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CPD Lab Tests_MH > CPD 3 Midterm > Flashcards

CPD 3 Midterm Flashcards

1
Q

Anatomy of the penis:

A
  • Shaft: 2 lateral dorsal columns (corpora cavernosa) and 1 ventral column (corpora spongiosum/ cavernosum urethrae) which contains urethra
  • head = glans penis, forms a shoulder (corona) at jxn w shaft.
  • Prepuce= foreskin, covers glans (unless circumcised)
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2
Q

Before you begin the male exam:

A
  • Always wear gloves.

* Have pt stand while you sit to his side

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3
Q

Order of Male exam palpation:

A

• inguinal nodes, penis, scrotum, testis, epididymis, spermatic cords, inguinal canals

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4
Q

Inguinal LN chains (M), and what they drain:

A
  • horizontal: just below inguinal ligament. drains skin of lo abd wall, external genitalia (except testis), anal canal, lower vagina, and gluteal area.
  • vertical: beside upper segment of great saphenous v, drains that area of leg. often palpable.
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5
Q

M Inguinal LN palpation, LA:

A
  • note size (in cm), consistency, symmetry, and tenderness.
  • no validated scales for lymphadenopathy
  • UL: infx scrotum, epididymis, urethritis, chancroid, lymphogranuloma. Testes drain deep into pelvic nodes, so LA dt testicular issue won’t be palpable
  • BL: mb syphilis or gonorrhea
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6
Q

Inspection and Palpation of Penis:

A
  • View in dorsal position, then have pt retract prepuce (if present)
  • Begin at root, palpate entire length of shaft
  • Note nodules, ulcers, scars, tenderness, bruising, retraction of foreskin, edema, fracture of shaft
  • nits or lice at base of hair shaft.
  • location of urethral meatus.
  • Check terminal urethra by compressing glans bw thumb and forefinger. Look for redness, d/c
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7
Q

Anatomy of scrotum:

A
  • L testicle and scrotum usu lower than right
  • Thin skin overlies dartos tunic muscle, internally separates scrotum into 2 halves; each half contains testis, epididymis, spermatic cord
  • Drains to inguinal nodes
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8
Q

Potential finding in scrotum:

A
  • Sebaceous cysts: Common, usu multiple. Firm, nontender. Yellowish contents of cyst may show through skin.
  • Edema: Assoc w generalized edema (CHF). Thickened walls pit on pressure. Lymphedema (elephantiasis) dt blocked ducts from filariasis
  • Hernia: may auscultate for bowel sounds
  • Carcinoma: painless nodule
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9
Q

Anatomy of testis & epididymis:

A
  • Solid ovoid in shape, suspended in scrotum, vertical long axis
  • upper pole capped by head of epididymis
  • body of epididymis attached vertically to posterior surface of testis
  • tail of epididymis continuous with vas deferens and other vessels, forms spermatic cord
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10
Q

Palpation and inspection of Testis, Epididymis, Spermatic cord:

A
  • T: Use thumb and forefinger; assess size, shape, consistency, sensitivity to pressure. Transilluminate each if any significant findings (eg swelling)
  • E: vertical ridge of soft nodule at upper testicular pole, usu behind testis (~7% are anterior, a normal variant). Compare head, body, tail segments BL
  • S: distinct hard cord, width of a lead pencil, contains vas deferens. trace cord down to testis and compare BL
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11
Q

Potential finding of testicle:

A
  • Maldescended testis = cryptorchism: In children, one side mb raised. May result in sterility.
  • Hydrocele: NT accum serous fluid from infx or trauma. Testis and epididymis usu behind the mass. Transilluminates
  • Hematocele: NT accum blood. Swells like hydrocele, but opaque on transillumination
  • Chyocele: NT lymph accum. Mass is translucent.
  • Tuberculosis: Large hard nodular mass (neoplasm and tertiary syphilis also produce indurated NT masses).
  • Acute orchitis: Painful, tender, swollen. Assoc w mumps, infx dz. Mb simultaneous epididymitis. Must r/o testicular torsion (mb after rigorous workout)
  • CA: painless nodule
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12
Q

