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9 CLET > CLET FINAL VERBALS > Flashcards

CLET FINAL VERBALS Flashcards

1
Q

MENTAL STATUS EVALUATION

A

1 Orientation 2 Level of Alertness, Attention, and Cooperation 3 Memory 4 Language 5 Calculations 6 Apraxia 7 Sequencing tasks 8 Abstraction

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2
Q

ORIENTATION

A

Ask the patient’s name, location, and date

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3
Q

LEVEL OF ALERTNESS, ATTENTION, and COOPERATION

A

Ask the patient to spell a word forward and back ward Ask the patient to repeat a string of integers forward and backward Ask the patient to name the months forward and backward

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4
Q

MEMORY

A

Recent - Ask patient to recall three items after 5 minute delay Remote - Ask patient to recall certain historical facts within patient’s memory (lifetime) ** “Where did you go to high school?”

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5
Q

LANGUAGE

A

Object naming - Ask patient to name 3 objects/shapes Repetition - Ask patient to repeat words or a sentence Reading - Ask patient to read a sentence

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6
Q

CALCULATIONS

A

Simple additions and subtractions, should be 2 or more steps - ask patient to do a calculation

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7
Q

APRAXIA

A

Following a complex motor command like “pretend to comb your hair” or “pretend to brush your teeth”

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8
Q

SEQUENCING TASKS

A

Ask the patient to tap the table with: fist, open palm, then side of open hand (rock, paper, scissors) perform as rapidly as possible

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9
Q

ABSTRACTION

A

Ask patient to interpret a proverb or colloquialism “The early bird gets the worm”

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10
Q

DIADOCHOKINESIA

A

Patting Test: Rapid, rhythmic, alternating movements. Have patient pat leg with each hand as fast as possible * Mostly testing cerebellum (coordination and gait)

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11
Q

DIADOCHOKINESIA alt.

A

Supination - Pronation *Mostly testing cerebellum (coordination and gait)

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12
Q

DYSMETRIA

A

Index finger test: Have patient touch your (doctor’s index finger) (while Dr. moves finger to all 4 quadrants) and then his/her nose alternately several times. (Note tremors or lack of coordination)

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13
Q

GAIT

A

Gait- observe patient walking toward and away, note posture, stability, foot elevation, trajectory of leg swing, balance, and arm motions. Tandem gait- ask the patient to walk heel to toe (police DUI test, walk in a straight line) (cerebellum). Forced gait testing- ask the patient to walk on heels for 6 steps and then on toes for 6 steps (test lumbar roots).

INSIDE, OUTSIDE, HEELS, AND TOES

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14
Q

What are the 2 spinothalamic tract tests?

A

Crude touch and Pain (pinprick)

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15
Q

CRUDE TOUCH

A

Ask the patient to identify when he or she is being touched with the dull end of the neurotip. (inability = spinothalamic tract involvement)

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16
Q

PAIN (PINPRICK)

A

Ask the patient to identify when he or she is being touched with the pin or toothpick or the neurotrip (inability = spinothalamic tract involvement)

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17
Q

What are the Dorsal Column Tests?

A

1 Vibration - Pallesthesia 2 Light Touch 3 Joint Position Sense 4 Romberg Test

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18
Q

VIBRATION PALLESTHESIA

A

Place the handle of a vibrating 128 Hz tuning fork on the joint line of the upper and lower extremities. utilize 3 distal interphalangeal joints. If abnormal continue to evaluate proximally until a normal finding is achieved at the base of the 5th metacarpal or metatarsal, and the radial and ulnar styloid processes, or medial and lateral malleoli. Ask the patient to identify when he or she feels vibration and when the doctor has stopped the vibration (inability = dorsal column involvement)

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19
Q

LIGHT TOUCH

A

ask the patient to identify when he or she is being touched with a cotton swab or brush. (inability = dorsal column involvement)

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20
Q

JOINT POSITION SENSE

A

Dr. stabilizes lateral surface of fingers or toes and asks patient to identify if finger or toe is up or down. Start with DIP, if positive, then move to PIP, then MCP of the lower extremity and then proceed to the upper extremity. If negative at any time, then move to the next digit. (inability = dorsal column involvement)

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21
Q

ROMBERG TEST

A

ask the patient to stand with the feet shoulder width apart, and with eyes closed, while doctor stands close to steady the patient. (swaying, or falling = dorsal column involvement)

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22
Q

What does Discriminatory Sensation test?

A

Tests the integrity of the somatosensory cortex***

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23
Q

POINT LOCALIZATION (TOPOGNOSIS)

A

Ask the patient to identify multiple points the doctor touches with the dull end of the neurotip, a paperclip, or toothpick

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24
Q

SHARP VS DULL DESCRIMINATION

A

Ask the patient to identify whether the sharp or dull end of the neurotip is being applied to multiple points on the skin of each extremity.

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25
Q

STEREOGNOSIS

A

Ask the patient to identify familiar objects (keys, pencils, coins) by the sense of touch.

“WHAT’s different about these” ?

** SOMATOSENSORY CORTEX

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26
Q

GRAPHESTHESIA

A

Ask the patient to identify numbers or letters traced lightly on the skin.

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27
Q

BAROGNOSIS

A

Ask the patient to identify the difference between two same sized objects of different weight.

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28
Q

TWO POINT DISCRIMINATION

A

Determine the smallest area in which two points can be separately perceived on the hands. Touch the patient with a paperclip opened wide enough that two separate stimuli are felt, then bring the stimuli closer together until only one is felt. Repeat in three locations (fingertip, finger & palm). Compare bilaterally.

* State that you would measure the 2 and see if it gets better/worse

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29
Q

What is the Westphal sign?

A

Absence of any DTR (especially patellar; LMNL)

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30
Q

DIRECT LIGHT

A

RESPONSE: Ipsilateral pupillary constriction when light is shined in the eye AFFERENT: Optic N. II (ipsilateral to light source) INTEGRATING CENTER: Midbrain EFFERENT: Oculomotor Nerve III (ipsilateral to light source)

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31
Q

INDIRECT LIGHT

A

RESPONSE: Contralateral pupillary constriction when light is shined in the eye AFFERENT: Optic N. II (Ipsilateral to light source) INTEGRATING CENTER: Midbrain EFFERENT: Oculomotor N. III (Contralateral to light source)

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32
Q

ACCOMMODATION

A

RESPONSE: Convergence of the eyes with with pupillary constriction AFFERENT: Optic N. II INTEGRATING CENTER: Occipital Cortex EFFERENT: Oculomotor N III

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33
Q

CAROTID SINUS

A

RESPONSE: Reduction in heart rate when examiner presses the carotid sinus AFFERENT: Glossopharyngeal N. IX INTEGRATING CENTER: Medulla EFFERENT: Vagus Nerve X

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34
Q

OCULOCARDIAC

A

RESPONSE: Reduction in heart rate when examiner presses the eye AFFERENT: Trigeminal N. V INTEGRATING CENTER: Medulla EFFERENT: Vagus N. X

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35
Q

CILLIOSPINAL

A

RESPONSE: Pupillary dilation when examiner pinched the base of the neck at the cervical sympathetic chain AFFERENT: Cervical Sympathetic Chain INTEGRATING CENTER: T1-T2 Spinal Cord EFFERENT: Cervical Sympathetic Chain

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36
Q

CORNEAL

A

RESPONSE: Blinking and tearing of the eye upon touching the cornea with a cotton wasp AFFERENT: Trigeminal N. V INTEGRATING CENTER: Pons EFFERENT: Facial N VII

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37
Q

GAG/PHARYNGEAL

A

RESPONSE: Gagging upon touching the back of the throat with a tongue depressor AFFERENT: Glossopharyngeal N. IX INTEGRATING CENTER: Medulla EFFERENT: Vagus N X

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38
Q

UVULAR/PALATEAL

A

RESPONSE: Raising of the uvula upon phonation, or touching with a tongue depressor AFFERENT: Glossopharyngeal IX INTEGRATING CENTER: Medulla EFFERENT: Vagus N

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39
Q

INTERSCAPULAR

A

RESPONSE: Drawing inward of scapular when skin or interscapular space is irritated AFFERENT: T2-T7 Spinal Nerves INTEGRATING CENTER: T2-T7 Spinal Cord EFFERENT: Dorsal Scapular Nerve

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40
Q

ABDOMINAL

A

RESPONSE: Umbilicus deviation to the stroked side. Absence is normal only if bilateral (see Beevor sign) AFFERENT: Upper T7-10, Lower T11 - T12 INTEGRATING CENTER: Spinal Cord T7-T12 EFFERENT: Upper T7-10, Lower T11-T12

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41
Q

PLANTAR

A

RESPONSE: Plantar flexion (curling) of toes upon stroking sole of foot AFFERENT: Tibial N INTEGRATING CENTER: Spinal Cord S1-S2 EFFERENT: Tibial N.

