Physical Exam
A 12-year-old with episodic wheezing, worse at night, reversible with albuterol.
What is Asthma?
Physiologic splitting that widens with inspiration.
What is Split S2?
Soft, low-pitched sounds heard over most lung fields in healthy patients.
What are Vesicular breath sounds?
Correct order of lung exam.
What is Inspect → Palpate → Percuss → Auscultate?
Vibration felt on chest wall when patient says “99.”
What is Tactile Fremitus?
A 65-year-old smoker with chronic productive cough for years and hyperinflated lungs on CXR.
What is COPD?
A low-frequency sound after S2 associated with volume overload and heart failure.
What is S3?
High-pitched tubular sounds heard over the trachea.
What are Tracheal breath sounds?
Correct order of abdominal exam.
What is Inspect → Auscultate → Percuss → Palpate (light then deep)?
Elevated in right-sided heart failure and measured at the internal jugular vein.
What is JVP (Jugular Venous Pressure)?
A crescendo-decrescendo systolic murmur at the right upper sternal border radiating to the carotids.
What is Aortic Stenosis (AS)?
A stiff ventricle causing atrial contraction sound just before S1.
What is S4?
Discontinuous, high-pitched popping sounds during inspiration, often seen in pulmonary fibrosis.
What are Fine crackles?
Why do we auscultate the abdomen before palpation?
What is to avoid altering bowel sounds?
Palpation finding at left sternal border indicating right ventricular enlargement.
What is Right Ventricular Heave?
A blowing diastolic murmur best heard at the left sternal border with patient leaning forward.
What is Aortic Regurgitation (AR)?
A harsh systolic murmur that radiates to carotids and may cause pulsus parvus et tardus.
What is Aortic Stenosis?
Low-pitched snoring sounds that may clear with coughing.
What are Rhonchi?
Where do you use the bell during cardiac exam?
What is Mitral & Tricuspid areas (low-pitched sounds like MS, S3, S4)?
Which pulses are checked in the lower extremity during cardiac exam?
What are Posterior tibial and dorsalis pedis pulses?
A low-pitched diastolic rumble at the apex with opening snap in a patient with history of rheumatic fever.
What is Mitral Stenosis (MS)?
A holosystolic murmur best heard at the apex radiating to the axilla.
What is Mitral Regurgitation?
High-pitched inspiratory sound due to upper airway obstruction.
What is Stridor?
How do you position a patient to better hear aortic regurgitation?
What is Sitting up, leaning forward, exhale fully, hold breath, use diaphragm at left sternal border?
In what order should you perform the cardiac exam after inspection?
What is:
Listen to carotids
Palpate for RV heave
Palpate apical impulse
Auscultate (ATPM diaphragm, MT bell, apex bell left side, AP diaphragm sitting forward)
Check peripheral pulses and edema