PHYSICAL EXAM PRACTICE -- OBJECTIVE, Description from the doctor

Observable elements: There are portions of the physical exam that can remain
unless otherwise abnormal (may be observed about a patient by carefully
watching them move and listening to them speak.)

Definition of terms:
 ED- Emergency department
 Cachectic- Loss of body weight and muscle mass, and weakness that may
occur in patients with cancer, AIDS, or other chronic diseases
 Jaundice - A condition in which the skin and the whites of the eyes become
yellow, urine darkens, and the color of stool becomes lighter than normal.
Jaundice occurs when the liver is not working properly or when a bile duct
is blocked.
 Icteric Scelera -  the white part of your eye is yellow, a sign of jaundice
 Systolic murmurs - Grade 2/6 - Audible, but faint. Grade 3/6 - Easily heard.
Grade 4/6 - Very easily heard. Grade 5/6 - Very loud. Grade 6/6 - Can be
heard without the stethoscope being in contact with the chest wall.
 JVD(Jugular vein distention) - is when the vein that runs down the right side
of the neck is swollen. This happens when blood is unable to flow as it
should.
- JVD is usually a sign of heart failure, which often involves high blood
pressure.
 Hepatomegaly
 RUQ  Acute right upper quadrant -
 LUQ Left upper quadrant -
 RLQ Right lower quadrant -
 LLQ Left lower quadrant -
 voluntary guarding - a conscious contraction of the abdominal wall in
anticipation of an exam that will cause pain.
 Involuntary guarding - is a reflex contraction or spasm of the abdominal
muscles on palpation due to localized peritoneal inflammation
  Ascitic wave/ Fluid wave test:  positive fluid wave test indicates that there
is a free fluid (ascites) in the abdomen. When one side of the abdomen is
pressed, the other side may also be painful due to the transfer of the fluid
in it
 CVA tenderness – Na
 Erythema abnormal redness of skin or mucous membranes.

Practice Question
Example: The patient is a 52 year old male who presents to the ED(Emergency
department with abdominal pain. On physical exam he appear cachectic and older
than stated age. Full body jaundice and sclera are icteric. Dry mucous membranes.
Breath sounds are clear but diminished and there is a 2/6 systolic ejection
murmur and distant heart sounds. He has JVD. He has hepatomegaly and diffuse
abdominal tenderness that is worse in the right upper quadrant. There is also an
ascitic wave. No rebound but there is voluntary guarding. 2+ pitting edema
bilaterally and there are chronic venous statis changes of both lowers extremities.

Example Answer: The patient is a 52-year-old male who presents to the ED

(Emergency department with abdominal pain. On physical exam he appears
cachectic and older than stated age. (Constitutional) Full body jaundice (Skin) and
sclera are icteric (Eyes). Dry mucous membranes (HENT). Breath sounds are clear
but diminished (Thorax & Lungs) and there is a 2/6 systolic ejection murmur and
distant heart sounds (Cardiovascular ). He has JVD(Neck). He has hepatomegaly
and diffuse abdominal tenderness that is worse in the right upper
quadrant(Abdominal). There is also an ascitic wave (Abdominal). No rebound but
there is voluntary guarding (Abdominal). 2+ pitting edema bilaterally
(Muscuskeletal/Extremities) and there are chronic venous statis changes of both
lowers extremities. (Muscuskeletal/Extremities or skin)

DELETE CONTRADICTING STATEMENTS (and in real life, things that were not
examined)
Example Answer:

Constitutional: Well-developed. Well nourished. Cachectic and appears older than

stated age
HENT (Head, Eye, Nose, Throat): Normocephalic. Atraumatic. Bilateral external
ears normal. Nose Normal. Moist mucous membranes. Dy mucous membranes.
Eyes: PERRL.EOMI.Conjuctiva normal. No Discharge. No scleral icterus. Scleral
icterus
Lymphatic: No lymphadenopathy noted
Endocrine: No palpable thyromegaly.
Neck: Neck is supple. Normal ROM. No stridor. JVD
Cardiovascular(heart): Normal heart rate. Normal rhythm. No murmur, gallops or
rubs. 2/6 systolic ejection murmur. Distant heart sounds.
Thorax & Lungs: Normal breath sounds. No respiratory distress. No wheezing.
Diminished.
Abdomen: No masses. No pulsatile masses. No distention. No palpable
organomegaly. Soft. No tenderness. Hepatomegaly and diffuse that is worst in the
RUQ. No rebound but there is voluntary guarding. Ascitic wave
GU(genital and urinary organs) No CVA tenderness.
Skin: Warm, Dry, No erythema. No rash. Normal capillary refill. Full body jaundice.
Muscuskeletal/Extremities (bones, ligaments, tendons, and cartilage muscles)
Good range of motion in all major joints as observed. No major deformities noted.
No extremity tenderness. No cyanosis. No clubbing. 2+ pitting edema bilaterally
and there are chronic venous stasis changes of both lower extremities.
Back: No tenderness
Neurologic: Alert & Oriented x3. No focal deficits noted. Normal motor function.
Psychiatric: Affect normal. Judgement normal. Mood normal.