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phase 2b > physical examination > Flashcards

physical examination Flashcards

1
Q

what is liver flap suggestive of

A 
opiate overdose
hepatic encephalopathy
cirrhosis
acute liver failure
wilsons disease
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2
Q

leukonychia

  • what does it look like
  • what causes it
A

white marks on nails

trauma / hitting nails
hypoalbuminaemia
liver cirrhosis
chemo

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3
Q

xanthelasma is suggestive of

A

liver cirrhosis

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4
Q

what are some signs found on examination that may suggest chronic liver disease

A 
bruising
ascites (rare(
clubbing
dupuytrens contracture
hepatomegaly
asterexis liver flap
spider naevi
palmar erythemia
wasting
jaundice (Rare)
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5
Q

murphys sign

  • examination technique
  • what does this suggest
A

hand in RUQ
pain during inspiration (‘breath catches’)
no pain LUQ

cholecystitis, ascending cholangitis

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6
Q

kaiser fleischer rings

A

dark ring in iris

copper - Wilsons

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7
Q

non cardiac chest pain

A 
GORD
peptic ulcer
pulmonary
MSK (eg arthritis in small rib joint)
pscyhosomatic, anxiety, stress
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8
Q

what does it indicate if chest pain is relieved by

a) position
b) rest

A

a) fluid

b) ischaemia

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9
Q

ankle swelling that goes at night (postural)

A

not pathological

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10
Q

below what age for MI/stroke etc stuff of family history

A

60

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11
Q

Central sternotomy

A

Midline vertical quite long

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12
Q

Midline of tummy, goes around umbilicus

A

aortic surgery scar

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13
Q

aortic surgery scar

A

Midline of tummy, goes around umbilicus

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14
Q

Pacemaker insertion

A

L, upper chest, above axilla, under clavicle, mid clavicular line

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15
Q

L, upper chest, above axilla, under clavicle, mid clavicular line

A

Pacemaker insertion

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16
Q

Midline vertical quite long

A

central sternotomy

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17
Q

how many splinter haemorrhages is fine

A

0-1

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18
Q

capillary refill time

A

Pressure for 5s

Normal refill within 2s

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19
Q

radiofemoral delay=

indicates

A

See if femoral pulse comes in after and weaker, than the radial pulse

Coarctation of aorta (congenital narrowing of aorta)

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20
Q

where do you feel for femoral artery

A

Femoral is in mid-inguinal point (halfway between pelvis and midline) (kinda in groin)

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21
Q

what do you palpate the brachial artery for

what does this indicate

A

Feel for a collapsing pulse aka water hammer! (Rapidly increasing and rapidly collapsing) - arm raised above heart

Aortic valve regurgitation

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22
Q

slow rising pulse in carotid =

A

aortic stenosis

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23
Q

JVP moves

A

tamponade

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24
Q

JVP high (and raised?)

A

HF (Rside?)

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25
Q

JVP low

A

dehydration

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26
Q

normal JVP

how to make it more visible

A

3cm above sternal angle

press RUQ

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27
Q

high arched palate

A

marfans

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28
Q

displaced apex beat

A

HF

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29
Q

locating apex beat

A

hand in L 5th intercostal space midclavicular.

roll onto L to increase prominince

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30
Q

1st heart sound =

2nd heart sound =

A

1 mitral and tricuspid valve closing

2 aortic and pulmonary valve closing

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31
Q

fixed splitting of 2nd heart sound

A

atrial septal defect

normal = pulmonary valve closure delay on inspiration so delayed (= this splitting is normal)

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32
Q

added heart sounds =

A

HF

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33
Q

where to auscultate:

mitral valve
tricuspid valve
pulmonary valve
aortic valve

which uses bell

A

mitral - L 5th intercostal space midclavicular
tricuspid- L 4th intercostal space next to sternum
aortic - R 2nd intercostal space next to sternum
pulmonary - L 2nd intercostal space next to sternum

mitral uses bell

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34
Q

where do the murmurs radiate:

  • aortic
  • mitral
A

carotids

axilla

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35
Q

sacral oedema examination

A

palpate lower back - are there any indents left

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36
Q

where to palpate the aorta

where to palpate renal arteries

A

bit above umbilicus

few cm either side of umbilicus

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37
Q

Palpate popliteal pulses

A

posterior knee at knee crease, knees flexed 30degree
Thumbs at front, fingers in crease feeling
this is deep so hard to feel .

