ASSESSMENT OSPE Flashcards
Explain Murphy’s Sign
Tests for Cholecystitis
- Places hand below right costal margin along the
mid clavicular line. - Asks patient to take deep breath in.
If positive:
patient will experience pain at peak inspiration
How do you test for Kidney Tenderness (Ballot)
- Left hand on patient’s back (flank area) under the 12th rib, pushing upwards.
- Right hand pushing down just below the (anterior) costal margin.
- Asks the patient to take a deep breath to help descend the kidney and ‘trap it’ between their two hands.
Easily palpable and/or tender kidney is = abnormal (hydronephrosis or pyelonephritis)
Testing Costovertebral Angle (CVA) Tenderness
- Finds the CVA by assessing for posterior 12th rib and the spine…just below the 12th rib in between the spine is the angle.
- Lays non-dominate hand flat over the angle.
- Makes fist with dominate hand and firmly thumps the fist onto flat non-dominate hand.
- Ask the patient if they felt tenderness or pain.
What is Blumberg sign?
Rebound tenderness
Positive sign for possible peritonitis
How do you carry out Blumberg Sign Assessment?
- Finds the CVA by assessing for posterior 12th rib and the spine…just below the 12th rib in between the spine is the angle.
- Lays non-dominate hand flat over the angle.
- Makes fist with dominate hand and firmly thumps the fist onto flat non-dominate hand.
- Ask the patient if they felt tenderness or pain.
Describe Rovsing sign
Right lower quadrant pain when palpating left lower quadrant
Suggestive of peritoneal irritation
Describe Psoas Sign
Right lower quadrant pain with extension of the right hip
or
with flexion of the right hip against resistance
Is present when the inflamed appendix is retrocecal and overlying the right psoas muscle.
Describe Obturator Sign
Right lower quadrant pain with internal and external rotation of the flexed right
Is present when the inflamed appendix is in contact with the obturator internus muscle.
Where is McBurney’s Point located?
2/3 of the day from umbilicus to anterior superior iliac spine
Describe the Pinch Test
- Pinches fold of abdominal skin over McBurney’s point.
- Elevates skin away from the peritoneum.
- Allows skin to recoil back briskly against the peritoneum.
If the patient has increased pain when the skin fold strikes the peritoneum, the test is positive, and peritonitis probably is present.
Where would you auscultate the Aortic Valve?
2nd Intercostal space
Right sternal edge
Where would you auscultate the Pulmonary Valve?
2nd Intercostal space
Left Sternal Edge
Where would you auscultate the Tricuspid Valve?
5th Intercostal space
Lower Left Sternal Edge
Where would you auscultate the Mitral Valve?
5th Intercostal Space
Mid Clavicular Line (Apex beat)
What does lateral displacement of Apical beat suggest?
Cardiomegaly
Cranial Nerve Exam
Neurological Assessment
I - Olfactory Nerve
Have you noticed any change in your sense of smell?
True test performed in clinical settings using peanut butter and coffee.
Noxious odours not used as they can stimulate trigeminal nerve endings in nasal mucosa
Cranial Nerve Exam
Neurological Assessment
II - Optic Nerve
Any changes to your vision?
Consider Snellen Chart
Cranial Nerve Exam
Neurological Assessment
II, III Optic and Oculomotor nerves
Assess pupils
Shape:
Abnormal shapes can be congenital or due to pathology.
PEARL:
Both pupils should constrict equally with light shined in one
Convergence:
Look at an object in the distance and then at your finger, pupils should constrict and converge.
Cranial Nerve Exam
Neurological Assessment
III, IV, VI – Oculomotor, Trochlear and Abducens Nerves
Note any Ptosis
(drooping of eyelid/s)
Have you been having any double vision?
Eye Movements
H-Test:
Move finger in an ‘H’ shape and have patient follow with their eyes only to assess motor function.
Cranial Nerve Exam
Neurological Assessment
V – Trigeminal Nerve
Sensory
Light touch test on three branches of nerve
Forehead (Opthalmic Branch)
Cheeks (Maxillary Branch)
Jaw (Mandibular Branch)
Cranial Nerve Exam
Neurological Assessment
V – Trigeminal Nerve
Motor
Clench teeth:
Feel for equal bilateral muscle mass/tone.
Open mouth against resistance:
Feel for strength and deviation (will deviate to side of lesion)
Cranial Nerve Exam
Neurological Assessment
VII - Facial Nerve
Facial expressions:
Raise eyebrows and frown.
