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physical exam II > comprehensive skills > Flashcards

comprehensive skills Flashcards

1
Q

test for direct and consensual light reflex

A
  • shine light into R eye -> constriction of R eye

- shine light into R eye -> consensual constriction of L eye

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2
Q

rest for RAPD/ marcus gunn pupil

A
  • swinging flashlight test
  • normal: each eye illuminated constricts right away, consensual constriction
  • in RAPD light in normal eye –> constriction of both, light in affected eye -> dilation of both
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3
Q

what CN are being assess with EOM

A
  • 3, 4, 6
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4
Q

results of cover uncover test

A
  • used for strabismum

- uncovering affected eye causes it to focus and deviate

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5
Q

weber test

A
  • tuning fork on forehead or top of head
  • normal: lateralize to both ears equally
  • conduction: lateralizes to affected ear
  • sensorineural: lateralizes to good ear
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6
Q

rinne test

A
  • place tuning fork in mastoid
  • normal: AC > BC
  • conduction: BC > AC
  • sensorineural: AC > BC
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7
Q

CN I

A
  • olfactory
  • determine patency of nares
  • occlude one nostril and with eyes closed ID a smell
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8
Q

motor of CN V

A
  • muscles of mastication
  • pt firmly clench jaw, palpate temporal and masster mm
    move jaw from side to side, protract and retract
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9
Q

CN X

A
  • vagus N
  • symmetric rise of uvula
  • gag reflex
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10
Q

CN XI

A
  • spinal accessory

- shoulder shrug and head turn against resistance

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11
Q

CN XII

A
  • hypoglossal
  • stick tongue out to ensure midline
  • look for atrophy or fasciculations
  • push tongue into cheek if weakness suspected
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12
Q

rapid UE neuro screen

A
  • C5 elbow flexion
  • C6 wrist ext
  • C7 elbow ext
  • C8 “ok” sign
  • T1 little finger abduction
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13
Q

rapid LE neuro screen

A
  • L2 hip flexion
  • L3 knee ext
  • L4 dorsiflexion
  • L5 great toe extension
  • S1 plantarflexion
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14
Q

SLR test

A
  • pt supine
  • lift leg with knee straight
  • lift leg to point of pain then slightly lower and dorsiflex foot
  • no pain with dorsiflexion: hamstring tightness
  • pos: pain up leg, +/- LBP or opposite leg pain
  • hamstring pain localizes to posterior thigh
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15
Q

ladder technique for pulm auscultation

A
  • 6 in front
  • 7 in back
  • listen for adventitions breath sounds: rales, rhonchi, wheezing
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16
Q

vesicular breath sounds

A
  • normal breath sounds
  • soft or low pitched
  • heard throughout inspiration
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17
Q

bronchovesicular breath sounds

A
  • inspiratory and expiratory sounds equal in length
18
Q

bronchial breath sounds

A
  • louder, harsher, higher in pitch
19
Q

what does it mean of bronchial or bronchovesicular lung sounds heard in distant locations?

A
  • air filled lung replaced bu fluid or solid lung tissue
20
Q

when is tactile fremitus decreased

A
  • obstructed bronchus
  • COPD
  • pneumothorax
  • pleural effusion
  • fibrosis
  • tumor
21
Q

when is tactile fremitus increased

A
  • pneumonia
22
Q

how many spots do you palpate for tactile fremitus

A
  • 3 on front
  • 4 on back
  • while pt says 99
23
Q

normal diaphragmatic excursion

A
  • no more than 3 cm

- symmetrical with both lungs

24
Q

bronchophony

A
  • pt says 99
  • normal- muffled
  • abnormal- loud
25
Q

egophony

A
  • pt says “eee”
  • normal- sounds like eee
  • abnormal- sounds like aaa
26
Q

whispered pectoriloquy

A
  • pt whispers 99
  • normal- sounds faint
  • abnormal- sounds loud and distinct
27
Q

location of cardiac valves

A
  • aortic: R 2nd interspace
  • pulmonic: L 2nd interspace
  • erbbs: 3rd/4th interspace
  • tricuspid- L 5th interspace
  • mitral: apex of heart, midclavicular line
28
Q

where are S1 and S2 heard louded

A
  • S1 loudest at apex

- S2 loudest at base

29
Q

ABG indications

A
  • general dx
  • exacerbation of asthma/ COPD
  • hyperventilation
  • CPR
30
Q

C/I to ABG

A
  • no palpable pulse
  • surface landmarks not visible
  • presence of arterial disease
  • hand does not pink up after allens test
31
Q

steps to allen test

A
  • occlude radial/ unlar a
  • pt makes fist then opens it
  • when release artery hand should pink up in 3-5 sec
32
Q

augmentation of HOCM murmur

A
  • listen at erbbs point
  • crescendo decrescendo systolic murmur
  • used diaphragm
  • pt squat -> louder when standing
  • pt valsalva-> louder with strain
33
Q

auscultation for aortic insufficiency

A
  • listen at erbbs point
  • use diaphragm
  • pt sit up, lean forward
  • exhale and hold breath
  • diastolic decrescendo murmur
  • radiation: apex, R sternal boarder
34
Q

lachman’s test

A
  • knee in 15-20 degrees flexion and ER
  • grasp distal femur on lateral side
  • place thumb on tibial at joint line
  • pull tibia forward, femur back
  • assess unaffected side first
  • pos: forward excursion
  • suggests ACL tear
35
Q

thompson test

A
  • pt pron and knee flexed
  • squeeze calf
  • look for plantarflexion
  • pos: no mvmt, suggests achilles tendon rupture
  • do unaffected side first so that you can assess for partial teaer
36
Q

general splenic percussion

A
  • left lower anterior chest wall from boarder of cardiac dullness at 6th rib -> anterior axillary line, down to costal margin
37
Q

psoas sign

A
  • hand above right knee, raise thigh against resistance
  • put pt on L side and extend R hip
  • pos: RLQ pain
  • heightens suspicion for appendicitis
38
Q

obturator sign

A
  • flex pt R hip, knee bent, then IR
  • pos: RLQ pain
  • heightens suspicion for appendicitis
39
Q

measure the liver span

A
  • start in lquar quadrant where tympanic, percuss to liver dullness an dmark
  • start from resonant lung sounds and move down to liver dullness
  • normal: 6-12 cm at midclavicular line
  • OR normal: 4-8 cm at midsternal line
40
Q

murphy’s sign

A
  • hook fingers under costal margin
  • ask pt to take deep breath in
  • pos: sharp increase in tenderness and sudden stop of inspiration
  • test for cholecystitis
41
Q

abdominal arteries to auscultate for bruis

A
  • renal
  • iliac
  • femoral
  • aorta
  • listen will bell

physical exam II (5 decks)

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