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CLET > Lab Practical > Flashcards

Lab Practical Flashcards

1
Q

Yeoman

A

Patient prone, dr flexes patient’s leg to ipsilateral butt then extends thigh

P: Pain DEEP in the SI joint
I: Sprain of the anterior SI ligaments

Deep voice: Yo man, put my leg down!

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2
Q

Dawbarn

A

Patient seated, palpate shoulder for tender spot (subacromial bursa), note tenderness, continue pressure while abducting extended arm past 90*.

P: Decrease in pain and/or tenderness
I: Subacromial bursitis

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3
Q

Fromet Paper Sign

A

DON’T TEST THUMB/INDEX
Patient tries to hold paper squeezed b/w fingers

P: The patient is unable to maintain grip on paper
I: Ulnar nerve paralysis

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4
Q

Accommodation reflex

State what you are observing for and what neurological structure is being evaluated

A

Move object to and away from patient, they focus on it.

Convergence of eyes w/ pupillary constriction
Afferent: Optic (CN II)
Efferent: Oculomotor (CN III)
Int Center: Occipital cortex

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5
Q

Weber Test

State what you are observing for and what neurological structure is being evaluated

A

Place handle of 512 Hz vibrating tuning fork on midline of skull
“can you hear this? and is it equal in both ears or more loud in one or the other?”

( - ) Normal: Sound is equal in both ears
( + ) Conductive deafness: Sound lateralizes to the bad ear
( + ) Sensorineural deafness: Sound lateralizes to the good ear

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6
Q

Palpate the peripheral pulses of the neck and upper extremity Left Side Only
State the definition of the amplitude of a pulse
rhythm
rate
contour

A 
2-3 seconds
Carotid
Subclavian
Brachial
Radial
Ulnar

amplitude- height or intensity of pulse
rhythm- regularity of heart pattern
rate- number of pulsations per min
contour- pulse wave, should be rounded or smooth

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7
Q

You suspect your patient has a kidney stone perform a test to confirm this state the positive finding for this test, no indication required

A

Murphy’s Punch

Palm of hand over posterior costovertebral angle (T10-T12), strike back of hand w/ ulnar surface of fist.

Should thud w/ no pain or tenderness
Pain indicates inflamed kidney (nephritis - stones, infection, etc)

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8
Q

Muscle Test the S1 nerve root

A

Dr instructs patient how to position for muscle test.

Plantar flexion: Gastrocnemius and soleus (Tibial N.)

Plantar flexion and eversion: Peroneus longus & brevis (Superficial Peroneal N.)

Hip extension: Gluteus maximus (Inferior Gluteal N.) knee bent

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9
Q

Reflex of the C7 Nerve Root

A

Triceps (broad end of hammer)

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10
Q

L4-L5-S1 Dermatome evaluation

A

L4: Medial leg, behind med malleolus, up med side of big toe

L5: Antero-lateral tibia, dorsum of foot, 3 middle toes

S1: Lateral leg, behind lat malleolus and up pinky toe

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11
Q

Bony palpation of the elbow (right side only)

A 
Medial epicondyle
Medial supracondylar line of humerus
Lateral epicondyle
Lateral supracondylar line of humerus
Groove of Ulna
Trochlea
Olecranon
Olecranon fossa
Radial head
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12
Q

Wright test

A

AKA Hyper-abduction Maneuver

Patient seated, find radial pulse, bring arm out to tension and hyper abduct slowly

P: Pain &/or paresthesia, decreased or absent pulse, pallor.
I: Compression of axillary artery by pectorals minor or coracoid process. Thoracic Outlet Syndrome

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13
Q

Perform a a test to evaluate for a SacroIliac pathology

A 
Lewin Standing:
Goldwait test
Laguerre test
Gaenslen test
Lewin-Gaenslen test
Hibb test
Pelvic rock test (pain in either hip joint, SI joint lesion)
Nachlas test
Yeoman Test
Minor sign
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14
Q

Shoulder depressor test

A

Patient seated, actively laterally flexes, support head and press down on shoulder for 3 seconds.

P: Localized pain on side being tested INDICATES Dural sleeve adhesion, Muscular adhesion or contracture, Muscle spasm, or Ligamentous injury

P: Radiating pain on side being tested INDICATES Neurovascular bundle compression, Dural sleeve adhesions, or TOS

P: Radiating pain on opposite side being tested INDICATES Foraminal encroachment w/ nerve root compression

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15
Q

Graphesthesia

State what you are observing for and what neurological structure is being evaluated

A

Eyes closed, pt identifies #’s or letters traced on palm of hand (tell them which category is used and angle for THEIR perspective)

Observing for pt’s ability to identify traced outline; testing integrity of Somatosensory cortex

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16
Q

Mitral maneuver no verbalization required

A

Patient lies on back, place BELL @ mitral area (mid-clavicle), patient then leans 45* towards their left side, “Take a deep breath & hold”

Female: drop left arm off table and use right arm to cover both breasts.

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17
Q

Respiratory excursion

State the normal finding and 2 conditions associated with an abnormal finding

A

Patient seated, from behind tissue pull w/ ball of hand T8-T10, thumbs along S.P.’s; 3 deep breaths; watch thumbs diverge.

LAG indicates pathology such as Pneumonia, Bronchitis, Fractured rib, Collapsed lung

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18
Q

Muscle test the C5 nerve root

A

Dr instructs pt how to position arm

Shoulder abduction: Deltoid (Axillary N.)

