Final demonstration testing Flashcards
Demonstrate EOM testing
6 cardinal fields are tested
What does EOM testing test for?
Nystagmus and CN 3,4,6
Describe nystagmus
motion of the eyes during EOMs related to the function of the vestibular brach of the acoustic nerve
What sinuses can you transilluminate?
maxillary and frontal
What do you look for when you transilluminate the sinuses?
symmetrical red glow
What does transillumination of the sinuses help diagnose?
sinusitus
How would you test the trigeminal nerve?
motor: clench teeth; sensory; forehead and cheek or corneal reflex
Demonstrate a thyroid exam
anterior or posterior position with swallow as well as visual inspection
What should the thyroid feel like?
smooth, passing fingers with swallow, no lumps
If thyroid exam is abnormal, what other testing could you do?
TSH, ultrasound
Where do you palpate the anterior cervical and submental lymph nodes?
anterior sternocleidomastoid and anterior jaw/chin
What does swollen lymph nodes indicate?
inflammation or infection
What findings regarding lymph nodes is of most concern?
painless, hard, immobile
HOw do you test for TMJ?
palpation of the jaw with opening and closing mouth
What constitutes a positive test for TMJ?
clicking, locking, crepitus
What symptoms can TMJ cause?
Ear pain, often worse in the morning
Demonstrate auscultation of the heart
Five positions in proper order: aortic, pulmonic, 2nd pulmonic, tricuspid, mitral
When might you check heart tones in the left lateral position?
When extra heart sounds are heard
When are you most likely to hear a normal split S2?
During inspiration
Demonstrate bronchophony
patient is to verbalize when auscultating lung fields: include anterior and posterior auscultation of upper and lower lungs
Auscultate for aortic aneurysm
2 inches above the umbilicus, midline with the bell
What do you listen for when auscultating for aortic aneurysm?
bruit, turbulence, whooshing sound
What other physical findings might a person with AAA have?
unequal pulses in the lower extremities
Demonstrate Murphy’s sign
patient asked to take a breath during palpation of RUQ
What is a positive Murphy’s sign?
patient halts breath, pain elicited
What does a positive Murphy’s sign mean?
cholecystitis
What does increased bronchophony mean?
consolidation
What is it called when the whispered voice is auscultated?
Whispered petoriloquy
Demonstrate Rosvig sign
palpate deeply in left side of abdomen
What is a positive Rosvig sign?
patient complains of pain on right side
What does positive Murphy’s sign mean?
appendicitis or perotinitis
Demonstrate CVA tenderness
percuss with fist on flat hand or directly on flank
What is a positive CVA tenderness test?
patient complains of tenderness
What does a positive CVA tenderness test mean? mean?
pyelonephritis or kidney stone
Demonstrate forward flexion of the shoulder and hyperextension.
Domonstrate passively or actively raising arm forward
What is the ROM for shoulder forward flexion?
180 degrees
What should be amount of ROM for shoulder hyperextension?
50 degrees
What do you use to measure range of motion?
goniometer
Demonstrate Phalen’s test
wrists flexed with backs of hands together
How long should a patient perform the Phalen test?
1 minute
What is a positive Phalen test?
numbness and tingling of hands and fingers
What does a positive Phalen test mean?
carpal tunnel
Demonstrate empty can test
Shoulder flexed 90 degrees, 30 degree abduction, with thumb down, exert downward pressure
What is a positive empty can test?
pain in shoulder
What does a positive empty can test indicate?
rotator cuff inflammation or tear (supraspinatus)
Demonstrate McMurray’s test
patient supine, knee flexed, external rotation with extension and internal rotation with extension
What is a positive McMurray’s test?
palpable or audible clicking, pain, or locking
What does a positive McMurray’s test mean?
meniscus tear
Demonstrate the anterior and posterior drawer test for the knee
Flex knee 45 to 90 degrees and anchor with foot flat on table, exert anterior and posterior pressure to the tibia
What are you looking for when doing anterior posterior drawer test for the knee?
Movement of the knee more than 5 mm
What could a positive anterior posterior drawer test mean?
movement anteriorly means anterior cruciate ligament injury, movement posteriorly means posterior cruciate ligament injury
Test movement and sensation for C5
Motor: test deep tendon reflex of bicep
Sensation: anterior shoulder
Which reflex would respond to test for movement of C5?
radial
How would you rate flexion of the bicep that brings the arm through full range of motion but no resistance?
3/5
Demonstrate movement and reflex for L-4
Have them extend knee against resistance, elicit patellar reflex
How would you rate a reflex that is less than expected?
1+
How would you rate strength in the quads that was able to extend knee fully and resist opposition partially?
4/5
Demonstrate the standard straight leg lift and the modified (sitting) straight leg lift
Have patient lay on back and raise leg to at least 60 degrees, have patient sit with back straight and straighten leg to 90 degrees
What is a positive straight leg test?
Pain radiating from buttock to knee
What does it mean if there is pain in the opposite buttock with the straight leg lift?
This is a more sensitive indication of nerve root impingement
Demonstrate biceps reflex
percuss with hammer the biceps tendon either directly or over finger
Demonstrate triceps reflex
percuss posterior elbow with arm flexed
How would you rate a response that wsa greater than expected but no clonis?
