physical examination Flashcards
1
Q
what is liver flap suggestive of
A
opiate overdose hepatic encephalopathy cirrhosis acute liver failure wilsons disease
2
Q
leukonychia
- what does it look like
- what causes it
A
white marks on nails
trauma / hitting nails
hypoalbuminaemia
liver cirrhosis
chemo
3
Q
xanthelasma is suggestive of
A
liver cirrhosis
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)
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
6
Q
kaiser fleischer rings
A
dark ring in iris
copper - Wilsons
7
Q
non cardiac chest pain
A
GORD peptic ulcer pulmonary MSK (eg arthritis in small rib joint) pscyhosomatic, anxiety, stress
8
Q
what does it indicate if chest pain is relieved by
a) position
b) rest
A
a) fluid
b) ischaemia
9
Q
ankle swelling that goes at night (postural)
A
not pathological
10
Q
below what age for MI/stroke etc stuff of family history
A
60
11
Q
Central sternotomy
A
Midline vertical quite long
12
Q
Midline of tummy, goes around umbilicus
A
aortic surgery scar
13
Q
aortic surgery scar
A
Midline of tummy, goes around umbilicus
14
Q
Pacemaker insertion
A
L, upper chest, above axilla, under clavicle, mid clavicular line
15
Q
L, upper chest, above axilla, under clavicle, mid clavicular line
A
Pacemaker insertion
16
Q
Midline vertical quite long
A
central sternotomy
17
Q
how many splinter haemorrhages is fine
A
0-1
18
Q
capillary refill time
A
Pressure for 5s
Normal refill within 2s
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)
20
Q
where do you feel for femoral artery
A
Femoral is in mid-inguinal point (halfway between pelvis and midline) (kinda in groin)
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
22
Q
slow rising pulse in carotid =
A
aortic stenosis
23
Q
JVP moves
A
tamponade
24
Q
JVP high (and raised?)
A
HF (Rside?)
25
JVP low
dehydration
26
normal JVP
| how to make it more visible
3cm above sternal angle
| press RUQ
27
high arched palate
marfans
28
displaced apex beat
HF
29
locating apex beat
hand in L 5th intercostal space midclavicular.
| roll onto L to increase prominince
30
1st heart sound =
| 2nd heart sound =
1 mitral and tricuspid valve closing
| 2 aortic and pulmonary valve closing
31
fixed splitting of 2nd heart sound
atrial septal defect
normal = pulmonary valve closure delay on inspiration so delayed (= this splitting is normal)
32
added heart sounds =
HF
33
where to auscultate:
mitral valve
tricuspid valve
pulmonary valve
aortic valve
which uses bell
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
34
where do the murmurs radiate:
- aortic
- mitral
carotids
axilla
35
sacral oedema examination
palpate lower back - are there any indents left
36
where to palpate the aorta
where to palpate renal arteries
bit above umbilicus
few cm either side of umbilicus
37
Palpate popliteal pulses
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
38
Palpate dorsalis pedis pulses
First metatarsal web space (lateral to extensor tensor hallucis tendon) - top of foot
39
Palpate posterior tibial pulses
Posterior and just inferior to medial malleolus (ankle bone)
40
Burgers test
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
41
tandem walking
one foot in front of another
| tests balance
42
parkinsons gait
```
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
```
43
Hemiplegic gait
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
44
Scissoring gait
in spasticity, increased tone - so can't move legs freely
Small steps
Legs straight
Knees locked and knock together
45
spastic gait
increased tone - so can't move legs freely
Small steps
Legs straight
Knees locked and knock together
= scissoring gait
46
Steppage
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
47
waddling gait
proximal weakness
48
sensory ataxia gait
unsteady
49
Cerebellar ataxia gait
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
50
pinhole visual test
problem if they see better through pinhole
51
Test for inattention/ visual extinction
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
52
pupil reflex - light in one eye
both should restrict
53
3rd nerve palsy eyes
one eye closed, when lid opened - eye points down and out
54
bells palsy = which cranial nerve
| UMN/LMN
7th - facial
| LMN
55
forehead spared from facial nerve pathology when
UMN lesion
56
Rinne’s test
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)
57
Unterberger test
Walk with eyes closed. Watch for rotation to side of lesion
58
bovine cough indicates
vagal palsy
59
where is bicep vs tricep vs brachioradialis reflex
inc nerve roots
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
60
how to test (Dys)diadochokinesia
rapidly alternate placeing hand face up and down into your other hand
61
neural examination power scale
```
5 full strength
4 - weaker than normal
3 - can move against gravity, but not against resistance
2- twitch - contraction
1 - nothing
```
62
spastic tone
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
63
rigid tone
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
64
pronator drift
- 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
65
plantar/dorsi flexion
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
66
inversion/eversion of foot
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
67
selective weakness =
| indicates?
abductor vs adductor
| indicates UMN
68
pyramidal weakness =
| indicates?