Forearm flexion: Biceps (Musculocutaneous N.)

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19
Q

Reflex of the S1 nerve root

A 
Achilles tendon 
(broad end of hammer; foot in slight dorsiflexion proximal portion of tendon)
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20
Q

L3-L4-L5 Dermatome evaluation

A

L3: Lateral to medial above knee

L4: Medial leg, post med. malleolus, up medial big toe

L5: Anterolateral tibia, foot dorsum, middle 3 toes

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21
Q

Cervical spine bony palpation

A

Anterior: Hyoid, Thyroid cartilage, 1st cricoid ring, Mandible

Posterior: Occiput, Mastoids, Inion (EOP), Superior nuchal line, S.P’s of cervicals, Facet joints

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22
Q

Lachman Test

A

Patient supine, knee in slight (30*) flexion, dr grabs proximal tibia & distal femur, pull tibia forward to feel jt play

P: Gapping w/ tibia moving away from the femur
I:Anterior cruciate ligament or posterior oblique ligament instability

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23
Q

Cozen Test

A

Pt seated, show: “put your wrist in this position(EXTENSION), I will try to pull down, resist,” one hand over fist, other below wrist, Hold for > 3 seconds

P: Pain over the lateral epicondyle
I: Lateral epicondylitis (Tennis Elbow)

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24
Q

Maximal Foraminal Compression Test

A

Pt seated w/ dr standing behind, pt hyperextends head then turns head one direction (while extended), Bilateral.

P: Pain on concave side
I: Foraminal encroachment w/ or w/o nerve root compression.

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25
Q

Abdominal reflex

State what you are observing for and what neurological structure is being evaluated

A

Use smooth edge of reflex hammer to lightly stroke abdomen in all 4 quadrants, starting @ umbilicus and going out diagonally

Umbilicus deviation to stroked side. Absence is normal only if bilateral (Beevor sign)

Afferent: Upper T7-T10; Lower T11-T12
Integrating Center: Spinal cord T7-T12
Efferent: Upper T7-T10; Lower T11-T12

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26
Q

Perform a test to identify a sensorineural hearing loss State what you are observing for and what neurological structure is being evaluated

A

Weber (512 Hz tuning fork, center of skull, sound even?)
or
Rinne ((512 Hz fork on mastoid, no longer heard move to ear, should hear twice as long as on bone)
-evaluating cochlear portion of vestibularcochlear nerve, CN VIII

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27
Q

Obturator Sign

State the pathological finding and the associated indication

A

Pt supine, instruct pt to flex hip and knee to 90*, dr supports knee (superior hand) and ankle (inf hand), Pt internally/externally rotates HIP against resistance of dr.

P: Increased pain
I: Ruptured appendix or pelvic abscess

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28
Q

Auscultate the abdomen for bruits

State the pathological finding, no indication requred

A

Using BELL, auscultate:
Aorta (one inch up, one inch LEFT of umbilicus)
Renal arteries (2” up, 2” R and L) HOLD BREATH
Common Iliac arteries (2” down. 2” R and L)

Pathological findings are bruits: signs of turbulent blood flow.

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29
Q

Muscle Test the L4 nerve root

A

Foot Dorsiflexion & Inversion BILATERALLY!

Tibialis Anterior muscle (Deep peroneal nerve)

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30
Q

Reflex of the C5 nerve root

A

Biceps (Musculocutaneous N.)

Thumb tractions tendon inferior, strike thumb w/ point of hammer

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31
Q

C6-7-8 Dermatome

A

C6: Lateral forearm and palmar side of thumb and index
C7: Palmar side of middle finger
C8: Medial forearm and palmar side of pinky & ring finger

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32
Q

Bony Palpation of the shoulder (right side only)

A

Sternoclavicular articulation, Clavicle, Coracoid process, Acromioclavicular articulation, Acromion, Greater tuberosity of humerous, Lesser tuberosity…, Bicipital groove, Spine of scapula, Body of scapula, Scapulothoracic articulation (pt puts their ipsilateral hand in back waist band)

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33
Q

ThomPson test

A

Patient Prone, leg up to 90* by examiner, dr squeezes belly of calf (look at foot - expect plantar flexion)

P: Absence of foot plantar flexion motion
I: Achilles tendon ruPture

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34
Q

Perform an orthopedic test to evaluate tarsal tunnel syndrome in your patient

A

Tinel Foot Sign
Dr taps medial plantar nerve (post to med. malleolus) w/ point of hammer

P: Paresthesia radiating into the foot
I: Tarsal tunnel syndrome

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35
Q

Anterior apprehension test

A

Patient seated, dr abducts arm and flexes elbow to 90*, externally rotate arm (Look @ their face, don’t grab wrist, support hand behind GH)

P: Noticeable look of apprehension or alarm on face w/ possible pain
I: CHRONIC anterior dislocation of GH joint

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36
Q

Dysmetria of the upper extremity

State what you are observing for and what neurological structure is being evaluated

A

Index finger test (nose to finger, 4 quadrants) OR Heal-Shin (seated, heel down shin)

Looking for tremors or lack of coordination
Tests Cerebellum

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37
Q

Psoas sign

State what you are observing for and what the finding would indicate

A

Patient supine, dr’s superior hand on ipsilateral iliac crest (fingers down), inferior hand on thigh, patient raises straight leg against resistance. RIGHT SIDE ONLY

P: Increase in pain
I: Appendicitis

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38
Q

Millgrams test

A

Patient supine, DR raises both legs 2-3” asks patient to hold in this position for 30 secs

P: Inability to perform test and/or low back pain
I: Weak abdominal muscles or space occupying lesion

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39
Q

Aortic maneuver

Pathological finding

A

Patient seated, use DIAPHRAGM at right sternal border (aortic area) or left sternal border (Erbs point), ask patient to take deep breath in and learn forward while exhaling completely.

