OSCE for Abd, C spine, L spine Flashcards
what is the joint between vertebral articular processes?
zygapophyseal joint “facet”
what does an increased jugular venous pressure indicate?
right sided heart failure
what does a non midline trachea indicate?
tension pneumothorax
what can be observed doing thyroid palpation?
goiter, tenderness
what does a positive c spine compression/spurlings maneuver test indicate?
central neuropathy
what does a neck distraction test indicated?
central neuropathy
what does a positive valsalva test indicate?
+ is when sx are reproduced with valsalva
indicates space occypying lesion in cervical canal
what is a positive Roos/east test and what does it indicate?
+ reproduction of sx
thoracic outlet due to subclavian compresion
what does a positive adson test indicate?
+ loss or change in pulse
when looking away=thoracic outlet due to scalenes
when looking towards=thoracic outlet due to 1st rib
what does wrights hyperabduction test indicate?
+ loss or change in pulse
indicates thoracic outlet syndrome via pec minor
what does a costoclavicular/halstead test indicate?
+ loss or change in pulse
thoracic outlet due to 1st rib
what does a kerning sign (nuchal rigidity) indicate?
+neck stiffness
indicates meningitis
what does a brudzinski sign indicate?
+flexion in both hips and knees
indicates meningitis
what does a kernig sign indicate?
+ increased resistance to hip flexion and pain behind knee
indicates dural irritation
what is a jefferson fracture? cuase?
C1 compression fracture
head on hit like football
what is a wedge fracture?
flexion and compression injury of c spine
what is a dens fracture?
C2 odontoid process fracture needs surgury
what is a hangmans fracture?
hyperextension C2 bilateral arch fracture
spinous process fracture?
hyperextension or avulsion force from muscle contraction
what is clay shovelers fracture?
C6 or C7 fracture
whaat is a teardrop fracture?
flexion/compression injury –> anterior/inferior teardrop fragment
what is a burst fracture?
idk
what causes anterior subluxation?
facet dislocation without fracture
what is the order of an abdominal exam?
inspect, auscultate, percuss, palpate
what is cullens sign?
eccymosis around the umbilicus indicating hemmorhage
what is grey turners sign?
flank ecchymosis secondary to hemmorhage
what are normal bowel sounds? abnormal?
5-34 clicks,
high pitched, decreased, absent
what sound do you want to hear upon percussion of the abdomen? when will you hear dullness?
tympani
over the liver and spleen
where do you percuss the liver?
6-12 cm down at the mid clavicular line on the right
where do you percuss the spleen?
ribs 6-10, mid axillary line on left
how do you want to palpate the abdomen?
light 1cm then moderate 2-3cm then deep 3 cm. all in all 4 quadrants
what is rebound tenderness? what does it indicate?
pain upon removal of pressure rather than the application of pressure
peritonitis
where is mcburneys point and what does tenderness here indicate?
1/3 distance between ASIS and umbilicis
+pain indicates appendicitis
what does rosvigs sign indicate?
appendicitis
what does a positive iliopsoas test indicate?
indicates irritation of the psoas muscle from the appendix
what does a positive obturator test indicate?
irritation of the obturator muscle from the appendix
what does a positive heel strike indicate?
appendicitis or peritonitis
how do you palpate the liver?
palpate liver edge during patient inhalation
what does a positive murpheys sign indicate?
cholecystitis or cholelithiasis
what is courvoisiers sign and what does it indicate?
enlarged non tender gallbladder, indicates pancreatic disease/cancer
what does a positive lloyds punch indicate?
infection around kidney, pyelonephritis, kidney stone
how do you palpate the aorta?
just above umbilicus, slightly left of midline, should be less than 3cm
where do lumbar roots exit the vertebra?
below whatever one theyre named for
where does the spinal cord end?
L1-L3ish
where does the cauda equina begin?
L2-L3
what do you want to look for when observing a low back pain complaint?
slumped over, erect, assymetry, lordosis, gait changes
what could a slumped over stance indicate?
depression, muscle spasm, reactive effort to relieve impinging lumbar nerves in intervertebral foramen
what could an erect stance indicate?
protecting herniated discs or effects of spinal stenosis
what could asymmetry indicate?
short leg, sacral base problem, scoliosis
what could gait changes indicate?
listing-disc herniation, muscle weakness
foot drop-fibular nerve injury
shuffling-parkinsons
what do you want to palpate when examining the low back? and what are you looking for at each landmark
spinous processes (step offs, fracture, dislocation, arthritis)
SI joint- sacroiliitis, ankylosing spondylitis
paravertebral muscles-MSK a normalities, strain, overuse, SD
palpate area over symptoms-herniated disc may produce tenderness pretty much anywhere near it
palpate for sciatic nerve tenderness-could indicate herniated disc or mass lesion
palpate the skin
what does the straight leg test tell you? (lasegue test)
+ test is worsening radicular pain at 30-60 degrees
indicates lumbosacral radiculopathy (usually from herniated disc)
+ at >70 is more likely mechanical issue
>15 could be IT band
what are other signs or symptoms of radiculopathy?
muscle weakness and dermatomal sensory loss
where do most disc herniations occur?
L5-S1
what does the cross straight leg test tell you?
+ pain in the contralateral leg
indicates lumbosacral radiculopathy
what does a positive hoovers sign indicate?
+ no downward force of unaffected leg when they “attempt” to life the affected leg
indicates malingering
what does a postive thomas test indicate?
iliopsoas contracture, causes a lot of LBP
what does the gaenlen test indicate?
+ pelvic pain
SI joint dysfunction
what can a valsalva test indicate?
+ reproduction of sciatic symptoms
indicates sciatica
what can a stork test indicate?
+ low back pain
indicates pars defect/stress fracture
what are symptoms of cauda equina syndrome? is this emergent?
yes its emergent
low back pain, bowel/bladder dysfunction, sensory loss of perineum, bilateral sciatica
what is spina bifida?
split in vertebrae with no spinal protrusion
what is a meningocele?
meninges forced out between vertebrae
what is a myelomeningocele?
spinal cord protrudes through opening
what is fergusons angle? what is normal?
the angle between the planes of the most fucked up vertebrae in scoliosis i guess
30-40 degrees
what is spondylosis?
degenerative change in vertebrae, osteoarthritis pretty much
what is spondylolysis?
scotty dog pars interarticularis fracture of vertebrae
what is spondylolisthesis?
anterior displacement of vertebrae
