neck is called the ______ pulse

carotid

Heart sounds normal means there is no ___

Murmurs, rubs, gallops, or extrasystoles

Normal range for a pulse rate/Heart rate on vitals is

Between 60-100

Low oxygen saturation

Hypoxic, Hypoxia

Having a fever

Febrile

Constitutional exam looks at what

the whole body overall, in general

What does NAD Stand for?

no acute distress

If the patient is somnolent, can we document that they are alert?

No - these are contradictions.

TM erythema, effusion, bulging, and dullness are finding consistent with which disease?

Otitis media

An otoscope examines what part of the body?

Ear

What does epistaxis mean?

nosebleed

The provider auscultates the patient's neck. What are they listening for?

carotid bruit

Tachycardia is a ____ heart rate

fast

Bradycardia is a ____ heart rate

slow

The patient's heart rate is 150 bpm. They are ______

tachycardic

The patient's heart rate is 54 bpm. They are _____.

Bradycardic

The patient has an irregularly irregular rehythm. This means they likely have _______

atrial fibrillation

What number (0, 1+, 2+, 3+, or 4+) means the patient has normal pulses?

2+

What is mcburney's point sign and what does it indicate?

Specific area of tenderness to the RLQ on the abdominal exam indicating appendicitis

What is murphy's sign and what does it inidicate?

Specific area of tenderness to the RUQ on abdominal exam indicating cholecystitis

The provider is auscultating the patient's belly. What are they listening for?

bowel sounds

The patient has right calf tenderness. This may make your provider concerned for ______

Deep vein thrombosis (DVT)

The pulse in the wrist is called the ______ pulse

radial

The pulse in the groin is called the ______ pulse

femoral

The pulse in the top of the foot is called the ______ pulse

dorsalis pedis

The pulse in the back on the ankle is called the ______ pulse

posterior tibial

What is fluctuance?

A palpable collection of fluid, indicative of an abscess

The patient has an irregularly irregular rhythm with a rate of 80 bpm. Can you document "regular rate"?

Yes

Respiratory distress is characterized by one or more of these findings...

1. Tachypnea 2. Accessory muscle use 3. Pursed lip breathing

What does CTAB stand for?

Clear to auscultation bilaterally

What does organomegaly stand for?

Organ enlargement

There are 2 meanings for the abbreviation CVA. What does it mean in the context of the physical exam?

costovertebral angle

The patient's oxygen saturation is 80% on room air when they first come into the ED and they have cyanosis on their lips and the tips of their fingers. They are severely ______.

hypoxic

#/# represents normal motor strength to the extremities.

Answer should follow the format of number/number

5/5

Moist mucous membranes' should be documented under what body system?

ENT (Ears, nose, throat)

No wheezes, rales, or rhonchi' should be documented under what body system?

Pulmonary/Respiratory

+McBurney's point tenderness' should be documented under what body system?

Gastrointestinal

No meningismus' should be documented under what body system?

Neck

No acute distress' should be documented under what body system?

Constitutional

What is the neurological symptom meaning uncoordinated when moving?

ataxia

What is the term meaning to walk in such a way as to avoid pain?

antalgic

What is the Romberg test? What does it indicate?

Patient stands with arms outstretched and eyes closed. It evaluates balance and proprioception.

When is the only time we can use the word “pain” in the physical exam?

when it is a limiting factor

Expressive vs receptive aphasia

expressive means a pt has trouble producing speech while receptive means they have trouble understanding speech

Define somnolent

drozsy

Define purulent

pus-like

What is a urticarial rash?

hives indicating allergies

What does Brudzinski’s sign indicate?

meningitis

What is positive Brudzinskis’s sign?

manually move the head of a pt upwards and their knees jerk upward as well

Define edentulous

without teeth

What are exudates and what do they indicate?

pus spots on the tonsils indicating tonsillitis

What are three signs of peritonsillar abscess?

tonsillar hypertrophy, tonsillar asymmetry, or uvular shift

Define cachectic

skeleton-looking

Define obtunded

awake but not mentally capable

What is the range of a normal respiratory rate?

12-18

What does AT/NC mean?

atraumatic/normocephalic

In which body system would you document “TM erythema and bulging”?

ears

What would dry mucous membranes indicate?

dehydration

What does A&Ox4 mean?

alert and ordiented to person, place, time, and situation

What section of the neurological exam would you document “Normal finger-nose-finger test” and “Normal heel-to-shin”?

Cerebellar/coordination

How do you document normal reflexes?

2+

What is a normal GCS?

15

How do you document normal strength?

5/5

What does TTP mean?

tender to palpation

What is the medical term for swollen lymph nodes?

lymphadenopathy

If the physician checks the pulse on the right wrist and says “The pulses are fine”, what would you document in the PE?

Right radial pulse is 2+