Listening for high pitched murmurs

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40
Q

Reflex of C6 nerve root

A

Brachioradialis

Broad side of reflex hammer

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41
Q

Soft tissue of lumbar spine

A
  1. Anterior abdominal muscles (supine)
  2. Paraspinal muscles (unit and indiv) - I Love Spine (Lateral to medial): Iliocostalis, Longissimus, Spinalis
  3. Gluteus Maximus (sacrum to greater trochanter)
  4. Gluteus Medius (Greater trochanter to iliac crest)
  5. Sciatic nerve (Between greater troch and ischial tube)
  6. Hamstrings (unit and indiv) Biceps femoris (lateral), Semitendinosus (under gluts and median - not an adductor), Semimembranosus (most medial)
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42
Q

Hoover sign

A

(Hoover: patients SUCK because they LIE - malingering)
Patient supine, dr puts one hand under healthy leg and asks patient to lift opposite leg.

P: Lack of counter-pressure on the healthy side
I: Lack of organic basis for paralysis (malingering/hysteria)

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43
Q

Nachlas test

A

Pt prone, dr takes heel to ipsilateral butt WHILE stabilizing pelvis preventing hip flexion

P: Pain in buttock and/or pain in lumbar region
I: Sacroiliac joint lesion or lumbar pathology

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44
Q

Jackson compression test

A

Pt seated and THEY laterally flex their head, dr stands behind, clasp hands over head (w/ elbows on sides of head) and apply increasing downward pressure. Perform bilaterally.

P: Exacerbation of localized cervical pain
I: Foraminal encroachment w/o nerve root pressure or facet pathology

P: Exacerbation of cervical pain w/ a radicular component
I: Foraminal encroachment w/ nerve root compression

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45
Q

Perform a neurological test to evaluate the dorsal columns

State what you are observing for, no indication required

A

Pallesthesia
Light Touch
Joint Position Sense
Romberg Test

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46
Q

Stereognosis

State what you are observing for and what neurological structure is being evaluated

A

Pt identifies familiar objects w/ eyes closed w/ light touch

Observing ability to identify objects, indicates involvement of somatosensory cortex

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47
Q

Perform a test to evaluate for the presence of pneumonia State what you are observing for, no indication required

A

Patient seated, from behind tissue pull w/ ball of hand T8-T10, thumbs along S.P.’s; 3 deep breaths; watch thumbs diverge.

LAG indicates pathology such as Pneumonia, Bronchitis, Fractured rib, Collapsed lung

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48
Q

Rebound Tenderness

State the clinical significance of Rovsing and Blumberg signs

A

Pt supine, dr gently and deeply presses into abdomen w/ fingers extended and quickly releases.

Looking for the return to position (rebound) of the structures which were compressed.

Pain in any quadrant upon rebound = Blumberg’s Sign = Peritonitis

Pain in Rt lower quadrant (@ McBurney’s Pt) when rebounding in Lft lower quadrant = Rovsing’s Sign = Appendicitis

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49
Q

C7 - 8 - T1 Dermatome

A

C7: Middle finger (palmar side)

C8: Medial forearm, medial 2 digits

T1: Medial elbow joint

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50
Q

Bony palpation of the foot & ankle (right side only)

A

Medial malleolus, Lateral malleolus, Talus, Navicular, Cuboid, 3 Cuneiforms, 5 Metatarsals, Metatarsophalangeal joints, Calcaneus, Sustentaculum, Navicular tubercle

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51
Q

Laguerre’s Test

A

Pt supine, dr puts affected leg into figure 4 position (hip flexion, ext rotation, and abduction), stabilize contralateral ASIS while putting downward pressure on knee.

P: Pain in the hip joint
I: Hip joint pathology

P: Pain in the sacroiliac joint
I: Sacroiliac joint pathology

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52
Q

Perform a test to identify meningeal irritation/meningitis in your patient

A

Look for Kernig Sign
Pt supine, dr flexes pt’s hip and knee to 90* then extends leg completely

P: Inability to fully extend the leg and/or pain (usually in neck region)
I: Meningeal irritation/meningitis

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53
Q

Anterior Innominate Test akas?

A

AKA Mazion Pelvic Maneuver AKA Advancement Sign
Pt standing, dr instructs pt to step one leg forward 2-3 ft, pt then instructed to bend forward from the waist and touch front foot with both hands (front leg straight)

Inability to bend more than 45* from the waist due to
P: Radiating pain along sciatic nerve (unilateral or bilat)
I: Sciatic neuralgia or radiculopathy, etc. possibly due to lumbar disc pathology
OR
P: Low back pain
I: Anterior (rotational) displacement of ilium relative to sacrum

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54
Q

Evaluate the motor branch of CN VII

State what you are observing for, no indication required

A 
Facial Nerve (CN VII)
Inspect face for asymmetry (@ rest and in motion), ask pt to: 
Raise eyebrows, Close eyes tight, Puff out cheeks, Show teeth, Smile, Frown

Observing for symmetry of face muscles at rest and in motion

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55
Q

Perform a test to identify a conductive hearing loss in your patient
State what you are observing for and what neurological structure is being evaluated

A

Weber test
512 Hz tuning fork on midline of skull, ask pt to compare intensity of sound

Normal = sound equal in both ears
Conductive hearing loss = sounds lateralizes to bad ear
Testing sensory Cochlear portion of vestibulo-cochlear n.