Potential findigs with spermatic cord:

A

• Deferentitis: Inflam vas deferens. Tender, swollen.
Hydrocele: dt failure of succus vaginalis to obliterate around spermatic cord →fills w fluid → mass, smooth, resilient, sausage-shaped, above testis
• Varicocele: Varicosities of pampiniform plexus of veins of spermatic cord. soft, irregular mass. Feels like bag of worms. L mc dt pressure of L venous outflow. Collapses slowly when scrotum is elevated in supine pt
• Testicular torsion: Twisted spermatic cord occludes blood to and from testis. Acutely painful, tender, swollen; retracted upward in scrotum. Pt may flex same leg for pain relief

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13
Q

Know the technique for palpating the inguinal ring for hernias.

A
  • Place tip of index finger at most dependent part of scrotum, slowly direct it up into external inguinal ring.
  • Have pt strain (valsalva) and cough (away from you). Note any palpable herniating mass against your fingertip
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14
Q

Know the difference between direct and indirect inguinal and femoral hernias.

A
  • Indirect: MC, tissue herniates thru internal ring often into scrotum
  • Direct: LC, us M >40, tissue herniates behind external ring rarely into scrotum, dt weak floor of inguinal canal
  • Femoral: least common, F>M (PG and birth), never into scrotum; go into femoral canal, more likely to stangulate
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15
Q

What is the normal size and shape of the testicle?

A
  • 5-7cm x 2.5cm

* ovoid

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16
Q

Know the difference between acute orchitis and acute epididymitis.

A
  • Orchitis: entire testicle inflamed, usu seconday to mumps

* Epididymitis: bacterial infection (usu Chlamydia)

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17
Q

Size, position, anatomy of a normal prostate:

A
  • 2.5 cm, about size of a chestnut
  • 2 cm posterior to symphisis pubis, posterior surface next to rectal wall
  • median sulcus: shallow, divides into R & L lateral lobe
  • median lobe delineated by slight depression near superior edge
  • Seminal vesicles near superior margin only palpable if inflamed
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18
Q

Prostate Exam:

A
  • Pt lies in left lateral simms position, or bends over table
  • Insert lubed gloved finger past anal canal into rectal ampulla. Keep pad of forefinger facing anterior wall
  • Note: Smooth or nodular; Round or flat; Atrophied, normal size, or enlarged; Elastic, hard, boggy, soft; Mobile or fixated; Tender or nontender
  • Normal feels like tip of nose, boggy like cheek, hard like forehead
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19
Q

Work-up for Prostate CA:

A

o Prostate Cancer Risk Calculator combines DRE, PSA, FHx; correlates well w bx
o Bx: indicated w abn DRE: induration, asymmetry, palpable nodularity
o DRE can detect tumors in posterior and lateral lobes. Up to 35% in other parts, not palpable
o PSA: for dx and px. Only do before bx (rises a lot). Ok to do after DRE (will rise a little)

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20
Q

Prostatic massage:

A

• Contraindicated in acute prostatitis

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21
Q

Know the difference between BPH, prostatic cancer, and acute prostatitis on digital rectal exam (DRE).

A
  • BPH: smooth, enlarged symmetric lobes, elastic—rubbery, nontender
  • Prostate cancer: hard, nontender nodules, median sulcus may be obscured
  • Acute prostatitis: enlarged, tender prostate with asymmetrical edematous tissue, boggy
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22
Q

What is Peyronie’s disease? What are the findings on PE?

A

• Scarring of the tunica albuginea in the corpora cavernosa formation of plaques that can cause painful erection and dorsal curvature

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23
Q

• Sections of the neuro exam:

A 
o	Mental status
o	Cranial nerves
o	Motor system
o	Coordination
o	Sensory system 
o	Reflexes, including deep tendon reflexes
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24
Q

• Motor system screening:

A 
o	Observe:
o	Walking: Normal gait; Tandem Heel-to-toe; On toes (plantarflexion); On heels (dorsiflexion)
o	Hopping in place
o	shallow knee bend on each leg
o	Drift of upper extremities (20-30 sec)
o	Assess grip strength
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25
Q

How do we rate muscle strength? How do we test muscle tone? What is spasticity? What is cogwheel rigidity? What conditions cause them?