Obvious may indicate aneurysm

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38
Q

Palpate dorsalis pedis pulses

A

First metatarsal web space (lateral to extensor tensor hallucis tendon) - top of foot

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39
Q

Palpate posterior tibial pulses

A

Posterior and just inferior to medial malleolus (ankle bone)

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40
Q

Burgers test

A

Raise leg straight to 45 degrees (passive) for 2 -3 mins
Look for pallor, or superficial vein emptying/ guttering
The sit up with legs hanging over pain

Reactive hyperaemia / spreading redness - significant PAD

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41
Q

tandem walking

A

one foot in front of another

tests balance

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42
Q

parkinsons gait

A 
Apraxic gait
Stoop gait - Festinant
Small shuffling steps - stride decrease
Elbow and wrist flex
May lose balance when turning
Unilateral loss of arm swing
Increasingly rapid steps to maintain upright posture
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43
Q

Hemiplegic gait

A

one sided weakness
Dragging one of their legs, swing it round, foot scrapes on ground
Arm hanging on same side as leg weakness
Lurches
Shoulder adducted, elbow flexed, wrist flexed
Hip adducted, knee extended, ankle plantar flexion

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44
Q

Scissoring gait

A

in spasticity, increased tone - so can’t move legs freely
Small steps
Legs straight
Knees locked and knock together

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45
Q

spastic gait

A

increased tone - so can’t move legs freely
Small steps
Legs straight
Knees locked and knock together

= scissoring gait

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46
Q

Steppage

A

weakness/paralysis of dorsiflexion (can’t lift foot up).
Unilateral = common peroneal nerve palsy, foot drop, spinal lesion
Bilateral = generlaised polyneuropathy
So they avoid normal steps as they would trip on the toes that would flop down → exaggerated walk with high lift to pull feet above ground, high knees
Loud slapping noise as foot hits the ground

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47
Q

waddling gait

A

proximal weakness

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48
Q

sensory ataxia gait

A

unsteady

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49
Q

Cerebellar ataxia gait

A

Unsteady, patient sways side to side when walking
Wide based
Difficulty turning
Cannot stand steadily with feet close together / eyes closed
Walking heel to toe exaggerates this

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50
Q

pinhole visual test

A

problem if they see better through pinhole

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51
Q

Test for inattention/ visual extinction

A

Hold up both hands between you and patient, at periphery
Move fingers on each side then both together and ask patient which is moving
If there is visual inattention/ extinction, the patient will be able to detect unilateral movement but will ignore one side when both stimuli are presented simultaneously

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52
Q

pupil reflex - light in one eye

A

both should restrict

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53
Q

3rd nerve palsy eyes

A

one eye closed, when lid opened - eye points down and out

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54
Q

bells palsy = which cranial nerve

UMN/LMN

A

7th - facial

LMN

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55
Q

forehead spared from facial nerve pathology when

A

UMN lesion

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56
Q

Rinne’s test

A

Put on mastoid and near ear – to compare bone and air conduction
Ideally equal / air conduction slightly better
Conductive deafness = bone conduction is better than air (louder)

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57
Q

Unterberger test

A

Walk with eyes closed. Watch for rotation to side of lesion

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58
Q

bovine cough indicates

A

vagal palsy

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59
Q

where is bicep vs tricep vs brachioradialis reflex

inc nerve roots

A

bicep reflex hit the hard bit in the elbow-pit
C5 C6

tricep hits the back of the elbow, slightly above the tip
C6 C7

brachioradialis hits the bit above the bony prominence thumb side
C5 C6

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60
Q

how to test (Dys)diadochokinesia

A

rapidly alternate placeing hand face up and down into your other hand

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61
Q

neural examination power scale

A 
5 full strength
4 - weaker than normal
3 - can move against gravity, but not against resistance
2- twitch - contraction
1 - nothing
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62
Q

spastic tone

A

type of high tone

First increase, then decrease in tone
Tone depends on speed (higher tone/ resistance with higher speed)
Tone is different for different muscles (abduct/adduct)
UMN eg stroke