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42
Q

GLABELLA aka MCCARTHY

A

Contraction of orbicularis occuli muscle upon percussion of supraorbital ridge (glabella)

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43
Q

HOFFMAN

A

Clawing of the fingers and thumb (flexion and adduction of thumb with flexion of the fingers) upon flicking tip of index finger into extension

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44
Q

TROMNER

A

Flexion of the fingers and thumb upon tapping palmar surface or tips of middle three fingers

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45
Q

ANKLE CLONUS

A

Continued involuntary contraction (sustained plantar flexion) or foot upon quick forcible dorsiflexion of the foot

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46
Q

BABINSKI

A

Dorsiflexion of the big toe and fanning or splaying of other toes upon stimulation of the plantar surface of the foot (lateral to medial) (Plantar Reflex)

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47
Q

What are the alternate ways to elicit Babinski?

A

Oppenheim Sign Chaddock Sign Gordon Sign Schaefer Sign

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48
Q

Oppenheim Sign

A

Application of pressure to anterior tibia stroking downward

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49
Q

Chaddock Sign

A

Stroking down the lateral leg around the lateral malleolus

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50
Q

Gordon Sign

A

Squeezing the calf

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51
Q

Schaefer Sign

A

Squeezing the achilles tendon

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52
Q

OLFACTORY NERVE (I)

A

a) Ask about disorders of sense of smell and of taste (will diminish with loss of smell) b) Using a penlight, make sure nostrils are not blocked. c) Occlude one nostril at a time (eyes should be closed) Have patient sniff familiar and non-irritating odors, use the milder scent first. Ask the patient: 1) Do you smell anything? 2) Can you identify the substance?

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53
Q

OPTIC NERVE (II)

A

a) Inspect external structures of eye b) Inspect the optic fundi with ophthalmoscope c) Test visual acuity Screen by reading print Screen with shapes and/or colors d) Confrontation Test Examine directly in front and level with patient’s face Have patient cover one eye Bring object into view from eight different directions (P-A) per eye e) Direct light reflex- ipsilateral pupillary constriction f) Indirect light reflex (consensual reflex)- contralateral pupillary constriction g) Accommodation reflex Test ability of the eyes to adapt for near vision Instruct patient to follow object inward from a distance Convergence of the eyes, constriction of the pupil

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54
Q

OCULOMOTOR (III), TROCHLEAR (IV), and ABDUCENS (VI)

A

The following four tests are for CN III specifically: a. Check for ptosis b. Direct light reflex c. Indirect light reflex d. Accommodation reflex The following will test CN III, IV, and VI combined: a) Extraocular movements with six cardinal fields of gaze. Observe patient’s eyes for normal conjugate, or parallel movements of the eyes and nystagmus as you have him/her follow your finger or pencil while it makes a wide “H” in the air: Trochlear = down and in Abducens = lateral Oculomotor all other fields.

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55
Q

(V) Trigeminal Nerve (Ophthalmic, Maxillary, and Mandibular)

A

a) Oculocardiac Reflex: Take pulse, apply pressure over the patient’s closed eye, pulse rate should decrease 2-3 beats per 15 sec. b) Test corneal reflex with wisp of cotton, should see blinking and tearing c) Test pain (sharp pinprick) on face bilateral in all 3 divisions (3 places per division for a total of 18 touches) d) Test for light touch to the face with wisp of cotton or brush in all 3 divisions (3 places per division for a total of 18 touches) e) Light touch to anterior 2/3 of tongue, inside cheeks, and hard palate with toothpick. (Use a penlight to view the inside of the mouth) f) Have patient clench teeth, palpate masseter and temporalis muscles at rest & motion.

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56
Q

FACIAL NERVE (VII)

A

a) Ask the patient about changes in taste sensations sweet, salty, and sour on the anterior two thirds of the tongue. b) Inspect face for asymmetry (at rest and during motion) Ask the patient to perform the following: Raise eyebrows Close eyes tightly Show teeth Puff out cheeks Smile Frown

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57
Q

VESTIBULO-COCHLEAR NERVE (VIII)

A

Sensory-Cochlear Portion a) Screening tests to confirm side of hearing loss: Finger Rub Test: Assess hearing by rubbing fingers together near the EAM (external auditory meatus), find maximal distance sound can be heard. Whisper Test Have patient close his eyes (to prevent lip-reading) and cover the ear on the side not being tested. Place your head/mouth 2 feet from the ear being tested and whisper words to the patient and ask patient to repeat the words. You can also ask questions to the patient and have the patient answer yes or no to each question. b) Distinguish between perceptive and conductive hearing loss using a 512 Hz tuning fork by using Weber and Rinne tests. Weber Test Procedure: Place the handle of the vibrating tuning fork on the midline of the skull and ask the patient to compare the intensity of the sound in the two ears. Indicates: (-) Normal: sound is equal in both ears. (+) Conductive deafness: sound lateralizes to the bad ear. (+) Sensorineural deafness: sound lateralizes to the good ear. CLINICAL SCIENCES DIVISION 94 Rinne Test Procedure: Place the handle of a vibrating tuning fork against the mastoid bone for bone conduction. Begin counting or timing the interval with a watch. Ask the patient to tell you when the sound is no longer heard, noting the amount of time. Then quickly hold the vibrating fork near the external ear canal without touching the patient (.5 to 1”) for air conduction, and again have the patient indicate when the sound ceases. Again, note the amount of time. Indicates: Normal: air conduction persists twice as long as bone conduction Abnormal: Conduction deafness: air conduction is absent, equal to, or less than bone conduction. Abnormal: Sensorineural deafness: air conduction and bone conduction are both radically decreased or absent. Vestibular Portion Fukuda Step Test Procedure: Patient marches in place, eyes closed for 50 steps. Positive: A turning to one side Indicates: Vestibular lesion on the side of rotation Hallpike Dix Maneuver Procedure: Patient is seated with head turned 45º to the right or left. Examiner quickly brings the patient into the supine position with head extended off the table. Examiner notes any nystagmus. Patient is then brought to the seated position. Repeat with head turned to the opposite direction. Positive: Nystagmus starting 2-5 seconds after movement and stopping within 30 seconds. Indicates: Benign positional vertigo Barany Whirling Chair Test Procedure: Seated patient is spun in chair in one direction Indicates: Normal: fast component of nystagmus will be in the direction of the spin. Vestibulo-ocular Reflex Procedure: Dr. holds patient’s head and instructs patient to fix vision on the doctor’s face. Observe and note spontaneous nystagmus. Dr. then turns patient’s head into rotation, lateral flexion, and flexion and extension. Indicates: Normal patient should maintain eye contact eyes moving at the same speed in the opposite direction of head movement. Inability to maintain fixation or spontaneous nystagmus indicates a vestibular lesion.

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58
Q

GLOSSOPHARYNGEAL AND VAGUS IX AND X

A

a) Note any hoarseness of the voice. b) Ask the patient about change in bitter taste sensation on the posterior third of the tongue. c) Uvula reflex = Patient says “ah” while doctor shines light in mouth and depresses tongue as necessary Watch for symmetrical rising of soft palate. Unilateral paralysis = One side of palate does not rise and uvula deviates to the normal side. d) Gag reflex. e) Have patient swallow while you palpate thyroid cartilage. f) Carotid sinus reflex.

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59
Q

SPINAL ACCESSORY NERVE XI

A

a) Trapezius Muscle Inspect Palpate Muscle test b) Sternocleidomastoid Muscle Inspect Palpate Muscle test - Ask patient to rotate head to one side. Dr. instructs patient to hold, while Dr. attempts to return the head to neutral.

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60
Q

HYPOGLOSSAL NERVE XII

A

a) Inspect tongue for: 1. Atrophy 2. Fasciculations 3. Deviation b) Have patient stick out tongue and test bilateral with tongue depressor, or use the tongue in cheek method Unilateral paralysis = Protruded tongue deviates to involved side.

