Adv Health Assessment Flashcards
Trendelenberg sign
stand on one foot, + if opposite hip drops down to hold position; “lurch,” pt walks bending over weak hip
Whispered pectoriloquy
Ask the patient to whisper a sequence of words such as “one-two-three”, and listen with a stethoscope. Normally, only faint sounds are heard. However, over areas of tissue abnormality, the whispered sounds will be clear and distinct.
antalgic gait
gait that develops as the patient tries to avoid pain while walking
Bronchophony
Ask the patient to say “99” in a normal voice. Listen to the chest with a stethoscope. The expected finding is that the words will be indistinct. Bronchophony is present if sounds can be heard clearly.
Mouth
Inspect
say “ah”
lift tongue (CN 4)
stick out tongue (CN 7)
apprehension sign
pt supine, makes L with arm, try to externally rotate shoulder past 90 deg, pt will object; indicates instability of shoulder joint
Obturator sign
patient lying down, flex right leg at hip and knee and internally rotate hip; increased RLQ pain in acute appendicitis
Murphy’s sign
ask the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line; Ginny’s way: press on right MCL under rib cage as patient breathes in, if acute gb inflammation will have interrupted inspiration
FABER (Flexion Abduction External Rotation)
Pt supine, put hip in “figure 4” position (one leg “Indian style”) +if knee points up, - if can push knee parallel to table without pain.
pelvic compression test
pt supine, outward pressure to inner aspects of ASIS, then hands at iliac crests and inward pressure to hips; + if pain/ symptoms at sacroiliac joint
Nose
Inspect
Patency of each nostril
Speculum exam
Phalen’s test
for carpal tunnel; upside down prayer hands, + if pain/numb/tingling in thumb and first two fingers
Tinel’s test
for carpal tunnel; tap/press over middle of wrist at base of hand; paresthesia in fingers can be elicited in CTS
eversion
sole of foot away from midline
inversion
sole of foot toward midline
Neuro
- Remaining CNs: Puff cheeks, clench teeth, raise eyebrows
- RAMs: finger to thumb, toe taps; alternating nose touches, heel to shin
- Sensory: Soft vs. Sharp
- Graph/Stereo
- Reflexes: triceps, biceps, brachioradialis, patellar, Achilles, Babinski
- Spine: bend back, twist, side bends, touch toes/Scoliosis check
- Gait: Walk away to assess gait, return heel to toe, tiptoes, walk on heels
- Romberg/Pronator drift
Diaphragmatic excursion
ask patient to exhale and hold it, percusses down starting below the scapula until sounds change from resonant to dull, mark the spot. Then the patient takes a deep breath in and holds it, percuss down again, marking the spot where the sound changes from resonant to dull again. Then measure the distance between the two spots. Repeat on the other side, is usually higher up on the right side. Should be 2-5 cm, if less, PNA, PTX, etc.
Empty can test
pt holds “can” and internally rotates wrist, hold position against resistance; if pain, shoulder issue
Respiratory
Inspect (while palpating thyroid) Palpate spine Tactile Fremitus "99" Thoracic Expansion Percuss lungs Auscultate lungs (check CVAT)
Allen’s test
test for perfusion of upper extremeties; raise hand and occlude ulnar and radial artery; open each individually and ensure reperfusion
Kernig’s sign
Pt supine, lift their leg and flex knee, if that causes back/neck pain it’s +
tests for acute appendicitis
Psoas, Obturator, Aaron’s
talar tilt test
to test for injury to the lateral ligaments of the ankle; hold leg steady and hold heel, thumb on lateral ligaments; invert foot (tip to midline.) Grade laxity.
