Labs Flashcards
What is the order of examination for the abdomen?
- inspection
- Ascultation
- Percussion
- Palpation
White or silvery lines on the abdomen are what? Are they concerning?
Rapid growth, not concerning
True or false: bulging at the umbilicus in an infant is a sign of umbilical hernia due to abdominal muscles failing to close, and is always concerning
False-usually will resolve on its own. otherwise true
What is borborygmi?
growling stomach sounds
What is a normal liver size?
6-12 cm
Guarding and rigidity. Which is voluntary and which is not?
Guarding = voluntary
Rigidity is not
Which side do you have to stand on when assessing the abdomen?
Right side for some reason
True or false: a normal sized spleen is not palpable
True
What is the obturator test?
Flex at the hip. Rotate pt. If there is pain, may be appendicitis
What is the Iliopsoais test?
Pt flexes hip against resistance. If there is pain, may be appendicitis
What is the heel jar test?
Having the pt stand on their heels, then dropping to floor. If there is pain, may be appendicitis
What is Rovsing’s sign?
RLQ pain is increased when palpating the LLQ. May be appendicitis
What is Kehr’s sign?
Abdominal pain radiation to the left shoulder. May be sleen issue
What is shifting dullness?
Assessing tympany and dullness supine, then again on a side. If areas of sounds change, could be ascites
What is Aaron’s sign?
Pain or distress in the area of the pts heart or stomach on palpation of Mcburney’s point. May be appendicitis
What is Ballance?
Fixed dullness to percussion in the left flank and dullness in the right flank that disappears on change of position
Indicates peritoneal irritation
What is Blumberg’s sign?
Rebound TTP. May be Peritoneal irritation or appy
What is the dance sign?
Absence of bowel sounds in the RLQ
May be Intussusception
What is Romberg-Howship’s sign?
Pain down the medial aspect of the thigh to the knees
May be strangulated obturator hernia
What is the Vaginal Introitus?
the vaginal opening
What are the Skene glands?
(paraurethral/lesser vestibular) glands - Situated just below the inferior opening of the
urethral meatus.
What is the ectocervix?
the vaginal surface of the cervix that is visible when using a
speculum
Lymph from the vulva and lower vagina drains where?
Into the inguinal nodes
Lymph from the internal genitalia and upper vagina drain where?
The pelvic and abdominal nodes
True or false: Asymmetric labia majora are normal
True
How do you differentiate between a caruncle (benign) and a carcinoma (malignant) of the urethra?
palpate the urethra through the
vagina feeling for thickening, nodularity, or tenderness. The inguinal
nodes should be palpated for masses as well.
What are the two ways of assessing muscle control of the perineum in women? What is an abnormal result?
a. Have the patient squeeze the vaginal opening around your finger.
b. Kegel contraction, or
contract her pelvic floor muscles as if she were trying to stop the flow of urine
during micturition.
Abnormal if she cannot contract for longer than 3 seconds
If the muscles of the perineum of a women are weak, what can this lead to? (2)
Pelvic/LBP
Urinary incontinence
How do you inspect the Skene gland?
Insert your index finger into the vagina up to the second joint
Exert an upward pressure and move the finger forward
How do you inspect the Bartholin gland?
Insert your index finger into the vagina near the posterior end of the introitus
Palpate the tissue between your finger and thumb
How do you ascess for a Cystolcele or a rectocele? (2)
Ask pt to bear down
Cystocele- a bulge is appreciated in the upper, anterior vaginal wall
Rectocele- a bulge is appreciated in the lower, posterior vaginal wall
What are the steps of a pelvic exam? (5)
- Lube
- Apply downward pressure with hand
- Insert speculum above finger
- Remove finger
- Do pelvic stuffs, then remove
What should be done with the speculum to keep the introitus relaxed?
assert a gentle downward pressure with the speculum
Along which wall should the speculum be inserted? Why?
Posterior to avoid pressure on the urethra
What is the size of a normal cervical os?
1-3 cm
White and curdy discharge = ?
Candidal vaginitis
Yellowish green or gray discharge = ?
Trichomonas
Gray or white thin discharge that is smell = ?
BV
When in the menstrual cycle should a women have a pap smear performed?
Anytime when she is not actually menstruating
What is a pap smear?
Using a brush during a pelvic exam to gather endothelial cells to diagnose cervical CA
What is the purpose of a bimanual exam? (2)
To check the position of the uterus and ovaries and for masses
What are the steps to performing a bimanual exam?
- Lube
- Insert 2nd and 3rd fingers using downforce
- Allow for relaxation
- Palpate
Cervical motion tenderness = ?
PID
How do you palpate a uterus? What five things should you assess for?
bimanual exam, use pressure on abdomen onto hand
- Position
- Size
- Mobility
- Tenderness
- Contour
What percent of patients can ovaries be felt in?
~50%
What is the term for a uterus that is tipped forward toward the front of the abdomen?
Anteverted
What is the term for a uterus tin which the body and fundus of the uterus flex forward at the cervix
Anteflexed
What is the term for a uterus that is tilted posteriorly?
Retroverted
What is the term used to describe when the body of the uterus is angled backward in relation to the cervix?
Retroverted
Thickening of the skin, particularly on the palms and soles may be a sign of what?
A systemic disorder, including exposure to arsenic or other
toxins.
How do you ascess for skin turgor?
