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Emergency Medicine | Medicine (MD/DO) School Study Aid

History & Physical Exam Skills
21 Picmonics to Learn | 39 mins

Next
WBC Differential Lab Value
White Blood Cells (WBC)
5-10 (5,000-10,000)
Leukocyte Differential
Neutrophils (50%-70%)
Bands (2%-5%)
Segs (50%-70%)
Lymphocytes (20%-40%)
Monocytes (4%-8%)
Eosinophils (2%-4%)
Basophils (0.5%-1.5%)
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2 mins
Casts in Urine (Differential Diagnosis)
Characteristics
RBC Casts
Glomerular Disease
WBC Casts
Acute Interstitial Nephritis
Acute Pyelonephritis
Fatty Casts
Maltese Cross Sign
Nephrotic Syndrome
Granular Muddy Brown Casts
Acute Tubular Necrosis (ATN)
Waxy Casts
End Stage Renal Disease (ESRD) (Chronic Renal Failure)
Hyaline Casts
Non-Specific
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2 mins
Sepsis Assessment
Signs and Symptoms
Systemic Infectious Process
Fever
Hypotension
Change in LOC
Increased WBC
Shift to the Left
Tachycardia
Tachypnea
Hyperglycemia
Edema
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2 mins
Severe Sepsis and Septic Shock Assessment
Microthrombi
DIC
Decreased Oxygen Saturation
Decreased WBC
Oliguria
High Output Heart Failure
Multiple Organ Failure
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2 mins
Disseminated Intravascular Coagulation (DIC)
Pathophysiology
Bleeding state
Activation of clotting factors
Deficiency of clotting factors
Causes
Sepsis
Trauma
Obstetric complications
Acute Pancreatitis
Malignancy
Nephrotic Syndrome
Transfusion
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2 mins
Motor Neuron Signs UMN and LMN
Upper Motor Neuron (Increases)
Increased DTRs
Positive Babinski
Spastic Paralysis
Clasp-Knife Reaction
Lower Motor Neuron (Decreases)
Decreased DTRs
Negative Babinski
Flaccid Paralysis
Muscle Atrophy
Fasciculations
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2 mins
Glasgow Coma Scale
LOC Assessment
Score of 3 to 15
8 or Less = Coma
Eye Opening
Verbal Response
Motor Response
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1 min
Lung Sounds - Wheezes
Location
Throughout Lung
Description
High Pitched
Sounds Like
Musical
Cause
Air Moving through Narrowed Airways
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37 secs
Lung Sounds - Crackles
Location
Lower Lobes
Description
Fine/Coarse
Sounds Like
Fine: Twisting Hair through Fingers
Coarse: Velcro
Cause
Collapsed Small Airways and Alveoli "Popping Open"
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1 min
Lung Sounds - Rhonchi
Location
Trachea and Bronchi
Description
Low Pitched Rumbling
Sounds Like
Gurgling
Cause
Narrowed Airway
Secretions or Bronchospasm
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48 secs
Lung Sounds - Pleural Friction Rub
Location
Anterior Lateral Lung
Description
Dry, Rubbing, or Squeaking
Sounds Like
Rubbing a Balloon with Finger
Cause
Inflamed Pleura
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49 secs
Neurovascular Assessment 6 P's
Pain
Paresthesia
Pulse
Pallor
Pressure
Paralysis
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1 min
Skull, Scalp and Hair Assessment
Skull
Inspect Size, Shape and Contour
Inspect and Palpate Areas for Tenderness or Lesions
Scalp
Inspect for Tenderness, Lesions or Rashes
Inspect for Dandruff
Inspect for Lice or Nits
Hair
Inspect Quality and General Appearance of Hair
Observe Hair Distribution
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2 mins
Cognitive Abilities Assessment
Mental Status Examination (MSE)
Collecting/Organizing Objective Information
Cognitive assessment tests
Mini-Mental State Examination (MMSE)
Montreal Cognitive Assessment Test (MoCA)
Mini-Cog
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3 mins
Head, Face and Neck Assessment
Head
Inspect Size and Shape of Skull
Palpate Temporal Artery
Face
Observe Facial Expression
Inspect Facial Structures and Symmetry
Neck
Look for Symmetry
Check Range of Motion
Inspect Lymph Nodes and Thyroid Gland
Confirm Trachea is Midline
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2 mins
Eye Assessment
Inspect External Structures
Eye and Eyebrow Symmetry
Eyeball Alignment
Inspect Eyeball Structures
Examine Cornea and Lens for Cloudiness
Iris and Pupil Shape and Size
Pupillary Light Reflex and Accommodation
P.E.R.R.L.A
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2 mins
Nose Assessment
External Nose
Inspect for Deformity or Asymmetry
Inspect for Inflammation and Skin Lesions
Nasal Cavity
Check for Nasal Obstruction
Inspect Nasal Mucosa
Note Discharge, Bleeding or Foreign Body
Sinus Area
Palpate the Sinus Areas
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2 mins
Throat and Mouth Assessment
MOUTH
Inspect for Color, Asymmetry and Swelling
Inspect Lips, Teeth, Gums and Oral Mucosa
Assess Tongue
THROAT
Examine Pharynx with Tongue Depressor
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2 mins
Reflexes Assessment
Grading
Hyperactive
Hypoactive
Deep Tendon Reflexes (DTRs)
Biceps
Triceps
Brachioradialis
Patellar (Quadriceps)
Achilles Tendon
Cutaneous (Superficial) Reflexes
Plantar Reflex (Babinski Sign)
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3 mins
Nail Assessment
Observe the Nails
View Index Finger at its Profile
Look at Consistency
Observe Color
Check Capillary Refill
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2 mins
Ear Assessment
EXTERNAL EAR
Inspect Position and Symmetry
Inspect for Lesions, Drainage, Nodules or Redness
Inspect Opening of Ear Canal
OTOSCOPIC EXAMINATION
Insert Speculum
Position Scope
View Structures
Light Reflect
HEARING ACUITY TESTS
Whisper Test
Weber’s Test
Rinne Test
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4 mins

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