Thompson’s test
test for Achilles tendon rupture; squeeze calf and watch foot, should plantar flex slightly
Finklestein’s test
for DeQuervain’s tenosynovitis/Gamer’s thumb; pt places arm thumb up on table with wrist hanging over table; pain at styloid process with gravity; active movement down or passive down is +
Straight leg raise test
with pt supine, have them raise their straightened leg @ the hip; pain indicates sciatic, nerve root irritation or disk issue
Eyes
Inspect Visual Acuity Cardinal Fields Fishbowl Accomodation Pupils Fundoscopic Exam
Psoas sign
have patient lying down, lift right left against resistance-abd pain in RLQ if there is appendicitis
Hornblower’s test
same position as apprehension only pt is seated and they try to externally rotate shoulder; pain indicates impingement
JVD
have pt turn head to side; place one stick perpendicular to sternum; use another to measure highest point of internal jugular wave-measure where they cross
Head
Inspect
Palpate (skull, hair, facial bones, conjunctivae, TMJ)
Percuss sinuses
Buerger’s test
test for perfusion of lower extremities; raise leg
assessment of arterial sufficiency.
Buerger’s test is used in an assessment of arterial sufficiency. In a limb with a normal circulation the toes and sole of the foot stay pink, even when the limb is raised by 90 degrees. In an ischemic leg, elevation to 15 degrees or 30 degrees for 30 to 60 seconds may cause pallor.
Brudzinski’s sign
Pt supine, flex patients neck they will flex knees and hips
varus
position of the joint when the distal segment of the bone is angled toward the midline (bow legs)
Ears
Inspect
Palpate
Whisper test
Otoscope
Rovsing’s sign
in acute appendicitis: pain in RLQ with palpation of LLQ
Scapular winging
have patient extend arms and push forward onto a flat surface if scapulae wing out could have thoracic nerve damage or serratus muscle weakness
Neck
Inspect
Palpate lymph nodes
Palpate thyroid (inspect back also)
Rinne test
strike a tuning fork and places it on the mastoid bone
When pt can no longer hear the sound, they signal
Move the tuning fork next to ear canal.
When pt can no longer hear that sound, once again signal
Record the length of time you hear each sound–air conduction should be 2x bone conduction (should hear 2x longer than they could feel.)
If conductive hearing loss, the bone conduction is heard longer than the air conduction sound.
If sensorineural hearing loss, air conduction is heard longer than bone conduction, but may not be twice as long.
McMurray test
pt supine, grasp knee and heel, knee at 90deg. Passively externally rotate tibia while straightening leg (valgus force, tests lateral meniscus); then passively internally rotate knee while straightening leg (varus force, tests medial meniscus); pain, pops or clicks if meniscus tears
Egophony
While listening to the chest with a stethoscope, ask the patient to say the vowel “e”. Over normal lung tissues, the same “e” (as in “beet”) will be heard. If the lung tissue is consolidated/fibrotic/compressed, the “e” sound will change to a nasal “a” (as in “say”).
Cardiac
Inspect chest
Palpate APETM
Auscultate with diaphragm
Auscultate with bell (including carotids for bruit)
Ausc with diaphragm lying down
Ausc with bell lying down
Ausc Aorta, Renals, Iliacs, Femorals (also bowel sounds)
Peripheral pulses (brachials, radials, femorals, popliteals, DP/PT
Abdomen
Inspect (already ausc with cardiac) Percuss 4 quadrants Percuss liver and spleen Light palpation Deep palpation Palpate liver and spleen
Aaron’s sign
epigastric pain with continuous pressure over Mc Burney’s point–>acute appendicitis
valgus
position of a joint when the distal segment of the bone is angled away from the midline of the body (knock-knee)
Weber test
strike tuning fork and place in center of upper forhead; patient should hear equally on both sides; Conductive loss will cause the sound to be heard best in the abnormal ear; Sensorineural loss will cause the sound to be heard best in the normal ear.
Cozen’s test
test for lateral epicondylitis (tennis elbow) ; pt holds elbow at 90deg flexion, makes fist with wrist fully flexed; examiner stabilizes elbow and asks pt to extend wrist against their resistance; + if pain in lat epi with test
Lachman’s test
for ACL tear; pt supine, flex knee slightly, stabilize femur; pull lower leg anteriorly quickly to see if can displace femur
anterior drawer test
for ACL tear; pt supine, bend knee with foot on table, sit on foot; hold knee with fingers in pop space and thumbs on front; pull forward, will feel laxity in joint