Extensor > flexor in arms
Flexor > extensor in legs
UMN
69
Proximal muscle weakness (but distal is strong) --- indicates?
muscle disease
70
distal muscle weakness (but proximal strong)-- indicates?
nerve disease
71
one sided weakness -- indicates
problem in brain eg stroke
72
weakness at a certain level indicates
spinal cord problem
73
Knee jerk/ Patella reflex
Ankle jerk
plantar reflex
inc nerve roots
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
74
ankle clonus =
seen in what pathology
= repeated rhythmic jerking
support ankle and force dorsiflexion on foot (toes point up)
UMN lesions
75
zig zagged lines when doing heel to shin
ataxia
76
what Hz from vibration sense
128 hz tuning fork
77
Stereognosis
Graphesthesia
3D object placed in hands (Eyes closed)- work out eg key, coin
Eyes closed work out what is ‘drawn’ in skin (eg 8 shape)
78
koilonychia
iron def anaemia
| spoon shaped nails
79
what causes clubbing
```
lung cancer
pulmonary fibrosis
IBD
liver disease
heart problems
idiopathic
bronchiectasis
```
80
palmar erythema
Raised oestrogen - pregnancy
| Liver disease
81
liver flap asterix
- how long held
- indicates
30s
encephalopathy
respiratory failure - CO2 retention
82
corneal arcus
light ring is iris
phospholipid/cholesterol
83
apthous ulcer
ulcer on inside of mouths/lips
84
when might you see breast atrophy in women
liver disease
85
where is c section scar
pant line
86
where is kidney transplant scar
angled line in iliac fossa
87
pitting oedema examinatino
5 seconds press over bony prominence
bi/unilateral
how far proximally does it extend
88
virchows node
- where
- indicates
in L supraclavicular
| associated with abdominal cancer especially ovarian, kidney, gastric and testicular
89
which side should patient roll to if you palpate spleen and want to feel it again
R
90
rovsing sign
indicates what
palpate L iliac fossa and the R side hurts
Appendicitis
91
percussion
| - dull/ tympanic
```
dull = solid stuff, liquid (organs, bones, poo, fluid collections)
tympanic = air/ gas (lungs, empty bowel)
```
92
shifting dullness
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
fluid thrill
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
high pitched tinkling bowel sounds
bowel obstruction
95
absent bowel sounds
- how long til you can be like yeah g theyre absent
- what might cause absent bowel sounds
2mins
Peritonitis
Constipation
Electrolyte abnormalities
Recent surgery
96
scrotal transillumination =
| possible pathologies for each case
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
'getting above' scrotal swelling
No
- Hernia
- Infantile hydrocele
Yes = true swelling
98
tender scrotal swelling differential diagnosis
Testicular torsion
Infection/ inflammation
Trauma
Strangulation
99
how to assess anal tone during DRE
ask them to squeeze
100
asthma worse when (in the day)
night
| intermittent - some days fine
101
MRC dyspnoea breathless scale
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
inspiratory/ expiratory wheeze
```
Expiratory = intrathoracic obstruction
Inspiratory = extrathoracic obstruction
```
103
purulent sputum suggests (2)
suggests lung abscess or bronchiectasis
104
what does childhood bronchitis often lead on to as an adult
asthma
105
what infections can lead to bronchiectasis
pneumonia
whooping cough
measles
106
paroxysmal nocturnal dyspnoea associated with what condition
pulmonary oedema
107
orthopnea indicates
| how is it gauged
pulmonary oedema
obesity
severe pneumonia
pleural effusion
number of pillows - eg 2, 3
108
beta blockers resp s/e
wheeze
109
stridor =
inspiratory wheeze
110
SVC obstruction may present how
face/neck swelling
111
Chemosis=
swollen conjunctival oedema (underlid) due to exudate
112
horners syndrome
Ptosis (top eyelid droop)
Enopthalmous (Sunken eye)
pupil constriction
113
fine tremor may indicate
adrenergic (Adrenaline) stimulation -- beta 2 agonists eg salbutamol
114
warm hands (Resp)
CO2 retention - T2RF
115
causes of bounding, hyperdynamic pulse
CO2 retention, respiratory failure
116
Pulsus paradoxus
indicates
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
different chest shapes (3)
barrel chest- hyperinflated, COPD
pigeon chest - bit sticks out -Pectus carinatum
funnel chest - bit goes in - pectus excavatum
118
ankylosing spond effect on chest wall
