comprehensive skills Flashcards
test for direct and consensual light reflex
- shine light into R eye -> constriction of R eye
- shine light into R eye -> consensual constriction of L eye
rest for RAPD/ marcus gunn pupil
- 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
what CN are being assess with EOM
- 3, 4, 6
results of cover uncover test
- used for strabismum
- uncovering affected eye causes it to focus and deviate
weber test
- tuning fork on forehead or top of head
- normal: lateralize to both ears equally
- conduction: lateralizes to affected ear
- sensorineural: lateralizes to good ear
rinne test
- place tuning fork in mastoid
- normal: AC > BC
- conduction: BC > AC
- sensorineural: AC > BC
CN I
- olfactory
- determine patency of nares
- occlude one nostril and with eyes closed ID a smell
motor of CN V
- muscles of mastication
- pt firmly clench jaw, palpate temporal and masster mm
move jaw from side to side, protract and retract
CN X
- vagus N
- symmetric rise of uvula
- gag reflex
CN XI
- spinal accessory
- shoulder shrug and head turn against resistance
CN XII
- hypoglossal
- stick tongue out to ensure midline
- look for atrophy or fasciculations
- push tongue into cheek if weakness suspected
rapid UE neuro screen
- C5 elbow flexion
- C6 wrist ext
- C7 elbow ext
- C8 “ok” sign
- T1 little finger abduction
rapid LE neuro screen
- L2 hip flexion
- L3 knee ext
- L4 dorsiflexion
- L5 great toe extension
- S1 plantarflexion
SLR test
- 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
ladder technique for pulm auscultation
- 6 in front
- 7 in back
- listen for adventitions breath sounds: rales, rhonchi, wheezing
vesicular breath sounds
- normal breath sounds
- soft or low pitched
- heard throughout inspiration
bronchovesicular breath sounds
- inspiratory and expiratory sounds equal in length
bronchial breath sounds
- louder, harsher, higher in pitch
what does it mean of bronchial or bronchovesicular lung sounds heard in distant locations?
- air filled lung replaced bu fluid or solid lung tissue
when is tactile fremitus decreased
- obstructed bronchus
- COPD
- pneumothorax
- pleural effusion
- fibrosis
- tumor
when is tactile fremitus increased
- pneumonia
how many spots do you palpate for tactile fremitus
- 3 on front
- 4 on back
- while pt says 99
normal diaphragmatic excursion
- no more than 3 cm
- symmetrical with both lungs
bronchophony
- pt says 99
- normal- muffled
- abnormal- loud
egophony
- pt says “eee”
- normal- sounds like eee
- abnormal- sounds like aaa
whispered pectoriloquy
- pt whispers 99
- normal- sounds faint
- abnormal- sounds loud and distinct
location of cardiac valves
- aortic: R 2nd interspace
- pulmonic: L 2nd interspace
- erbbs: 3rd/4th interspace
- tricuspid- L 5th interspace
- mitral: apex of heart, midclavicular line
where are S1 and S2 heard louded
- S1 loudest at apex
- S2 loudest at base
ABG indications
- general dx
- exacerbation of asthma/ COPD
- hyperventilation
- CPR
C/I to ABG
- no palpable pulse
- surface landmarks not visible
- presence of arterial disease
- hand does not pink up after allens test
steps to allen test
- occlude radial/ unlar a
- pt makes fist then opens it
- when release artery hand should pink up in 3-5 sec
augmentation of HOCM murmur
- listen at erbbs point
- crescendo decrescendo systolic murmur
- used diaphragm
- pt squat -> louder when standing
- pt valsalva-> louder with strain
auscultation for aortic insufficiency
- listen at erbbs point
- use diaphragm
- pt sit up, lean forward
- exhale and hold breath
- diastolic decrescendo murmur
- radiation: apex, R sternal boarder
lachman’s test
- 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
thompson test
- 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
general splenic percussion
- left lower anterior chest wall from boarder of cardiac dullness at 6th rib -> anterior axillary line, down to costal margin
psoas sign
- hand above right knee, raise thigh against resistance
- put pt on L side and extend R hip
- pos: RLQ pain
- heightens suspicion for appendicitis
obturator sign
- flex pt R hip, knee bent, then IR
- pos: RLQ pain
- heightens suspicion for appendicitis
measure the liver span
- 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
murphy’s sign
- 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
abdominal arteries to auscultate for bruis
- renal
- iliac
- femoral
- aorta
- listen will bell