Big Smile.
Puff out cheeks.
Can they close eyes tight and resist you trying to open them (gently).
Cranial Nerve Exam
Neurological Assessment
VII – Vestibulocochlear Nerve
Have you noticed any changes in your hearing?
Whisper test:
Whisper a number or word 15cm away from ear and ask patient to repeat it. (Cover other ear)
Cranial Nerve Exam
Neurological Assessment
X & X – Glossopharyngeal and Vagus Nerves
Say “Ahhh!”
Check that uvula remains mid-line.
Check that soft palate raises equally.
Cranial Nerve Exam
Neurological Assessment
XI – Accessory Nerve
Ask patient to shrug shoulders against resistance.
Turn head left and right against resistance.
Cranial Nerve Exam
Neurological Assessment
XII – Hypoglossal Nerve
Stick out tongue, Check for deviation.
(deviation always towards side of lesion)
Place finger on patient’s cheek and have them push tongue against it, assess power.
What is Dysdiadochokinesia?
The inability to carry out rapidly alternating movement.
Cranial Nerve Exam
Neurological Assessment Additional Test for Fine Motor Movement
“Piano playing”
Can patient mime this without awkward or difficult movements?
Cranial Nerve Exam
Neurological Assessment Additional Test for Repetitive Movements
Have patient touch the tip of your finger then their nose repeatedly with eyes closed.
Clap hands or slap thigh alternating between palm and back of hand.
What does the Romberg Test Assess?
Assesses for:
Sensory Ataxia (gait disturbance)
Suggestive of mild lesions of the sensory vestibular.
or
proprioceptive systems disequilibrium caused by:
Central Vertigo.
Peripheral Vertigo.
Head trauma.
Steps involved in Romberg Test?
- Asks the patient to remove their shoes and stand with their two feet together.
- Asks the patient to hold their arms next to their body or crossed in front of them.
- Asks the patient to first stand quietly with eyes open, and subsequently with eyes closed for 30secs.
- It is essential that the student stands close to the patient to prevent potential injury if they were to fall.
The test is positive when the patient sways and loses balance with their eyes closed.
What does Pronator Drift test for?
Upper Motor Neurone Disease.
Steps involved in Pronator Drift test?
1) Asks the patient to close their eyes, then to stretch out both arms in the appropriate position: extend the arms 90 degrees
2) The palms should be facing up (supinated).
3) Asks the patient to maintain this position for 20 to 30 seconds.
4) Observes both arms: if the motor pathway is intact, the arms should remain in this position equally.
- Patients with a slight weakness in one arm won’t be able to keep the affected arm raised, and ultimately the palm may begin to pronate (palm facing down).
- Pronator drift indicates abnormal function of the corticospinal tract in the contralateral hemisphere.
- In some patients, the arm may remain supinated but drop lower than the unaffected arm, and the fingers and elbow might flex.
What are the Ottawa knee rules?
A set of criteria which guide clinicians as to when an X-ray of a knee is required.
List the Ottawa knee rules.
Age > 55 years
Isolated patella tenderness
Tenderness of the fibular head
Inability to flex the knee to 90 degrees
Inability to bear weight immediately garter injury and in the emergency department.
What is a Patella Tap?
Technique used in an examination of the knee to test for knee effusion aka “water-on-the-knee”.
How to perform a Patella Tap?
- Positions the patient on their back.
- Extends the knee and presses the area above the kneecap with the palm of one hand. This would push any fluid under the patella and lifts it.
- While keeping the pressure on with the first hand, uses the fingers of their other hand to press down on the patella.
If a knee effusion is present, the kneecap will move down and “tap” the bone beneath.
What does the Anterior Drawer Test Assess?
Tests the stability of the knee’s anterior cruciate ligament (ACL).
Describe the Anterior Drawer Test.
- Ensures the patient lays supine with their hips flexed to 45 degrees, their knees flexed to 90 degrees and feet flat.
- Gently sits on the toes of the tested extremity to help stabilize it.
- Grasps the proximal lower leg, just below the tibial plateau or tibiofemoral joint line with both hands and attempt to translate (pull) the lower leg anteriorly.
The test is considered positive if there is a lack of ‘end feel’ or excessive anterior translation relative to the contralateral side
What does the Posterior Drawer Test Assess?
Tests to assess the function of the posterior cruciate ligament (PCL)
Describe the Posterior Drawer Test.
