Exam (elaborations)
Part 4 Irene Gold: The Physical Exam (Purple) – Questions & Answers
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Part 4 Irene Gold: The Physical Exam (Purple) – Questions & Answers
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Part 4 Irene Gold: The Physical Exam (Purple) –Questions & Answers
Initial: LMNOPQRST PAA PAA
Red Flags: Fatigue, weight change, appetite change, thirst changes,
fevers/chills/sweats, px that doesn't change with position, px waking you up
at night. Bruising easily.
Past health history: Surgery, hospitalizations, infections or immunizations,
trauma, or allergies.
Family history: Ask about family members who are close blood-relations. Easy
way to ask: "Does anyone in the family have heart disease, stroke, cancer,
diabetes, arthritis".
Social: Smoking, sleep habits, sexual activity, drugs, drinking, diet, and
exercise. Occupation, hobbies, etc.
ROS: Integumentary, HEENT, Respiratory, cardiovascular, gastrointestinal,
Genitourinary, OB GYN or male repro, neuromusculoskeletal,
Endocrine/hematological, neurological/psychological. ✔️Ans - Practice
going through a full history.
Guillain Barre (especially if she is an artist). ✔️Ans - A women complains
of rubbery legs. What should we think of?
dissecting aneurysm ✔️Ans - If someone describes tearing pain we should
immediately think of...
If over epigastric its likely an ulcer. If anywhere else with a known bursa... its
bursitis. ✔️Ans - If you ask where the pain is and they point with their
finger to single area it is likely...>
Temp: 98.6 (Can fluctuate 96,4 in morning to 99.1 in evening).
Pulse: 60-100
Respiratory Rate: Irene Gold says 14-18. We learned in school 12-20. Below
12 and above 25 is abnormal.
Blood Pressure: 120/80 ✔️Ans - Normal values for temp, pulse,
respiratory rate, and BP.
99 degrees ✔️Ans - At what temperature do we tell most people they have
a temperature?
,Normal: 120/80
Elevated: Systolic 120-129 and diastolic <80.
Stage 1: Systolic 130-139 or diastolic 80-89.
Stage 2: Systolic 140+ or diastolic 90+.
Crisis: Systolic >180 and/or diastolic >120. ✔️Ans - Give the values for BP
for normal, elevated, hypertension stages I and II, and hypertensive crisis.
Increase it ✔️Ans - What will grave's disease do to pulse rate?
Low ✔️Ans - If intracranial pressure is high, pulse rate will be...
Systemic lupus erythematosus ✔️Ans - Butterfly rash
Psoriasis ✔️Ans - Silvery scales
Herpes Zoster ✔️Ans - Vesicles which follow a thoracic dermatome and is
sensitive to clothing.
Impetigo ✔️Ans - Pustules
Lymes disease ✔️Ans - Bulls eye, bacterial/spirochete infection and insect
vector
Kaposi Sarcoma ✔️Ans - Red or purple patches of abnormal tissue
myasthenia gravis ✔️Ans - bilateral ptosis
Horners syndrome (loss of cervical sympathetics, ptosis, miosis, and
anhydrosis) or CNIII lesion. ✔️Ans - Unilaterael ptosis
early stages of ankylosing spondylitis ✔️Ans - Iritis/uevitis
Increased intracranial pressure ✔️Ans - Papilledema indicates...
AV nicking, silver wire arterioles, widened light reflex ✔️Ans - What will
we see in the eye for arteriosclerosis?
, Flame hemorrhages, cotton wool spots, narrow light reflex. ✔️Ans - What
will we see in the eye for hypertension?
Yellow, hard, waxy exudates, neovascularization, microaneurysms, and absent
led light reflex ✔️Ans - What will we see in the eye for someone with
diabetes mellitus?
Percussion is dull (over fluid) rales aka crackles, increased tactile fremitus
✔️Ans - What are the exam findings for a patient with lobar pneumonia?
Mycobacterium tuberculosis ✔️Ans - What causes tuberculosis?
Presents with low grade fever, night sweats, productive cough, yellow/green
sputum. ✔️Ans - How will the patient present who has tuberculosis?
Starts in apices of the lungs. Crackles in upper lobe. Tine test/mantoux test
positive. Positive purified protein derivative, most definitive test for dx is
sputum culture ✔️Ans - What are the exam findings for a patient with
tuberculosis?
Since it is inflammation of the pleura, it will usually produce an exudative
pleural effusion and stabbing chest pain worsened by respiration and cough.
✔️Ans - How will a patient present to your clinic with pleurisy?
Dull on percussion (typically, could be resonant too), dry/non-productive
cough, decreased respiratory excursion, decreased tactile fremitus, dull on
percussion, friction rub is present, decreased breath sounds, +schepelmann's
test. ✔️Ans - What will the exam findings be for a patient with pleurisy?
Normal ✔️Ans - What will an x-ray look like for pleurisy?
Decreased chest expansion, decreased tactile fremitus, hyper resonant,
decreased breath sounds.
Important: There will be unilateral darkening of the chest due to collapse of
the lung; tracheal shift AWAY from the lesion. ✔️Ans - What will the exam
findings be for a patient with pneumothorax?
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