A
  • Strength: 0-5 scale, hold active resistance for 3-5 seconds
  • Tone: resistance even when patient passive
  • Spasticity: UMN/corticospinal tract system lesion, rate dependent hypertonia. “clasp-knife resistance”. ↑Tone w rapid passive movement
  • Cogwheel rigidity: ratchet like jerkiness, parkinsonism
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26
Q

Muscle strength scale:

A
  • 0: No mm contraction, no joint movement
  • 1: Visible contraction w/o strength to move joint
  • 2: can move joint, but not overcome gravity
  • 3: moves against gravity, but not active resistance
  • 4: moves against gravity and some resistance by examiner
  • 5: Normal strength, active movement against full resistance w/o fatigue
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27
Q

Things to note w mm strength and tone:

A
  • Plegia (partial or incomplete paralysis)
  • Paresis (weakness)
  • Involuntary movements (tremor, chorea, myoclonus, dystonia)
  • Muscle bulk or atrophy
  • Muscle tone (flaccidity, spasticity or rigidity)
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28
Q

Muscle Movements and the Corresponding Nerves:

A
  • Elbow Flexion; C5, 6
  • Elbow Extension; C6, 7, 8
  • Wrist Extension; C6, 7, 8
  • Grip Strength; C7, 8; T1
  • Finger Abduction; C8, T1, ulnar nerve
  • Thumb Adduction, opposition; C8, T1, median nerve
  • Hip Flexion; L2, 3, 4
  • Hip Adduction; L2, 3, 4
  • Hip Abduction; L4, 5; S1
  • Knee Extension; L2, 3, 4
  • Knee Flexion; L4, 5; S1, 2
  • Ankle Dorsiflexion; L4, 5; S1
  • Ankle Plantarflexion; S1, 2
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29
Q

What tests check coordination?

A
  • Rapid alternating movements of arms on lap; dysdiadochokinesis (inability, sign of cerebellar dysfunction)
  • Finger tapping test: rapidly tap DIP of thumb w tip of index finger (normal 2 taps/sec)
  • finger-to-nose test: dysmetria (ataxia, can’t control distance, power, speed), cerebellar disorders. Extend arm fully. Note any intention tremor
  • forearm rolling
  • heel to shin test: supine. Also test proprioception.
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30
Q

Pain, temp, light touch sensation and their sensory tracts:

A
  • Note: anesthesia, hypesthesia, paresthesia. Compare arms, legs, trunk
  • Pain (LSTT): sharp vs. dull. Don’t reuse sharps (risk transmit infx)
  • Temp (LSTT): hot vs. cold
  • Light touch (ASTT): brush, cotton, or Semmes-Weinstein monofilament. Diabetic foot: insensate to 5.07 monofilament, ↑risk subsequent foot ulceration and amputation
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31
Q

Posterior Column:

A

• vibration and proprioception.

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32
Q

Digit Position sense for proprioception:

A

• hold digit in a “neutral”, up, down, position. Usu big toe, or other

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33
Q

Vibration:

A
  • Tests proprioception
  • 128-Hz tuing fork. Strike on your palm ~20 cm
  • heathy 40yo should perceive vibrations for at least 11 secs at med malleolus, 15 at lat, 15 at ulnar styloid. ↓ 2 secs w every decade > 40
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34
Q

• Discriminative sensations:

A

o Depends on normal cortical function
o Stereognosis: recognize common objects 90% of time in 5 secs
o Graphesthesia: identify numbers or letters (1 cm height on fingertips, 6 cm elsewhere)
o 2-point discrimination: distinguish 2 sharp points simultaneously on skin. Normal: 3 cm on hand or foot, 6 mm on fingertips

