Exam 3: Muscle and Abdomen Flashcards
1
Q
What are the screening recommendations for colorectal cancer?
A
Grade A Recommendation Adults age 50-75 years
Stool-based tests
Direct Visualization tests
CT colonography every 5 years
Grade C Recommendation Adults age 76-85 – Individualized decision making
Grade D Recommendation Adults older than 85 – DO NOT SCREEN
2
Q
What are the screening recommendations for an abdominal aortic aneurysm?
A
USPSTF Grade B Recommendation for one time abdominal US screening for men 65-75 years old that have smoked more than 100 cigarettes in their lifetime.
Grade C Recommendation: Clinicians selectively screen men who have never smoked aged 65-75 years.
Grade D Recommendation: Do not screen women who have never smoked
3
Q
When auscultating the abdomen What would a hepatic bruit suggest?
A
Vascular occlusive disease
Liver carcinoma or cirrhosis
4
Q
When auscultating the abdomen what would Venous hum indicate?
A
portal hypertension r/t Hepatic Cirrhosis
increased collateral circulation between portal and systemic venous systems
5
Q
When auscultating the abdomen what would a Friction rub indicate?
location
indication
A
LOCATION:
Liver & Spleen
INDICATION:
- Liver Cancer
- Chlamydial/gonoccocal perihepatitis
- Recent liver biopsy
- Splenic Infarct
6
Q
What does a friction rub sound like?
A
Grating sound with respiratory variation
7
Q
When auscultation the abdomen, when would an arterial bruit indicate?
A
Systolic and diastolic components = occlusion
= renal artery stenosis
= Renovascular hypertension
8
Q
Acute Gouty Arthritis
Location
Characterisitcs
What is it commonly mistaken for?
A
Location:
- metatarsophalangeal joint of the great toe = site of initial attack
- Ankle, tarsal joints, & knee commonly involved
Characteristics:
- pain, tender, hot, dusky red swelling that extends beyond joint
- Commonly mistaken for cellulitis*
9
Q
Ingrown toenail
What
Character
Assoc
Location
A
Sharp edge of toenail digs into lateral nail fold
Characteristics:
-Tender, red, overhanging nail fold.
Associated Manifestation:
-Sometimes with granulation tissue and purulent discharge
Location:
-Usually Great Toe
10
Q
Hammer Toe
location
characteristics
associated with
A
Location:
-Usually 2nd toe
Characteristics:
-Hyperextension at the metatarsophalangeal joint w/flexion at proximal interphalangeal (PIP) joint
Associated with:
Corn develops at pressure point
11
Q
Callus
A
Similar to corn
Involves skin that is usually thick under recurrent pressure
Painless (if there is pain suspect underlying wart)
12
Q
Plantar Wart
Cause
Location
Characteristic
A
Cause:
-HPV
Location:
-Sole of foot
Characteristic:
- Small dark spots that give a stippled appearance
- Tender if pinched side to side
13
Q
Neuropathic ulcer
how to detect loss of sensation
A
Cause:
-Dim/Absent pain sensation from diabetic neuropathy
Location:
-Pressure points on feet
Characteristics:
- Painless r/t sensory disruption
- Usually deep, infected and indolent
Associated with:
Osteomyelitis & ensuing amputation
**Use a nylon filament to detect loss of sensation*
14
Q
When auscultating the abdomen, what would be normal findings?
A
Normal sounds consist of clicks and gurgles, occurring at an estimated frequency of 5-34 per minutes.
15
Q
What is referred pain, give an example
duodenal/pancreas referred to?
biliary tree ….
MI…
A
Felt in more distant sites that are innervated at approximately the same spinal levels as disordered structures.
Develops as initial pain and becomes more intense
Site palpation is not tender
Example:
- duodenol/pancreas»_space;> back
- biliary tree»» R scapula or R post thorax
- MI»>epigastric
16
Q
What is visceral pain, give example
RUQ
Periumbilical
RLQ
Pain disproportionate to findings
A
Abdominal organs unusually contracted OR distended
Palpation:
Near midline at varying levels depending which structure is involved
Ischemia stimulates visceral nerve pain fibers
Characteristic:
Gnaw/cramp/ache»_space; systemic s/s (sweat, N/V..)