- Ensures the patient is supine and the knee to be tested is flexed to approximately 90 degrees.
- Gently sits on the toes of the tested extremity to help stabilize it.
- Grasps the proximal lower leg, approximately at the tibial plateau or joint line, and attempt to translate (push) the lower leg posteriorly.
The test is considered positive if there is a lack of end feel or excessive posterior translation.
What Does The Valgus Stress Test Assess?
Tests for damage to the medial collateral ligament (MCL)
Describe The Valgus Stress Test
- The patient’s leg should be relaxed for this test.
- The knee should be in neutral position and assessor should palpate the medial joint while fixating the femur with one hand, and with the other, slightly externally rotate the tibia/fibula.
There should be no gapping at 0 degrees.
- The test should be repeated with a passive bend in the affected leg to about 30 degrees of flexion.
- The assessor should again externally rotate tibia/fibula whilst applying passive abduction of the femur/thigh.
- A positive test occurs when pain or excessive gapping occurs (some gapping is normal at 30 degrees).
- The assessor should not include rotation of the hip in the application of force.
A positive test occurs when pain or gapping is produced.
What Does The Varus Stress Test Assess?
Tests for damage to the lateral collateral ligament (LCL)
Describe The Varus Stress Test.
Assessor applies lateral rotation to the knee joint by applying internal rotation of tib/fib at ankle joint and passive adduction at knee joint.
What is McMurray’s Test?
Tests for meniscus damage.
Describe McMurray’s test
Lateral and Medial
Lateral meniscus
1) Fully flexes the knee joint.
and
2) Rotates the tibia medially and brings the knee into full extension.
Medial meniscus
1) Brings the knee into full flexion.
and
2) Rotates the tibia laterally and brings the knee into full extension.
Pain, locking or clicking at any point indicates damage to the respective ligament.
What does pain in the Anatomical Snuff Box Indicate?
Indication of a Scaphoid Fracture
Describe what telescoping entails with regards to suspected scaphoid fracture?
1) Holds thumb firmly and push it into the wrist.
(Apply axial load to thumb)
Pain an indication of a scaphoid
fracture.
What does Kumar Test Assess?
Tests radial, ulnar, and medial nerves (motor function) in hand.
Describe Kumar Test.
Ask the patient to perform three simultaneous movements:
- Dorsiflex his/her wrist.
- Abduct the fingers of 3rd , 4th and 5th fingers.
- Make a ring (O) sign with thumb and index fingertips touching each other.
Inability to dorsiflex wrist indicates radial nerve weakness.
Inability to abduct the ulnar half of fingers indicates ulnar nerve weakness.
Inability to oppose thumb and index finger-tips: indicates median nerve weakness.
What is Tinel’s Test?
Test to detect irritated medial (as in carpal tunnel) or ulnar nerves.
Describe Tinel’s Test.
Assessor lightly taps (percusses) over the transverse carpal ligament
If a sensation of tingling or “pins and needles” in the distribution of the nerve is elicited.
Indication of positive Tinel’s sign in respective nerve(s).
What does Phalen’s Test Assess?
Diagnostic test for Carpal Tunnel Syndrome.
Describe Phalen’s Test.
- Asks the patient to place their wrists in complete unforced flexion for at least 30 seconds .
If the median nerve is entrapped at the wrist, this manoeuvre reproduces the symptoms of carpal tunnel syndrome
(pain and tingling).
Describe the Simmond’s test
- Asks pt to kneel, with ankles hanging over the edge of bed.
- Squeezes calf muscle and notes movement of foot.
Positive test if:
foot does not flex = torn tendon.
What does the Simmond’s Test Assess?
Tests for ruptures of the Achilles Tendon
What does Regimental Badge Sign Assess?
Tests for axillary nerve impingement/lesion (originates from C5-6).
Innovates teres minor and deltoid muscles, innovates sensory information over deltoid.
What does Cross Body Adduction test assess?
Assesses for supraspinatus and ACJ impingement.
Describe Regimental Badge Sign Assessment.
- Asks the patient to place their arms by their sides.
- Simultaneously lightly palpates deltoids in superior-inferior direction.
- Then asks patient to abduct their arms.
The patient should report equal sensation and have equal movement.
If not, the patient is positive for Regimental badge sign on the effected side
Describe Croissant Body Adduction Test
1) Positions themselves posteriorly behind the patient’s shoulder which isn’t being assessed.
2) Asks the patient to bring the opposite arm across their body.
3) Gentles pull the elbow into the patient’s chest.
