Rovsing sign
Palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant
Murphy sign
Performed by asking the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line (the approximate location of the gallbladder). The patient is then instructed to inspire (breathe in). Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) and winces with a "catch" in breath, the test is considered positive.
Rebound tenderness (Blumberg sign)
Peritonitis
Physical examination – HEENT
Head: Normocephalic and atraumatic Eyes: - Pupils equally round and reactive to light (PERRLA)- Visual acuity 20/20 with intact visual fields- Extraocular movements (EOM) intact- Fundi without papilledema, lesions, or exudates- Conjunctive without erythema- No icterus Ears:- Pinnae without inflammation or tenderness- Tympanic membranes intact without erythema or effusion- Weber midline, Rinne with air conduction > bone conduction- Hearing grossly intact bilaterally Nose:- Septum midline with patent nares- No nasal polyps or lesions- No sinus tenderness to palpation Throat: - Oropharynx clear without tonsillar erythema or exudates- Uvula midline- Normal dentition and gums without ulcers or lesions
Physical examination – Neck
- Supple without lymphadenopathy or thyromegaly - Carotid pulse 2+ without jugular venous distension (JVD) - Trachea midline without accessory muscle use
Physical examination – Lungs/chest
- No chest wall lesions, scars, or tenderness to palpation- Fremitus symmetrical- Resonant to percussion bilaterally- Clear to auscultation bilaterally with vesicular breath sounds- No wheezes, crackles, or rhonci
Physical examination – Heart
- No visible heaves or lifts- Point of maximal impulse at 5th intercostal space in left midclavicular line- Normal S1 and S2 without murmurs, gallops, or rubs
Physical examination – Abdomen
- Nondistended without scars, bruises, or visible pulsations- Normoactive bowel sounds throughout without bruits- Typanitic to percussion in all 4 quadrants- Soft and nontender with no rebound tenderness or peritoneal signs- No hepatosplenomegaly- No costovertebral angle tenderness
Physical examination – Extremities
- No cyanosis, clubbing, or edema- Pulses 2+ bilaterally throughout
Physical examination – Neurologic
- Patient is alert and oriented to person, place, and time- Cranial nerves II-XII intact- Motor strength 5/5 bilaterally in all muscle groups- Sensations grossly intact bilaterally- Deep tendon reflexes (DTR) 2+ bilaterally- Gait fluid with normal speed and balance- Normal Romberg test
Physical examination – Musculoskeletal
- No pain or tenderness to palpation in all joints- Normal range of motion (ROM) in all joints- No abnormalities in spine or paraspinal tenderness to palpation
Pediatrics – Mnemonic
CUB FEVERS PAM IF BIG DEALS ColdsUrinaryBowelFeverEar pullingVomitingEar/eye dischargeRashSeizures Past medical historyAllergiesMediations Ill contactsFamily history Birth historyImmunizationsGrowth & development DaycareEating habitsAppetiteLook of the babySleep
