Examination Process Flashcards
Examination Process
-Hx
-observation
-Scanning exam
-ROM
-Muscle
-Joing
-Palpation
-Special Tests
SINSS
-severity
-irritability
-nature of complaint
-stage
-stability
Severity
-clinician assessment of intensity of symptoms in terms of function
Fracture: high
Sprain: low
Irritability
-ease with which symtoms can be provoked
1. Amount of activity needed to trigger s/s
2. Severity of s/s
3. What activity and amount of time for symptoms to subside
Nature of Complaint
Describe assessment of:
-structures, syndromes
-caution things
-character of problem
Stage of Pathology
-stage of injury
Stability
-progression of s/s over time
Pt Hx Red Flags
-trauma: Fx
-age >50: cancer, AAA, fx, infection
-Hx cancer
-fever,chills, sweats: infection, cancer
-unexplained weight loss: cancer
-infection
-immunosuppression
-rest/night pain: cancer, infection, AAA
-saddle anesthesia: cauda equina
-B/B dysfunction: cauda equina
-LE neuro deficit: cauda equina
Pain Referral: Heart
-Left side of chest, arm, jaw, neck
-middle of upper back
Pain Referral: Lungs
-neck and shoulders
Pain Referral: Esophagus
-front of chest
Pain Referral: Liver and Gallbladder
-front and back right side of back/abdomen
-front and back of right side of chest and neck
Pain Referral: Stomach
-middle of chest
-middle of back
Pain Referral: Pancreas
-anterior, middle abdomen
Pain Referral: Kidney
-hips and thighs
Pain Referral: Small Intestine
-anterior lower abdomen
Pain Referral: Appendix
-right, anterior, lower mid to low abdomen and pelvis
Pain Referral: Ovaries
-bilateral pelvic
Pain Referral: Colon
-anterior pelvis
Pain Referral: Bladder
-Anterior and posterior pelvis
-genital
-back of thighs
MSK Symptom Investigation
-pain that changes over 24h
-motions change pain
Non-MSK Symptom Investigation
-referral from organ systems
-pain doesn’t fluctuate with mmt
-insidious onset
-vague pain
-during eating or urinating
Unusual:
-throbbing, pounding, pulsating (vascular)
-shooting, burning, shocking (neuro)
-aching, squeezing, cramping (visceral)
Sequence of Symptom Questions
-what interferes most w/ normal function
-describe it
-behavior of s/s
-intensity
-s/s elsewhere
Low Back Red Flags
-Tumor
-Infection/Osteomyelitis
-Cauda Equina
-Fx
-Abdominal Aneurysm
Back Related Tumor Red Flags
Hx:
->50
-Hx Cancer
-unexplained weight loss
-failure of treatment
Exam:
-Constant Pain
-worse at night
Back Related Infection/Osteomyelitis Red Flags
Hx:
-infection/drug use
-immunosuppressed
Exam:
-deep constant pain
-fever, malaise, swelling
-spine rigidity
Cauda Equina Red Flags
Hx:
-spinal stenosis
-DDD
Exam:
-urinary retention
-fecal incontinence
-saddle anesthesia
-weakness of LE
-sensory issues
Spinal Fx Flags
Hx:
-trauma
-steroid use
->70
Exam:
-tender with palpation
-edema
Abdominal Aneurysm Flags
Hx:
-back, groin pain
-PVD or CAD
-s/s not related to movement
Exam:
-Abnormal width of aortic or iliac arterial pulses
-bruit
Pelvis, Hip, and Thigh Red Flags
-colon cancer
-femoral neck Fx
-Osteonecrosis
-Legg- Calve Perthes
-SCFE
Colon Cancer Red Flags
Hx:
->50
-Bowel Disturbances
-Hx cancer in immediate fam
-pain unchanged by position
Exam:
-hypo or hyperactive bowel
-tenderness in abdomen
-ascites
-metastases to liver,lung, brain, bone
Femoral Neck Fracture
Hx:
-older women