Positive if pain/reduced movement elicited at supraspinatus/ACJ impingement
What does Painful Arc Assess?
Subacromial
OR
Supraspinatus
impingement
Describe Painful Arc Assessment.
- Asks patient to stand with their arms by their sides.
2. Then asks the patient to fully abduct their arm in the scapular plane.
Painful Arc
Pain within 45 - 120 degrees of motion suggests?
Most likely Glenohumeral Joint impingement
Painful Arc
Pain within 60 - 120 degrees of motion suggests?
Subachromial/Supraspinatus
Impingement
Painful Arc
Pain within 170 - 180 degrees of motion suggests?
Acromioclavicular Joint Impingement
What Does The Drop Arm Test Assess?
Assesses for rotator cuff tears.
Particularly of the Supraspinatus.
Describe The Drop Arm Test
- Positions the patient sitting or standing.
- Stands behind the patient and abducts the patient’s arm to 90 degrees, whilst supporting the arm at the elbow.
- The student should release the elbow support and ask the patient to slowly lower the arm back to their side.
Test is positive if:
Pain while lowering the arm.
Sudden dropping of the arm.
Weakness in maintaining arm position during lowering (with or without pain), suggesting injury to the supraspinatus.
What Does The Lift Off Test Assess?
Assesses for Subscapularis Rupture
or
Dysfunction (isolated or related to anterior dislocation)
Describe the Lift Off Test Assessment.
1) Asks the patient to place their hand against the mid-lumbar spine with the palm facing outward.
2) Then asks the patient to push their hand away from their back (internally rotate + extend) against resistance.
Positive if:
Patient is unable to perform internal rotation and extension against resistance.
What Does Hornblower’s Sign Assess?
Assesses for:
Rotator Cuff Tear usually including the Teres Minor
Describe The Hornblower’s Sign Assessment.
1) Asks the patient to abduct their arm 90 degrees in the scapular plane and flex their elbow to 90 degrees.
2) Then asks the patient to perform external rotation against resistance.
Positive if:
The patient can’t externally rotate in that position.
What is The Empty Can Test Assessing?
Assesses for:
Supraspinatus Tendonitis
or
Weakness as a result of a tear in the Supraspinatus muscle or tendon.
Describe the Empty Can Test
1) Uses one hand to stabilise the shoulder girdle.
2) Then moves the arm to be tested into 90 degrees of forward flexion in the plane of the scapula (approximately 30 degrees of abduction).
3) Ensures (passive) full internal rotation with the thumb pointing down as if the patient is emptying a beverage can.
4) The Assessors other hand should then apply downward pressure on the superior aspect of the distal forearm and ask the patient to resist.
Positive test if:
Pain or weakness in subacromial region.
(Can sometimes be felt into the upper arm).
Describe Barrel Shape Chest
Anteroposterior to Transverse diameter ratio is 1:1
infancy/old age/COPD
Describe Pectus Carinatum
Forward protrusion of the sternum and adjacent costal cartilage.
Causes:
Childhood Asthma
Rickets
Marfan’s
Describe Pectus Excavatum
Backwards protrusion of the sternum and adjacent costal cartilage.
Associated with:
Marfan’s
Ehlers–Danlos Syndrome
Normal Chest Wall Expansion Consists of
Symmetrical expansion during deep inhalation.
What is Tactile Fremitus?
Palpation of sound vibrations on the chest wall as patient speaks.
Tactile Fremitus - In Healthy Lungs (sound)
Vibrations barely palpable
Tactile Fremitus - In Consolidation
Vibrations are increased
Due to
Fluid
Mucus
Exudate
Or
Cellular debris
Tactile Fremitus - Absent or Decreased
Vibrations from larynx to chest surface are impeded
Caused by:
COPD
Obstruction
Pleural Effusion
Or
Pneumothorax
Explain Bronchophony Assessment.
Ask patient to say 99
In health should sound very faint and muffled.
If sound is clear though a stethoscope, likely consolidation of the lung and positive bronchophony.
Explain Pectoriloquy Assessment
Ask patient to whisper
One, Two, Three
In health - whispered voice will be distant and very muffled
If whispered words are heard clearly - likely presence of consolidation.
Explain Egophony Assessment
Ask patient to say “EE”
In health it sounds muffled, but will remain with he long sound of the “EE”
IF
Sound changes to “AY”, resembling the bleating of a goat, then egophony is present, indicating consolidation (fluid in the lungs)
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