The Physical Exam

Cachectic/Emaciated

physically wasting (extremely thin)

morbidly obese

Large body mass index (BMI)

Nontoxic appearing

well-appearing patient in minimal distress (often used to describe well-appearing pediatric patients)

Atraumatic

No evidence of trauma to the body

exopthalmos

bulging of eyes out of socket

Extraocular Movements Intact (EOMI)

appropriate function of the extraocular muscles, tested with "follow my finger"

Eyelid Eversion

flipping the eyelid for exam underneath the eyelid

Fundi Sharp

non-swollen optic nerve on exam of fundus (back of eye) with ophthalmoscope

icterus

Yellowing of sclera due to bilirubin build-up (often seen with jaundice)

Normal Palpebral Conjunctiva

eyelid membrane is clear

Normocephalic

normal appearance and size of the head

nystagmus

involuntary rapid eye movements - often reported as horizontal, vertical, or rotary

papilledema

Swelling of optic disk due to increased intracranial pressure, seen fundoscopically

Pupils equal, round and reactive to light (PERRL)

normal evaluation of the size, shape of the pupils and their reaction to light

subconjunctival hemorrhage

Bright red patches in conjunctiva of eyes due to ruptured blood vessels

visual acuity

acuteness/sharpness of vision as measured by the eye chart

Bulging TM

protruding/outward curvature of the TM

cerumen impaction

excessive earwax

Clear Rhinorrhea

clear nasal drainage

dental caries

cavity

dry mucous membranes

dry mouth

erythematous TM

red color of the TM

Hemotympanum

Blood on the TM

Malocclusion

misalignment of the teeth when mouth closed

Mastoid Tenderness

Tenderness over mastoid bone (located posterior to ear)

No Signs of Oral Trauma

no cuts/chipped teeth/etc.

parotid mass

enlargement of the parotid gland

Pericoronitis

infection of the gums

poor dentition

bad teeth

Poor Light Reflect

cone of light does not reflect on TM

retracted TM

inward curve of the TM

septal deviation

displacement of nasal septum

septal hematoma

bruising or bleeding in the nasal septum

tongue laceration

cut on the tongue

trismus

inability to open mouth normally due to spasm of the jaw muscles

Unable to Visualize Landmarks

Provider cannot see landmarks behind TM

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 distention (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 bpm)

diastolic murmur

heart murmur heard during diastole (rest/active filling)

rubs

an abnormal sound heard when listening to the heart

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)

systolic murmur

heart murmur heard during systole (active pumping)

tachycardia

Fast heart rate (HR greater than 100bpm)

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 cessation of breathing

Accessory muscle use

using extra muscles to breath (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; the 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

ascites

accumulation of fluid in the peritoneal cavity

Cullen's Sign

bruising in the skin around the umbilicus

Distension

bloating

gravid

pregnant

Grey Turner's Sign

bruising in flank area (lower back area)

Heel Tap Test

tap the heal to see if it causes pain, also done by having the patient jump up to see if pain is felt in the abdomen - may indicate appendicitis

hepatomegaly

enlarged liver

McBurney's Point Tenderness

tenderness to palpation in the mid-point of the right lower quadrant (RLQ) which can indicate appendicitis

Murphy's Sign

pain in RUQ that may indicate gallbladder infection

Organomegaly

enlarged organ

Psoas Sign

pain produced with bending of the patient's knees to chest that may indicate appendicitis

Rovsing's Sign

palpation of the left lower quadrant causes right lower quadrant pain that may indicate appendicitis

splenomegaly

enlarged spleen

tympanitic

sound generated by examiner tapping his/her finger in contact with the belly distended due to extra gas/air in the large or small bowel

umbilical hernia

outward protrusion of intra-abdominal tissue and/or bowel through belly button

adnexal tenderness

tenderness in location of the ovaries and fallopian tubes

Cervical Motion Tenderness (CMT)

pain with movement of cervix

cremasteric reflex

upward pull of testicles and scrotum due to touch

Guaiac (Hemoccult) positive/negative

blood present/absent in stool

inguinal hernia

protrusion in the groin

melena

dark, tarry like stool containing blood

Os Open/Closed

cervical os (opening to cervix) is open or closed

Paraphimosis

inability to pull back foreskin back over glans penis to its normal position

POC

product of conception (fetus, placenta, etc)

rectal tone

tone of rectal muscles during digital exam

vaginal vault

vaginal canal

AKA/BKA

above/below knee amputation (indicate R or L)

Bursa

small fluid filled sack surrounding a joint

clubbing

deformity of finger/fingernail due to chronic cyanosis