-hip, groin, thigh pain
-Hx of fall
Exam:
-severe, constant pain
-shortened LE
Osteonecrosis
Hx:
-corticosterioid
-Hx of osteonecrosis
-trauma
Exam:
-gradual onset
-stiff joint, restricted 1 deg IR or Flx
Legg-Calve-Perthes
Hx:
-5-8 yr old boys
-groin/thigh pain
Exam:
-antalgic gait
-pain worse with hip mmt (hip abd/IR)
Slipped Capital Femoral Epiphysis
Hx:
-overweight child
-Hx of growth spurt
Exam:
-aching in groin
-leg in ER
-ROM IR limitations
Knee, Leg, Ankle, Foot Red Flags
-PAD
-DVT
-Compartment Syndrome
-Septic Arthritis
-Cellulitis
Peripheral Arterial Occlusive Disease
Hx:
->60
-DM
-H of ischemic HD
-Smoking
-sedentary
-claudication
Exam:
-cool extremity
-prolonged capillary fill time
-decreased pulses
-prolonged vascular fill time
DVT
Hx:
-surgery
-trauma
-pregnancy
-immobilization
Exam:
-pain
-edema
-warmth/redness
-relieved by rest and elevation
Compartment Syndrome
Hx:
-blunt trauma
Exam:
-severe leg pain
-swelling/tenderness
-paresthesia, pallor, pulselessness
Septic Arthritis
Hx:
-recent infection
-surgery
-immunosuppressive
Exam:
-constant aching
-joint swelling
-warmth
-elevated body temp
Cellulitis
Hx:
-recent skin ulceration
-abrasion
-venous insufficiency
-Cirrosis
-CHF
Exam:
-pain
-skin swelling
-warmth
-irregular redness
-fever, chills, weakness
Thoracic Spine and Rib Cage Regions Red Flags
-MI
-Angina (stable and unstable)
-Pericarditis
-PE
-Pleurisy
-Pneumothorax
-Pneumonia
-Cholecystitis
-Peptic Ulcer
-Pyelonephritis
-Kidney stones
-Spinal Fx
Myocardial Infarction
Hx:
-risk factors for CAD
Exam:
-chest pain
-pallor, sweating, dyspnea
-not relieved by nitroglycerin
Unstable Angina
Hx:
-Hx CAD
Exam:
-outside of the predictable pattern
-not responsive to nitroglycerin
Stable Angina
Hx:
->65
-Hx CAD
Exam:
-predictable exertion
-predictably alleviated or w/rest or nitroglycerine
Pericarditis
Hx:
-autoimmune diseases
-MI
-Renal failure
-open heart surgery
-radiation
Exam:
-sharp feeling in chest that might be referred to neck or shoulder
-increased pain with sidelying
-releived by sitting forward
Pulmonary Embolism
Hx:
-risk factors
-immobility
-trauma
-cancer
Exam:
-chest, shoulder and upper abdominal pain
-dyspnea
-tachypnea
-tachycardia
Pleurisy
Hx:
-respiratory disorder
-infection
-pneumonia
-tumor
-TB
Exam:
-severe, sharp pain with inspiration
-dyspnea
-decreased chest wall excursion
Pneumothorax
Hx:
-coughing
-strenuous exercise
-trauma
Exam:
-chest pain with inspiration
-difficulty breathing
-hyperresonance
-decreased breath sounds
Pneumonia
Hx:
-infections
Exam:
-pleuritic pain
-fever, chills, HA, nausea
Cholecystitis
Hx:
-most common in middle age women
-WBC elevated
Exam:
-colicky pain in R upper abdomen
-worsen w/ ingestion of fatty foods
-s/s don’t increase with activity or decrease with rest
Peptic Ulcer
Hx:
-burning pain in epigastrium
-symp relieved by food
-infection
-stressors
Exam:
-tenderness at R epigastriumm
-constipation, bleeding, vom, tarry colored stools, coffee ground emesis
Pyelonephritis
-kidney infection
Hx:
-women
-UTI
-Kidney stones
Exam:
-fever, chills, malaise, flank pain
-enlarged prostate
-murphy’s sign
Nephrolithiasis
Hx:
-hot and humid climate
-Hx kidney stones
Exam:
-severe back or flank pain
-chills, fever, vom
-renal colic
-UTI symptoms
Spinal Fx
Hx:
-trauma
-osteoporosis
-steroid
->70