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63
Q

rigid tone

A

type of high tone

Increased tone over joint radius, and in both directions (eg abduct and adduct)
Tone high for slow and high speeds - irrespective
Parkinsons

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64
Q

pronator drift

A
  • Ask patients to copy you and put hands out in position like carrying a stack of books, but arm fully extended.
  • Then ask them to close their eyes and observe the position of the arms
  • if one of their arms drifts down and pronates. (pronators are the ones spared of weakness in UMN problem)

Contralateral pyramidal tract lesion - UMN lesion

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65
Q

plantar/dorsi flexion

A

plantar flexion = they push foot towards ground against hand on ball of feet
Dorisflexion = they raise toes/ foot towards their face whilst doctor hand resist on superior of foot

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66
Q

inversion/eversion of foot

A

Inversion - lateral malleolus facing down (pic). Doctor tries to pull foot flat (pull lateral side up) whilst patient maintains inversion
Eversion - foot flat. Doctor tries to invert it by pulling lateral side down to curled position while patient maintains eversion

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67
Q

selective weakness =

indicates?

A

abductor vs adductor

indicates UMN

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68
Q

pyramidal weakness =

indicates?

A

Extensor > flexor in arms
Flexor > extensor in legs

UMN

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69
Q

Proximal muscle weakness (but distal is strong) — indicates?

A

muscle disease

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70
Q

distal muscle weakness (but proximal strong)– indicates?

A

nerve disease

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71
Q

one sided weakness – indicates

A

problem in brain eg stroke

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72
Q

weakness at a certain level indicates

A

spinal cord problem

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73
Q

Knee jerk/ Patella reflex

Ankle jerk

plantar reflex

inc nerve roots

A

Knee jerk/ Patella reflex- lift knee slightly and tap hammer below knee
L3 L4

Ankle jerk- Patients leg is semiflexed with knee pointing out to side. Pull toes (dorsiflex) to stretch tendon. Hammer on achilles tendon
S1

plantar reflex- (Socks off). Start at lateral border of the bottom of the foot towards the big toe
Observe toes:
- Normal : flexion of big toe (goes down)
- Pathological : big toe goes up and other toes fan out
This reflex is present in babies/infants <2y but is pathological in adults

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74
Q

ankle clonus =

seen in what pathology

A

= repeated rhythmic jerking

support ankle and force dorsiflexion on foot (toes point up)

UMN lesions

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75
Q

zig zagged lines when doing heel to shin

A

ataxia

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76
Q

what Hz from vibration sense

A

128 hz tuning fork

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77
Q

Stereognosis

Graphesthesia

A

3D object placed in hands (Eyes closed)- work out eg key, coin

Eyes closed work out what is ‘drawn’ in skin (eg 8 shape)

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78
Q

koilonychia

A

iron def anaemia

spoon shaped nails

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79
Q

what causes clubbing

A 
lung cancer
pulmonary fibrosis
IBD
liver disease
heart problems
idiopathic
bronchiectasis
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80
Q

palmar erythema

A

Raised oestrogen - pregnancy

Liver disease

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81
Q

liver flap asterix

  • how long held
  • indicates
A

30s

encephalopathy
respiratory failure - CO2 retention

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82
Q

corneal arcus

A

light ring is iris

phospholipid/cholesterol

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83
Q

apthous ulcer

A

ulcer on inside of mouths/lips

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84
Q

when might you see breast atrophy in women

A

liver disease

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85
Q

where is c section scar

A

pant line

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86
Q

where is kidney transplant scar

A

angled line in iliac fossa

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87
Q

pitting oedema examinatino

A

5 seconds press over bony prominence
bi/unilateral
how far proximally does it extend