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61
Q

BOWEL SOUNDS OF ABDOMEN

A

POSITIVE: Listen for frequency and character INDICATES: 1. hyperactive ( > 35/min) 2. Normoactive (5-35/min) 3. Hypoactive (1-4/min) 4. Absent (0 bowel sounds, but you must listen for 5 continuous minutes) - Medical emergency (obstruction or perforation)

** 5 seconds per quadrant

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62
Q

FRICTION RUBS

A

POSITIVE: High pitched sandpaper rubbing sound associated with respiration INDICATES: Inflammation of peritoneal surface of the liver and/or spleen from infection, tumors, or infarct

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63
Q

MAJOR ARTERIES OF THE ABDOMEN FOR BRUITS

A

POSITIVE: Harsh, musical wooshing sound (bruit) INDICATES: Possible vascular disease

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64
Q

VENOUS HUM IN THE ABDOMEN

A

POSITIVE: Soft, low pitched, continuous sound that is louder during diastole INDICATES: Increased collateral venous circulation

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65
Q

SCAN ABDOMINAL REGIONS FOR TONE

A

POSITIVE: Detect the presence of fluid, air, or solid masses INDICATES: Size and shape of the organs

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66
Q

PERCUSS THE URINARY BLADDER

A

POSITIVE: Dullness of suprapubic area INDICATES: Distended bladder

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67
Q

PERCUSS THE LIVER FOR SIZE

A

NORMAL: Usual span of liver is approximately 6-12 cm (2 1/2 to 4 1/2 in) INDICATES: A span greater than this may indicate liver enlargement (hepatomegaly) A lesser span may suggest atrophy

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68
Q

PERCUSS FOR GASTRIC AIR BUBBLE

A

POSITIVE: Tympany INDICATES: Location of the fundus of the stomach

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69
Q

PERCUSS THE SPLEEN

A

POSITIVE: Dullness INDICATES: Location of the spleen and/or splenomegaly

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70
Q

LIGHT PALPATION OF THE ABDOMEN

A

POSITIVE: Pain, tenderness, muscle guarding, and masses

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71
Q

DEEP PALPATION OF THE ABDOMEN

A

POSITIVE: Pain, tenderness, muscle guarding, and masses

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72
Q

DISTINGUISH A SUPERFICIAL FROM A DEEP MASS

A

POSITIVE: 1. Mass remains visible and/or palpable 2. Mass is no longer visible and/or palpable INDICATES: 1. Superficial Mass 2. Deep Mass

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73
Q

PALPATE FOR LIVER EDGE USING STANDARD MANEUVER

A

POSITIVE: Nodules, tenderness, irregularity INDICATES: Liver Disease

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74
Q

GALLBLADDER PALPATION

A

POSITIVE: Increased pain and reflex apnea (Murphy’s SIGN) INDICATES: Cholecystitis

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75
Q

PALPATE FOR SPLEEN

A

POSITIVE: Palpable Spleen INDICATES: Splenomegaly

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76
Q

PALPATE AROUND THE UMBILICUS

A

POSITIVE: Bulges, nodules, and or irregularities INDICATES: Possible abdominal hernia

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77
Q

PALPATE THE ABDOMINAL AORTA PULSE

A

POSITIVE: Prominent lateral pulsation INDICATES: Possible aortic aneurysm

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78
Q

PERFORM KIDNEY ENTRAPMENT

A

POSITIVE: Increased pain over the kidney INDICATES: Nephritis

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79
Q

PALPATE THE URINARY BLADDER

A

POSITIVE: Smooth rounded dense mass INDICATES: Distended bladder

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80
Q

BLUMBERG’S SIGN

A

POSITIVE: Sharp pain upon rebound in any of the 4 quadrants

INDICATES: Peritonitis

** Once in every 4 quadrants, start RUQ and go clockwise

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81
Q

ROVSING’S SIGN

A

POSITIVE: Sharp pain upon rebound in the right lower quadrant when pressing into the left lower quadrant INDICATES: Appendicitis

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82
Q

TEST FOR ASCITES: FLUID WAVE

A

POSITIVE: Easily detected fluid wave

INDICATES: Ascites (pathological increase of fluid in the abdomen)

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83
Q

PSOAS SIGN

A

POSITIVE: Increased pain in Right Lower Quadrant

INDICATES: Appendicitis

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84
Q

OBTURATOR SIGN

A

POSITIVE: Increased pain in right lower quadrant INDICATES: Ruptured appendix or pelvic abscess

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85
Q

MURPHY’s PUNCH

A

POSITIVE: Increased pain over the kidney INDICATES: Nephritis of inflamed kidney

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86
Q

PALPATION OF POSTERIOR THORAX

A

POSITIVE: Pain, tenderness, masses, sensations and further assess for any abnormalities

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87
Q

TACTILE FREMITUS (posterior thorax)

A

POSITIVE:

  1. Increase Fremitus
  2. Decreased or Absent Fremitus

INDICATES:

  1. Fluid or a solid mass within the lungs e.g. Lung Consolidation
  2. Excess air in the lungs e.g. Emphysema
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88
Q

RESPIRATORY EXCURSION

A

POSITIVE: Loss of symmetry in the movement of the thumbs

INDICATES: Underlying lung problem on one or both sides

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89
Q

PERCUSSION of POSTERIOR THORAX

A

Normal: Resonance

Abnormal: Dullness indicates mass or fluid in the lung (Lung cancer or pneumonia) Hyper-resonance indicates trapped air in the lung (Emphysema, atelectasis or pneumothorax)

** 1 FOR UPPER LOB, 2 SPOTS INTERSCAPULAR, 2 SPOTS MIDDLE, 2 SPOTS LATERAL

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90
Q

DIAPHRAGMATIC EXCURSION

A

POSITIVE: Limited measurement

INDICATES: Pathologies of pulmonary (eg result of emphysema (bilateral limited movement), abdominal (result of massive ascites, tumor), or superficial pain (fractured rib)

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91
Q

NORMAL BREATH SOUNDS (both anterior and posterior are same verbals)

A

Listen for Characteristics: Pitch, Intensity, duration of the normal breath sounds of Bronchial (best heard over the trachea), and Broncho-vesicular (best heard over the main bronchus and upper right posterior lung field), Vesicular (best heard over the periphery of the lung)

** ONE SPOT PER AREA BILATERALLY

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92
Q

VOCAL RESONANCE POSTERIOR

A

SEATED ONLY Normal: The sounds transmitted are usually muffled and indistinct and are best heart medially

* 10 AREAS TOTAL

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93
Q

VOCAL RESONANCE: WHISPERED PECTORILOQUY

A

POSITIVE: Increased clarity and loudness of spoken sounds INDICATES: Presence of consolidation in the lung

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94
Q

VOCAL RESONANCE: EGOPHONY

A

POSITIVE: Increased clarity and nasal quality of “E” becoming “A” INDICATES: Presence of consolidation in the lung

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95
Q

PALPATION of THE ANTERIOR THORAX

A

POSITIVE: Pain, tenderness, masses, sensations, and further assess for any abnormalities

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96
Q

PALPATION of the LYMPH NODES of the THORAX and AXILLA

A

POSITIVE:

  1. Enlarged, hard, immobile, non-tender
  2. Enlarged, soft, mobile, tender

INDICATES:

  1. Cancer
  2. Infection
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97
Q

TRACHEAL POSITION

A

POSITIVE: Deviation of the trachea INDICATES: Underlying pathology

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98
Q

PERCUSSION OF ANTERIOR THORAX

A

NORMAL: Resonance ABNORMAL: Dullness indicates mass or fluid in the lung (pneumonia or lung cancer) Hyper-resonance indicates trapped air in the lung (Emphysema, Atelectasis or Pneumothorax)

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99
Q

COSTOCHONDRITIS

A

POSITIVE: Pain at the costochondral junction INDICATES: Inflammation at the costochondral junction

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100
Q

POSSIBLE RIB FRACTURES

A

POSITIVE: Pain radiating from site of fracture

INDICATES: Possible rib fracture

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101
Q

CHECK THE 5 CARDIAC AREAS FOR PULSATIONS

A

POSITIVE: Impulse that rhythmically lifts your fingers

INDICATES: Possible cardiac hypertrophy

*aortic, pulmonic, aoritc, erb’s, tricuspid, mitral

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102
Q

CHECK FOR APICAL IMPULSE

A

NORMAL: Normal size is approximately 1 cm

ABNORMAL: Displacement of the apical impulse right or left

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103
Q

CHECK FOR EPIGASTRIC PULSATIONS

A

POSITIVE:

  1. Pulsations coming from superior to inferior
  2. Pulsations coming from inferior to superior

INDICATES:

  1. May indicate right ventricular enlargement
  2. May indicate abdominal aortic aneurysm
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104
Q

CHECK THE 5 CARDIAC AREAS FOR THRILLS

A

POSITIVE: A fine, palpable, rushing vibration

INDICATES: Grade IV murmur or higher

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105
Q

PAIRING OF S1 AND CAROTID PULSE

A

NORMAL: S1 and the carotid pulse should be synchronous

** Listen at S1 for 5 seconds first, and then get carotid pulse and listen 5 seconds again

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106
Q

IDENTIFY THE LOCATION AND SIZE OF HEART (PERCUSS)