Pinching skin and seeing how long it takes to retract back
True or false: normally, moles on a person have one color (per mole) and tend to look alike to other moles
True
When are moles concerning, relative to their shape?
Irregular borders or fading into surrounding skin
When are moles concerning, relative to their surface?
scaly, rough, irregular, or “pebbly” appearance
When are moles concerning, relative to their size?
If larger than 6mm
True or false: Typical adult has 10-40 moles scattered over the
body
True
Nail darkening can result from what? (4)
- Antimalarial drug therapy
- candida infection
- hyperbilirubinemia
- chronic trauma.
Green to black discoloration can indicate what?
Pseudomonas infection
A single blue or black nail can suggest what?
melanoma or trauma
Longitudinal red or brown streak in the nail beds can indicate what?
endocarditis or vasculitis
Rippling of a nail is from what?
Chronic paronychia or eczema
A “boggy” nail base is associated with what?
Clubbing
What is Onycholysis?
separation of the nail plate from the nail
bed
How do you assess for the nail bed angle?
Schamroth’s sign
Clubbing is present if nail base angle is what greater than or equal to what?
≥ 180˚
What is the serous membrane surrounding the testes?
Tunica vaginalis
Lymphatic drainage of the penile and scrotal surfaces goes where?
to the inguinal nodes
Lymph from the testes drains where?
into the abdomen
What is phimosis?
When the foreskin cannot be retracted
What is Balanitis?
inflammation of the glans in an uncircumcised patient
What is Hypospadia?
a congenital condition in which the meatus is located
more ventrally
What is Epispadias?
a congenital condition in which the meatus is located on
the dorsal surface of the penis
Asymmetry of the scrotum is a normal finding. Why?
Due to the left spermatic cord being longer than the right
When can the testes be considered completely descended? (hint, not a time, but the result of a test)
If testicle can be pushed into the scrotum
What does a thickened vas deferens indicate?
Chronic infection
A hydrocele results
from what?
the tunica vaginalis (an embryonic structure) not completely
closing during development
Feeling a presence on the side of the finger indicates what type of hernia?
Direct
Feeling a presence on tip of the finger indicates what type of hernia?
Indirect
When documenting rectal lesions, what is the 12 o’clock position?
Ventral midline
What are the initial steps of performing a rectal exam? (4)
- Lube
- have pt bear down
- When relaxation felt, slip in more
- Tighten sphincter
What are the steps of assessing the rectal walls?
Reach as far into the resctum as possible, and palpate walls
What are the four things that should be assessed when performing a rectal exam?
- Sphincter tone
- Palpate muscular ring
- Palpate anal walls
- Palpate prostate
What is the consistency of a prostates?
Like a pencil eraser
What are the symptoms of prostatic enlargement?
Nocturia
Urine dribble
Tries to void, but can’t
Small urine stream
(NUTS)
What is the order of assessment for the lower limb?
Inspection Palpation ROM Strength Special testing
Which comes first in the assessment, AROM or PROM?
AROM
How is muscle tone assessed?
By feeling resistance to stretch
What does a 0 mean on strength testing?
No movement
What does a 1 mean on strength testing?
Trace movement
What does a 2 mean on strength testing?
full motion, but not against gravity
What does a 3 mean on strength testing?
Full motion against gravity, but not against resistance
What does a 4 mean on strength testing?
Full motion against gravity and some resistance, but weak
What does a 5 mean on strength testing?
Full motion against gravity and resistance (normal)
Weakness with pain indicates that the weakness is (BLANK) in origin, whereas painless
weakness is suggestive of a (BLANK) problem.
Weakness with pain indicates that the weakness is MUSCULAR in origin, whereas painless weakness is suggestive of a NEUROLOGICAL problem.
genu valgum = ?
Knock knees
genu varum = ?
Bowlegs
What are the four motions of the leg assessed?
Flexion/extension
Internal/external rotation
What is the ballottement test? What is it used for?
Pushing down on the patella of an extended leg, looking for movement of fluid
tests for patellar effusion
What is the bulge sign? What is it used for?
Moving fluid in an extended leg down from the patella, then tapping on the medial side, looking for fluid movement
assesses for minor effusions of the knee
What is the McMurrary test? What is it used for?
Rotating the tibia of a flexed knee, applying valgus stress, then extend the knee maintaining force
evaluates for a torn meniscus in the knee on the
posterior side
What is Lachman’s test? What is it used for?
Same and posterior drawer, but with knee flexed 20 degrees.
Evaluates the PCL w/o compensation by hamstrings
What is Pivot shift test? What is it used for?
Applying valgus stress to a slightly flexed knee, then extending
Evaluates the ACL
The varus stress test evaluates instability of the (BLANK) collateral ligament, and the valgus stress test evaluates for (BLANK) collateral ligament
instability.
The varus stress test evaluates instability of the lateral collateral
ligament, and the valgus stress test evaluates for medial collateral ligament
instability.
What are the steps of the varus/valgus stress test?
For the varus test, apply a varus force against ankle and internal rotation, while pulling laterally at the ankle.
For the valgus test, apply a valgus force against ankle
and external rotation, while pulling laterally at the ankle.
What are the steps of the Apley compression test? What does it test for?
Moving ankle of a 90 degrees flexed knee
Tests for torn medial/lateral meniscus
What are the steps of the Apley distraction test? What does it test for?
Moving ankle of a 90 degrees flexed knee, with compression on the posterior thigh
This evaluates ligament injury
Nodules along the Achilles =?
RA