35
Q

• Grade Deep Tendon Reflexes (DTRs) on a 0-4 Scale

A

o 0: Areflexia, absence of any reflex
o 1: Reduced, weak, or only w Jendrassik reinforcement (may bring out reflexes)
o 2: Average, normal
o 3: Brisk, upper normal
o 4: Extremely brisk hyperreflexia, with clonus (rapid involuntary alt contraction and relaxation)

36
Q

• Deep Tendon and Cutaneous Reflexes w Corresponding Nerves:

A 
o	Biceps; C5, 6
o	Triceps; C6, 7
o	Brachioradialis; C5, 6
o	Abdominal; T8-12; Frequently not seen in obese individuals
o	Cremasteric; L1,2
o	Knee; L2, 3, 4
o	Ankle; S1, 2; Ankle clonus suggests UMN disease
o	Plantar; L4, 5; S1, 2; Check Babinski
37
Q

Describe a Babinski reflex. What does a positive Babinski sign indicate in a 21-year old patient versus an 18-month old child?

A
  • Stroke lateral aspect of sole, curving medially across the ball
  • Negative: toes flex
  • Positive: toes abduct and extend (big toe dorsiflex) (physiologic response in infants)
  • (+) > 2 suggests UMN dz
38
Q

What do deviation from normal DTRs indicate?

A
  • Alone, do not signify neuro dz. sign only if assoc w other clinical findings
  • absent reflex: LMN dz (weakness, atrophy, facsiculations)
  • exaggerated reflex: UMN dz (weakness, spasticity, clonus, Babinski sign)
  • asymmetric: mb LMN or UMN dz
  • brisk compared to reflexes from higher spinal level: spinal cord dz at some level bw
  • ↓DTRs: must localize lesions in cervical or lumbosacral nerve roots (radiculopathy)
39
Q

Know tests for meningeal irritation.

A
  • Both tests are insensitive for meningitis!
  • Brudzinski: flex supine pt’s neck → flex both hips and knees
  • Kernig: hip and knees flexed, (+) when resists extension of knee
  • Neck stiffness: involuntary resistance to neck flexion
40
Q

Order of most →least sens/spec tests for UL cerebral hemisphere dz:

A
  • Arm rolling
  • Pronator drift
  • Finger tapping
  • Babinski
  • Hyperreflexia
  • Hemianopsia
  • Hemisensory disturbance
41
Q

What does “glove and stocking distribution” mean in terms of sensory testing?

A

• Affects distal extremities

42
Q

How are discriminative sensations tested? What part of the nervous system is responsible for sensory discrimination?

A
  • Depends on normal cortical function
  • Stereognosis: ability to recognize common objects 90% of time in 5 s
  • Graphesthesia: ability to identify numbers or letters
  • 2 point discrimination: sharp objects. Normal distance is 3cm for hand, 6mm for fingertips
43
Q

What is a dermatome?

A

• area of skin that is mainly supplied by a single spinal nerve

44
Q

Never OMIT for mental status:

A
  • Orientation: Time: day, day of the week, month, season, year; Place: Where they live, where they are; Person: Knows own name, family names, of medical personnel
  • Memory: Recent: pick a fact you can verify; Remote: Check a fact they should know
  • Intelligence: Calculating ability, knowledge (names of last 4 presidents), Abstract reasoning (interpreting a proverb, comparing similars apple/pear, piano/violin)
  • Talk: Speech, rate, quantity, fluency, articulation
45
Q

MSE: Appearance

A

• Level of consciousness, posture, hygiene, facial expression, manner/affect, speech, mood

46
Q

MSE: Thought processes

A

• Asses logic, relevance

a. circumstantiality: indirect delayed speech
b. flight of ideas: continuous rapid flow of speech
c. neologisms: invented words
d. incoherence
e. blocking: loss of though
f. confabulation: Wernick-Korsakoff
g. preservation: repeating words/ideas
h. echolalia: echoing
i. clanging: choosing word based on sound