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88
Q

virchows node

  • where
  • indicates
A

in L supraclavicular

associated with abdominal cancer especially ovarian, kidney, gastric and testicular

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89
Q

which side should patient roll to if you palpate spleen and want to feel it again

A

R

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90
Q

rovsing sign

indicates what

A

palpate L iliac fossa and the R side hurts

Appendicitis

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91
Q

percussion

- dull/ tympanic

A 
dull = solid stuff, liquid (organs, bones, poo, fluid collections)
tympanic = air/ gas (lungs, empty bowel)
92
Q

shifting dullness

A

Start at umbilicus, go out away from you
Resonant (bowel gas) → dull (stool, ascitic fluid). Keep finger here as a mark
Roll towards you
Wait 20-30 seconds
Tap again
If resonant now, likely to ascitic fluid rather than stool (stays dull)

93
Q

fluid thrill

A

if ascites present

Place hand flat on L side of abdomen
Ask patient to place hand ulnar (pinky) side on the midline - to stop skin transmission of fluid
tap/ flick on R side
Feel if thrill felt by flat L hand

94
Q

high pitched tinkling bowel sounds

A

bowel obstruction

95
Q

absent bowel sounds

  • how long til you can be like yeah g theyre absent
  • what might cause absent bowel sounds
A

2mins

Peritonitis
Constipation
Electrolyte abnormalities
Recent surgery

96
Q

scrotal transillumination =

possible pathologies for each case

A

torch . light seen?

Normal testis can be identified
No transillumination
- Spermatocele
- Epididymitis
- Epididymal tumors
Yes transillumination
- Epididymal Cyst
- Cyst of the cord
- Lax hydrocele
Not normal testis
No transillumination
- Testicular Tumour
- Haematocele (smooth surface, history of trauma)
- Orchitis (tender)
Yes transillumination
- Hydrocele
97
Q

‘getting above’ scrotal swelling

A

No
- Hernia
- Infantile hydrocele
Yes = true swelling

98
Q

tender scrotal swelling differential diagnosis

A

Testicular torsion
Infection/ inflammation
Trauma
Strangulation

99
Q

how to assess anal tone during DRE

A

ask them to squeeze

100
Q

asthma worse when (in the day)

A

night

intermittent - some days fine

101
Q

MRC dyspnoea breathless scale

A

1 - only SOB during exercise
2 - SOB when hurrying or walking uphill
3 - walks slower than average, stops walking 1-2 km
4- stops walking 100m or few mins
5 - SOB at rest, too breathless to leave the house, breathless dressing/undressing

102
Q

inspiratory/ expiratory wheeze

A 
Expiratory = intrathoracic obstruction
Inspiratory = extrathoracic obstruction
103
Q

purulent sputum suggests (2)

A

suggests lung abscess or bronchiectasis

104
Q

what does childhood bronchitis often lead on to as an adult

A

asthma

105
Q

what infections can lead to bronchiectasis

A

pneumonia
whooping cough
measles

106
Q

paroxysmal nocturnal dyspnoea associated with what condition

A

pulmonary oedema

107
Q

orthopnea indicates

how is it gauged

A

pulmonary oedema
obesity
severe pneumonia
pleural effusion

number of pillows - eg 2, 3

108
Q

beta blockers resp s/e

A

wheeze

109
Q

stridor =

A

inspiratory wheeze

110
Q

SVC obstruction may present how

A

face/neck swelling

111
Q

Chemosis=

A

swollen conjunctival oedema (underlid) due to exudate

112
Q

horners syndrome

A

Ptosis (top eyelid droop)
Enopthalmous (Sunken eye)
pupil constriction

113
Q

fine tremor may indicate

A

adrenergic (Adrenaline) stimulation – beta 2 agonists eg salbutamol

114
Q

warm hands (Resp)

