- Ear Exam
- Throat Exam
- Cardiovascular Exam
- Pulmonary Exam
- Abdominal Exam
Ear Exam
Rapid Review
- Background
- Ear examination typically includes inspection, palpation, otoscopy, +/- tuning forks. Typically and is warranted for patients who complain of ear pain, hearing loss, tinnitus, discharge, or vertigo.
- Common Findings
- Mastoiditis
- Erythematous, tender mastoid
- Loss of postauricular sulcus
- Anteroinferior displacement of pinna
- Otitis Media
- Bulging, erythematous TM
- Immobility of TM
- Otitis Externa
- Pain w/ palpation of tragus or traction to pinna
- Erythematous external auditory, +/- purulent discharge
- Tympanic Membrane Perforation
- Bloody otorrhea
- Hearing loss, tinnitus
- Mastoiditis
Pearls
Throat Exam
Rapid Review
- Background
- Throat examination is generally indicated for evaluation of cough, sore throat, or other upper respiratory symptoms.
- Common Findings
- Strep Pharyngitis
- Erythematous pharynx
- Tonsillar exudates (grayish-white)
- Palatal petechiae
- Peritonsillar Abscess
- Unilateral swelling of peritonsillar area
- Uvula deviation
- Strep Pharyngitis
Pearls
Cardiovascular Exam
Rapid Review
- Background
- Cardiovascular examination typically involves inspection/palpation of the chest wall, auscultation of heart sounds, evaluation of pulses, and +/- orthostatic vitals. Generally indicated for evaluation of chest pain, palpitations, and shortness of breath.
- Common Findings
- Aortic Dissection
- Asymmetric pulses/BP
- Atrial Fibrillation
- Irregularly irregular HR
- Aortic Stenosis
- Systolic Murmur; crescendo-decrescendo
- Cardiac Tamponade
- Muffled heart tones
- Aortic Stenosis
- Systolic murmur at upper right sternal border; crescendo-decrescendo
- Pulmonic Stenosis
- Midsystolic murmur at upper left sternal border; high-pitched crescendo-decrescendo
- Tricuspid Stenosis
- Mid diastolic murmur at lower left sternal border; continuous
- Mitral Stenosis
- Diastolic murmur at the apex
- Loud first heart sound, opening snap, and diastolic rumble
- Aortic Regurgitation
- Early diastolic murmur; best heard at right upper sternal border
- Soft, high-pitched, decrescendo
- Pulmonic Regurgitation
- Early diastolic murmur; best heard at the left upper sternal border
- Soft, high-pitched, decrescendo
- Tricuspid Regurgitation
- Holosystolic murmur; best heard at left lower sternal border
- High-pitched
- Mitral Regurgitation
- Holosystolic murmur; best heard at the apex in left lateral decubitus position.
- Aortic Dissection
Pearls
Pulmonary Exam
Rapid Review
- Background
- Pulmonary examination includes inspection of breathing pattern, palpation/percussion of chest wall, and auscultation of lung fields. Commonly performed for evaluation of chest pain, shortness of breath, and fever/chills
- Common Findings
- Bronchitis
- Early-inspiratory crackles. Possibly rhonchi/wheezing
- Resonant-hyperresonant percussion sounds
- Asthma
- Inspiratory and expiratory wheezing
- Hyperresonant percussion sounds
- Decreased fremitus
- Pneumonia
- Late inspiratory crackles
- Dull percussion sounds
- Pneumothorax
- Absent/diminished breath sounds unilaterally
- Tympanic percussion sounds
- Absent tactile fremitus
- Pulmonary Edema
- Basilar rales
- Flat-dull percussion sounds
- Bronchitis
Pearls
Abdominal Exam
Rapid Review
- Background
- Abdominal examination involves inspection/palpation/percussion of the abdomen, auscultation of bowel sounds, and +/- special tests (psoas, rovsings, murphy’s, etc.)
- Common Findings
- Appendicitis
- RLQ pain; rebound tenderness
- (+) Psoas, (+) Rovsings
- Cholecystitis
- RUQ tenderness, guarding
- (+) Murphy’s sign
- Pancreatitis
- Epigastric tenderness, guarding, distention
- (+) Gray-turner sign/cullen sign if hemorrhagic pancreatitis
- Diverticulitis
- LLQ tenderness, guarding
- May have rebound tenderness or palpable mass
- AAA
- Pulsating mass in middle of abdomen
- (+/-) tenderness, (+/-) Cullen Sign, (+/-) Grey-Turner Sign
- Appendicitis
Pearls
Latest posts by Brandon Simpson, PA-C (see all)