47
Q

MSE: Thought content

A

a. Obsessions: recurrent thoughts thatunhappy
b. Compulsions: acting on obsession
c. Phobias
d. Anxieties
e. Feelings of unreality
f. Depersonalization
g. Delusions
h. Rigid/repetitive

48
Q

MSE:

  • Perceptions, Insight:
  • Cognitive functions
  • Language and motor skills
  • Higher intellectual functions
A

P: Illusions/hallucinations
I: are they aware may be abnormal
• CF: Orientation, attentions, memory, new learning ability
• L: Comprehend words, name objects, copy figures
• H: Assess vocab, judgment

49
Q

Assessing suicide risk:

A 
Sex: male
Age: teens/elder
Depressed
Previous attempt
Ethanol
Rational thinking loss
Social support loss
Organized plan
No spouse
Sickness
50
Q

Cranial Nerves:

A 
I-Olfactory
II-Optic
III-Occulomotor
IV-Trochlear
V- Trigenimal
VI- Abducens
VII- Facial
VIII- Vestibulocochlear
IX- Glossopharyngeal
X- Vagus
XI- Accessoty
XII- Hypoglossal
51
Q

Olfactory N test:

A
  • smell, use a familiar non-irritating substance.
  • Painful or irritating stimulates CN V
  • Check for patency: ↓smell often dt rhinitis, smoking, aging.
  • UL loss w optic deficit and personality change → lesion in frontal lobe
52
Q

Optic N test:

A
  • visual acuity: Snellen for far, Rosenbaum for near
  • visual fields by confrontation
  • Ophthalmoscopic exam: clarity of optic disc, cup/disc ratio, optic atrophy, papilledema, Spontaneous venous impulses (absence suggests ↑intracranial P)
53
Q

Oculomotor N test:

A
  • Motor to pupil, eyelid, EO muscles
  • PERRLA
  • Note: ptosis (Drooping of the eyelid)
  • Slow pupilary response: CN II sensory lesion (optic atrophy)
  • EO extraocular movements with H in space
  • Horner’s syndrome = ptosis with miosis enophthalmos. Lesion of T1 sympathetic nerves
54
Q

Trochlear N test:

A
  • EO movements (down and in, assists with down and out)

* X in space

55
Q

Abducens N test:

A
  • Responsible lateral movement of the eye.
  • H in space
  • Nystagmus: Note quick and slow components. plane of movement (horizontal, vertical). A few beats of horizontal nystagmus is normal in extreme lateral gaze. Vertical nystagmus suggests brainstem lesion.
  • Diplopia: True = weakness or imbalance in EO mm. “how many fingers am I holding up?” True= disappears when one eye is closed. Problems w the lens or cornea may cause blurring that mimics diplopia.
56
Q

Trigeminal N test:

A
  • Motor to the masseter and temporal muscles. Sensory to the face
  • “clench your teeth”
  • 3 divisions: ophthalmic, maxillary and mandibular. cotton ball for light touch
  • Corneal reflex: only if deficit on light touch. Touch cornea (not conjunctiva) w cotton (no contact lens). CN V is sensory, CN VII is motor.
57
Q

Facial N test:

A
  • Motor to face, Taste on anterior 2/3 of tongue
  • “raise eyebrows, frown, close eyes tightly, smile (volitionally), puff out cheeks”
  • attempt to elicit a spontaneous smile.
  • weakness or asymmetry? only lower half or entire side?
  • Lesions in cerebral cortex → contralateral weakness of mouth, but not the forehead.
  • Peripheral lesions (ieBell’s Palsy) → total facial paralysis on ipsilateral side.
58
Q

Acoustic N test:

A
  • Auditory acuity, Balance
  • Gross hearing, if deficit → Weber and Rinne (conductive or sensorineural)
  • Romberg: vestibular system and proprioception when eyes are closed. Loss of balance with eyes open suggests cerebellar ataxia (incoordination)
59
Q

Glossopharyngeal N test:

A
  • Sensory to pharynx, Taste on posterior 1/3 of tongue.
  • cotton swab to stimulate gag reflex (minimum dose).
  • Is reflex symmetrical?
60
Q