Location: RUQ = Liver distension Periumbilical = acute appendicitis RLQ = progressive appendicitis Pain disproportionate to findings = mesenteric ischemia
17
Q
What is parietal/somatic pain, give example
cause
characteristic #3
aggravators #2
alleviators
A
CAUSE:
inflammation parietal peritoneum (peritonitis)
CHARACTERISTIC:
Steady ache
More severe than visceral pain
More localized
AGGRAVATORS:
- Movement
- Coughing
ALLEVIATORS:
-lying still
18
Q
How to percuss liver
A
start well below the umbilicus in the RLQ, percuss upward toward the liver identifying dullness (lower border).
Next, ID the upper border of liver for dullness starting at the nipple line and percuss downward.
19
Q
How to palpate liver
A
- Place your left hand behind the patient, parallel to and supporting the right 11th and 12th rib and adjacent soft tissue below.
- Remind pt to relax on your hand.
- Press your left hand upward.
- INHALE
- Place your right hand on right abdomen lateral to the rectus muscle with your fingertips.
20
Q
Hooking technique how to
A
for obse pt.
Stand to right and place both hands side by side and ask the pt to take a deep breath in.
21
Q
If someone has hypertension, where would you auscultate and look for?
A
LOCATION:
- epigastrum
- CVA
- aorta
- iliac & femoral arteries
CVA = renal artery stenosis
22
Q
What is borborgymi?
A
rumbling of bowel sounds
23
Q
Techniques to assess liver for children
A
Scratch test:
- Diaphragm just above the costal margin, midclavicular line.
- With fingernail, lightly scratch moving below umbilicus toward the coastal margin.
- Scratching sound will change on the liver’s edge.
24
Q
What history and exam findings are consistent with Diverticulitis?
Process location quality timing relieving factors #3 associates symptoms/setting #5
A
PROCESS:
acute inflame in sigmoid or descending colon
LOCATION:
LLQ or Pelvic
palpable mass
QUALITY:
cramping at first then steady
TIMING:
gradual onset
RELIEF:
analgesia
bowel rest
abx
ASSOC: fever diarrhea urinary s/s anorexia
25
What history and exam findings are consistent with Peritonitis?
cause #3
Signs #6
examples #5
Cause:
inflame
infection
ischemic intraabdominal process
```
Signs:
+cough test
involuntary guarding
rigidity
absent bowel sounds
rebound tenderness***
percussion tenderness
```
```
Example:
appendicitis
diverticulitis
cholecystitis
bowel ischemia
perforation
```
26
What history and exam findings are consistent with acute appendicitis?
```
Process
Location
Quality:
Timing
Aggravating factors
Relieving Factors
Associated symptom/setting
```
PROCESS:
-inflame appendix w distention or obstruction
LOCATION:
- Poorly localized
- Periumbilical
- migrates to RLQ
QUALITY:
- Mild > increasing > severe
- steady
- cramping
TIMING:
-worsens until treatment
AGGRAVATE:
-movement/cough
RELIEF:
if subsides=perforation
ASSOC S/S:
- Anorexia
- Nausea/Vomit
- Low fever
27
What history and exam findings are consistent with cholecystitis?
```
Process
Location/Radiates
Quality:
Timing
Aggravating factors
Relieving Factors
Associated symptom/setting
```
PROCESS:
-inflamed gall bladder r/t persistent obstruction of cystic duct by gallstone
LOCATION:
- RUQ or epigastrum
- radiates R shoulder
QUALITY:
-steady, persistent cramp
TIMING:
-gradual onset
AGGRAVATE:
-prior history of biliary colic symptoms
RELIEF:
-NONE
```
ASSOC S/S:
-anorexia
-N/V
-Fever
NO JAUNDICE
```
28
What history and exam findings are consistent with acute/chronic pancreatitis?
```
Process
Location/radiates
Quality:
Timing
Aggravating factors
Relieving Factors
Associated symptom/setting
```
PROCESS:
-Pancreatic enzymes activated and autodigest and inflame pancreas
LOCATION:
- epigastric
- Radiate straight to back or other areas of abdomen
* 20% w/ severe sequelae of organ failure
QUALITY:
-steady, progressive & severe
TIMING:
-acute onset, persistent pain
AGGRAVATE:
-Movement
RELIEF:
- Hydration
- Bowel Rest
ASSOC S/S:
- N/V
- Abdominal distension
* 80% hx alcohol abuse or gallstones
29
What history and exam findings are consistent with Obstruction?