A

1) Men = 3, 4, 5 with VERTICAL mark going lateral to medial. Women = 3 and 5 with VERTICAL mark going lateral to medial (move breast tissue down, move it up)
2) Percuss down the right sternal border beginning at Aortic Area. Dullness is heard at the 6th intercostal space indicating the superior border of liver (make 1 horizontal mark)

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107
Q

AUSCULTATE FOR HIGH PITCHED GENERAL CARDIAC SOUNDS

A

NORMAL: Listen for rate and rhythm

*Use DIAPHRAGM and PALPATE angle of Louis first,

*5 SECONDS EACH AREA (1-5)

108
Q

AUSCULTATE FOR LOW PITCHED GENERAL CARDIAC SOUNDS

A

NORMAL: Listen for rate and rhythm

** USE THE BELL and palpate ANGLE of LOUIS (1-5)

109
Q

LISTEN IN THE MITRAL AREA FOR S1 AND PALPATE THE CAROTID PULSE - CHECK FOR PAIRING OF THE TWO

A

NORMAL: S1 and the carotid pulse should be synchronous

** USE DIAPHRAGM, pair the two for 3-5 seconds and ask the patient to take a deep breath in, EXHALE and HOLD

110
Q

LISTEN AT THE PULMONIC AREA TO S2 DURING DIASTOLE

A

VERBALIZE: S2 is heard loudest at base during diastole. I am listening for accentuated, diminished, and splitting, and splitting of S2, abnormal heart sounds and pulmonic murmurs

* USE THE DIAPHRAGM and use the PULMONIC AREA (2nd IC space on LEFT)

111
Q

SPECIAL MANEUVER FOR MITRAL MURMUR

A

BELL

(deep breath in AFTER left lateral decubitus position, 3-5 seconds)

112
Q

SPECIAL MANEUVER FOR AORTIC MURMUR

A

DIAPHRAGM

EXHALE AND HOLD

113
Q

Bony Palpation: SHOULDER

A
  1. Sternoclavicular Articulation
  2. Clavicle
  3. Coracoid Process
  4. Acromioclavicular Articulation
  5. Acromion
  6. Greater Tuberosity of the Humerus
  7. Bicipital Groove
  8. Lesser Tuberosity of the Humerus
  9. Spine of the Scapula
  10. Body of Scapula
  11. Scapulothoracic Articulation
114
Q

Soft Tissue Palpation: SHOULDER

A
  1. Rotator Cuff Muscle: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
  2. Subacromial Bursa
  3. Subdeltoid Bursa
  4. Axillary Borders: Pectoralis Major, Serratus Anterior, Axillary Lymph Nodes, Latissimus Dorsi, Bicipital Tendon
  5. Prominent Muscles of Region: Sternocleidomastoid, Biceps, Deltoid as a whole, (anterior, middle and posterior portion of deltoid), Trapezius, Rhomboid (minor and major)
115
Q

RANGE OF MOTION: SHOULDER

A
  • Flexion: 180
  • Abduction: 180
  • External Rotation: 90
  • Internal Rotation: 70
  • Extension: 60
  • Adduction: 50

Scapular retraction, elevation, protaction

116
Q

Yergason Test (Cipriano)

A

POSITIVE:

  • Localized Pain and/or tenderness at the bicipital groove
  • Audible click or the biceps tendon subluxes or dislocates

INDICATES:

  • Bicipital Tendinitis
  • Instability of the biceps tendon possibly associated with a torn transverse humeral ligament
117
Q

Abbott-Saunders Test

A

POSITIVE:

  • Palpable and/or audible click

INDICATES:

- Subluxation or dislocation of the biceps tendon due to a rupture of the transverse humeral ligament or tendon subluxation beneath subscapularis muscle belly/tendon

118
Q

SPEED TEST

A

POSITIVE:

  • Pain and/or tenderness in the bicipital groove

INDICATES:

  • Bicipital Tendinitis
119
Q

APLEY TEST:

A

POSITIVE:

  • Exacerbation of pain

INDICATES:

  • Degenerative tendinitis of rotator cuff tendons (usually supraspinatus)
120
Q

IMPINGEMENT SIGN:

A

POSITIVE:

  • Pain in the shoulder

INDICATES:

  • Overuse injury to the supraspinatus and possibly biceps tendon
121
Q

DUGAS TEST

A

POSITIVE:

  • Inability to touch the opposite shoulder and/or inability of the elbow to touch the chest

INDICATES:

  • Acute dislocation of the shoulder (glenohumeral joint)
122
Q

ANTERIOR APPREHENSION TEST

A

POSITIVE:

  • Patient will have a noticeable look of apprehension or alarm on their face with possible pain

INDICATES:

  • Chronic anterior dislocation of the shoulder (glenohumeral joint)
123
Q

POSTERIOR APPREHENSION TEST

A

POSITIVE:

  • Patient will have a noticeable look of apprehension or alarm on their face with possible pain

INDICATES:

  • Chronic Posterior dislocation of the glenohumeral joint
124
Q

DROP ARM TEST/ aka CODMAN DROP ARM TEST

A

POSITIVE:

  • Patient will not be able to lower the arm slowly or the arm drops suddenly

INDICATES:

  • Rotator cuff tear, usually supraspinatus
125
Q

DAWBARN TEST

A

Deep palpation of shoulder elicits well-localized tender area, by subacromial bursa

POSITIVE:

  • Decrease in pain and/or tenderness

INDICATES:

  • Subacromial bursitis
126
Q

BONY PALPATION OF THE ELBOW

A
  1. Medial Epicondyle
  2. Medial Supracondylar line of the humerus
  3. Groove of the ulnar nerve
  4. Trochlea
  5. Olecranon
  6. Olecranon fossa
  7. Lateral Epicondyle
  8. Lateral Supracondylar line of the humerus
  9. Radial head
127
Q

SOFT TISSUE PALPATION of ELBOW

A
  1. Biceps muscle
  2. Triceps muscle
  3. Suprcondylar Lymph Nodes
  4. Brachial Artery
  5. Medial Collateral Ligament
  6. Lateral Collateral Ligament
  7. Ulnar Nerve
  8. Olecranon Bursa
  9. Wrist flexor muscles (Palpate as a unit and individually)
    1. Pronator Teres
    2. Flexor Carpi Radialis
    3. Palmaris Longus
    4. Flexor Carpi Ulnaris
  10. Elbow Flexors muscles “mobile wad of three” (palpate as a unit and individually)
    1. Brachioradialis
    2. Extensor Carpi Radialis Longus
    3. Extensor Carpi Radialis Brevis
128
Q

Range of motion: ELBOW

A
  • Elbow Flexion: 150
  • Elbow Extension: 0
  • Forearm Supination (radio-ulnar joint): 80
  • Forearm Pronation: 80
129
Q

MEDIAL COLLATERAL LIGAMENT TEST

A

POSITIVE:

  • Excessive gapping & pain

INDICATES:

  • Medial Collateral ligament tear and/or instability
130
Q

LATERAL COLLATERAL LIGAMENT TEST

A

POSITIVE:

  • Excessive gapping & pain

INDICATES:

  • Lateral collateral ligament tear and/or instability
131
Q

TINEL ELBOW SIGN

A

” This is my Taylor Reflex Hammer it feels something like this, is that ok? “

POSITIVE:

  • Pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area (fingers 4,5)

INDICATES:

  • Neuroma of the ulnar nerve
132
Q

COZEN TEST

A

POSITIVE:

  • Pain over the lateral epicondyle

INDICATES:

  • Lateral Epicondylitis (Tennis Elbow)
133
Q

MILLS TEST

A

POSITIVE:

  • Pain over the lateral epicondyle

INDICATES:

  • Lateral Epicondylitis (Tennis elbow)
134
Q

GOLFER ELBOW TEST

A

POSITIVE:

  • Pain over the medial epicondyle

INDICATES:

  • Medial Epicondylitis
135
Q

BONY PALPATION: CERVICAL SPINE

A

ANTERIOR ASPECT:

  1. Hyoid Bone
  2. Thyroid Cartilage
  3. First Cricoid Ring
  4. Mandible

POSTERIOR ASPECT:

  1. Occiput
  2. Inion (EOP)
  3. Superior Nuchal Line
  4. Mastoid Processes
  5. Spinous processes of Cervical Vertebrae
  6. Facet Joints
136
Q

SOFT TISSUE PALPATION: CERVICAL SPINE

A
  1. Sternocleidomastoid muscle
  2. Anterior lymph node chain
  3. Posterior lymph node chain
  4. Thyroid gland
  5. Carotid Pulse
  6. Supraclavicular Fossa
  7. Trapezius Muscle
  8. Greater Occipital Nerves
  9. Superior Nuchal Ligament
137
Q

