Night before/morning of Flashcards
UL Exam
TPR SC
Tone, Power, Reflexes, Sensation, Coordination
Inspection SWIFT (Scars, Wasting, Involuntary movements, Fasciculations, tremor)
Pronator Drift & Rebound phenomenon
Tone = Fully relax, test tone of wrist, elbow, shoulder. test spasticity vs rigidity. test for hand clonus
Power = Shoulder Abduction, Adduction
Elbow Flexion, Extension
Wrist flexion, extension
Finger flexion/power grip. Abduction. Adduction, hold paper between finger.
Thumb Abduction
Reflexes - Biceps (C5/6), Triceps (C7/8), Brachioradialis (C6)
Sensation - test on sternum then distal to proximal - proximal to distal. Do with light touch, pinprick, vibration.
Proprioception (up and down finger)
Coordination - Finger to nose. Dysdiadochokinesia
LL Exam
TPR SC
Tone, Power, Reflexes, Sensation, Coordination
Inspection - Swift (Scar, wasting, involuntary movements, fasciculations, tremor)
Gait , Romberg’s
Tone (leg roll, leg lift with heel on bed, clonus)
Power (Isolate joint + one side at a time).
Hip Flexion, extension, abduction, adduction
Knee - flexion, extension
Ankle - Dorsiflexion, inversion, eversion, plantarflexion
Toe - Extension
Reflexes
Knee (L3/4)
Ankle (L5,S1)
Plantar (S1)
Sensation - Light touch, pinprick, vibration, proprioception
Coordination - Heel to shin, foot tap
CN Exam
I = Change in smell?
II = AFRO BC
Change in vision? Glasses/Contacts?
Acuity = How many fingers
Fields = Inattention, Fields
Reflexes = Direct, consensual, accommodation, swinging
Opthalmoscopy
Blind Spot
Colour Vision
III, IV, VI = H Test, Double Vision, Nystagmus
V = Motor (Temporalis/Masseter, Jaw Jerk, Corneal)
Sensory = Forehead, cheek, jaw)
VII - Eyebrows, Scrunch up eyes, puff out cheeks, smile. Change in taste?
VIII - Change in Hearing? Number in ear. Weber/Rinne’s, Audiometry
IX, X - Ahh, Red lorry yellow lorry, baby hippopotamous, cough, gag reflex
XI- Shrug shoulders, turn head
XII - Tongue out
MMSE
Age
DOB
Time
Place
Remember Address
Identify 2 people
20-1 backwards
WW2 dates
Current Monarch
Recall Address
Hand exam
Intro
Inspection
Feel - temperature, radial/ulnar pulse,
Palms up - thenar/hypothenar bulk, palmar thickening,
Palms down - Radial Nerve (first dorsal webspace), bimanual joint palpation, snuffbox
Wrist palpation
Elbow - elbow palpation along ulnar
Active movement - Splay fingers
Make fist
Palms together and extend wrists
Back of hands together and flex wrists
Passive movement
Motor ->
Wrist/finger extension
Index finger abduction
Thumb abduction
Squeeze fingers, squeeze finger between thumb and index finger
Pick up coin
Tinel’s (Tap over the carpal tunnel)
Phalen’s (Hold wrist in maximum forced flexion for 60s, sx?)
Finkelstein’s
Paper Test
How would you perform a knee exam?
Intro - Waist down, 45 degree bed
Inspection - Standing
Gait
Inspection - supine
Measure - Quads circumference 20cm above tibial tuberosity (Disuse atrophy, OA/Ligament damage)
Feel -
Straight leg - Quads, Quads tendon, patella
Flexed 90 - Patella Tendon, Tibial Tuberosity, Medial Joint Lines, Popilteal Fossa, Lateral Joint Lines
Patellar tap/sweep test (M->L)
Move
Straight Leg raise
Active flexion, Hip flexed
Active extension
Passive flexion for creps
Posterior Sag
Anterior Drawer
Posterior Draw (then offer Lachmann’s)
Stress Test (fingers into popliteal fossa, fingers on joint line, flex knee to 15 to relax capsule, feel for joint opening/solid endpoint)
Varus = LCL
Valgus = MCL
Offer McMurray’s Test - Flex knee, Externally rotate Foot. FIngers on medial joint line. Extend slowly to feel for click/pain. Knee locking = meniscal tear
Offer patellar apprehension test
How would you perform a hip exam?
Intro, Waist down flat bed
Inspect
Gait, Trendelenburg’s test
Feel (Temperature, pulses,greater trochanter, leg length (true and apparent - Xiphisternum to medial malleolus then asis to medial malleolus ))
Galeazzi Test = Flex knees, see if level
Feel ASIS to Iliac Crest to Pubic Rami
GT Tenderness = Trochanteric Bursitis
Move
Straight Leg raise
Active Flexion = Knees to chest
Passive Flexion with hand over greater trochanter
IR + ER with knee at 90
Abduction and Adduction with hand on contralateral hip to prevent pelvic tilt
Offer Hip extension with patient prone
Special - Thomas’
Ask about hip replacement - don’t do if yes
Hand under lumbar spine
Active flexion of both hips, hold
Extend one knee down at a time, look for fixed flexion deformity
How would you present a hip exam?