```
Process
Location
Quality:
Timing
Aggravating factors
Relieving Factors
Associated symptom/setting
```
```
PROCESS:
-caused by adhesions/hernia small bowel
OR
-Cancer
-Strictures
```
LOCATION:
- Generalized abdominal pain, nonspecific
- Distension
QUALITY:
- cramping
- colicky
TIMING:
- progressive
- intermittent
AGGRAVATE:
-ingestion food/liquids
RELIEF:
-bowel rest, hydration
ASSOC S/S:
- No flatus
- N/V
- Abdominal distension
30
What techniques can the FNP use to assess for ascites?
Shifting dullness
| Fluid wave
31
What shifting dullness and how to assess?
+ ascites= Dullness shifts to a more dependent side and tympany shifts to top
Percuss tympanic border supine and again lateral
32
what is fluid wave and how to assess?
detect impulse transmitted through ascitic fluid from one flank to opposite side.
Only positive when ascites is obvious
Even people without ascites can be positive
33
Dysphagia
Presentation
Etiology
Difficulty swallowing
"not go down right"
Motility or Structural disorder
Etiology:
- Neurologic: stroke/parkinksons/ALS (old)
- Muscular: MD/myasthenia gravis (old)
- Structural: stricture (young)
34
Odynophagia
Presentation
Etiology
Painful swallowing
Etiology:
Ingestion: Esophageal ulceration r/t NSAIDS/ASA
Radiation
Infection: Candida, CMV, Herpes, HIV
35
What is the Murphy sign and what does it indicate?
Who would you do it for?
What is it?
What is a positive sign
what does it mean?
Who?:
RUQ pain, no tenderness on palpation but suspicious for acute cholecystitis
PERFORM:
deep palpation on deep inspiration
+Murphy sign = sharp halting in inspiratory effort d/t pain
Triples likelihood of acute cholecystitis
36
What is the Psoas sign and what does it indicate?
HOW TO:
supine, hand above R knee and patient raise thigh against hand
Pain w/increased intrabdominal pain = positive
+Psoas = appendicitis
37
What is the Obturator sign and what does it indicate?
+Obturator sign = R hypogastric pain = inflamed appendix
HOW TO:
Knee bent and internally rotate
38
What is the Rovsing sign and what does it indicate?
+Rovsing sign= Pain at RLQ during L sided pressure = appendicitis
HOW TO:
pt supine, press deep in LLQ, then quickly withdraw
"indirect tenderness & referred rebound tenderness"
39
What are the various presentations of bloody stool? What are the possible etiologies?
????
40
What are the various etiologies for constipation? How do they present?
```
Life Activities
IBS
mechanical obstruction
painful anal lesions
drugs
depression
neurologic disorders
metabolic conditions
```
41
IBS
Process
Assoc Symptom, setting
Diagnosis
Fxal change w/o known pathology
Possibly change from intestinal bacteria
3 Patterns:
Diarrhea
Constipation
Mix
```
Diagnose
S/S >6 months
Pain >3 months
2-3 features
(stool improvement, onset w change in stool frequency, form or appearance)
```
42
Rectum/Sigmoid Cancer
type of obstruction
s/s #4
MECHANICAL OBSTRUCTION
Narrowing of bowel from carcinoma
Change bowel habits
diarrhea, abdominal pain
Blood
Pencil shaped stools
43
Fecal Impaction
MECHANICAL OBSTRUCTION
rectal fullness
abdominal pain
diarrhea
usually older adults
44
Obstructing lesions:
diverticulitis, volvulus, intussusception, hernia
s/s
Colicky pain, distension
45
what do stools look like in intussception?
currant "jelly stools"
| red & mucus
46
What drugs cause constipation?
anticholinergics
opiates,
antacids containing calcium or aluminum
47
What metabolic conditions cause constipation?
pregnancy
hypothyroidism
hypercalcemia
48
what does pain precipitated by exertion indicate?
CAD
49
what does RUQ pain/upper abdominal pain indicate?
cholecystitis & cholangitis
50
What does epigastric pain indicate?
GERD
pancreatitis
perforated ulcers
51
what does sudden, epigastric, knife-like pain indicate?
pancreatitis
52
what does colicky pain indicate?
renal stone
53
What are some reasons for bulges in the abdominal wall? How would you assess for these and what would you expect to see on exam?
incisional hernia
proturusion through operative scar
palpate to detect the length and width
small defect has greater risk
54
What are some reasons for bulges in the abdominal wall? How would you assess for these and what would you expect to see on exam?
epigatric hernia
small midline protrusion through defect in linea alba occurs between xiphoid process and umbilicus
with the patient coughing or performing. a valsava maneuver, palpate by running fingerpad down the linea alba
55
What are some reasons for bulges in the abdominal wall? How would you assess for these and what would you expect to see on exam?