56
Q

Egophony of the Posterior Thorax

State the pathological finding and what this finding would associate

A

Pt speaks in normal tone and volume, ask pt to say the letter “E” when dr places diaphragm on skin

Pathological if “E” sounds like an “A” - indicates consolidation of lungs such as Pneumonia

57
Q

Palpate the peripheral pulses of the abdomen and RIGHT lower extremity

Define what contour is in reference to the peripheral pulses

A

Use 2 fingers to palpate:
Abdominal aorta ( 1 ) (1” up and over)
Femoral ( 2 ) (pt makes triangle w/ hands over groin)
Popliteal ( 2 ) (behind knee)
Dorsalis pedis ( 2 ) (dorsum of foot b/w 1st & 2nd toe)
Posterior tibialis ( 2 ) (posterior to MEDIAL malleolus)

Contour describes the pulse wave in a healthy artery; should be rounded, smooth, or domed shaped.

58
Q

Muscle test the C8 nerve root

A

Finger flexion: Flexor digitorum superficialis, Flexor digitorum profundus, Lumbricals (Median & Ulnar N.)

59
Q

Reflex of the L4 nerve root

A

Patellar tendon

broad side of hammer

60
Q

Retinacular Test (left hand only)

A

Pt seated, place DIP joint in neutral (extended) and try to flex Distal Interphalangeal joint, repeat w/ PIP flexed

P: Flexion of the distal interphalangeal joint cannot be achieved
I: Joint capsule contracture

P: Flexion of the distal interphalangeal joint is achieved
I: Tight retinacular ligament

61
Q

Linder’s sign

A

Pt supine, dr flexes pt’s head toward chest

P: Pain along sciatic distribution or sharp, diffuse pain in leg
I: Sciatic radiculopathy

62
Q

Uvular reflex

State what you are observing for and what a positive finding would indicate

A

Instruct pt to open mouth, stick out tongue and say “ahh”

Observing for symmetrical rising of soft palate (uvula) upon phonation; Unilateral paralysis = one side does not rise and uvula will deviate to normal side

Just in case:
Afferent: Glossopharyngeal N (CN IX)
Integrating center: Medulla
Efferent: Vagus N (CN X)

63
Q

Palpate the peripheral pulses of the neck and upper extremity (left side only)

State the definition of the amplitude of a pulse

A 
2 fingers palpate each spot one at time bilateral 3-5 secs:
Carotid
Subclavian
Brachial
Radial

Amplitude = the height or intensity of the pulse

64
Q

Percuss and mark the location of the gastric air bubble

No verbal component required

A

Percuss down midclavicular line, make one mark at superior edge of tympanic sound

65
Q

C4 - 5 - 6 Dermatome

A

C4: Nape of neck to A-C joint

C5: Lateral arm

C6: Lateral forearm, thumb and palmar side of index index

66
Q

Perform an orthopedic test to evaluate for medial epicondylitis

A

Golfer Elbow Test
Pt seated, instruct pt to extend elbow supinate hand and flex wrist in a fist, dr triest to extend wrist

P: Pain over medial epicondyle
I: Medial epicondylitis

67
Q

Bechterew test

A

Pt seated, instruct pt to extend knee at a time, extend opposite knee, then both at same time.

P: Reproduction of radicular pain or inability to perform correctly due to tripod sign.
I: Sciatic radiculopathy

68
Q

Beevor sign

A

Pt supine, dr instructs pt to cross arms across chest and perform a partial sit-up
*seen with ALS

P: Superior or inferior movement of the umbilicus
I: Superior mvmt of umbilicus indicates spinal cord lesion and/or nerve root involvement at T10 or weak lower abdominal muscle
Inferior mvmt of umbilicus indicates nerve root involvement and/or spinal cord lesion at T7-T10 or weakness of upper abdominal muscle

69
Q

Indirect Light Reflex

State what you are observing for and what neurological structure is being evaluated

A

Shine light into one eye, look in the other eye for pupillary constriction

observing for contralateral pupillary constriction, should this not occur it could be a lesion in the ipsilateral optic nerve, contralateral occulomotor nerve, or in the midbrain

Afferent: Ipsilateral Optic N (CN II)
Integrating center: Midbrain
Efferent: Contralateral Oculomotor N (CN III)

70
Q

Palpate the lymph nodes of the head and neck

State the normal finding and identify the clinical characteristics of a patient who has an infection

A 
Occipital
Post auricular
Pre auricular
Tonsillar (angle of mandible)
Submandibular
Submental
Facial
Anterior cervical chain
Posterior cervical chain
Supraclavicular

Normal lymph nodes are mobile and non-tender
Swollen, tender, and non-movable lymph nodes could indicate infection