A

CO2 retention - T2RF

115
Q

causes of bounding, hyperdynamic pulse

A

CO2 retention, respiratory failure

116
Q

Pulsus paradoxus

indicates

A

Normally BP decreases during inspiration, compared to expiration. Here this decrease is exaggerated. It is a paradox as you can detect beats at heart but not at distal radial pulse due to decrease in BP peripherally

Severe obstructive airway disease eg severe asthma and cardiac tamponade

117
Q

different chest shapes (3)

A

barrel chest- hyperinflated, COPD

pigeon chest - bit sticks out -Pectus carinatum

funnel chest - bit goes in - pectus excavatum

118
Q

ankylosing spond effect on chest wall

A

reduced chest wall mvmt

119
Q

what do intercostal and subcostal recession indicate

A

respiratory distress

120
Q

how far should tracheal notch be from cricoid

A

3/4cm/ fingers

121
Q

normal chest expansion

A

3-5cm

122
Q

tactile vocal fremitus

A

vibration feeling
“99”
consolidation= more vibration
effusion/pneumothorax = less vibration (particles further apart)

123
Q

lung lobes

A

R - upper, middle, lower

L- upper, lower

124
Q

whispering pectoriloquy

A

if you suspect consolidation, do this
Patient Whisper “1, 2, 3” or “99”
Listen for dramatic increase in volume around consolidated lung

125
Q

Crepitations vs rhonchi

A 
Rhonchi = low pitched rattling lung sound (obstruction/secretions in larger airways)
Crepitations = crackling/rattling
126
Q

vocal resonance

A

Breath in, breath out,“Say 99 each time i make contact with the stethoscope”
Consolidated lung sounds louder (sound travels quicker through solid than air)
Quiter in effusion / pneumothorax – lung separated from wall

127
Q

where would an inguinal hernia be (roughly)

A

groin/ base of penis/ pubic bone

128
Q

inguinoscrotal hernia :direct vs oblique hernia

  • shape
  • reducibility
A

Globular (sphere shape) = direct hernia
Pyriform (pear, long shape) = oblique hernia

Direct = backwards
Oblique = up, backwards, laterally
129
Q

enterocele charachteristics

A 
enterocele - small bowel hernia (rather than ommentum)
soft
visible peristalsis
gurgling sensation
tympanic resonance
audible sounds
130
Q

strangulated hernia charechteristics

A

hot to touch
tender
tense

131
Q

scrotal neck test

A

Hold neck of scrotum between fingers, both hands

Tell if swelling is scrotal / inguinal / inguinoscrotal

132
Q

omentocele charachterisitc

A

dough-y

133
Q

varicocele characteritics

A

bag of worms

134
Q

omentocele vs enterocele reducibility

A 
Omentocele = easy at first, difficult later
Enterocele = difficult first, easy later
135
Q

3 fingers test aka Ziemans test

A 
Cough
Feel impulse
On the finger of the :
Deep inguinal ring  = indirect hernia
Superficial ring = direct hernia
Saphenous opening = femoral hernia
136
Q

proper names for high/ low arch foot

A

Flat foot = pes planus

High arch = pes cavus

137
Q

lingual/ thyroglossal/ pyramidal/ retrosternal thyroid lump

location and other examination features

A

lingual - migrates up neck, seems kinda at back of thraot/oral cavity (Rare!) - may be able to see when mouth opened

thyroglossal - midilne, adams apple kinda level
- moves up when tongue poked out

pyramidal - just adding a bit on top of where normal thyroid is

retrosternal - gone now, partially/fully behind sternum

  • unable to get below it on palpation
  • dull upper sternal percussion
138
Q

appetite in hypo/hyperthryoidism

A

hyper- increased appetite (despite weight loss!) – this occasionally acc causes weight gain
hypo- decreased appetite (Despite weight gain!)