Lipoma
common fatty tumor
press finger down on the edge of lipoma, usually slips out from under the finger and is well demarcated, nonreducible and nontender
56
What would the FNP expect to see in the examination of the newborn umbilical cord? What would be some abnormal findings of the umbilical cord?
2 arteries & 1 vein at 12 o'clock
umbilicus amnioticus dries up and falls off in 2 weeks
An umbilical granuloma at the base of the navel is the development of pink granulation tissue formed during the healing process
Infection of the umbilical stump (omphalitis) is characterized by periumbilical edema and erythema.
57
What are the symptoms and exam findings of pyloric stenosis?
Assess:
-Deep palpation RUQ/midline = "olive"
When feeding:
-peristaltic waves pass across abdomen.
Present at 4-6 weeks of age
vomiting after feeding/ persistent hunger
58
What techniques can the FNP use to make the abdominal examination of the pediatric patient easier?
Infant Exam= hold legs flexed at knees and hips with one hand and palpate the abdomen with the other
Palpating liver in infants= start low in abdomen, moving upward with fingers. You can feel liver edge in most infants. 1-3cm below costal margin.
59
how long are the symptoms of functional dyspepsia
3 months nonspecific upper abdominal pain
60
describe appendicitis
RLQ migrates from periumbilical area & abdominal wall rigidity
61
describe PID, ruptured ovarian cysts, ectopic pregnancy
RLQ pain
62
Decribe diverticulitis pain
LLQ palpable mass
63
Small or large bowel obstruction pain descripiton
diffuse abdominal pain
distension
hyperactive/high pitched bowel sounds
tenderness
64
peritonitis pain description
```
pain
absent bowel sounds
rigidity
percussion tenderness
guarding
```
65
colon cancer descrption
change in bowel habits
| mass
66
What are the four key features of the MSK exam?
Is this articular or extra-articular?
Is this an acute symptom (usually < 6 weeks) or chronic (> 12 weeks)?
Is this inflammatory or non-inflammatory?
Is this localized (monoarticular) or diffuse (polyarticular)?
67
```
What are the four key features of the MSK exam?
inspect
palpate
ROM
Special Maneuvers
```
1. Inspect: visually evaluate any signs of deformity, swelling, scars, inflammation or muscle atrophy
2. Palpate: use surface anatomy landmarks (bony contours and structures) to localize points of tenderness or fluid collection
3. Range of motion: have patient actively move involved joints then move them passively as the examiner
4. Special maneuvers: perform stress maneuvers if indicated to evaluate joint stability and integrity of ligaments, tendons and bursae particularly if pain or trauma is present
68
Which are some examples of monarticular disease processes?
```
Monoarticular
Injury
Monoarticular arthritis
Monoarticular osteoarthritis
Tendinitis
Bursitis
Soft tissue injury
Acute gout
```
Pain in a single joint suggests injury, monoarticular arthritis, or tendonitis or bursitis (extra-articular). can be traumatic, crystalline, or septic.
69
Which are some examples of Polyarticular?
involves several joints.
Ask what the PATTERN of INVOLVEMENT is (migrating, moving steadily from one joint to another? Symmetric?)
Polyarticular arthritis may be viral or inflammatory from RA, SLE, or psoriasis.
Polyarticular Rheumatoid arthritis or gonococcal arthritis: migratory pattern
```
Rheumatic fever
Rheumatoid arthritis
Connective tissue disease
Osteoarthritis
systemic lupus erythematosus
Psoriatic arthritis
Scleroderma
Gonococcal arthritis
```
70
What is crepitus? What does it indicate?
Audible or palpable crunching during movement of tendons or ligaments over bone or areas of cartilage loss
It may occur in joints without pain and is more significant when associated with symptoms or signs.
Often indicates joint disease
EX: osteoarthritis or rheumatoid arthritis.
Can also indicate subcutaneous air in the tissues.
71
What are the four cardinal signs of inflammation?
Swelling, redness, warmth, and pain
72
symptoms of chronic pancreatitis
hx alcohol abuse
diarrhea & DM from pancreatitis insufficiency
increasing weakness
RUQ pain that radiates to back
73
What is right shoulder pain & prolonged abdominal pain indicative of?
biliary colic
74
What is McBurney's point indicative of?
acute appendicitis
in RLQ
75
What is tenderness over sacroiliac joint indicative of?
ankylosing spondylitis
76
what is torticollis?
contraction of sternocleidomastoid muscle that presents as lateral deviation and rotation of the head
77
Which muscle is used to flex the neck?