Today I performed a hip examination on Mr/s ____, a ____ fe/male.
From the end of the bed they appeared calm and comfortable at rest. There was no external paraphernalia indicative of musculoskeletal disease.
On inspection there was no scars, swelling wasting or deformities, gait was normal and leg lengths were equal.
There was no pain, effusion or differences in temperature on palpation. There was normal ROM throughout and no associated crepitus.
Trendelenburg and Thomas’ test were negative.
In summary this is a normal hip examination.
Significant negatives: pain, signs of OA, NOF
How would you perform a hand exam?
Intro - below elbows, hands on pillow
Inspect - Pt, hands, elbows, ears (psoriasis, ra nodule, gouti tophi)
Feel - Temperature
Radial Pulse, CRT
Wrist Joint, Carpal Bones, Metacarpals, All joints, Squeeze snuffbox
Palms for tendons and muscle bulk
Sensation - Median, ulnar, radial on dorsal side
Move -
Wrist Extension (Prayer)
Wrist flexion (Reverse Prayer)
Passive wrist for crepitus
Finger flexion (Make a wrist)
Finger Extension (Stabilise Wrist)
Power -
Finger extension (Radial, C7)
Finger Abduction (Ulnar, T1)
Thumb Abduction (Median, T1)
Function -
Power Grip
Pincer Grip
Pick up coin
Write name
Undo a button
Tinel’s - Extend wrist, tap at carpal tunnel
Phalen’s - Reverse prayer for 60s
Froment’s - Hold paper for ulnar palsy, +ve = flexion of thumb IPJ
Finkelstein’s - Hold thumb, ulnar deviate for 60s. Dequervain’s syndrome
How would you perform a shoulder exam?
Intro - Waist up, edge of bed
Inspect
Feel - SCJ, clavicle, ACJ, acromion, humeral head, greater tuberosity, long head of biceps, spine of scapula. Associated muscle mulk
Move
Active flexion
Active Extension
Passive Flexion/Extension (Press one hand on shoulder)
Ab/Adduction
ER (Hands behind head)
IR (Reach to shoulder plades
Special = I SITS
Impingement = Kennedy Hawkins
Supraspinatus = Jobe’s Empty Can Test
Infrapsinatus = External rotation with elbow flexed 90 degrees at side
Teres Minor
Subscapularis = Belly Press
Winging of scapula
ACJ Scarf Test
Offer apprehension test
How would you examine the spine?
Intro - Waist up
Inspect
Gait
Feel spinous processed, muscle bulk and sacroiliac joints
Move - Cervical Spine touch chin, look at ceiling, look left and right, ear to shoulder)
Lumbar - Touch toes, tilt back, run hand down leg, Schober’s test
Thoracic spine - sit down, cross arms, twist
Sciatic/Femoral stretch test (lying on back and front respectively)
How would you examine the foot/ankle?
Intro - Knee downwards, standing
Inspect
Gait -> tiptoes, heels
Inspect (sat)
Feel (all joints and bones, squeeze mtp, feel for temp and pulses)
Move -
Dorsiflexion
Plantarflexion
Inversion
Eversion
Toe flexion
Toe extension
Passive - Ankle dorsi/plantarflexion
Inversion/Eversion
Ad/Abduction
Symond’s Test (Squeeze calf, foot should plantarflex)
How would you examine the elbow?
Intro - Arms bare and on pillow
Inspect
Feel - temperature, radial head/capitellum, olecranon, medial epicondyle , Biceps tendon
Move - Active Flexion, extension
Passive flexion and extension and crepitus
Pronation and supination with elbows at side at 90
How would you undertake GALS screening?
Any stiffness?
Any difficulty dressing?
Any problem with stairs?
Inspection in anatomical position, turn 90 degree increments
Gait
Arms -
hand behind head, point elbows to side
Hands held out in front with palms facing down
hands held in front with palms up
Make a fist
Grip strength
Ask the patient to touch each finger in turn to their thumb
Squeeze MCP joints
Legs -
Passive Knee flexion, extension
Hip internal rotation
MTP squeeze
Patellar tap
Spine -
Cervical lateral flexion (touch ear to shoulder)
Lumbar flexion (shobers) touch toes with fingers 5-10cm apart on back
TMJ joint, open mouth and put three fingers in mouth
Cardio Exam
Intro - Waist up, 45 degree
Inspection
Hands, CRT, Clubbing, Radial Pulse, Radio-Radial delay, Offer RF Delay, Collapsing pulse
Offer BP in both arms
Eyes, Mouth, Face
JVP, Listen to carotids and feel for pulse
Inspect Chest with arms up.
Feel for apex beat, thrills and heaves
Ascultate valves. Mitral manoeuvre, aortic manoeuvre
Percuss and auscultate lung bases
Sacral oedema
Peripheral oedema
