General medical exams

Chief Complaint (CC)

History of Present Illness (HPI)

Past Medical History (PMH)

Past Surgical History (PSH)

Medications

Allergies

Family History

Social History (tobacco, alcohol, drugs, occupation, etc.)

Review of Systems (ROS)

recommended order of history

General Appearance/Vital Signs

HEENT

Neck

Cardiovascular

Respiratory

Abdomen

Genitourinary (if applicable)

Musculoskeletal

Skin

Neurological

Psychiatric

recommended order of physical exam

shoulder abduction (deltoid); Sensory - lateral upper arm

C5 motor and sensory functions

elbow flexion/wrist extension; Sensory - lateral forearm, thumb

C6 motor and sensory functions

elbow extension/wrist flexion; Sensory - middle finger

C7 motor and sensory functions

Motor - finger flexion/grip; Sensory - medial forearm, 4th-5th fingers

C8 motor and sensory functinos

Motor - finger abduction/adduction; Sensory - medial arm

T1 motor and sensory functions

Motor - hip flexion; Sensory - anterior thigh

L2 motor and sensory functions

Motor - knee extension; Sensory - anterior thigh/knee

L3 motor and sensory functions

Motor - ankle dorsiflexion; Sensory - medial leg/ankle

L4 motor and sensory functions

Motor - great toe extension (EHL); Sensory - lateral leg, dorsum of foot

l5 motor and sensory functions

Motor - plantarflexion; Sensory - posterior leg, lateral foot

S1 motor and sensory functions

Motor - anal sphincter; Sensory - perianal area (saddle anesthesia in cauda equina/conus medullaris)

S2-4 motor and sensory ffunctions

tested by : Pupillary reflex, extraocular movements

function:Most eye muscles, pupil constriction

tests and functions of CN III

tests: Eye movement (look down/in)

innervation: superior oblique m.

CN IV tests and functions

Sensation face, muscles of mastication

innervation of CN V

test lateral gaze

innervates lateral rectus

CN VI tests and function

test: Smile, puff cheeks, taste anterior 2/3 tongue

innervation: Muscles of facial expression, lacrimation, taste

CN VII test and innervation

test: Gag reflex, taste posterior 1/3 tongue

function: Swallowing, taste, parotid secretion

CN IX tests and inervation

tests: Palate elevation, gag reflex, voice

function: Swallowing, palate, larynx, parasympathetics

tests for and funcction of CN X

tests: shoudler shrug, head turn

innervation: SCM, traapezius

tests for and function of CN XI

test: tongue protusion

innevates tongue muscles

tests for and innervatin of CN XII

C5-6

biceps brachii reflex tests what nerve roots?

C5-6

brachioradialis reflex tests what nerve roots?

C6-C7 (mainly C7)

tricceps reflex tests what nerve rootss?

nerve roots: L2-4

muscle: quadriceps femoris

patellar reflex tests what nerve roots and whata muscle?

nerve roots: S1 (±S2)

muscles: gastrocnemius, soleus

achilles refflex tests what nerve roots and what muscle?

0 No contraction

1 Flicker/trace contraction but no movement

2 Active movement possible with gravity eliminated

3 Active movement against gravity only

4 Active movement against gravity and some resistance

5 Normal strength, active movement against full resistance

define the grades of strength testing

Eye response (1-4)

Verbal response (1-5)

Motor response (1-6)

what are the 3 categories of GCS testing?

4 = Opens spontaneously

3 = Opens to speech

2 = Opens to pain

1 = No eye opening

define the scoring of eye response in calculaation of GCS

5 = Oriented, converses normally

4 = Confused conversation, disoriented

3 = Inappropriate words

2 = Incomprehensible sounds

1 = No verbal response

define the scoring of verbal response in calcullation of GCS

6 = Obeys commands

5 = Localizes painful stimulus

4 = Withdraws from pain

3 = Abnormal flexion (decorticate)

2 = Abnormal extension (decerebrate)

1 = No motor response

define the scoring of motor response in calculating GCS

3-8

GCS score range indicating severe TBI

9-12

GCS score range indicating moderate TBI

13-15

GCS score range indicating mild TBI

back off head (occiput)

C2 dermatome

neck (posterior, high cervical)