Sternocleidomastoid muscle
78
What muscle is used to extend the neck?
splenus capitus & trapezius & splenus cervisus
79
How would the FNP perform the following tests and what do positive results indicate? Crossover/crossed body adduction test
assesses acromioclavicular joint/shoulder joint
+test = pain w/adduction
80
How would the FNP perform the following tests and what do positive results indicate? Apley scratch test,
Assess overall shoulder rotation
pain = rotator cuff or adhesive capsulitis
81
How would the FNP perform the following tests and what do positive results indicate?...painful arc test
Pain @ 60-120 degrees
Pain @ full 120
Assess rotator cuff & pain provocation test
Pain at 60-120 = rotator cuff disorder/impingement syndrome
Pain at full 120 = disorder of acromioclavicular joint
82
How would the FNP perform the following tests and what do positive results indicate? ... Neer impingement sign,
examines shoulder joint
+ pain = subacromal impingement or rotator cuff tendonitis
83
How would the FNP perform the following tests and what do positive results indicate? Hawkins impingement sign
+ pain= supraspinatus impingement or rotator cuff tendonitis
84
What does a negative Neer and Hawkins test mean?
Unlikely shoulder impingement syndrome/ rotator cuff disorder
85
How would the FNP perform the following tests and what do positive results indicate? ....
external rotation lag test,
rotator cuff tear
90* abduct in plane of scapula then external rotate shoulder 45* then ask to hold position
+ test = inability to maintain position
86
How would the FNP perform the following tests and what do positive results indicate?.....
internal rotation lag test
"Lift off test"
subscapularis disorder/ full thickness tear
+test = failure to actively hold hand off of back
87
How would the FNP perform the following tests and what do positive results indicate?
drop arm test
Fully abduct to 90* and lower slowly.
+ test = patient unable to slowly control downward movement
diagnosis supraspinatus rotator cuff tear or bicipital tendinitis
88
How would the FNP perform the following tests and what do positive results indicate?
external rotation resistance test
Patient adduct & flex at 90* w/ thumbs up patient has to push outwards
+ test = pain/weakness = infaspinatus disorder
89
How would the FNP perform the following tests and what do positive results indicate?
the empty can test
elevate arms to 90* with thumbs pointed down...patient has to push upwards
+ test = unable to hold arm full abducted at shoulder level or can't control lower arms = suprasinatus rotator cuff tear
90
Which muscle groups make up the rotator cuff?
SITS
supraspinatus,
infraspinatus,
teres minor, and
subscapularis
91
What exam findings would be consistent with a clavicle fracture in the newborn?
lumps, tenderness or crepitus = fracture from a difficult birth
92
In considering the elbow, what history and exam findings are consistent with lateral epicondylitis?
"Tennis elbow"
HISTORY:
- repetitive extension of wrist or pronation
- Pain tenderness 1cm distal to lat. epicondyle
tenderness distal to epicodyle
Cozen test = pain reproduced along lateral aspect of elbow
Mill Test
Maudsley test
93
Cozen test
What does it test?
How do you do it?
muscles invovled
Patient extends arm
then pronates and extends wrist against resistance
pain reproduced along the lateral aspect of elbow = lateral epicondylitis/tennis elbow
MUSCLES INVOLVED
chronic tendinosis of extensor carpi radialis brevis
94
In considering the elbow, what history and exam findings are consistent with Medial condylitis?
muscles invovled
"pitcher's/golfer's/Little league elbow"
HISTORY:
Repetitive wrist flexion like throwing
EXAM:
Tender lateral & distal to medial epicondyle
Wrist flexion against resistance increases pain.
MUSCLES INVOLVED:
Pain caused by tendinosis of pronator teres or flexor carpi radialis
95
In considering the elbow, what history and exam findings are consistent with Olecranon bursitis?
swelling and inflammation up to 6cm of olecranon bursa
HISTORY:
gout
trauma
RA
96
What is the pathology of articular structures?
What would you ask the patient inorder to assess?
#7
"Ask about movements & ADLs"
"any pinching?"
```
swelling
tenderness
crepitus
instability
locking
deformity
ROM-passive and active limited d/t stiffness/blockage/pain
```
97
What is the pathology of extra-articular structures?
"point or focal tenderness in regions adjacent to articular structures"
Limits ACTIVE ROM only
98
What are the articular structures?
```
joint capsule
articular cartilage
synovium & fluid
intraarticular ligaments
juxtaarticular bone
```
99
What are the extra-articular structures?