71
Q

Standard Maneuver

Identify the significance of Murphy’s sign

A

Palpate for livers edge (usually not felt - if felt should be smooth, even, and non-tender)

Dr stands on pt’s right, place left hand under 11-12th ribs pulling P-A, right hand on abdomen fingers extended and pointing to head at midclavicular line, pt breathes normally then takes a deep breath and holds, as pt exhales dr pushes in an up gently and deeply

Murphy’s sign = reflex apnea (gasping/shocked breath) positive for inflamed gallbladder AKA Cholecystitis

72
Q

Perform a test to evaluate a patient for Bicipital Tendonitis

A

Speed Test
Pt seated w/ forearm supinated and elbow flexed to 45*, dr places fingers on bicipital groove, instruct pt to extend elbow w/ hand going upward against dr’s resistance

P: Pain and or tenderness in bicipital groove
I: Bicipital tendinitis

73
Q

Adam’s sign

A

Pt standing w/ shirt off, dr stands behind looking for evidence of scoliosis, instruct pt to bend forward at waist w/ fingers extended and hands together, observe for change in scoliosis

P: A “c” or “s” shaped scoliosis is observed to straighten
I: Evidence of a functional scoliosis, trauma or subluxation

P: A “c” or “s” shaped scoliosis does not straighten
I: Evidence of a pathologic or structural scoliosis

74
Q

Goldwaith’s sign

A

Pt supine, dr places fingers of superior hand under interspinous space of lower lumbars (skin on skin!), dr then raises pt’s extended leg (SLR)

P: Localized pain in the low back or radiating pain down the leg
I: Lumbo-sacral problem if pain occurs after spinous processes have moved.
Possible sacroiliac problem with pain occurring before spinous’s have moved.

75
Q

Plantar Reflex

State the normal and abnormal findings
State what a pathologic finding would indicate

A

Stiff stroke to lateral curve of foot, normal for toes to curl, pathologic if toes flare

76
Q

Auscultate for friction rubs

State what you are observing for, no indication required

A

Use diaphragm to auscultate liver (mid clavicle - pts rt) and spleen (midaxillary - pts left) over the ribs, take deep breath in and out 3 times through the mouth

Listening for grating sound - inflamed organ

77
Q

Tactile Fremitus

State the normal finding
Give 2 examples for increased fremitus

A

Pt says “99” when being felt by dr’s ball of hand (lung apices, inter scapular area, triangle of auscultation, medial/lateral lung)

Normal = transmission of spoken word thru lung & soft tissue
Increased fremitus = Lung consolidation, compressed lung or tumor

78
Q

Muscle Test the C7 Nerve root

A

Elbow extension: Triceps (Radial N.)

Wrist flexion: Flexor carpi radialis (Median N.), Flexor carpi lunaris (Ulnar N.)

Finger extension: Extensor digitorum communis, Extensor indices profundus, extensor digiti minimi (Radial N.)

79
Q

Soft tissue of the wrist (right side only)

A

Radial artery, Ulnar artery, Palmaris longus tendon, Thenar eminence, Hypothenar eminence, Palmar aponeurosis, Carpal tunnel region, Tissues surrounding PIPs, DIPs, and distal tufts

80
Q

Adduction stress test of the elbow

A

AKA Lateral Collateral Ligament Test
Pt seated, dr stabilizes medial arm and applies adduction (Varus) pressure on pt’s lateral forearm

P: Excessive gapping and pain
I: Instability of lateral collateral ligament

81
Q

Hibbs test

A

Pt prone, stabilize pelvis on side dr standing on, lift OPPOSITE leg to bring knee to 90* then maximally flex knee and push leg away from dr (pt’s internal rotation)

P: Pain in the hip region
I: Hip joint pathology

P: Pain in the buttock or pelvic region
I: Sacroiliac joint lesion

82
Q

Turyn’s sign

A

Pt supine, dr dorsiflexes big toe of effected extremity.

P: Pain in the gluteal region or radiating sciatic pain.
I: Sciatic radiculopathy

83
Q

Pallesthesia (right hand only)

State what you are observing for and what neurological structure is being evaluated

A

Vibration - 128 Hz fork on 3 bony spots per limb distal to proximal

“Tell me when you feel it and when it stops”

Testing ability to sense vibration and integrity of ascending dorsal column tract

84
Q

Evaluate for a pathologic reflex in the lower extremity

State what you are observing for and what a pathological finding would indicate

A

Ankle clonus
Pt supine, one hand under calf and quickly and forcibly dorsiflex the foot and release

Observing for continued involuntary contraction (sustained plantar flexion) indicates an abnormal response and upper motor neuron lesion

85
Q

Percuss and mark the borders of the liver state the normal finding

Give normal
Give 2 examples for hepatomegaly

A

Percuss superior border of liver starting on right side at midclavicular line over an area of resonance moving S - I, mark when you hear dullness (5th to 7th intercostal), percuss upward from resonant area at midclavicular line and mark inferior border where dullness is heard (costal margin or slightly below)

normal live is 6-12 cm

alcoholic fatty liver or hepatitis

86
Q

C5 - 6 - 7 Dermatome

A

C5: Lateral arm

C6: Lateral forearm, thumb and palmar side of index

C7: Middle finger

87
Q

Bony palpation of the knee (left side only)

A

Patella, Medial tibial plateau, Medial femoral condyle, Lateral tibial plateau, Lateral femoral condyle, Fibula head, Tibial tubercle

88
Q

Perform an orthopedic test to determine if your patient has a medial meniscal tear

A

McMurray Sign
Pt supine, dr flexes patients hip and knee to 90*, applies external rotation to knee, place hand on lateral knee, flexes knee completely and applies Valgus (knee inward) stress while extending knee. Then internal rotation to knee w/ Varus (knee out) while extending leg.

