Exam 3 Flashcards
Abdominal percussion
• Percuss the abdomen lightly in all four
quadrants to determine the distribution of
tympany and dullness.
• Tympany usually predominates because of gas
in the GI tract, but scattered areas of dullness
from fluid and feces are also common.
Percuss to determine the small area of tympany that notes the spleen.
Dullness suggests enlargement.
Normal sized spleen will not be palpable so if you feel it, it’s enlarged.
What you will hear for intestinal obstruction percussion?
Tympany
RLQ abdominal pain
Patients with RLQ pain should be assessed for the possibility of appendicitis.
The RLQ pain includes ( Appendix? Colon? Ovary? )
Abdominal assessment sequence ?
Inspection, auscultation, percussion, light palpation, deep palpation
Rebound tenderness
is when the patient experiences more pain after you release your hand from deep
palpation than they did from the palpation itself. “Which hurts more, when I press or let go?”
What test will perform with patient with RUQ abdominal pain?
Patients with RUQ pain should be assessed for the possibility of cholecystitis.
Test to do : • Murphy’s sign
Quadrant organs location
Different type of pain ( Visceral pain)
Visceral pain is directly related to the organ involved and most organs do not have an abundance of nerve fibers. Visceral pain is usually difficult to localized. The pain is
usually dull or aching, it can be constant or intermittent.
Different type of pain ( Parietal pain )
Parietal pain occurs when there is an irritation of the peritoneal lining. The peritoneum has a higher number of sensitive nerve fibers, so the pain is generally more severe and easier to localize. Pain is usually sharp, constant and on one side or the other.
Different type of pain ( Referred pain )
Referred pain is visceral pain that is felt in another area of the body and occurs
when organs share a common nerve pathway. It is poorly localized and generally constant in
nature. An example is a patient with a gallbladder problem that experiences referred pain in
the right scapula.
In abdominal what does it mean large pulsation?
If an abdominal pulsatile mass is seen on physical examination, auscultation over the
mass may identify the presence of turbulent flow (bruits) within the aorta.
What alarm symptoms for nausea and vomiting?
First, if this is a female patient, is she pregnant?
Next, assess for life-threatening causes. Nausea & Vomiting associated with:
• Bloody emesis or coffee-ground emesis
• Recent head injury, headache or altered mental status
• Neurological symptoms like weakness, blurred vision, paresthesia
• Severe abdominal pain
• Chest pain
• Inability to retain oral liquids (>8hrs in a child or >12hrs in adults)
Differential diagnosis for constipation ?
If you have patient has issue with gallbladder (chronic) what the possible sign can be appear on him ?
Jaundice
Differential diagnosis for constipation, if the patient has bloody stole and weight loss?
If patient has Difficulty swallowing which CN is affected?
CN IX and X : glossopharyngeal and vagus
When would you do rectal exam?
• Assessment of the prostate (particularly symptoms of outflow obstruction)
• When there has been gastrointestinal bleeding
• Constipation • Change of bowel habit
• Problems with fecal continence
• Specific rectal complaints
What the symptoms it’s not an alarm symptoms with nausea and vomiting?
Diarrhea
Where is the spleen?
LUQ
carpal tunnel syndrome test ?
Phalen’s test
What test you have to do for ACL?
Lachman
When someone comes in with injury in their forearm what you will assess?
Elbow and the wrist “the joints above and down the injury”
Using prednisone susceptible for what ?
“compression fracture” back pain.
Patient with no alarm symptoms, comes with back pain, no radiculopathy what
Your diagnose?
◦ Radiculopathy without alarm symptoms, tends to suggest disc
herniation.
◦ Pain without radiculopathy tends to be nonspecific and resolves
on its own with time.
Signs of shoulder impingement what you can’t do?
No overhead activities
Raynaud’s syndrome
Color changes. As blood flow stops and then returns, your skin color may change from white to blue to red.
Patient with Knee red, swollen, fever what the diagnosis?
Sepsis arthritis.
Iliotibial band tendonitis (location) ?
Lateral knee pain
Flexion
Extension
Rotation
Lateral flexion
Internal rotation: place hands behind the back with palm out
• Measure level of spinous
process of thumb - Normal
is above T7
Abduction
Adduction
Impingement Tests: Neer’s Test
Forward flexion with arm internally rotated.
Stabilize the patient’s scapula with one hand, while passively flexing the arm while it is internally rotated.
Impingement Tests: Hawkins Test
Arm at 90o, 30o of forward flexion, bend elbow and take from external rotation to internal rotation
Posterior Drawer
With the knee flexed to 90 degrees and the patient’s foot flat on the table, grasp the tibia with both hands and push posteriorly
Laxity at the conclusion of movement is indicative of a PCL injury
What does the pain associate with AC joint look like? And what test will do ?
Cross-Arm Test
Pull arm across body (thereby compressing the AC joint)
◦ look for pain at the AC joint not just
general shoulder pain
ACL injury
Lachman
( With the knee flexed at 30 degrees, grasp the inner aspect of the calf with one hand, grasp outer aspect of distal thigh with the other hand Pull on the tibia to assess the amount of anterior motion of the tibia in comparison to the femur)
ACL injury – increased forward translation of the tibia at the end of movement
Jersey Finger
flexor tendon injury at DIP
◦ Can’t flex at DIP
◦ Urgent follow up
Mallet finger
extensor tendon injury at DIP
◦ Can’t extend at DIP
ROS for musculoskeletal ?
◦ For obvious traumatic injury, you may only require a limited ROS.
Constitutional, Skin, Neuro (strength, numbness, tingling)
◦ For more systemic issues (like pain in multiple joints), an expanded review of systems may be necessary.
Constitutional symptoms of fever, weight loss, swelling with no injury, or system illness suggest medical conditions. History of insect bite?
HEENT (dry eyes, scleritis, corneal ulcer—rheumatoid arthritis) CV, Resp, Lymphatics
Scale for Grading Muscle Strength