RANGE OF MOTION: CERVICAL SPINE

A

ACTIVE AND PASSIVE

  • ​Flexion 50
  • Extension 60
  • Lateral Bending Left 45
  • Lateral Bending Right 45
  • Left Rotation 80
  • Right Rotation 80
138
Q

FORAMINAL COMPRESSION

A

POSITIVE:

  1. Exacerbation of localized cervical Pain
  2. Exacerbation of cervical pain with a radicular component

INDICATES:

  1. Foraminal Encroachment or facet pathology without nerve root compression
  2. Foraminal Encroachment or facet pathology with nerve root compression
139
Q

CERVICAL DISTRACTION TEST

A

POSITIVE:

  1. Diminished or absence of local cervical pain
  2. Diminished or absence or radiating pain
  3. Increase of cervical pain

INDICATES:

  1. Foraminal encroachment without nerve root compression
  2. Foraminal encroachment with nerve root compression
  3. Muscular strain, ligamentous sprain, myospasm or facet capsulitis
140
Q

SPINAL PERCUSSION TEST

A

” This is my Taylor reflex hammer it feels something like this “

POSITIVE:

  1. Local Pain
  2. Radiating

INDICATES:

  1. Possible fractured vertebrae, ligamentous involvment (spinous pain), and muscular involvment (muscular pain)
  2. Possible disc pathology
141
Q

SHOULDER DEPRESSION TEST

A

POSITIVE:

  1. Localized pain on the side being tested
  2. Radicular pain on either side

INDICATES:

  1. Localized Pain: Dural sleeve adhesion, and muscular adhesion/contracture, or spasm, or ligamentous injury
  2. Radiating Pain: On side being tested neurovascular bundle compression, dural sleeve adhesions, or Thoracic Outlet Syndrome. On opposite side being tested foraminal encroachment with nerve root compression
142
Q

VALSALVA MANEUVER

A

POSITIVE: Radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine)

INDICATES: Space occupying lesion (e.g. disc pathology)

143
Q

SWALLOWING TEST

A

POSITIVE: Difficulty in swallowing

INDICATES: Space-Occupying lesion at anterior portion of cervical spine. Possibly esophageal or pharyngeal injury, anterior disc defect, muscle spasm or osteophytes etc.

144
Q

SOTO-HALL SIGN

A

POSITIVE: Generalized pain in the cervical region, which may extend down to the level of T2

INDICATES: Non-specific test for structural integrity of cervical region

145
Q

KERNIG SIGN

A

POSITIVE: Inability to fully extend the leg and/or pain (usually in the neck region)

INDICATES: Meningeal irritation/meningitis

146
Q

O’ DONOGHUE MANEUVER

A

POSITIVE:

  1. Pain during passive range of motion
  2. Pain during resisted range of motion

INDICATES:

  1. Ligamentous sprain. (Passive ROM stresses ligaments)
  2. Muscle/tendon strain. (Active ROM stresses muscles and tendons)
147
Q

Bony Palpation Wrist and Hand

A

Radial Syloid Process

Ulnar Styloid Process,

Lister’s Tubercle,

Scaphoid (navicular),

Lunate, Triquetrium,

Pisiform,

Trapezium,

Trapezoid,

Capitate,

Hamate,

Hook of Hamate,

Metacarpals,

Phalanges

148
Q

Soft Tissue Palpation: Wrist and Hand

A

Ulnar Artery,

Radial Artery,

Palmaris Longus Tendon,

Carpal Tunnel Region,

Thenar Eminence,

Hypothenar Eminence,

Palmar Aponeurosis,

Tissues surrounding proximal interphalangeal joints,

Tissues surrounding distal interphalangeal joints,

Distal tufts of fingers

149
Q

Range of Motion: 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

150
Q

Tinel Wrist Sign

A

” This is my Taylor reflex hammer, it feels something like this, is that ok? “

POSITIVE: Reproduction of pain, tenderness, and/or paresthesia in the median nerve distribution area (1st, 2nd, 3rd, and the lateral 1/2 of the 4th digit)

INDICATES: Median Neuritis, possibly Carpal Tunnel Syndrome

151
Q

PHALEN SIGN AND REVERSE PHALEN SIGN

aka Prayer Sign

A

Elbows same level as shoulders for 60 seconds

POSITIVE: Reproduction of pain and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and the lateral 1/2 of the 4th digit)

INDICATES: Median Neuritis, possibly Carpal Tunnel Syndrome

152
Q

FINKELSTEIN TEST

A

POSITIVE: Pain distal to the radial styloid process

INDICATES: Stenosing tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons (DeQuervain’s Disease)

153
Q

ALLEN TEST

A

57, 58, 59, 60 …… both hands pumping, bring them down both closed, open at same time, then let off of one artery and compare (TURN HEAD)

POSITIVE: A delay of more than 10 seconds (Evans 5 sec) in returning a reddish color to the hand

INDICATES: Radial or Ulnar Artery insufficiency. The artery held (occluded) by the examiner is not the artery being tested

154
Q

RETINACULAR TEST

A

Patient presents with difficulty flexing the DIP joint

POSITIVE:

1) Flexion of the distal interphalangeal joint cannot be achieved
2) Flexion of the distal interphalangeal joint is achieved

INDICATES:

1) Joint Capsule Contracture
2) Tight Retinacular Ligament

155
Q

BUNNEL - LITTLER TEST

A

Patient presents with difficulty flexing the PIP joint

POSITIVE:

  1. Flexion of the proximal interphalangeal joint cannot be achieved
  2. Flexion of the proximal interphalangeal joint is achieved

INDICATES:

  1. Joint Capsule Contracture
  2. Tight intrinsic muscles
156
Q

Explain the “Initial Examination Procedure” of testing nerve roots:

A

“This is my pinwheel, it’s pointy and prickly and feels something like this, is that ok?”

  1. C4 on right compared to C4 on left (dermatome above)
  2. C5 on right compared to C5 on left (dermatome package)
  3. C6 on right compared to C6 on the left (dermatome below)
157
Q

Explain the Secondary Examination Procedure with nerve roots:

A

FIRST

  1. C4 on the right side compared to C5 on the right side
  2. C5 of right side compared to C6 of right side

SECOND

  1. C4 of left side compared to C5 of left side
  2. C5 of left side compared to C6 of left side

“Can you feel this? AND does it feel like this?

158
Q

S2 NERVE ROOT

A
  • DISC LEVEL: S1
  • SENSATION: Posterior aspect of thigh over popliteal fossa on to posterior medial calf
159
Q

BONY PALPATION: LUMBAR SPINE

A
  1. Lumbar Spinous Processes
  2. Sacral Tubercles
  3. Iliac Crest
  4. PSIS
160
Q

RANGE OF MOTION: LUMBAR SPINE

A
  • FLEXION: 25
  • EXTENSION: 30
  • LEFT LATERAL BENDING: 25
  • RIGHT LATERAL BENDING: 25
  • LEFT ROTATION: 30
  • RIGHT ROTATION: 30
161
Q

HOOVER SIGN

A
  • POSITIVE: Lack of counter-pressure to opposite side
  • INDICATES: Lack of organic basis for paralysis (Malingering/hysteria). With organic hemiplegia, the patient will still exert downward pressure when attempting to raise paralyzed leg
162
Q

STRAIGHT LEG RAISER (SLR)

A
  • POSITIVE: Radiating pain and/or dull posterior thigh pain
  • INDICATES: Sciatic radiculopathy or tight hamstrings.
    • Positive between 35-70 degrees equals possible discogenic sciatic radiculopathy
    • > 70 equals tight hamstrings
163
Q

GOLDTHWAIT SIGN

A
  • POSITIVE: Localized pain, low back or radiating pain down the leg
  • INDICATES: Lumbo-sacral or sacroiliac pathology
    • Pain occuring after the lumbar spinouses move equals possible lumbo-sacral problem
    • Pain occuring before the lumbars move equals possible sacroiliac problem
164
Q

BRAGARD SIGN

A
  • POSITIVE: Radiating pain in posterior thigh
  • INDICATES: Sciatic Radiculopathy
165
Q

BUCKLING SING (CIPRIANO)

A
  • POSITIVE: Pain in the posterior thigh with sudden knee flexion (buckle)
  • INDICATES: Sciatic Radiculopathy
166
Q

BOWSTRING SIGN

A
  • POSITIVE: Pain in the lumbar region or radiculopathy
  • INDICATES: Sciatic nerve root compression, helps rule out tight hamstrings
167
Q