Vagus N test:

A
  • Motor to pharynx
  • “swallow.” Note symmetry.
  • “say ‘ahh’.” soft palate should elevate symmetrically, uvula should stay midline.
  • asymmet gag w normal swallow and phonation prob dt CN9 lesion.
  • asymmet gag w UL loss elevation on phonation and asymmet swallow prob dt CN10 lesion
61
Q

Spinal accessory nerve test:

A
  • Motor to trapezius and SCM
  • Usu injured from trauma to neck.
  • “shrug against manual resistance.”
  • Test SCM if trap tests abn.
  • Use caution in cases of neck trauma
62
Q

Hypoglossal N test:

A
  • Motor to tongue
  • “stick out your tongue”
  • Deficit: tongue deviates toward side of lesion.
  • If question, have pt press tongue into their cheeks
63
Q

What is the normal ROM of the TMJ? What other findings will you encounter?

A
  • 3cm bw upper and lower incisors

* Palpate: swelling, crepitus, deviation, ROM

64
Q

Cervical Spine tests:

A
  • Compression & Distraction (traction)- pt looks straight ahead, and head rotated 20º to each side.
  • Adson’s: + in TOS (peripheral neuropathy) paresthesias/↓ radial pulse (compression of Subclavian a) when abduct, extend, ER arm, look to same side and valsalva
65
Q

Inspect and Palpate hands and wrists:

A
  • for swelling (note Heberden’s and Bouchard’s nodes), redness, deformity, nodules or atrophy.
  • Hand ROM: Extension: Spread fingers of both hands. Flexion: Make a fist with both hands. MCP joints: Flexion 90º, Extension 35º. PIP jts: 100º. DIPs: 90º
  • Wrist ROM: Flexion: 80º; Extension: 70º; Ulnar deviation: 30º; Radial deviation: 20º
66
Q

What is Finkelstein’s test?

A

• Make fist with thumb inside, eviate fist ulnarly.  severe pain + Finkelstein: indicates tenosynovitis

67
Q

What are the best exams for ruling in/out Carpal Tunnel syndrome? Others?

A
  • RULE IN Best clinical: Katz hand diagram [gold standard: electrodiagnostic] and weak thumb abduction
  • RULE OUT Hypalgesia: ↓ perception painful stimuli along palmar aspect of index finger compared to little finger
  • (also good predictor of electro-dx) Weak Thumb Abduction. elevate thumb against resistance. (+) = weakness.
  • Tinel’s sign: Percuss lightly over flexor retinaculum. (+) = tingling sensation
  • Phalen’s sign. maintain position for 60 seconds. (+)=sensation of tingling in median n distribution over hand
68
Q

Inspect and Palpate elbows:

A
  • redness and swelling. lateral and medial epicondyles for point tenderness
  • ROM: Flexion: 135-150º; Extension: 0-5º; Supination and pronation: 180º
69
Q

Shoulder assess:

A
  • swelling, crepitus, deformity.
  • Palpate SC jt, ACjt, bicipital groove for tenderness
  • Screening Method: Apley’s Scratch Test: ER and abd, IR and add
  • ROM: Abduction: 180º; Adduction: 45º; Flexion: 90º; Extension: 45º; Internal rotation: 55º; External Rotation: 40º
70
Q

What are the findings in tennis elbow? Golf?

A
  • Tennis= Lateral= painful, tender lateral epicondyle

* Golf= medial Epicondylitis

71
Q

Where is the subacromial bursa?