reduced chest wall mvmt
119
what do intercostal and subcostal recession indicate
respiratory distress
120
how far should tracheal notch be from cricoid
3/4cm/ fingers
121
normal chest expansion
3-5cm
122
tactile vocal fremitus
vibration feeling
"99"
consolidation= more vibration
effusion/pneumothorax = less vibration (particles further apart)
123
lung lobes
R - upper, middle, lower
| L- upper, lower
124
whispering pectoriloquy
if you suspect consolidation, do this
Patient Whisper “1, 2, 3” or “99”
Listen for dramatic increase in volume around consolidated lung
125
Crepitations vs rhonchi
```
Rhonchi = low pitched rattling lung sound (obstruction/secretions in larger airways)
Crepitations = crackling/rattling
```
126
vocal resonance
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
where would an inguinal hernia be (roughly)
groin/ base of penis/ pubic bone
128
inguinoscrotal hernia :direct vs oblique hernia
- shape
- reducibility
Globular (sphere shape) = direct hernia
Pyriform (pear, long shape) = oblique hernia
```
Direct = backwards
Oblique = up, backwards, laterally
```
129
enterocele charachteristics
```
enterocele - small bowel hernia (rather than ommentum)
soft
visible peristalsis
gurgling sensation
tympanic resonance
audible sounds
```
130
strangulated hernia charechteristics
hot to touch
tender
tense
131
scrotal neck test
Hold neck of scrotum between fingers, both hands
| Tell if swelling is scrotal / inguinal / inguinoscrotal
132
omentocele charachterisitc
dough-y
133
varicocele characteritics
bag of worms
134
omentocele vs enterocele reducibility
```
Omentocele = easy at first, difficult later
Enterocele = difficult first, easy later
```
135
3 fingers test aka Ziemans test
```
Cough
Feel impulse
On the finger of the :
Deep inguinal ring = indirect hernia
Superficial ring = direct hernia
Saphenous opening = femoral hernia
```
136
proper names for high/ low arch foot
Flat foot = pes planus
| High arch = pes cavus
137
lingual/ thyroglossal/ pyramidal/ retrosternal thyroid lump
location and other examination features
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
appetite in hypo/hyperthryoidism
hyper- increased appetite (despite weight loss!) -- this occasionally acc causes weight gain
hypo- decreased appetite (Despite weight gain!)
139
voice changes with thyroid problems
```
hypo
- hoarse
- slow
- low
(if extreme)
```
140
diar/const hyper/hypothyroidism
```
diar = hyper
const = hypo
```
141
concentration levels hypo/hyperthyroidism
both decrease in concentration
142
clubbing hyper/hypothyroidism
hyper - in the poptarts! -- graves
143
periods hyper/hypo thryoidism
| - fertility
lesss periods in hyper
more periods in hypo
fertility problems in both
144
does goitre cause swallowing problems
no, rarely, even when large
145
hyper/hypothyroidism speed of onset
slow - hypo
| quicker - hyper
146
does amiodarone/lithium cause hypo/hyperthyroidism
hypo mainly for both
147
tremor - hypo/hyperthryoidism
hyper
148
thyroid examination swallowing
only thyroid swellings move with swallowing
149
thyroid swelling bruit indicates
hyper - graves
150
graves eye disease
```
exophthalmos = bulging eyes graves
lid lag
diplopia
bloodshot - conjunctival oedema
lid retration -(can see white above circles) - all types of hyper
visual acuity
```
151
hyper/hypothyroidism reflexes
```
hyper = increased
hypo= decreased
```
152
where is great saphenous vein
| drains into what
medial leg
| drains into femoral vein via saphenofemoral junction (groin) (4cm lateral and inferior to pubic tubercle)
153
where is small saphenous vein
| drains into what
posterior calf
| Drains into popliteal vein via saphenopopliteal junction (knee popliteal fossa)
154
venous insufficency / venous HTN effects
Oedema
Pigmentation
Fibrosis
Ulceration
155
how long is warfarin prescribed for after DVT
6m
156
what are perforator veins
connect superficial to deep veins
157
varicose veins
2 causes
Deformed wall + valves→ dilated veins, thin walls
Bulging
perforator vein incompetence
saphenofemoral incompetence
158
varicose veins
- gender
- occupation
- pain charachter
- worse when
- associated symptoms
- 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
cough impulse venous insufficiency
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
Lipodermatosclerosis =
| seen in ?