139
Q

voice changes with thyroid problems

A 
hypo
- hoarse
- slow
- low 
(if extreme)
140
Q

diar/const hyper/hypothyroidism

A 
diar = hyper
const = hypo
141
Q

concentration levels hypo/hyperthyroidism

A

both decrease in concentration

142
Q

clubbing hyper/hypothyroidism

A

hyper - in the poptarts! – graves

143
Q

periods hyper/hypo thryoidism

- fertility

A

lesss periods in hyper
more periods in hypo
fertility problems in both

144
Q

does goitre cause swallowing problems

A

no, rarely, even when large

145
Q

hyper/hypothyroidism speed of onset

A

slow - hypo

quicker - hyper

146
Q

does amiodarone/lithium cause hypo/hyperthyroidism

A

hypo mainly for both

147
Q

tremor - hypo/hyperthryoidism

A

hyper

148
Q

thyroid examination swallowing

A

only thyroid swellings move with swallowing

149
Q

thyroid swelling bruit indicates

A

hyper - graves

150
Q

graves eye disease

A 
exophthalmos = bulging eyes graves
lid lag
diplopia
bloodshot - conjunctival oedema
lid retration -(can see white above circles) - all types of hyper
visual acuity
151
Q

hyper/hypothyroidism reflexes

A 
hyper = increased
hypo= decreased
152
Q

where is great saphenous vein

drains into what

A

medial leg

drains into femoral vein via saphenofemoral junction (groin) (4cm lateral and inferior to pubic tubercle)

153
Q

where is small saphenous vein

drains into what

A

posterior calf

Drains into popliteal vein via saphenopopliteal junction (knee popliteal fossa)

154
Q

venous insufficency / venous HTN effects

A

Oedema
Pigmentation
Fibrosis
Ulceration

155
Q

how long is warfarin prescribed for after DVT

A

6m

156
Q

what are perforator veins

A

connect superficial to deep veins

157
Q

varicose veins

2 causes

A

Deformed wall + valves→ dilated veins, thin walls
Bulging

perforator vein incompetence
saphenofemoral incompetence

158
Q

varicose veins

  • gender
  • occupation
  • pain charachter
  • worse when
  • associated symptoms
A
  • females
  • standing up
  • dull ache
  • worse at end of day/laying down
  • skin pigmentiation, ulcer (lower 1/3, medial leg), swelling/oedema, constipation, DVT, eczema, venous stars, gangrene, hot
159
Q

cough impulse venous insufficiency

A

if you feel thrill at saphenofemoral junction (aka saphenous opening) (4cm lateral and inferior to pubic tubercle) then it is saphenofemoral (aka saphenous) incompetence

160
Q

Lipodermatosclerosis =

seen in ?

A

Hardening of skin, around ankles

varicose veins / venous insufficiency

161
Q

Schwartz test / percussion/ tap test

A

tap at saphenofemoral junction (aka saphenous opening) (4cm lateral and inferior to pubic tubercle)
if impulse felt in varicosites down the leg, then is it SFJ incompetence

162
Q

modified perthe’s test

A

Checks for deep vein function , DVT
Tourniquet tied in standing position (full veins) below saphenous opening, thigh
Patient walks 3-5mins/ exercise / foot raises to tip toe 10 times
observing vein distension
Secondary varicose veins distend more than primary - If superficial veins are empty, deep veins are patent (primary)

(unmodified: pain and vein distension = secondary. no pain, collapsed veins = primary)

163
Q

leg raising test to distinguish primary/secondary varicose veins

A

Legs raised, veins empty. Quick evacuation indicates primary varicose veins. Slow evacuation – delay/obstruction = secondary varicose veins

164
Q

Trendelenburg test

A

where is the incompetence? Perforator or saphenofemoral junction or communicating system
1. veins empty by stroking ankle to thigh
2. tonriquet below SFJ
3 If varieties fill → perforator incompetence (problem is more distal to SF junction). If they don’t fill quickly, then problem with SF junction
4. Then if they don’t refill - tie on mid-thigh perforators, saphenopopliteal junction and the mid-calf perforators
5. If is already distended, then distends more on tourniquet removal – both perforator and saphenofemoral incompetence!