P: Clicking sound or pain by knee joint
I: Tear of medial meniscus if positive on external rotation ; lateral meniscus if positive on internal rotation

The higher the leg is raised during extension when positive is elicited, the more posterior meniscus injury

OR

Apley Compression Test

pt prone, knee at 90 use knee to stabilze their thigh. internally rotate, push the tibia, externally rotate, push tibia
P: patient points to the side of pain
I: pain on medial side is medial meniscus tear, pain on lateral side is lateral meniscus tear

89
Q

Apley’s scratch

A

Pt seated, instruct to place affected hand behind their head to touch opposite superior angle of scapula; then they place hand behind back to touch inferior angle of opposite scapula

P: Exacerbation of pain
I: Degenerative tendinitis of rotator cuff tendons (usually supraspinatus)

90
Q

Bonnet’s sign

A

Pt supine, dr strongly internally rotates and adducts affected leg across midline then performs SLR

P: Pain in posterior thigh or leg
I: Immediate pain is sciatic neuropathy from piriformis syndrome

91
Q

2 point descrimination (right hand only)

State what you are observing for and what neurological structure is being evaluated

A

Pt’s eyes closed, start w/ wide 2-point touch repeating till only one is felt, repeat @ 3 points hands and arm

Determining the smallest area in which two points can separately be perceived; evaluates somatosensory cortex

92
Q

Extraoccular eye movement

State the action and innervation of the lateral rectus & inferior oblique muscles

A

Pt follows dr’s finger in a wide “H” in the air starting in the center and ending in starting position

Observing for nystagmus, parallel eye movement or normal conjugate

Lateral rectus abductus eye innervated by Abducens N.
Inferior oblique elevates and abducts eye innervated by Oculomotor N.

93
Q

Palpate the lymph nodes of the axilla (right side only)

State the normal finding and the findings associated with a patient with cancer

A

Palpate for size, consistency, mobility, condition

Lateral axillary - Medial portion of arm and biceps tendon
Medial axillary - Up and in armpit, adduct arm; women cover breast tissue
Anterior axillary - Under pec w/ fingers, use thumb to drag pec nodes; females cover breast
Posterior axillary - Under latissimus using thumb and fingers

94
Q

Leg length discrepancy test

A

Pt supine, dr uses cloth measuring tape to measure from ipsilateral ASIS to medial malleolus, then contralateral leg for True leg length discrepancy, for apparent discrepancy measure from umbilicus to each medial malleolus

P: Different measurements
I: True = bony abnormality above or below the level of trochanter difference (anatomical short leg)
Apparent = pelvic obliquity (tilted pelvis)

95
Q

Bakody’s sign

A

Shoulder abduction test
Pt seated, instruct pt to place palm of affected side flat on top of hear

P: Decrease or absence of radiating pain
I: Cervical foramina compression, nerve root entrapment (usually C5-C6, this motion elevates supra scapular nerve and relieves traction to upper brachial plexus)

96
Q

Thomas test

A

Pt supine, instruct pt to bring one knee to chest and hold, look for lumbar curve to flatten and other leg should stay straight

P: Lumbar spine maintains lordosis (should flatten) and hip or leg flexes
I: Contracture of the hip flexors (iliopsoas)

97
Q

Perform a test to evaluate for a vestibular lesion in your patient state what you are observing for, no indication required

A

Fakuda Step Test
Pt closes eyes and marches in place for 50 steps w/ arms out in front

P: Turning of body position to one side

98
Q

Auscultate for venous hum

State the pathologic finding and a condition that would be associated with this finding

A

Use BELL, listen 3-5 seconds, take a breath and hold

Epigastrium - right under xyphoid
Base of neck (bilateral) - pt looks to opposite side and looks up, listen ant to SCM in supraclavicular triangle

Pathological to hear low-pitched continuous sound; associated w/ Anemia, Pregnancy, Thyrotoxicosis

99
Q

Palpate and mark the location of the spleen

State the normal finding and state a condition that would present with splenomegaly

A

At or posterior to midaxillary line on left side percuss S-I and make one mark where dullness is heard

Normal findings are splenic dullness from 6th to 10th intercostal space, associated w/ mononucleosis

100
Q

Muscle test the L5 nerve root

A

Foot dorsiflexion: Proneus tertius; extensor hallicus longus; extensor digitorum longus/brevis (Deep Peroneal N.)

Big toe dorsiflexion: Extensor hallicus longus (Deep Peroneal N.)

Toes 2,3,4 dorsiflexion: Extensor digitorum longus & brevis (Deep Perineal N.)

Hip & pelvis abduction: Gluteus medius & minimus (Superior Gluteal N.)

101
Q

Halstead test

A

Pt seated, dr finds radial pulse in neutral position, w/ other hand traction arm to floor, dr asks pt to lift chin and if negative (pulse doesn’t disappear), rotate head to opposite side.