Hardening of skin, around ankles
| varicose veins / venous insufficiency
161
Schwartz test / percussion/ tap test
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
modified perthe's test
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
leg raising test to distinguish primary/secondary varicose veins
Legs raised, veins empty. Quick evacuation indicates primary varicose veins. Slow evacuation -- delay/obstruction = secondary varicose veins
164
Trendelenburg test
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
varicose vein investigation beyond examination
doppler US aka duplex
166
first line treatment for intermittent claudication
and next steps
compared to critical ischaemia
exercise
risk factor modification
statin, anti-platelet
angioplasty
critical ischaemia Can not treat conservatively, needs revascularization
- Amputation
- Stent
- Angioplasty
- Bypass
167
Varicose Veins TREATMENT
compression stockings
168
sicca
dry eyes / mouth
169
GALS 3 questions
“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
how to test thoracic spine rotation
"turn side to side"
| Put your hands on their hips to stop them moving
171
Temporomandibular joints tested how
open mouth wide / swing jaw L /R
172
Normal limit of flexion at hip =
120 deg
173
Normal limit of flexion at knee =
140 deg
174
normal range of hip rotation (knee above hip lying flat, knee and hip flexed 90 deg, move lower leg around)
45 deg each way
175
Thomas test
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
patella tap
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
"hands behind head" tests what msk
Full shoulder abduction and external rotation of glenohumeral joint
178
how to test supraspinatus
Initiates abduction (below 90degrees, then deltoid takes over)
179
how to test infraspinatus
External rotation
180
how to test subscapularis
internal rotation
181
how to test teres minor
external rotation
182
how to test deltoid
Abducts after 90 degrees (before than, supraspinatus does it)
183
how to test trapezius
shrug shoulders
Controls scapula movement
Clunky, symmetry, smoothness
184
shoulders examination initial two active movements (screen), and what are they testing for
hand behind back holding hands pushing up the back --- internal rotation, abduction, extension
hands behind head --- external rotation, abduction, (extension)
185
shoulder external rotation
elbow at side, elbow flexed 90 deg
186
normal range of motion in shoulder abduction
120 deg
187
subacromial space pathology seen as
what are some examples of subacromial space pathology
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
acriomoclavicular joint pathology seen as
painful at the top of the arc only - 120-180 deg
189
deltoid abduction
self fist bump. doctor tries to push arms down
190
shoulder internal rotation
hands behind back, whats the highest vertebra you can touch
191
lift off test=
| tests what
their hand behind their back and pushing against your hand
| Subscapularis internal rotation only
192
how to test subscapularis internal rotation only
lift off test
their hand behind their back and pushing against your hand
acromioclavicular joint
193
scarf test =? and why isnt it done
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
painful arc test
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
nerves vs vertebrae in cervical spine
nerves come out above vertebra (c3 nerve exits above c3 vertebra), except for C8 - which comes out below C7
196
normal cervical spine flexion
chin to chest
| 80 deg
197
normal cervical spine extension
head look up
| 50 deg
198
normal cervical spine rotation
watch tennis
| 80 deg each way
199
normal cervical lateral flexion
ear to shoulder
| 45 degrees in each direction (90 degrees total)
200
schobers test
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
normal straight leg raising
80-90 degrees,
202
Tibial nerve stretch test
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
Femoral nerve stretch test
Flex knee
Then extend the hip
This stretches the femoral nerve
Positive = pain in back/ front of thigh
204
nail pitting can indicate
psoriasis
205
Onycholysis =
| indicates
Onycholysis = nail lifted off bed
| fungal disease
206
koilonchya
nail spooning
207
melanoma nail presentation
dark pigment / black in nail - often in base / skin fold at base
208
Paronychia
White / pale skin adjacent to the nail = pus
| Nail needs to be removed + pus drained
209
Onychogryphosis
One side of the nail grows quicker than the other
| Look thick and curvy like a ram’s horn
210
Arachnodactyly
long thin fingers eg marfans
211
wrist flexion and extension normal
90 Deg each
212
describe thumb abduction
| what nerve does this test (when done against resistance)
90 deg perpindicular to palm
| median
213
fromans test =
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
what action tests ulnar nerve
adduction and abduction of fingers
215
wrist drop signifies which nerve palsy
radial
216
carpals tunnel treatment
```
Neutral Wrist splint (for night)
Steroid injection (into carpels tunnel)
Surgery
```
217
normal hip flexion
what should be noted about hip flexion
120 deg
Lumbar flexion can contribute, masking limitation
218
normal hip abduction
45 degrees
219
normal hip adduction (moved across other leg)
25 deg
220
normal hip rotation (foot used as indicator)
45 degrees each way
221
normal hip extension (lying on front)
20 deg
222
measuring limb lengths (both!)
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
Ripple test aka bulge test
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
normal knee flexion
140 deg
225
ligament pathologies when doing knee valgus/ varus stresses
Ligament lax / ruptured → movement may occur but painless
| Ligament strained but intact → limited movement and painful
226
mc murrays test
| - tests for what
Meniscus injury -- click /clunk +/- pain, and feel something pop out
when medial / lateral meniscus stressed (how confuses me - see notes)