3+
What level of the spinal cord does the triceps reflex evaluate?
C 6-7-8
Demonstrate the Romberg test
have patient stand with feet close together and close eyes
What is a positive Romberg test?
inability to balance or swaying enough to fall (slight swaying is normal
What does a positive Romberg test mean?
cerebellar ataxia, vestibular dysfunction
Demonstrate Kernig’s sign
Flex knee and hip and then extend rapidly
What is a positive Kernig sign?
back pain and resistance to extension
What does a positive Kernig sign mean?
menningeal irritation
Demonstrate the cover/uncover test
Have patient focus on object, cover eye and watch uncovered eye for movement or adjustment, uncover and watch the uncovered eye for the same
What is a positive cover/uncover test?
movement or adjustment of the eyes
What does a positive cover/uncover test indicate?
strabismus
Demonstrate Thomas test
Patient supine with one leg extended and the other hip and the knee are flexed to 120 degrees
What is a positive Thomas test?
The extended leg raises off the table
What does a positive Thomas test mean?
hip flexion contracture of extended leg
Demonstrate Neer test
Internally rotate and forward flex shoulder to 180 degrees
What is a positive Neer test?
pain in shoulder beyond 150 degrees
What does a positive Neer test mean?
rotator cuff inflammation or tear
Demonstrate hip flexion (knee flexed and extended)
Patient supine, flexes hip with leg extended, then with knee bent
What is normal range of motion of the extended leg?
90 degrees
What is normal range of motion of the flexed knee?
120 degrees
Palpate the liver
Demonstrate deep palpation of RUQ with inspiration positioned either below ribs or crooked over costal margin
When palpating liver, what is considered normal?
Usually not palpable except the edge which should be smooth, firm, and non-tender
What would happen if the patient had cholecystitis with palpation of liver?
they would halt inspiration
Demonstrate forearm pronation and supination
Show from neutral position, rotate palm down and palm up (respectively)
What is expected ROM with forearm pronation and supination?
90 degrees for both
How would you test for lateral epicondylitis?
Supination against resistance
Demonstrate the Achilles reflex
Percuss Achilles tendon
What is the expected finding of Achilles reflex
plantar flexion
Rate reflex response correctly with explanation
0: absent; 1+: trace; 2+: normal; 3+: brisk; 4+: repetitive vibratory movement; 5+: sustained clonus
Demonstrate ankle anterior posterior drawer
With knee at 90 degrees flexion, grasp tibia and the back of the heel pulling forward on the heel
What is a positive ankle anterior posterior drawer?
Forward glide greater than on the opposite side
What does a positive ankle anterior posterior drawer mean?
damage to the talofibular ligament
Demonstrate shoulder internal and external rotation
demonstrate from neutral position with 90 degree abduction and elbow at 90 degrees
What is the expected ROM for internal and external rotation of the shoulder?
90 degrees with both
How might you prevent scapular winging with internal external rotation of the shoulder?
hold scapular area with your hand or perform test with patient supine
Test for anterior shoulder dislocation
Have patient lay on back and abduct shoulder to 90 degrees and externally rotate
What is a positive test for anterior shoulder dislocation
Patient apprehension or resistance to the maneuver
What is the name of the test for anterior shoulder dislocation?
Apprehension test
You suspect your patient has appendicitis. Demonstrate 2 tests you could do to check this
McBurney’s Point, Markle Heel Jar test, or Rosvig
What are positive tests for appendicitis?
McBurney’s- pain with palpation of RLQ, Markle- RLQ pain with heel jar, Rosvig- pain in RLQ with deep palpation of LLQ
What diagnostic tests could you do to help confirm appendicitis?
CBC, CT scan of abdomen (or ultrasound but this is less sensitive)
Demonstrate testing of all knee ligaments
Demonstrate anterior/posterior drawer (flex knee at 90 degrees and push and pull on tib/fib looking for 5mm movement); or Lachman (leg at 20-30 degrees and push and pull on tib/fib looking for 5mm movement)
Demonstrate varus and valgus stress (put pressure on ankle and knee in opposite directions and check for laxity in either direction)
When performing knee ligament tests, what is a positive test?
increased laxity in either direction
What diagnostic test would you order to confirm a ligamental tear?
MRI
Demonstrate the procedure for an ophthalmic examination
Start at 70 degree angle to get red reflex and then move in closely to visualize fundus
With an ophthalmic examination, what might you see if the patient has a long standing uncontrolled hypertension?
AV nicking, copper wiring, cotton wool spots
What would macular degeneration look like?
yellow spots in the retina
Demonstrate a method for checking for lumbar nerve root impingement
may do straight leg lift with patient supine or sitting
What is a positive finding of lumbar nerve root impingement?
Pain radiating from buttock to knee at 60 degrees or radiating pain at 90 degrees with sitting
What is more sensitive for disc herniation than a positive test in the ipsilateral buttock and leg?
Pain in the opposite one
Demonstrate visualization of the TM
Pull back and up on pinna and observes the TM
What might you see if the patient has an ear infection?
Red dull bulging TM
What might you find if there is an effusion?
Air bubbles, air fluid levels, lack of TM mobility with insufflation