LASEGUE TEST

A
  • POSITIVE: Reproduction of sciatic pain before 60 degrees
  • INDICATES: Sciatica
168
Q

MILGRAM TEST

A
  • POSITIVE: Inability to perform test and/or low back pain
  • INDICATES: Weak abdominal muscles or space occupying lesion
169
Q

VALSALVA MANEUVER

A
  • POSITIVE: Radiating pain from site of lesion (usually recreating the complaint in cervical or lumbar area of the spine)
  • INDICATES: Space occupying lesion (e.g. disc pathology)
170
Q

BECHTEREW TEST

A
  • POSITIVE: Reproduction of radicular pain or inability to perform correctly due to tripod sign
  • INDICATES: Sciatic radiculopathy
171
Q

NERI BOWING TEST (Neri Sign)

A
  • POSITIVE: Pain accompanied by flexion of the knee on the affected side and body rotation away from the affected side
  • INDICATES: Positive with a variety of low back pathologies. Hamstring tension on the pelvis may trigger the response
172
Q

ANTERIOR INNOMINATE aka MAZION PELVIC MANEUVER (ADVANCEMENT SIGN)

A
  • POSITIVE:

The inability to bend at the waist more than 45 degrees, because of either/or

  1. Radiating pain along the sciatic nerve, either unilateral or bilateral
  2. Low back pain (lumbar or pelvic regions)
  • INDICATES:
    1. Sciatic neuralgia or radiculopathy, etc., possibly due to lumbar disc pathology
    2. Anterior (rotational) displacement of the ilium relative to the sacrum
173
Q

LEWIN STANDING TEST

A
  • POSITIVE:

Radiating pain down the leg causing flexion of the patient’s knee or knees

  • INDICATES:

Gluteal, lumbosacral or sacroiliac pathologies

174
Q

HEEL WALK

A
  • POSITIVE:

Inability to perform the test

  • INDICATES:

L4-L5 disc lesion (L5 nerve root)

175
Q

TOE WALK

A
  • POSITIVE:

Inability to perform test

  • INDICATES:

L5-S1 disc lesion (S1 nerve root)

176
Q

ELY HEEL TO BUTTOCK TEST (Evans calls this Ely sign as an a.k.a.)

A

POSITIVE:

  1. Inability to raise the thigh
  2. Pain in the anterior thigh
  3. Pain in the lumbar region

INDICATES:

  1. Iliopsoas spasm
  2. Inflammation of lumbar nerve roots
  3. Lumbar nerve root adhesions
177
Q

RANGE OF MOTION:

HIP AND PELVIS

A
  • Flexion 120
  • Extension 30
  • Abduction 45
  • Adduction 45
  • Internal Rotation 45
  • External Rotation 45
  • Flexion and Adduction
  • Flexion, Abduction, and External rotation
178
Q

LEG LENGTH DISCREPANCY

A

POSITIVE:

  • Different Measurements

INDICATES:

  • True = bony abnormality above or below level of trochanter difference (anatomical short leg).
  • Apparent = pelvic Obliquity (Tilted pelvis)
179
Q

ALLIS SIGN

A

POSITIVE:

  • Difference in height and anteriority of the knees

INDICATES:

  1. If one knee is lower = ipsilateral congenital hip dislocation or tibial discrepancy (anatomical short leg)
  2. If one knee is anterior = ipsilateral congenital hip dislocation or femoral discrepancy (contralateral anatomical short leg)
180
Q

THOMAS TEST

A

POSITIVE:

  • Lumbar spine maintains lordosis (should flatten) and hip or leg flexes

INDICATES:

  • Contracture of the hip flexors (iliopsoas)
181
Q

ANVIL TEST

A

POSITIVE:

  • Localized pain in long bone or in hip joint

INDICATES:

  • Possible Fracture of long bones, or hip joint pathology
182
Q

PATRICK TEST aka FABERE sign

A

POSITIVE:

  • Pain in the hip region

INDICATES:

  • Hip joint pathology
183
Q

LAGUERRE TEST

A

POSITIVE:

  1. Pain in the hip joint
  2. Pain in the sacroiliac joint

INDICATES:

  1. Hip joint pathology
  2. Mechanical problem of the sacroiliac joint
184
Q

GAENSLEN TEST

A

POSITIVE:

  • Pain on the affected SI joint stressed into extension

INDICATES:

  • General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
185
Q

LEWIN - GAENSLEN TEST

A

POSITIVE:

  • Pain on the affected SI joint stressed into extension

INDICATES:

  • General sacroiliac joint lesion, anterior sacroiliac ligament sprain, or inflammation of the SI joint
186
Q

HIBB TEST

A

POSITIVE:

  1. Pain in the hip region
  2. Pain in the buttock/pelvic region

INDICATES:

  1. Hip joint pathology
  2. Sacroiliac joint lesion
187
Q

OBER TEST

A

POSITIVE:

Affected thgih remains in abduction (Normal biomechanics, the thigh/hip will adduct)

INDICATES:

Contraction of the iliotibial band or tensor fascia lata, (usually secondary to synovitis of the hip, secondary to trauma of the gluteus medius and maximus)

188
Q

PELVIC ROCK TEST aka ILIAC COMPRESSION TEST

A

POSITIVE:

  • Pain in either sacroiliac joint

INDICATES:

  • Sacroiliac joint lesion
189
Q

NACHLAS TEST

A

POSITIVE:

  • Pain in the buttock and/or pain in the lumbar region

INDICATES:

  • Sacroiliac joint lesion, or Lumbar pathology
190
Q

YEOMAN TEST

A

POSITIVE:

  • Pain deep in the SI joint

INDICATES:

  • Sprain of the anterior sacroiliac ligaments
191
Q

ELY SIGN (ELY TEST - CIPRIANO)

A

POSITIVE:

  • Hip on side being tested will flex causing the buttock to raise off the table

INDICATES:

  • Rectus Femoris or hip flexor contracture
192
Q

ELY HEEL TO BUTTOCK TEST (cipriano)

A

POSITIVE:

  1. Inability to raise the thigh
  2. Pain in the anterior thigh
  3. Pain in the lumbar region

INDICATES:

  1. Iliopsoas spasm
  2. Inflammation of lumbar nerve roots
  3. Lumbar nerve root adhesions
193
Q

TRENDELENBURG TEST

A

POSITIVE:

  • High iliac crest on supported side and low crest on side of elevated leg

INDICATES:

  • Weak gluteus medius muscle on the supported side
194
Q

BONY PALPATION: KNEE ​

A
  1. Patella
  2. Medial Tibial plateau
  3. Tibial tubercle
  4. Medial Femoral Condyle
  5. Lateral Tibial Plateau
  6. Lateral Femoral Condyle
  7. Fibula head
195
Q

SOFT TISSUE PALPATION:

KNEE

A
  1. Quadriceps muscles (Palpate as a unit and individually)
    • Vastus Lateralis
    • Vastus Medialis
    • Vastus Intermedius
    • Rectus Femoris
  2. Infrapatellar Tendon
  3. Bursae
    • Prepatellar
    • Superficial Infrapatellar
  4. Medial Meniscus
  5. Lateral Meniscus
  6. Pes Anserine Area
    • Sartorius
    • Gracilis
    • Semitendinosus
  7. Popliteal Fossa
  8. Lateral Collateral Ligament
  9. Medial Collateral Ligament
  10. Gastrocnemius Muscle
196
Q

RANGE OF MOTION:

KNEE

A
  • FLEXION : 135
  • EXTENSION: 0
  • INTERNAL ROTATION
  • EXTERNAL ROTATION
197
Q

McMURRAY SIGN

A

POSITIVE:

  • Clicking sound or pain by knee joint

INDICATES:

  • Tear of medial meniscus if positive on external rotation
  • Tear of lateral meniscus if positive on internal rotation
  • The greater the angle the knee is flexed when the positive is elicited, the more posterior the meniscal injury
198
Q

MEDIAL COLLATERL LIGAMENT TEST aka ABDUCTION STRESS TEST aka VALGUS STRESS TEST

A

POSITIVE:

  • Gapping and/or elicited pain above/at/or below joint line

INDICATES:

  • Tear and/or instability of the medial collateral ligament
199
Q

LATERAL COLLATERAL LIGAMENT TEST aka ADDUCTION STRESS TEST aka VARUS STRESS TEST

A

POSITIVE:

  • Gapping and/or elicited pain above/at/or below the joint line

INDICATES:

  • Tear and/or instability of the lateral collateral ligament
200
Q

BOUNCE HOME TEST

A

POSITIVE:

  • Knee does not go into full extension (slight flexion remains)

INDICATES:

  • Diffuse swelling of the knee, accumulation of fluid, due to possible torn meniscus
201
Q