```
ligaments
tendons
bursae
muscle
nonarticular bone
nerves
overlying skin
```
100
What symptoms are consistent with carpal tunnel syndrome?
Decreased sensation in median nerve territory
Nocturnal arm/hand numbness
Aching wrist/forearm of 1st 3 digits
101
What tests can use to assess for carpel tunnel syndrome?
Tinel
Phalen
Thumb Abduction and opposition
102
Tinel Sign
Tests carpal tunnel
repeatedly tap over medial nerve
+test= shooting pain/ache/numbness = carpal tunnel
103
Phalen sign
Tests carpal tunnel
Wrists in full flexion & juxtaposing dorsum of each hand against each other for 60 seconds
104
What is snuffbox tenderness? What does this indicate?
how to assess
DESCRIBE:
Tenderness w/ wrist in ulnar deviation
Pain at scaphoid tubercle
INDICATES:
poor blood supply = possible scaphoid bone avascular necrosis
105
What are Dupuytren flexion contractures?
thickened palmar fascia overlying ring finger that puckers and a thickened cord develops causing flexion contracture
Effects 3-5th fingers
106
What are Stenosing tenosynovitis?
Trigger digits
painless nodule in a flexor tendon in the palm
With assistance, finger extends & flexes with an audible snap
107
Colles fracture?
Tenderness over distal radius after a fall on an outstretched hand
108
example of oglioarticular arthritis
infection from gonorrhea or rheumatic fever
109
How would the FNP perform the Barlow test and what does it indicate?
Pull the leg forward and adduct with posterior force
+ test= feeling head of femur slip out
laxity and potential displastable hip
not diagnostic and needs close follow up/US/specialist referral
110
What is concerning for developmental dysplasia of the hip?
limited abduction
111
How would the FNP perform the Ortolani test and what does it indicate?
Abduct both hips out simultaneously
+ test= clunk as femoral head enters acetabulum = developmental dysplasia
112
How would the FNP assess for leg shortening?
Galeazzi or Allis sign
Place feet with knees flex & sacrum flat on table
Assess for different knee heights
113
How would the FNP assess for tibial torsion?
Normal = inwardly or outwardly on longitudinal access like toeing in/out of foot and awkward gait
-resolves @ 2-3yrs after weight bearing
pathologic= also deformities of the feet or hips
114
What is a SCFE? In whom might this occur?
Slipped capital femoral epiphysis (SCFE)
occurs in teens and preteens that are still growing
Ball of femoral head slips off backward
115
What exam techniques can you use to assess for a minor effusion?
Bulge Sign
Extend knee
L Hand above knee & apply pressure on suprapatellar recess to milk fluid downward
+ test= bulge on medial side between patella and femur
116
What exam techniques to assess major effusion?
Balloon Sign
-Thumb & index finger on R hand with each side of patella
-Palpate for "ballooning" into the spaces next to patella under the right thumb and index finger
+ test= palpable fluid wave returning into sprapatellar recess, present in Knee Fractures
Balloting of the patella
-Compress suprapatella pouch
-watch for fluid returning to pouch.
+ test = palpable wave or click (false positives)
117
How would the FNP perform the following tests and what do positive results indicate?
McMurray
ASSESS:
medial meniscus and lateral meniscus
Supine, knee flexed
externally or internally rotate tibia
+ test = click/pop along joint line = tear
118
How would the FNP perform the following tests and what do positive results indicate?
abduction (or Valgus) stress
ASSESS:
Medial Collateral Ligament (MCL)
Supine, legs extended
Stabilize femur & pull leg laterally
+test = gap/pain in medial joint line = MCL injury
119
How would the FNP perform the following tests and what do positive results indicate?
Adduction (or Varus) Stress test
ASSESS:
Lateral Collateral Ligament (LCL)
Supine, legs extended
Stabilize medial femur
Lateral rotation and passive adduction
+test= pain/gap in LCL = injury
120
What are symptoms and exam findings consistent with prepatellar bursitis?
CAUSE:
excessive kneeling (plumber, gardners etc.)
RA
S/S
pain with activity
rapid welling
tender
121
What are some spine abnormalities the FNP should assess for during infancy
Meningomyeloceles
Spina Bifida Occulta (vertebral defect)
Spina Bifida ( Brith marks, tufts)
Neurofibromatosis (cafe au lait)
122
How would the FNP assess for scoliosis? What findings would be indicative of scoliosis?
Adams forward bend test
