Final practical specialized exams Flashcards
hepatojugular reflex
- firm pressure to RUQ
- observe for JVD
auscultate leaning forward at cardiac base with diaphragm
- patient leans forward, exhales, holds breath in expiration
- listening for soft murmurs
- use firmer pressure
auscultate laying on side for cardiac apex with bell
- patient on left side (left lateral decubitus)
- listening for low-pitched murmurs, S3/ S4
- use lighter pressure
auscultate for bruits (CV and abd)
CV
- auscultate at carotid, aortic, renal, (verbalize iliac and femoral)
- if HTN or other relevant concerns
ABD
-renal and iliac arteries
palpate for pulses
-palpate carotid, brachial, aortic, femoral, poplitea, posterior tibialis, dorsalis pedis pulses
allen test
- occlude radial and ulnar arteries
- patient makes tight fist then opens hand
- release ulnar artery and check blood flow
- checking for: ulnar artery patency
homan sign
- dorsiflex patients food and assess for pain
- positive = pain in calf (DVT)
fluid wave
- ulnar aspect of hand on mid-abdomen
- tap one side of abdomen and feel for transmitted impulse on other side
- testing for: ascites
rebound tenderness
- more tender with pushing in or letting go quickly
- testing for: peritoneal signs (ex. intraperitoneal infection)
psoas sign
- patient supine, hand against R knee
- ask patient to flex right hip against resistance
- postitive= RLQ pain
- testing for: peritoneal signs (ex. intraperitoneal infection)
obturator sign
- patient supine, flex hip and knee, internal rotation at hip
- positive= RLQ pain
- testing for: peritoneal signs (ex. intraperitoneal infection)
rovsing sign
- press deeply in LLQ
- positive= referred pain to RLQ
- testing for: peritoneal signs (ex. intraperitoneal infection)
murphy sign
- fingers of R hand under R costal margin and apply pressure while having patient take deep breath
- positive= pain in RUQ during inspiration
- testing for: hepatic or GB inflammation
costovertebral angle tenderness (CVA)
-one hand over CBA and other fist for gentle percussion bilaterally
measure for pitting edema
- press firmly with thumb 2+ seconds over dorsum of feet and over shins
- compare bilaterally assessing for pitting
straight leg raising test (passive)
- patient supine and leg straight
- raise 1 leg off table and note angle to which it can be raised before patient complains of back or leg pain
- dorsiflex if pain not elicited
flip back
-similar to straight leg raise but patient seated and extending at knee
stability of pelvis
- patient supine
- hands to lateral pelvis and push toward table
FABER
- hip at 45 deg. of flexion with knee at 90 deg.
- externally rotate and abduct hip while placing ankle above knee of contralateral leg
FADIR
-place hip into full flexion then internally rotate and adduct
bulge sign
- slide one hand down distal anterior thigh (displacing fluid from prepatellar bursa into joint space)
- sweep along medial and lateral knee to observe for fluid bulge
ballottement sign
- slide one hand down distal anterior thigh (displacing fluid from prepatellar bursa into joint space)
- press patella directly toward knee joint
valgus stress test
- stabilize lateral knee and apply lateral pressure to ankle/ foot
- tests MCL
varus stress test
- stabilize medial knee apply medial pressure to ankle/ foot
- tests LCL
anterior drawer sign @ knee
- patient supine, knee bent at 90 deg., stabilize foot
- pull proximal tib/fib toward you
- checking for: ligament laxity of ACL
posterior drawer sign
- patient supine, knee bent at 90 deg., stabilize foot
- push proximal tib/fib toward patient
- checking for: ligament laxity of PCL
mcmurray test
- flex patient knee
- with one hand, palpate joint line, hold heel of foot in other hand with ball of foot on wrist
- lateral rotation of foot followed by extension of leg tests posterior horn of medial meniscus (for tear)
- medial rotation with extension tests posterior horn of lateral meniscus (for tear)
- positive= palpable click at knee joint
apley distraction test
- patient prone with knee flexed to 90 deg.
- stabilize posterior thigh with hand or knee
- distract at ankle, while internally and externally rotating the foot
- observing for: increased motion/ laxity = collateral ligament injury
compression grind test
- pressure on heel, while internally and externally rotating foot
- providing compression of tibia against femur while stressing meniscus
- positive= pain/ clicking = possible meniscal pathology (positive in ER = medial meniscus or positive in IR = lateral meniscus)
lachman test
- knee in 20-30 deg. flexion
- grasp distal femur with one hand and upper tibia with other
- move femur back and tibia forward and estimate degree of forward excursion
pivot test
- flex hip to 20 to 30 deg., knee extended
- proximal hand applying anterior pressure of tibia and fibula, distal hand placing lower leg in internal rotation while flexing knee
thompson test
- patient kneel on stool with knee bent at 90 deg.
- squeeze calf and look for plantar flexion of foot
anterior drawer sign @ ankle
- stabilize distal tibia; grasp posterior calcaneus and pull forward
- checking for: ligamentous laxity
rapid alternating movements
-pt to rapidly pronate and supine their hand, tapping their distal thigh
vibration (tuning fork)
-place vibrating tuning fork on bony prominence
proprioception (position of joints)
- gently hold finger laterally and medially, and move it up or down
- ask pt. to describe the direction it is moving
stereognosis
-ask pt to identify objects placed in his hand
2-point discrimination
-use 2 ends of paper clip or two wooden ends of Q-tip to determine whether pt detects one or two items
extinction (double simultaneous stimulation)
- pt’s eyes closed; touch pt in same place on both sides of body
- ask whether pt detects one or two touches
graphesthesia
-write letter or number in palm of pt’s hand; identify it
ankle clonus reflex
-forcefully dorsiflex pt’s foot to see if it “beats” >2 times
abdominal reflex
- use Q-tip
- gently stroke toward the umbilicus in all 4 quadrants
- observe for abdominal wall muscular contractions toward stimulus
kernig’s sign
- flex pt’s leg at hip and knee, then straighten leg
- positive= back pain/ resistance to straightening
- if finding is bilateral it suggests meningeal irritation
- checking for: signs of meningeal irritation/inflammation
brudzinski’s sign
- pt supine; flex pt’s neck
- positive= hip & knee flexion occurs
- checking for: signs of meningeal irritation/inflammation
nuchal rigidity
- test for ease of neck flexion, extension, & rotation
- checking for: signs of meningeal irritation/inflammation
