Physical Exam

  • Ear Exam
  • Throat Exam
  • Cardiovascular Exam
  • Pulmonary Exam
  • Abdominal Exam

Ear Exam

  • 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
Video Credit: Geeky Medics

*Deep Dive: Trick of the Trade: Pediatric Ear Exam (ALiEM)

Throat Exam

  • 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
Video Credit: Oxford Medical Education

*Deep Dive: Evidence-Based Evaluation and Management of Patients With Pharyngitis In The Emergency Department (EB Medicine)

Cardiovascular Exam

  • 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. 
Video Credit: Geeky Medics

*Deep Dive: Cardiovascular Examination (Merck Manual)

Pulmonary Exam

  • 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
Video Credit: Geeky Medics

*Deep Dive: Evaluation of the Pulmonary Patient (Merck Manual)

Abdominal Exam

  • 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
Video Credit: Geeky Medics

*Deep Dive: Evaluation of the Gastrointestinal Patient (Merck Manual)

Brandon Simpson, PA-C
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