physical exam final Flashcards
rheumatoid arthritis
bilateral joint pain, px in multiple joints, px worse in morning, px decreases w/ movement
can cause swan neck deformity (first joint can’t extend, middle joint can’t flex) and boutonniere deformity of the hands (middle joint can’t extend)
osteoarthritis
unilateral joint px, px in only one joint, px worse later in day, joint pain made worse w/ movement, heberden’s nodes on hands (bony swellings in interphalangeal joints)
trigger finger
requires extra effort to extend w/ an audible finger snapping (gets stuck in bent position; a defect in a tendon causing a finger to jerk or snap straight when the hand is extended.
lower motor neuron disease
steppage gait, hen walking, foot slaps on floor
rotator cuff tear
shoulder px, limited abduction and flexion, positive drop arm test
hallux valgus
great toe is abnormally abducted; medial deviation of the first metatarsal bone; bunion
gout
big toe inflamed and swollen; type of hot painful arthritis
sustained clonus
central nervous system disorder; hyper-exaggerated reflex, possible upper motor neuron lesion, This is a repetitive vibratory contraction of the muscle that occurs in response to muscle and tendon stretch.
babinski’s sign
big toe goes up; sign of upper motor neuron lesion
bell’s palsy
paralysis of facial muscles
astereognosis
inability to recognize objects place in the hand (unable to judge shapes or forms); associated w/ lesions in parietal lobe or dorsal column
arterial insufficiency
absent pulses, coolness to palpation, loss of hair, thick ridged nails
anxiety
feelings of apprehension, fearful, uneasiness
romberg test
ask pt to stand up straight w/ feet together, close eyes and tilt head back, abnormal: patient loses balance
rapid alternating movement test
test cerebellum fx, rapidly pronate and supinate hands, tap foot or touch each finger to thumb,
phalen’s test
carpal tunnel test, flex wrists and put backs of hands together, pins and needles feeling is positive for possible carpal tunnel
tinel’s test
Your doctor taps on the inside of your wrist over the median nerve. If you feel tingling, numbness, “pins and needles,” or a mild “electrical shock” sensation in your hand when tapped on the wrist, you may have carpal tunnel syndrome.
lachman’s test
for knee excursion to asses for acl rupture; The knee is flexed at 20–30 degrees with the patient supine.[2] The examiner should place one hand behind the tibia and the other grasping the patient’s thigh. It is important that the examiner’s thumb be on the tibial tuberosity.[3] The tibia is pulled forward to assess the amount of anterior motion of the tibia in comparison to the femur. An intact ACL should prevent forward translational movement (“firm endpoint”) while an ACL-deficient knee will demonstrate increased forward translation without a decisive ‘end-point’ - a soft or mushy endpoint indicative of a positive test.
allen test
arterial (blood) supply to hands (make sure there is dual blood supply);
The hand is elevated and the patient/person is asked to make a fist for about 30 seconds.
Pressure is applied over the ulnar and the radial arteries so as to occlude both of them.
Still elevated, the hand is then opened. It should appear blanched (pallor can be observed at the finger nails).
Ulnar pressure is released and the colour should return in 7 seconds.
Deep Tendon Reflex
0=no response \+1=deminished \+2=normal \+3=brisker than average \+4=hyperactive -can use reinforcement technique to elicit response: For example, have the patient gently contract the muscle being tested by raising the limb very slightly, or have them concentrate on forcefully contracting a different muscle group just at the moment when the reflex is tested.
patellar reflex
used to asses L4 nerve root (or 2 or 3)
bicep & brachioradialis reflex
cervical 5-6 nerve roots