165
Q

varicose vein investigation beyond examination

A

doppler US aka duplex

166
Q

first line treatment for intermittent claudication

and next steps

compared to critical ischaemia

A

exercise

risk factor modification
statin, anti-platelet
angioplasty

critical ischaemia Can not treat conservatively, needs revascularization

  • Amputation
  • Stent
  • Angioplasty
  • Bypass
167
Q

Varicose Veins TREATMENT

A

compression stockings

168
Q

sicca

A

dry eyes / mouth

169
Q

GALS 3 questions

A

“Do you have any pain or stiffness in your muscles, joints or back?”
“Can you dress without difficulty?”
“Can you walk up and down stairs without difficulty?”

170
Q

how to test thoracic spine rotation

A

“turn side to side”

Put your hands on their hips to stop them moving

171
Q

Temporomandibular joints tested how

A

open mouth wide / swing jaw L /R

172
Q

Normal limit of flexion at hip =

A

120 deg

173
Q

Normal limit of flexion at knee =

A

140 deg

174
Q

normal range of hip rotation (knee above hip lying flat, knee and hip flexed 90 deg, move lower leg around)

A

45 deg each way

175
Q

Thomas test

A

Thomas’s test for fixed flexion deformity of the hip - testing hip extension

  • Place one hand under the small of the back to feel the lumbar region. Other hand scoops both legs up, flexing hips and knees
  • Flex hips as far as possible, feeling lumbar spine flattening against hand
  • “Can you straighten you left leg” whilst holding the other in the same position
  • This tests hyperextension of the L side. In deformity, leg won’t be lowered fully or curvature remains in spine
176
Q

patella tap

A

Stroke down from mid thigh to above knee to empty the suprapatellar pouch
Keep hand there
With fingertips of other hand, press down briefly and firmly over the patella
Cause is Knee effusion

177
Q

“hands behind head” tests what msk

A

Full shoulder abduction and external rotation of glenohumeral joint

178
Q

how to test supraspinatus

A

Initiates abduction (below 90degrees, then deltoid takes over)

179
Q

how to test infraspinatus

A

External rotation

180
Q

how to test subscapularis

A

internal rotation

181
Q

how to test teres minor

A

external rotation

182
Q

how to test deltoid

A

Abducts after 90 degrees (before than, supraspinatus does it)

183
Q

how to test trapezius

A

shrug shoulders
Controls scapula movement
Clunky, symmetry, smoothness

184
Q

shoulders examination initial two active movements (screen), and what are they testing for

A

hand behind back holding hands pushing up the back — internal rotation, abduction, extension

hands behind head — external rotation, abduction, (extension)

185
Q

shoulder external rotation

A

elbow at side, elbow flexed 90 deg

186
Q

normal range of motion in shoulder abduction

A

120 deg

187
Q

subacromial space pathology seen as

what are some examples of subacromial space pathology

A

painful arc - painful in middle section, not painful at bottom or top of the arc

  • Osteophyte impingement - Grows down from acromioclavicular joint
  • Subacromial bursitis
  • Supraspinatus tendonitis
188
Q

acriomoclavicular joint pathology seen as

A

painful at the top of the arc only - 120-180 deg

189
Q

deltoid abduction

A

self fist bump. doctor tries to push arms down

190
Q

shoulder internal rotation

A

hands behind back, whats the highest vertebra you can touch

191
Q

lift off test=

tests what

A

their hand behind their back and pushing against your hand

Subscapularis internal rotation only

192
Q

how to test subscapularis internal rotation only

A

lift off test
their hand behind their back and pushing against your hand
acromioclavicular joint

193
Q

scarf test =? and why isnt it done

A

put hand of test arm over other shoulder. Doctor lifts the elbow so it is in line with shoulders and further adducts the joint.
acromioclavicular joint
postive test = pain

194
Q

painful arc test

A

pain in middle of arc of ab/aducting shoulder- arm by side to above head

  • Osteophyte impingement - Grows down from acromioclavicular joint
  • Subacromial bursitis
  • Supraspinatus tendonitis
195
Q

nerves vs vertebrae in cervical spine

A

nerves come out above vertebra (c3 nerve exits above c3 vertebra), except for C8 - which comes out below C7