DRAWER TEST

A

POSITIVE:

  1. Gapping > 6 mm (tibia moves posterior) when the leg is pushed
  2. Gapping > 6 mm (tibia moves anterior) when the leg is pulled

INDICATES:

  1. Torn posterior cruciate ligament
  2. Torn anterior cruciate ligament
202
Q

LACHMAN TEST

A

POSITIVE:

  • Gapping with the tibia moving away from the femur

INDICATES:

  • Anterior Cruciate ligament or posterior oblique ligament instability
203
Q

APPREHENSION TEST FOR PATELLA

A

POSITIVE:

  • Apprehension, distress or facial expression, contraction of quadriceps to bring patella back in line

INDICATES:

  • Chronic patella dislocation or pre-disposition to dislocation
204
Q

PATELLA FEMORAL GRINDING TEST

(aka Clarke Sign)

A

POSITIVE:

  • Retropatellar pain and the patient is unable to hold the quadriceps contraction

INDICATES:

  • Degenerative changes of the patellar facets and/or within the trochlear groove (chondromalacia patella)
205
Q

PATELLA BALLOTTEMENT TEST

A

POSITIVE:

  • A floating sensation of the patella

INDICATES:

  • A large amount of swelling in the knee
206
Q

APLEY COMPRESSION TEST

A

POSITIVE:

  • Patient points to the side of pain

INDICATES:

  • Pain on the medial side is medial meniscus tear. Pain on the lateral side indicates lateral meniscus tear
207
Q

APLEY DISTRACTION TEST

A

POSITIVE:

  • Patient will point to side of pain

INDICATES:

  • Pain on the medial side indicates medial collateral ligament tear. Pain on the lateral side indicates lateral collateral ligament tear
208
Q
A
209
Q

DRAWER SIGN

A

POSITIVE:

  • Translation with the talus moving away from or toward the tibia

INDICATES:

  1. With tibia pushed/foot pulled; a tear/instability of the anterior talofibular ligament
  2. With tibia pulled/foot pushed; a tear/instability of posterior talofibular ligament
210
Q

ANKLE DORSIFLEXION TEST (Hoppenfeld)

A

POSITIVE:

  1. The foot cannot dorsiflex with knee extended, but is able to with knee flexed
  2. The foot cannot dorsiflex in either knee position

INDICATES:

  1. Contracture of the gastrocnemius muscle
  2. Contracture of the soleus muscle
211
Q

RIGID OR SUPPLE FLAT FEET TEST

A

POSITIVE:

  1. Absence of medial longitudinal arch in both positions
  2. Presence of medial longitudinal arch while seated with a loss of medial longitudinal arch while standing

INDICATES:

  1. Rigid Flat Feet
  2. Supple Flat Feet
212
Q

HOMANS SIGN

A

POSITIVE:

Deep pain in the calf

INDICATES:

Deep vein thrombophlebitis

213
Q

THOMPSON TEST

A

POSITIVE:

  • Absence of foot plantarflexion motion

INDICATES:

  • Achilles tendon rupture
214
Q

MORTON TEST

A

POSITIVE:

  • Sharp pain in the forefoot

INDICATES:

  • Metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace)
215
Q

C5 NERVE ROOT

A
  • DISC LEVEL: C4
  • MUSCLE TESTS (2):
    1. Shoulder Abduction: Deltoid (axillary nerve)
    2. Forearm Flexion: Biceps (musculocutaneous nerve)
  • REFLEX: Biceps
  • SENSATION: Lateral Arm
216
Q

C6 NERVE ROOT

A
  • DISC LEVEL: C5
  • MUSCLE TEST (1):
    1. Wrist Extension: Extensor carpi radialis longus and brevis, and extensor carpi ulnaris (radial nerve)
  • REFLEX: Brachioradialis
  • SENSATION: Anterior Lateral Forearm, palm, thumb, and 2nd digit
217
Q

C7 NERVE ROOT

A
  • DISC LEVEL: C6
  • MUSCLE TESTS (3):
    1. Elbow Extension: Triceps (Radial Nerve)
    2. Wrist Flexion: Flexor carpi radialis (Median Nerve), Flexor ulnaris (ulnar nerve)
    3. Finger Extension: Extensor digitorum communis, extensor indicis profundus, extensor digiti minimi (Radial nerve)
  • REFLEX: Triceps
  • SENSATION: 3rd digit, middle of palm
218
Q

C8 NERVE ROOT

A
  • DISC LEVEL: C7
  • MUSCLE TEST (1):
    1. Finger Flexion: Flexor digitorum superficialis, flexor digitorum profundus, lumbricals (median and ulnar nerves)
  • REFLEX: NONE*
  • SENSATION: 4th and 5th digits, antero-medial hand and forearm
219
Q

T1 NERVE ROOT

A
  • DISC LEVEL: T1
  • MUSCLE TESTS (2):
    1. Finger Abduction: Dorsal Interossei (ulnar nerve)
    2. Finger Adduction: Palmer Interossei (ulnar nerve)
  • REFLEX: NONE**
  • SENSATION: Antero-medial arm (distal aspect of arm to proximal aspect of forearm)
220
Q

L4 NERVE ROOT

A
  • DISC LEVEL: L3
  • MUSCLE TEST (1):
    1. Foot Dorsiflexion and Inversion: Tibialis Anterior (deep fibular/peroneal nerve)
  • REFLEX: Patellar Tendon
  • SENSATION: Medial aspect of leg, medial foot, medial aspect of big toe
221
Q

L5 NERVE ROOT

A
  • DISC LEVEL: L4
  • MUSCLE TESTS (4):
    1. Foot Dorsiflexion: Gastrocnemius, Soleus
    2. Big Toe Dorsiflexion: Extensor hallucis longus (deep fibular/peroneal nerve)
    3. Toes 2, 3, 4 dorsiflexion: Extensor digitorum longus and brevis (deep fibular/peroneal nerve)
    4. Hip and Pelvis Abduction: Gluteus medius and minimus (superior gluteal nerve)
  • REFLEX: NONE*
  • SENSATION: Lateral leg, dorsum of foot, and middle third toes
222
Q

S1 NERVE ROOT

A
  • DISC LEVEL: L5
  • MUSCLE TESTS (3):
    1. Foot Plantarflexion: Gastrocnemius and Soleus (Tibial Nerve)
    2. Foot Plantar Flexion and Eversion: fibular/peroneus longus and brevis (superficial fibular/peroneal nerve)
    3. Hip Extension: Gluteus Maximus (Inferior gluteal nerve)
  • REFLEX: Achilles
  • SENSATION: Posterior aspect of the leg, lateral aspect of foot, and lateral aspect of little toe
223
Q

SOFT TISSUE PALPATION: LUMBAR SPINE

A
  1. Paraspinal Muscles (palpate as a unit and individually) superficial layer
    • Spinalis
    • Longissimus
    • Iliocostalis
  2. Gluteus Medius
  3. Gluteus Maximus
  4. Sciatic Nerve
  5. Hamstrings
    • Biceps Femoris
    • Semitendinosus
    • Semimembranosus
  6. Anterior Abdominal Muscles
224
Q

BONY PALPATION: HIP AND PELVIS

A

ANTERIOR

  1. ASIS
  2. Iliac Crest
  3. Iliac Tubercle
  4. Greater Trochanter

POSTERIOR

  1. PSIS
  2. Ischial tuberosity
  3. Coccyx
225
Q

SOFT TISSUE PALPATION: HIP & PELVIS

A
  1. Femoral Triangle Borders
    • Sartorius
    • Adductor Longus
    • Inguinal Ligament
  2. Quadriceps Muscle (palpate as a unit and individually)
    • Vastus Lateralis
    • Vastus Medialis
    • Vastus Intermedius
    • Rectus Femoris
  3. Greater Trochanteric Bursa
  4. Gluteus Medius
  5. Gluteus Maximus
  6. Sciatic Nerve
  7. Cluneal Nerves
  8. Hamstrings
    • Biceps femoris
    • Semitendinosus
    • Semimembranosus
226
Q

BONY PALPATION:

FOOT AND ANKLE

A
  1. Calcaneus
  2. Sustentaculum Tali
  3. Medial Malleolus
  4. Lateral Malleolus
  5. Talus
  6. Navicular
  7. Cuboid
  8. 3 Cuneiforms
  9. 5 Metatarsals
  10. Metatarsophalangeal joints
227
Q

SOFT TISSUE PALPATION:

FOOT AND ANKLE

A
  1. Tibialis Posterior tendon
  2. Tibialis Anterior Tendon
  3. Peroneous Brevis
  4. Achilles tendon
  5. Deltoid Ligament
  6. Spring ligament
  7. Anterior Talofibular ligament
  8. Posterior tibial artery
  9. Dorsal pedal artery
  10. Plantar Aponeurosis
228
Q