A

• On top of humerus

72
Q

Assess Feet and ankles:

A
  • All done w pt supine
  • Inspect: swelling, redness, nodules (podagra on great toe common in gout), deformity
  • Palpate: toes for tenderness. metatarsals.
  • ROM: Dorsiflexion: 20°; Plantar flexion: 50°; Inversion: 5°; Eversion: 5°; Adduction: 20°; Abduction: 10°
  • Ankle Drawer Sign: Hold calcaneus, pull anterior, push posterior.
73
Q

Assess knee:

A
  • Inspect: alignment, deformity, swelling, atrophy. Note any atrophy of quadriceps
  • Palpate: swelling, bogginess, tenderness. tibial plateau for meniscal injuries. tibial tuberosity in adolescents for Osgood-Schlatter dz. Note any suprapatellar pouches.
  • Tests for Fluid: Bulge sign, Ballottement
74
Q

Tests for lig stability in knee:

A
  • Valgus and Varus Stress: w knee extended and slightly flexed
  • Apley’s Compression/Distraction: meniscus and collateral ligs
  • McMurray’s Test: meniscus tears. Apply valgus stress to flexed knee while ER leg (toes point out) and slowly extend knee while still in valgus. popping, clicking, guarding = tears of medial meniscus. Repeat w varus stress and IR for lateral meniscus.
  • Anterior Drawer Sign: ACL
  • Lachman’s Test: ACL. knee flexed 20 to 30º, tibia displaced anteriorly to femur. soft endpoint or > 4 mm displacement is (+)
  • Posterior Drawer Sign: PCL
  • Patellar Entrapment: Chondromalacia patella
  • Thessaly: meniscus. Test normal knee first. (+)= med or lat jt line discomfort, mb locking or catching
75
Q

What test most sensitive for ACL tear?

A

• Lachman’s test: + when knee flex 20-30 degrees, >4mm displacement of tibia anterior to femur

76
Q

How does one test the knee for effusion? Where would you expect to find tenderness to palpation in a meniscal tear?

A
  • Bulge sign: look and milk
  • Ballotement: downward pressure towards the foot with one hand, while pushing the patella backwards against the femur with one finger of the opposite hand.
77
Q

Assess Hip:

A
  • Inspect: alignment, deformity, swelling, atrophy. Inspect greater trochanter.
  • ROM: Flexion (knee to chest) 135°; Abduction: 45°; Adduction: 20°; Rotation with hip at 90°
78
Q

Hip ortho tests:

A
  • Patrick-Fabere: flexion, abduction, ER. (+) in hip or SI dz
  • Gaenslen’s: extension, psoas tenderness, SI dz
79
Q

Assess spine:

A
  • Inspect: scoliosis, lordosis, kyphosis. levels of ears, shoulders, scapulae, iliac crests
  • Note any genu varus/valgus, pronation, eversion of feet. hypertrophy or atrophy of paraspinal muscles.
  • ROM :
  • Flexion: 90°. Measure how close to ground can reach w fingertips
  • Extension: 30°
  • Lateral bending: 20°. Should be equal on both sides.
  • Rotation: 30°. Compare both sides.
80
Q

Lumbar spine ortho test:

A
  • SLR: active and passive. Most sensitive.
  • Bragard’s SLR until painful, lower until pain stops then dorsiflex foot
  • Valsalva: (+) in lumbar disc syndrome
  • Kemp’s: R, E, LF. (+)=pain w f acet dz and lumbar disc herniation
  • X-SLR: SLR of CL limb reproduces more specific but less intense pain on affected side
  • Sit to Stand: Most reliable to detect quadriceps weakness. attempt to rise from chair using only one leg at a time
81
Q

Tests for lumbar disc herniation:

A
  • SLR
  • X-SLR
  • Sit-to-stand
82
Q

What are the tests for non-organic back pain (i.e. malingering)?

A
  • Flip test: + when SLR restricted/painful but pt can sit up and extend wihout pain
  • Hoover’s test: + when contralateral foot does not press into table w SLR
83
Q

What are the findings of DJD and RA in the hand?

A
  • Degenerative joint disease: swollen knuckles, phalanges deviated
  • Rheumatoid arthritis: boutonnière deformity of thumb, ulnar deviation of metacarpal phalangeal joints
84
Q

What is hallux valgus?

A

• Looks like a bunion. Medial deviation of the MT1 and lateral deviation/rotation of hallux

CPD Lab Tests_MH (3 decks)

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