196
Q

normal cervical spine flexion

A

chin to chest

80 deg

197
Q

normal cervical spine extension

A

head look up

50 deg

198
Q

normal cervical spine rotation

A

watch tennis

80 deg each way

199
Q

normal cervical lateral flexion

A

ear to shoulder

45 degrees in each direction (90 degrees total)

200
Q

schobers test

A

whilst standing, mark levels of dimples and 10 cm above and 5cm below this
ask them to touch their toes
distance should increase from 15cm to 20cm

201
Q

normal straight leg raising

A

80-90 degrees,

202
Q

Tibial nerve stretch test

A

possibly = bowstring test idk

  • Flex their knee and hip (hand on ankle and thigh/knee)
  • Gently extend knee. This will cause the tibial nerve to bowstring across the popliteal fossa.
  • Palpate over hamstring tendons on each side. Ask if sore
  • Palpate over nerve in middle of popliteal fossa. Ask if sore
  • Positive test = pain when nerve pressed but NOT when hamstring tendons are pressed
203
Q

Femoral nerve stretch test

A

Flex knee
Then extend the hip
This stretches the femoral nerve
Positive = pain in back/ front of thigh

204
Q

nail pitting can indicate

A

psoriasis

205
Q

Onycholysis =

indicates

A

Onycholysis = nail lifted off bed

fungal disease

206
Q

koilonchya

A

nail spooning

207
Q

melanoma nail presentation

A

dark pigment / black in nail - often in base / skin fold at base

208
Q

Paronychia

A

White / pale skin adjacent to the nail = pus

Nail needs to be removed + pus drained

209
Q

Onychogryphosis

A

One side of the nail grows quicker than the other

Look thick and curvy like a ram’s horn

210
Q

Arachnodactyly

A

long thin fingers eg marfans

211
Q

wrist flexion and extension normal

A

90 Deg each

212
Q

describe thumb abduction

what nerve does this test (when done against resistance)

A

90 deg perpindicular to palm

median

213
Q

fromans test =

A

hold piece of paper between thumbs and fists (thumbs together). try to pull paper away
postive = thumb DIP joint flexion
dorsal interossei not working

214
Q

what action tests ulnar nerve

A

adduction and abduction of fingers

215
Q

wrist drop signifies which nerve palsy

A

radial

216
Q

carpals tunnel treatment

A 
Neutral Wrist splint (for night)
Steroid injection (into carpels tunnel)
Surgery
217
Q

normal hip flexion

what should be noted about hip flexion

A

120 deg

Lumbar flexion can contribute, masking limitation

218
Q

normal hip abduction

A

45 degrees

219
Q

normal hip adduction (moved across other leg)

A

25 deg

220
Q

normal hip rotation (foot used as indicator)

A

45 degrees each way

221
Q

normal hip extension (lying on front)

A

20 deg

222
Q

measuring limb lengths (both!)

A

Legs stretched out as far as possible. Ensure they are lying straight:

Measure length from umbilicus/xiphisternum (either fine) to medial malleolus = apparent length
- Record and compare both sides

Measure length from anterior superior iliac spine to the medial malleolus = true length

223
Q

Ripple test aka bulge test

A

Hold the thigh just above the knee firmly with one hand - empty suprapatellar pouch
Stroke with other hand in upside down U and see for fluid movement (keep hand on suprapatellar pouch)
= fluid in knee - is it freely moving, or locked in position?

224
Q

normal knee flexion

A

140 deg

225
Q

ligament pathologies when doing knee valgus/ varus stresses

A

Ligament lax / ruptured → movement may occur but painless

Ligament strained but intact → limited movement and painful

226
Q

mc murrays test

- tests for what

A

Meniscus injury – click /clunk +/- pain, and feel something pop out
when medial / lateral meniscus stressed (how confuses me - see notes)

phase 2b (2 decks)

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