-loss of function/mobility
Exam:
-midline tenderness
-T11-L1
-bruising
-LE neuro defects
-increased thoracic kyphosis
Head, Face and TMJ Regions Red Flags
-meningitis
-brain tumor
-Subarachnoid hemorrhage
Meningitis
Hx:
-infection
-Skull fx
Exam:
-Positive slump sign
-HA
-Fever
-GI signs
-photophobia
-confusion
Primary Brain Tumor
Hx:
-20-64 yrs
Exam:
-HA
-altered mental status
-ataxia
-speech
-sensory issues
-GI signs
-Seizures
Subarachnoid hemorrhage
Hx:
-smoking, HTN
-sudden HA (worst of pt life)
Exam:
-LOC
-tumor signs
-rigidity, fever, photophobia, vom
Cervical Ligament Instability/Cord compromise
Hx:
-trauma
-RA or AS
-contraceptive
Exam:
-long tract neuro signs
-dizziness, nystagmus, vertigo
-clonus/Babinski
Cervical/Shoulder Entrapment/Neuropathies
Hx:
-Paresthesias
-pain at rest
-retrograde distribution
Exam:
-muscles tender to palpation
-muscle and sensory issues in specific nerve patterns
Spinal Accessory Nerve Issues
Hx:
-penetrating injury
-direct blow
-surgery around neck
Exam:
-asymmetry of neck line and dropping of shoulder
-inability to shrug
-lack of scapular stabilization
-weakness of shoulder abduction
Axillary Nerve Issues
Hx:
-shoulder dislocation
-traction force
-trauma
-brachial neuritis
Exam:
-weakness of shoulder abduction and flx
-lack of later sensation of arm
Long Thoracic Nerve Issues
Hx:
-sport playing that involves arms
Exam:
-serratus anterior weakness w/ scapular winging
-loss of scapulohumeral rhythm
Suprascapular Nerve Issue
Hx:
-deep, poorly localized pain
-fx of scap
-traction MOI
-direct compression
Exam:
-similar to RC tear w/ wasting of supra and infra
-loss of strength in shoulder abd and ER
Pancoast’s Tumor (apical lung tumor)
Hx:
-men >50
-smoking
Exam:
-nagging type pain in shoulder
-burning pain
-ulnar nerve distribution
Elbow, Wrist, and Hand Red Flags
-fx
-radial head fx
-Distal radius fx
-Scaphoid fx
-Lunate fx/dislocation
-TFCC tear
-Space infection of hand
-Long Flexor Tendon rupture
-Raynaud’s Disease
-Complex Regional Pain Syndrome
Fx’s
Hx:
-trauma
-osteoporosis
-steroids
Exam:
-signs of inflammation
Radial Head Fx
Hx:
-FOOSH
Exam:
-antero lateral pain at elbow
-cant supinate or pronate
-elbow held at side at 70 flx, slightly sup
Distal Radius (Colles’) Fx
Hx:
-FOOSH with extension
->40y
-osteoporosis
Exam:
-wrist in neutral
-swelling
-extension of wrist is painful
Scaphoid Fx
Hx:
-FOOSH
Exam:
-swelling
-held in neurtral
-pain in snuffbox
Lunate Fx/Dislocation
Hx:
-FOOSH
-diffuse synovitis
Exam:
-wrist swelling and pain
-decreased motion and grip strength
Triangular Fibrocartilaginous Complex tear
Hx:
-fall after FOOSH pronated
-ass with colles’ fx
Exam:
-ulnar side wrist pain
-tenderness and clicking during ulnar dev
-weak grip strength
-dorsal ulnar head sublux
Space infection of hand
Hx:
-skin puncture
-bite
-abscess
-tenosynovitis
Exam:
-inflammation in palm
-infection
Long Flexor Tendon Rupture
Hx:
-RA
-corticosteroid
-trauma
Exam:
-strain s/s
-inflammation
-decreased motion
-defect
Raynaud’s Phenomenon
Hx:
-RA
-oocclusive vascular disease
-smoking
-beta blockers
Exam:
-hands or feet that blanch or cyanotic then turn red
-pain and tingling
Complex Regional Pain Syndrome
Hx:
-trauma
-pain that does not respond to analgesics
Exam:
-pain not consistent with typical injury
-hypersensitivity
-swollen area