C3 dermatome

Shoulder region, clavicle

C4 dermatome

medial upper arm

T1 dermatome

nipple lline

T4 ddermatome

xiphoid process

T6 dermatome

umbiilcus

T10 dermatome

pubic symphysis

T12 dermatome

inguinal region

L1 dermatome

anterior thigh

L2 dermatome

medial knee

L3 dermatome

medial ankle/great toe

L4 dermatome

dorsum of foot/middle toes

L5 dermatome

lateral foot/sole

S1 dermatome

posterior thigh

S2 dermatome

Perianal region (saddle anesthesia)

S3-5 dermatome

Diabetic ketoacidosis (DKA), isopropyl alcohol ingestion

DDx of a pt with a fruity/acetone odor

Advanced uremia (renal failure)

DDx of a pt with ammonia lilke odor

Liver failure (fetor hepaticus)

ddx of a pt with sweet, musty odor

pseudomonas

ddx of pt with a sweet, grame like smell on woundd

resonant

low pitched, hollow sound

resonant

normal lung percussive sounds

Hyperresonant

Very loud, lower-pitched, booming

Pneumothorax, emphysema (hyperinflated lung)

DDx of hyperresonant lung sounsd

tympanic

Loud, high-pitched, drum-like soundd

gastric air bubble, bowel

normal location of tympanic percussion sound

dull

Soft, moderate-high pitch, thud-like sound

liver, spleen, consolidated lung

normal location of dull percuuussion

Pneumonia, tumor, organ enlargement

DDx of dull percussion

fflat

very soft, high pitchhed sound

Large pleural effusion, massive consolidation

DDx of flat percussion

standard Ophthalmoscope

what type of opthalmoscope?

Small field of view (~5°).

Requires close positioning to patient's eye.

More challenging for novice users.

panoptic ophthalmoscope

what type of ophthalmoscope?

Wider field of view (~25°).

Easier to visualize retina, optic disc, vessels, and pathology.

More expensive but often preferred in primary care for teaching and efficiency.

512 Hz tuning fork

what Hz tuning fork?

used most often for hearing assessment. (weber and rinne)

128 Hz tuning fork

what Hz tuning fork?

used for vibration sense in neurologic exam (e.g., diabetic neuropathy screening).

Executive function, planning, judgment, problem-solving, voluntary motor control (precentral gyrus), speech production (Broca's area - dominant hemisphere)

primary functions of frontal cortex

Somatosensory processing (postcentral gyrus), spatial orientation, body awareness, integration of sensory input

primary functions of parietal lobe?

Auditory processing, memory (hippocampus), language comprehension (Wernicke's area - dominant hemisphere), emotion (amygdala)

primary functions of the temporal lobe?

Taste, visceral sensation, autonomic functions, pain perception

main functions of insular cortex

emotion, memory, motivation

main functions Limbic system (cingulate gyrus, hippocampus, amygdala)

parkinsonism

Mask-like facies, decreased blink rate.

myxedema (hypothyroidism)

Puffy face, periorbital edema, coarse features, dry skin.

Williams sysndrome

Elfin facies" - broad forehead, short nose, wide mouth.

Benign, cyclic mastalgia, nodularity, fluctuates with menses.

PE findings of fibrocystic changes of the breast

fibroadenoma

Mobile, firm, rubbery, well-circumscribed mass on breast, common in young women.

breast cyst

Fluctuant, tender, often associated with fibrocystic changes.

fat necrosis

Firm, irregular mass on breast, often after trauma; can mimic malignancy.

Hard, immobile, irregular borders; peau d'orange skin changes; nipple retraction.

breast exam findings associated with breast carcinoma

Axillary tail of spence

superior lateral corner of breast tissue, projects up and laterally into axilla

Axillary lymph nodes (≈75%) → especially anterior (pectoral) nodes.

primary lymphatic drainage of the breast

Most breast cancers metastasize first to axillary lymph nodes

why is axillary node exam necessary in breast exam?

fibrocystic changes

Most common benign condition.

Cyclical breast pain, nodularity, tender before menses.

Often bilateral, lumpy "rope-like" texture.

fibroadenoma

Benign tumor of stromal/epithelial tissue.

Well-circumscribed, rubbery, firm, mobile ("slips under fingers").

Common in women

malignancy if new onset.

nipple retraction or inversion is suspicious for

intraductal papilloma, carcinoma.

serous/bloody nipple discharge is concerning for

prolactinoma, hypothyroidism, meds

DDX of milky nipple discharge

Paget's disease of breast (underlying ductal carcinoma)

eczema like changes of areola