RANGE OF MOTION:

FOOT AND ANKLE

A
  • Ankle Dorsiflexion 20
  • Ankle Plantarflexion 50
  • Subtalar Inversion 5
  • Subtalar Eversion 5
  • 1st MTP Joint Flexion
  • 1st MTP Joint Extension
229
Q

L HERMITTE SIGN

A

+ : Electric shock like sensations down the spine and or through extremities i : Dural irritation, severe spinal cord injury, inflammation, or degeneration

230
Q

KERNIG SIGN

A

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

231
Q

BRUDZINSKI SIGN

A

+ : Involuntary knee flexion i : Meningeal irritation or nerve root lesion (classic test for meningitis)

232
Q

SOTO HALL SIGN

A

+ : Generalized pain in cervical region, which may extend down to the level of T2 i : Non-specific test for structural integrity of cervical region

233
Q

FORAMINAL COMPRESSION TEST

A

+ : 1) Exacerbation of localized cervical pain 2) Exacerbation of cervical pain with a radicular component i : 1) Foraminal encroachment or facet pathology without nerve root compression 2) Foraminal encroachment or facet pathology WITH nerve root compression

234
Q

JACKSON COMPRESSION

A

+ : 1) Exacerbation of localized cervical pain 2) Exacerbation of cervical pain with a radicular component i : 1) Foraminal encroachment without nerve root pressure or facet pathology 2) Foraminal encroachment with nerve root compression (one would then want to evaluate the myotome, reflex and dermatome of the nerve root involved)

235
Q

MAXIMAL CERVICAL COMPRESSION

A

+ : Pain on the concave side i : Foraminal encroachment with or without nerve root compression (based on presence or absence of radicular component)

236
Q

VALSALVA MANEUVER

A

+ : Radiating pain from site of lesion (usually positive in cervical or lumbar area of the spine) i : Space Occupying lesion (e.g. disc pathology)

237
Q

CERVICAL DISTRACTION TEST

A

+ : 1) Diminished or absence of local cervical pain 2) Diminished or absence or radiating pain 3) Increase of cervical pain i: 1) Foraminal encroachment without nerve root compression 2) Foraminal encroachment with nerve root compression 3) Muscular strain, ligamentous sprain, myospasm or facet capsulitis

238
Q

BAKODY SIGN (shoulder abduction test)

A

+ : Decrease or absence of radiating pain i : Cervical foramina compression, nerve root entrapment (usually C5/C6 level because this motion elevates the supra scapular nerve and relieves traction on the upper brachial plexus)

239
Q

ADAM SIGN

A

+ : 1) A “C” or “S” shaped scoliosis is observed to straighten 2) A “C” or “S” shaped scoliosis does not straighten (look for rib humping, muscular imbalance, and symmetry in hand length) i: 1) Negative: evidence of a functional scoliosis, trauma or subluxation 2) Positive: evidence of a pathologic or structural scoliosis

240
Q

SCHEPELMANN SIGN

A

+ : Pain on the concave or convex side i : Pain on the concave side indicates intercostal neuritis (thoracic dermatomes can be evaluated in the corresponding intercostal spaces) while pain on the convex side indicates fibrous inflammation of the pleura (or possible intercostal myofascitis)

241
Q

BEEVOR SIGN

A

+ : Superior or inferior movement of the umbilicus i : Superior movement of the umbilicus is indicative of a spinal cord lesion at the level of T11-T12 or lower abdominal weakness. Inferior movement of the umbilicus is indicative of nerve root involvement T7-T10

242
Q

ROOS TEST aka E.A.S.T (elevated arm stress test)

A

+ : Ischemic pain, heaviness of the arms, or numbness and tingling of the hand i : Thoracic outlet syndrome on side involved (Evan’s considers this test to be most accurate for TOS evaluation)

243
Q

ADSON TEST

A

+ : Pain and/or paresthesia, decreased or absent pulse amplitude , pallor i : Compression of neurovascular bundle by scalenus anticus or cervical rib

244
Q

COSTOCLAVICULAR MANEUVER aka EDEN TEST

A

+ : Pain and/or paresthesia, decreased or absent pulse amplitude, pallor i : Compression of the neuromuscular bundle between the clavicle and 1st rib

245
Q

HYPERABDUCTION MANEUVER aka WRIGHT TEST

A

+ : Pain and/or paresthesia, decreased or absent pulse amplitude, pallor. i : Compression of the axillary artery by pectoralis minor or coracoid process. TOS

246
Q

TINEL ELBOW SIGN

A

+ : Pain and/or tenderness at the site being tapped and paresthesia in the ulnar nerve distribution area (fingers 4, and 5) i : Neuroma of the ulnar nerve

247
Q

FROMET PAPER SIGN

A

+ : The patient is seen to flex the thumb thereby recruiting the median nerve to compensate for apparent weakness i : Ulnar nerve paralysis (weakness or palsy of the adductor polices muscle)

248
Q

PHALEN SIGN and REVERSE PHALEN SIGN aka “Prayer Sign”

A

**** Hold for 60 seconds ***** + : Reproduction of pain and/or paresthesia in the median nerve distribution area (1st, 2nd, 3rd, and lateral 1/2 of 4th digit) i : Median Neuritis, possibly Carpal Tunnel Syndrome

249
Q

TINEL WRIST SIGN

A

+ : Reproduction of pain, tenderness and/or paresthesia in the median nerve distribution area (thumb, 2nd, 3rd, and lateral 1/2 of the 4th digit) i : Median neuritis, possibly Carpal Tunnel Syndrome

250
Q

MINOR SIGN

A

+ : Knee flexion of the affected leg while supporting upper body weight (hand on back or thigh) on unaffected side i : Sciatica, lumbosacral or sacroiliac joint lesion

251
Q

BELT TEST (Supported Adam Test, Supported Forward Bending Test)

A

+ : Low Back Pain i : 1) Pain while bending with the sacrum stabilized and unstabilized = Lumbar involvement 2) Pain during sacrum non-stabilized bending, and no pain during sacrum stabilized bending = pelvic involvment

252
Q

MILGRAM TEST

A

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

253
Q

HEEL WALK

A

+ : Inability to perform test i : L4-L5 disc lesion (L5 nerve root)

254
Q

TOE WALK

A

+ : Inability to perform test i : L5-S1 disc lesion (S1 nerve root)

255
Q

KEMP TEST

A

+ : 1) Pain usually radicular, recreating existing sciatic pain 2) Pain - Local i : 1) Disc Protrusion: - In medial disc protrusion, Kemps will be positive as the patient is leaning AWAY from the side of pain - In lateral disc protrusion Kemps will be positive as the patient is leaning INTO the side of pain 2) Localized pain may indicate lumbar spasm or facet capsulitis

256
Q

STRAIGHT LEG RAISE (SLR)

A

+ : Radiating pain and/or dull posterior thigh pain i : Sciatic radiculopathy or tight hamstrings. Positive between 35-70 degrees = possible discogenic sciatic radiculopathy > 70 degrees = tight hamstrings

257
Q

LINDNER SIGN

A

+ : Pain along sciatic distribution or sharp, diffuse pain (leg) i : Sciatic radiculopathy

258
Q

TURYN SIGN

A

+ : Pain in the gluteal region or radiating sciatic pain i : Sciatic Radiculopathy

259
Q

BRAGARD SIGN

A

+ : Posterior thigh and leg pain i : Sciatic radiculopathy (usually from disc lesion)

260
Q

SICARD SIGN

A

+ : Posterior thigh and leg pain i : Sciatic radiculopathy (usually from disc lesion)

261
Q

BONNET SIGN

A

+ : Pain in the posterior thigh or leg i : Immediate pain is sciatic neuropathy from piriformis syndrome

262
Q

FAJERSZTAJN TEST aka Well-Leg-Raising Test of Fajersztajn

A

+ : 1) Pain down affected leg 2) Decrease in pain down affected leg i : 1) Medial disc protrusion 2) Lateral disc protrusion

263
Q

FEMORAL STRETCH TEST (Femoral Nerve Traction Test)

A

+ : Pain on the anterior portion of the thigh i : Traction on the femoral nerve indicating involvement of the 2nd, 3rd, and 4th lumbar nerve roots

264
Q

TINEL FOOT SIGN

A

+ : Paresthesia radiating into the foot i : Tarsal tunnel syndrome

265
Q

MORTON TEST

A

+ : Sharp pain the forefoot i : Metatarsalgia or neuroma (usually at the 3rd and 4th metatarsal interspace)

9 CLET (6 decks)

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