P: Pain and/or paresthesia, decreased or absent pulse, pallor.
I: Compression of the neurovascular bundle by scalenus antics or cervical rib

102
Q

Bunnel Littler Test (left hand only)

A

Pt seated, dr places metacarpophalangeal joint in extension and flexes proximal interphalangeal joint, then flexes mcp joint few degrees and tries to flex PIP again

P: Flexion of proximal interphalangeal joint cannot be achieved
I: Joint capsule contracture

P: Flexion of proximal interphalangeal joint is achieved
I: Tight intrinsic muscles

103
Q

Posterior Apprehension test

A

Pt supine, dr flexes pt’s shoulder and elbow to 90*w/ arm bent across chest, dr presses arm into table and internally rotates shoulder (arm towards feet) looking @ face

P: Look of apprehension or alarm on the face w/ possible pain
I: Chronic posterior dislocation of the glenohumeral joint

104
Q

Tromner’s Test

State what youre observing for and what this finding would indicate

A

Support back of hand and flick tips of three middle fingers or tap center of palm

Observing for flexion of fingers and thumbing indicates Upper Motor Neuron lesion

105
Q

Auscultate the abdomen for bowel sounds (Right lower quadrant only)

State the findings for the assessment of all 4 quadrants and what the finding would indicate

A

Use diaphragm and listen for frequency and character in 3 spots per quadrant, 3-5 seconds each

Hyperactive = > 35 sounds / minute
Normoactive = 5 - 35 sounds / minute
Hypoactive = 1 - 4 sounds / minute
Absent = 0 bowel sounds after 5 continuous minutes
106
Q

You suspect your patient has a ruptured appendix, perform a test to confirm this

State the positive finding, no indication required

A

Obturator Sign - Unilateral test
Pt supine, instruct pt to flex right hip and knee to 90*, dr supports knee (superior hand) and ankle (inf hand), Pt internally/externally rotates HIP against resistance of dr.

P: Increased pain
I: Ruptured appendix or pelvic abscess

107
Q

Muscle test the C6 nerve root

A

Wrist extension: Extensor carpi radialis longus and brevis, extensor carpi ulnaris (Radial N.)

108
Q

Soft tissue of the knee (right side only)

A 
Quads (unit and individually)
   Vastus Lateralis
   Vastus Medialis
   Rectus Femoris 
   Vastus Intermedius
Pre patellar Bursae
Infra patellar Tendon
Superficial Infra patellar Bursae
Medial collateral ligament
Lateral collateral ligament
Medial meniscus
Lateral meniscus
Pes anserine area
   Sartorius
   Gracilis
   Semintendinosus
Gastrocnemius muscle
Popliteal fossa
109
Q

Rigid or Supple Flat feet test

A

Pt seated, dr examines presence of Medial Longitudinal Arch, repeat w/ pt standing

P: Absence of medial longitudinal arch in both positions
I: Rigid flat feet

P: Presence of medial longitudinal arch while seated w/ a loss of the arch while standing
I: Supple flat feet

110
Q

Ely’s heel to buttock test

A

Pt prone, dr flexes affected knee to 90*, then brings heel to CONTRALATERAL buttock an hyperextends thigh off table, stabilize ipsilateral iliac crest
ELY = 3 letters; 3 Positives and Indicators

P: Inability to raise the thigh
I: Iliopsoas spasm

P: Pain in the anterior thigh
I: Inflammation of lumbar nerve roots

P: Pain in the lumbar region
I: Lumbar nerve root adhesions

111
Q

Gordon’s sign ??

State what you are observing for and what neurological structure is being evaluated

A

Pt supine, dr squeezes calf, look at foot

Normal: nothing happens
Pathological if babinski response present
Indicated Upper Motor Neuron Lesion

112
Q

Perform a test to evaluate the presence of apraxia in your patient

State what you’re observing for and what this finding would indicate

A

Instruct patient to pretend to comb their hair or brush teeth, dr does not demonstrate how to perform action

Observing ability to recall task and follow a complex motor command testing mental status

113
Q

You suspect your patient has appendicitis, perform a physical examination test to confirm this

State what you are looking for, no indication required

A

Psoas sign: pt supine, dr presses thigh into table and pt lift’s right leg against resistance

Looking for pain

114
Q

Auscultate the vessels of the abdomen

State what you are observing for and what this finding would indicate

A

Use BELL To listen to:

Aorta
Renals
Common iliacs

Listening for bruits evidence of turbulent blood flow

115
Q

Muscle test the T1 nerve root

A

Finger abduction: Dorsal interossei (Ulnar N.)

Finger adduction: Palmar interossei (Ulnar N.)

116
Q

Allen’s Test (right hand only)

A

Pt seated, dr instructs pt to raise his/her hand above heart level w/ arm and elbow at 90*, open and close fist for 60 seconds then make a fist, dr occludes radial and ulnar artery, lower arm, pt opens fist and dr releases one artery, observe both hands for fill time; repeat w/ other artery

P: A delay of more than 10 seconds (Evans 5 sec) in returning a reddish color to the hand
I: Radial or ulnar artery insufficiency. The artery occluded is not the artery being tested

117
Q

Perform a test to determine the stability of the ACL

A 
Lachmant Test (or Drawer)
Pt supine, dr puts knee to 30* flexion, grasp proximal tibia and distal femur and pull tibia forward to feel joint play

P: Gapping w/ tibia moving away from the femur
I: Anterior cruciate ligament or posterior oblique ligament instability

118
Q

Schempelman’s sign

A

Pt seated w/ arms fully abducted above head, dr instructs pt to laterally flex thoracics to left then right side

P: Pain on the concave side
I: Intercostal neuritis

P: Pain on convex side
I: Fibrous inflammation of the pleura (possible intercostal myofascitis)

119
Q

Evaluate CN I

State what you are observing for and what neurological structure is being evaluated

A

Any changes in ability to smell or taste, using penlight inspect nostrils, instruct pt to occlude one nostril w/ eyes closed and ask: Do you smell anything? Can you identify the smell?

