The Physical Exam and Common Medical Conditions + Surgeries

somnolent

drowsy or sleepy disposition

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)

normocephalic

normal appearance and size of the head

atraumatic

no signs of trauma present

cyanosis

bluish discoloration of the skin due to a lack of oxygen

pallor

an unhealthy paleness of the skin

erythema

superficial reddening of the skin

jaundice

yellowing of skin due to abnormal bilirubin build-up

abrasion

superficial wound to the top most layer of the skin

contusion

a region of skin in which blood capillaries are ruptured; aka bruise

ecchymosis

an area of ruptured blood vessels similar to a contusion; aka bruise

laceration

a cut in the skin

puncture

a small hole in the skin

wheal

round, localized area of edema on the skin

wheal-and-flare

(a reaction) rash or hives (irregular, blanch raised areas with redness)

urticaria

hives or wheals which are either redder or paler than the surrounding area and are often accompanied by itching

maculopapular

rash or hives (flat red area covered with small confluent bumps)

pustules

small collection of pus under the skin

bullae

fluid-filled blisters

petechiae

a small round flat dark-red spot caused by bleeding into the skin or beneath the mucus membrane

purpura

purple spots or blotches (don’t turn white when pressed)

induration

a hardened area of normally soft tissue

fluctuance

movable and compressible

hemangloma

a benign tumor consisting of blood vessels

cornea

the transparent coat of the eyeball that covers the iris and pupil; lets light into the eye

sclera

the dense fibrous opaque outer coat enclosing the eyeball - except the part covered by the cornea

conjunctiva

white area of the eyes

icterus

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

subconjunctival hemorrhage

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

extraocular movements intact (eomi)

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

pupils equal, round and reactive to light (perrl)

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

papilledema

swelling of the optic disk due to an increase in intracranial pressure

fundi sharp

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

visual acuity

acuteness/sharpness of vision as measured by the eye chart

eyelid eversion

flipping the eyelid for exam underneath the eyelid

normal palpebral conjunctiva

eyelid membrane is clear

exophthalmos

bulging of eyes out of socket

nystagmus

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

erythema of the external canal

redness of outer ear canal

cerumen impaction

excessive earwax

tympanic membrane (tm)

eardrum

erythematous tm

red color of the tm

bulging tm

protruding/outward curvature of the tm

retracted tm

inward curve of the tm

poor light reflect

cone of light does not reflect on tm

unable to visualize landmarks

provider cannot see landmarks behind tm

hemotympanum

blood on the tm

mastoid tenderness

tenderness over mastoid bone (located posterior to ear)

clear rhinorrhea

clear nasal drainage

septal deviation

displacement of nasal septum

septal hematoma

bruising or bleeding in the nasal septum

dry mucous membranes

dry mouth

tongue laceration

cut on the tongue

no signs of oral trauma

no cuts/chipped teeth/etc.

dental caries

cavity

poor dentition

bad teeth

pericoronitis

infection of the gums

parotid mass

enlargement of the parotid gland

trismus

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

normal jaw approximation

normal jaw alignment

malocclusion

misalignment of the teeth when mouth closed

uvula midline

no deviation of the uvula to one side or another

pharyngeal erythema

redness of the throat

pharyngeal exudate

pus seen on the posterior throat

peritonsilar abscess

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

carotid bruit

abnormal flow of blood through the carotid artery

jugular vein distension (jvd)

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

cervical vertebral tenderness

pain along cervical spine

no step-offs or crepitus

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

anterior cervical lymphadenopathy

swollen lymph nodes under jaw and along anterior neck area

trachea midline

no deviation of trachea from its usual location

meningismus

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

nuchal rigidity

neck stiffness with neck movement

bradycardia

slow heart rate; less than 60 beats per minute

tachycardia

fast heart rate; greater than 100 beats per minute

murmur

an abnormal sound heard when listening to the heart

systolic murmur

heart murmur heard during systole (active pumping)

diastolic murmur

heart murmur heard during diastole (rest/active filling)

distant heart sounds

faint-sounding heart beats

rubs

coarse sounds produced when the heart “rubs” on inflamed pericardium (heart tissue) during contractions

gallops

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

bradypnea

abnormally slow breathing

tachypnea

abnormally rapid breathing

apnea

temporary absence or cessation of breathing

prolonged inspiratory expiratory phase

increased time between inspiratory and expiratory phases

rhonchi

a whistling or snoring sound hear on auscultation of the chest when air channels are partially obstructed; plural of rhochus

wheezes

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

stridor

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

intercostal retractions

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

accessory muscle use

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

costovertebral angle tenderness (cvat)

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

paraspinal muscle tenderness

tenderness in muscles adjacent to spine

midline tenderness

tenderness directly over spine

no step-offs

no misalignment of thoracic/lumbar spine

straight leg raise

if pain, indicative of herniated disk

saddle anesthesia

loss of sensation around buttocks area

distension

bloating

gravid

pregnant