PE

Question 1

Upper Extremities: shoulder

Answer 1

Palpate: clavicle, AC joint, sub-acromial bursa, coracoid process, deltoid muscle insertion
ROM: flexion/extension, abduction/adduction, internal/ext rotation
-Neer’s impingement, supraspinatus strength, elbow flexion, supination

Question 2

Upper extremities: elbow

Answer 2

• Palpate: medial/later epicondyles, radial head, olecranon process, olecranon bursa
• ROM: flexion, extension, pronation/supination
• Tinel’s test: ulnar compression
• Provocative tests for lateral epicondylitis:
  
  • grip test
  • forced wrist extension (motorcycle)

Question 3

Upper Extremities: hands/wrist

Answer 3

• palpate: radial & ulnar styloid processes, thumb abductor tendons, snuff box (scaphoid facture)
• ROM:
  
  • wrist: flexion/extension, radial & ulnar deviation
  • metacarpophalangeal flexion/extension
  • PIP, DIP flexion/extension
  • finger abduction/adduction
  • thumb: oppostion, flexion, extension, ab/adduction
• Assess for carpal tunnel syndrome (numbness, tingling)
  
  • Tinel’s sign
  • phalen’s sign
  • thenar muscle mass (atrophy: + sign)

Question 4

Neer’s impingement Test

Answer 4

pain= rotator cuff tear (teres minor, infraspinatus, supraspinatus, subscapularis)

hold scapula, passively move arm up

Question 5

Supraspinatus strength test

Answer 5

weakness= rotator cuff tear (teres minor, infraspinatus, supraspinatus, subscapularis)

pour soda can, V shape, rotate in, thumb down
Me: press down

Question 6

Elbow flexion

Answer 6

biceps muscle fxn, weakness=rotator cuff tear or bicipital tendonitis (inflammation of upper bicep tendon)

-elbows @ side, 90 degrees, lat push

Question 7

Supination test

Answer 7

• biceps muscle fxn, weakness=rotator cuff tear or bicipital tendonitis (inflammation of upper bicep tendon)
• elbows @ side, 90 degrees, pronate, try to supinate against resistance

Question 8

Tinel’s test (elbow)

Answer 8

• ulnar compression

- tap btwn med epicondyle & olecranon process

Question 9

Grip test

Answer 9

• for lateral epicondylitis (+: pain in lat condyle)

- pt squeezes 2 fingers

Question 10

Forced wrist extension

Answer 10

-for lateral epicondylitis (+: pain in lat condyle)

• hold elbow w/thumb on lat. epicondyle
• pt makes a fist & extends wrist against resistance

Question 11

Carpal tunnel Syndrome tests

Answer 11

1. Tinel’s sign: tap median n.
2. Phalen’s sign: back of hands together 1 min
3. sensation
4. thenar muscle mass: +: atrophy

Question 12

ACL/PCL tests

Answer 12

Drawer test: anterior & posterior

Lachman: ACL: one hand on femur other on tibia -> pull apart

Question 13

McMurray Test

Answer 13

meniscus integrity: +: clicking & popping

-baby foot: rotate in/out while flexing & hold knee joint

Question 14

Cardio Auscultation

Answer 14

-Diaphragm: Supine:
Aortic (R, 2nd), Pulmonic (L, 2nd), Tricuspid (L,4/5), Mitral (L, 5, mid clavicular)

-Bell, Supine: tricuspid, mitral
-Aortic murmurs:
diaphragm w/ patient seated, leaning forward, holding breath: tricuspid, mitral
-Mitral murmurs:
Bell, left lateral decubitus position, mitral

-carotid artery: bell (bruits)

Question 15

Cardio

Answer 15

1. BP, HR (50-90 beats/min)
2. Inspect/palpate chest, palpate PMI
3. Auscultate: diaphragm: A, P, T, M
4. Auscultate: bell: T, M
5. Pulses: radial, posterior tibial, dorsalis pedis
6. edema
   - —-
7. palpate: lifts, heaves, thrills
8. palpate for costochondral joint tenderness
   
   • differentiate btwn muscle & cardio pain
9. Auscultate Aortic murmur: diaphragm, pt leaning forward holding breath: T, M
10. Auscultate Mitral Murmur: bell, left lateral decubitus position: M
11. Pulses: carotid (ausculate 1st), brachial, femoral, popliteal

Question 16

Lower Extremities & Spine

Answer 16

1. Inspect
   Spine
2. check symmetry (forward bend) & palpate spinal processes
3. palpate: Si joints, sacrum, paravertebral muscles
4. Spine ROM + hip extension
5. Neck ROM
6. Deep tendon reflex: patellar & achilles
   7.