Inspecting their ability to smell and olfactory nerve

120
Q

Fakuda Step Test

State what you are observing for and what neurological structure is being evaluated

A

Pt marches in place w/ eye’s closed 50 steps

P: Turning of body position to one side
I: Side of vestibular portion of cranial nerve 8

121
Q

Murphy’s punch state the normal finding and a condition for a pathologic finding

A

Murphy’s Punch - BILATERAL

Palm of hand over posterior costovertebral angle (T10-T12), strike back of hand w/ ulnar surface of fist.

Should thud w/ no pain or tenderness
Pain indicates inflamed kidney (nephritis - stones, infection, etc)

122
Q

L5 - S1 - S2 Dermatome

A

L5: Anterolateral tibia, dorsum of foot, 3 middle toes

S1: Lateral leg, post lateral malleolus, lateral pinky toe

S2: Superior to politeal fossa, down joint and medial

123
Q

Cervical distraction test

A

Pt seated, dr grasps pt’s head w/ both hands and gradually presses up (keep hands off TMJ and ears)

P: Diminished or absence of localized cervical pain
I: Foraminal encroachment

P: Diminished or absence of radiating pain
I: Nerve root compression

P: Increase of cervical pain
I: Muscular strain, ligamentous sprain, myospasm, or facet capsulitis

124
Q

Trendelenburg test

A

Pt stands and shifts weight onto affected side, observe level of hips, stand in front & offer hand for support

P: High iliac crest on supported side and low crest on elevated leg
I: Weak gluteus medius muscle on supported side

125
Q

ROM: Cervical Spine

A

Flexion: 50*
Extension: 60*
Left/Right lateral flexion: 45*
Left/Right rotation: 80*

126
Q

ROM: Elbow

A

Flexion: 150*
Extension: 0*
Forearm supination: 80*
Forearm pronation: 80*

127
Q

Anvil test

A

Pt supine, dr elevates leg w/ knee extended, makes fist and strikes inferior calcaneus

P: Localized pain in long bone or in hip
I: Possible fracture of long bones or hip joint pathology

128
Q

ROM: Foot & ankle

A 
Dorsiflexion: 20*
Plantarflexion: 50*
Subtalar inversion: 5*
Subtalar eversion: 5*
1st Metatarsalphalangeal joint flexion & extension
129
Q

ROM: Hip

A 
Standing:
Flexion: 120*
Extension: 30* 
Abduction: 45*
Adduction: 45*
Internal rotation: 45*
External rotation: 45*

Seated:
Flexion & adduction (how mom sits)
Flexion, abduction & external rotation (how dad sits)

130
Q

ROM: Shoulder

A 
Flexion: 180*
Extension: 60* 
Abduction: 180*
Adduction: 50*
External rotation: 90*
Internal rotation: 70*
Scapular retraction
Scapular protraction
Scapular elevation
131
Q

Fajersztajns’s Test

A

Pt supine, dr performs SLR on healthy leg to 75* or until pain down affected leg, if no pain dorsiflex foot

P: Pain down affected leg (Cross over sign)
I: Medial disc protrusion

P: Decrease in pain down affected leg
I: Lateral disc protrusion

132
Q

ROM: Wrist and Hand

A 
Wrist flexion: 80*
Wrist extension: 70*
Wrist ulnar deviation: 30*
Wrist radial deviation: 20*
Finger abduction
Finger adduction
Finger flexion
Finger extension
Thumb flexion
Thumb extension
Finger opposition
133
Q

Soft Tissue Palpation Shoulder

A
  • rotator cuff muscles
    - supraspin, infraspin, teres minor, subscapularis
  • subacromical bursae
  • subdeltoid bursae
  • axillary borders
    - pec major
    - serratus anterior
    - axillary lymph nodes
    - latissimus dorsi
    - bicipital tendon
  • SCM
  • biceps
  • deltoid (group and indiv)
  • traps
  • rhomboids
134
Q

Soft Tissue of Elbow

A
  • ulnar nerve
  • wrist flexors (unit and indiv)
    - pronator teres
    - flexor carpi radialis
    - palmaris longus
    - flexor carpi ulnaris
  • medial collateral lig
  • supracondylar lymph
  • brachial artery
  • triceps
  • lateral collateral lig
  • biceps
  • olecranon bursa
  • elbow flexors muscles (mobile wad of three)
    - brachioradialis
    - extensor carpi radialis longus/brevis
135
Q

Bony Palpation of Hand

A
  • radial styloid process
  • scaphoid
  • lunate
  • listers tubercle
  • triquetrum
  • pisiform
  • trapezium
  • trapezoid
  • capitate
  • hook of hamate
  • ulnar styloid process
  • metacarpals
  • phalages
136
Q

ROM lumbar

A

flexion 25
extension 30
lateral flexion 25
rotation 30

CLET (9 decks)

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