23 - Lower Extremity Physical Exam

Question 1

What does it mean if the patient’s pulse is bounding (+3/4 or +4/4)

Answer 1

They have a wide pulse pressure (>60 mmHg difference between systolic and diastolic pressures)

Question 2

What can cause a wide pulse pressure?

Answer 2

FACTS

Fever
Aortic insufficiency
Complete heart block
Thyrotoxicosis
Systolic HTN

Question 3

Normal capillary fill time

Answer 3

<3 seconds

Question 4

Two types of edema

Answer 4

Non-pitting (acute)

Pitting (chronic)

Question 5

General feature of pitting edema

Answer 5

Protein-rich exudate

CHF

Question 6

General feature of non-pitting edema

Answer 6

Lack of protein in exudate

Liver or kidney problems

Question 7

Non-palpable lesions

Answer 7

Macule

Patch

Question 8

Solid, palpable lesions

Answer 8

Papule
Nodule
Tumor
Plaque

Question 9

Clear fluid filled, palpable lesion

Answer 9

Vesicle

Bulla

Question 10

Pus-filled, palpable lesion

Answer 10

Pustule

Abscess

Question 11

Causes of thick, dystrophic nails

Answer 11

TOE CLYPT

Trauma
Onychomycosis
Eczema
Circulatory problems
Lichen planus
Yellow nail syndrome
Psoriasis
Tumor

Question 12

Causes of dry skin

Answer 12

Insufficient sweat glands (diabetes)
Tinea pedis
Psoriasis
Eczema

Question 13

Range for muscle strength

Answer 13

0/5 - no muscle movement

1/5 - tendon movement

2/5 - movement on exam table

3/5 - movement off exam table

4/5 - slightly reduced

5/5 - normal muscle strength

Question 14

What will the patient complain of if they have a disorder in the spinothalamic tract?

Answer 14

Burning or cramping

Question 15

What will the patient complain of if they have a disorder in the posterior column?

Answer 15

Pins and needles or electric shock

Question 16

What is a normal monofilament test result?

Answer 16

The patient feels 7/10 touches

Question 17

What abnormal tests would indicate a small fiber disease?

Answer 17

Touch stimuli
Sharp stimuli
Temperature

Question 18

What abnormal tests would indicate a large fiber disease?

Answer 18

Vibration

Proprioception

Question 19

Tendon reflex scale

Answer 19

0/4 - hypo-reflexive

2/4 - normal

4/4 - hyper-reflexive

Question 20

Nerve roots for knee reflex

Answer 20

L2-L4

Question 21

Nerve roots for ankle reflex

Answer 21

S1-S2

Question 22

What nerve roots are responsible for the plantar response?

Answer 22

L4-S2

Question 23

What is a normal plantar response?

Answer 23

Plantar flexion

Question 24

What is an abnormal plantar response?

Answer 24

Dorsiflexion (Babinski response)

Question 25

What is the “all-in-one” lower limb test?

Answer 25

Hop-in-place with each foot

Question 26

What would indicate that someone has an autonomic nervous system disorder?

Answer 26

Orthostatic hypotension

If pulse rate decreases with inspiration or increases with expiration (normal is opposite)