Practical final

Question 1

Test for direct and consensual light reflex

Answer 1

(remember to wash hands)
Shine light in one eye, pupil constricts in that eye - verbalize this. Also see pupillary constriction in opposite eye - consensual constriction (verbalize this). Do other eye.

Question 2

Test for relative afferent pupillary defect in left eye (swinging flashlight test)

Answer 2

Shine flashlight in unaffected right eye and comment: “There’s a brisk constriction of both pupils”
Shine flashlight in affected left eye. Say, ”Positive test when light swings over to the abnormal left eye, partial dilation of both pupils occurs. CN II Optic nerve problem.”

Question 3

Perform cover/uncover test in patient with right sided monocular esotropia

Answer 3

Covering good eye causes bad eye to focus. PT focuses directly ahead, cover good eye, bad eye comes into focus. Verbalize, “Right eye moves/corrects to midline. Detects and confirms tropia (manifest deviation).”

Question 4

Test EOMs

Answer 4

Cardinal fileds of gaze (H pattern)
Tell patient to not move their head and to follow your finger while you move through the H pattern. Verbalize CNs involves in eye movements (LR6SO4)3.
Look for Nystagmus -> verbalize it is more common in lateral or upward gaze.
Test for convergence when finger goes toward nose (convergence is NOT the same as near reaction). Verbalize to patient, watch my finger as it comes toward you. Eyes move medially as finger nears patients nose

Question 5

Perform the Rinne test

Answer 5

Tuning fork on mastoid bone while vibrating and record how long heard by PT. When no longer heard have patient put up finger and place tuning fork close to ear canal
Verbalize: Normal is air conduction > bone conduction.
In conductive hearing loss, bone conduction = air conduction or bone conduction > air conduction
In sensory hearing loss = air conduction > bone conduction

Question 6

Perform the Weber test

Answer 6

Put vibrating tuning fork on top midline of the patients head/forehead. Normally heard equally in both ears.
Verbalize positive test
“In unilateral conductive hearing loss, sound lateralzes/heard to the impaired ear”
“In unilateral sensorineural hearing loss, sound lateralizes/heard to the good ear”

Question 7

Palpate lymph nodes of head and neck

Answer 7

• Pre and post auricular
• Occipital
• Tonsillar
• Submandibular
• Submental
• Anterior cervical, deep cervical, and posterior cervical
• Supraclavicular

Question 8

Palpate for tactile fremitus anteriorly and posteriorly

Answer 8

Ball or ulnar surface of hand on chest wall. 3 areas anteriorly bilaterally and 4 areas posteriorly bilaterally .
Direct patient to say “99”
Verbalize Positive test:
“asymmetric decrease in unilateral pleural effusion, neoplasm, pneumothorax”
“asymmetric increase in unilateral pneumonia”

Question 9

Assess for diaphragmatic excursion

Answer 9

Verbalize “percuss posteriorally during quiet respiration from high to low until dullness replaced resonance.” Mark spot with pen. Ask to take deep breath and hold and percuss again until new dull spot and mark. Measure difference and say, “ Normal is 3-5.5cm >5.5cm (abnormal) is found in pleural effusion, diaphragm paralysis.”

Question 10

Auscultate for transmitted voice sounds (posteriorly)

Answer 10

Bronchophony=“99”. Heard loudly and clearly on one side compared to the other (may indicate pneumonia).
Egophony=E changes to A
Whispered Pectriloquoy=Have patient whisper “1, 2, 3” -> will hear them speaking loudly, not whispering
Verbalize” positive test for any of these means consolidation (airless lung tissue)”

Question 11

General anterior/posterior auscultation

Answer 11

6 pairs anteriorly, 7 pairs anteriorly using ladder technique.
Describe different breath sounds:
Vesciular sounds=heard over most lung fields
Bronchovesicular sounds=heard over main bronchus area
Tracheal sounds=heard over the trachea

Question 12

Auscultate the cardiac valves and verbalize the anatomic areas

Answer 12

Use diaphragm
Aortic valve=2nd ICS at right sternal border
Pulmonic valve=2nd ICS at left sternal border
Erb’s point=3rd ICS at left sternal border
Tricuspid valve=4th ICS and left sternal border
Mitral valve/apex=5th ICS at left midclavicular line

Question 13

HOCM test

Answer 13

Diaphragm over Erb’s Point (3 ICS at left sternal border).
Patient squats (and you squat with them) while listen with stethoscope. While patient rises to standing, listen for a change in murmur. Verbalize, “HOCM murmur decreased with squatting, increases with standing or valsalva. High pitches crescendo decresxendo midsystolic murmur.”

Question 14

Perform the Allen’s test

Answer 14

Patient makes a fist. Compress both radial and ulnar arteries with thumbs. Patient opens fist while you release pressure from the ulnar artery.
Verbalize positive test, “Persistent palmar pallor >5 seconds can indicate arterial occlusion of ulnar artery.”

Question 15

Auscultate for aortic insufficiency

Answer 15

Use diaphragm of stethscope at Erbs point. Have patient lean forward and have them exhale.
Verbalize, “Mumur is high-pitched diastolic murmur.”

Question 16

Listen for abdominal bruits and name the vessels

Answer 16

With bell of stethoscope.
Aorta=1cm left and above umbilicis 
Renal arteries (both)=next to umbilicus 
Iliac arteries (both)=groin
Femoral arteries (both)=median femur

Question 17

Percuss for an enlarged spleen (splenic percussion sign)

Answer 17

PT supine, knees flexed, arms at side. 
Traube’s space=left hypochondriac region.
a. Percuss from heart border to traube’s space listening for resonance to dullness
Normal spleen=percussion note remains tympanic
Splenomegaly=Dullness on inspiration+ splenic percussion sign
Splenic percussion sign=percuss lowest IC in left ant axillary line (tympanic). PT deep breath and percuss again (remains tympanic). Change from tympanic to dull on inspiration=positive percussion sign

Question 18

Perform psoas sign

Answer 18

Have patient raise their thigh against resistance or have patient on their left side and you extends patients thigh passively.
Verbalize reason for the test, “Positive test means concern for appendicitis/peritonitis”
Explain a positive psoas sign=
a. When patient raises thigh against resistance or passive extension and have pain in the RLQ -> concern for appendicitis/peritonitis

Question 19

Perform obturator sign

Answer 19

Patients thighs flexed at hip with knee bent. Externally rotate patients hip/bring right foot to knee stretching internal obturator muscle.
Verbalize positive test, “Irritation of obturator muscle is concern for appendicitis”

Question 20

Perform Rovsing’s sign

Answer 20

Have patient in abdominal position - supine/hips/knees flexed. Deep palpation into the RLQ.
Verbalize positive test,”Pain in RLQ increases with this maneuver heightens suspicion of appendicitis”

Question 21

Perform Murphy’s sign

Answer 21

Palpate for liver in RUQ midclavicular line using hook the left thumb and fingers under the right costal margin.
Have patient take a deep breath in while palpating. Verbalize positive test, ”Sudden increase in pain and cessation of inhalation suggests cholecystitis.”

Question 22

Measure liver span

Answer 22

Supine, knees flexed, arms at side.
Percuss at right midclavicular line from point below the umbilicus upward towards the lower border of dullness and mark it.
At the right midclavicular line, percuss from just below the nipple from resonance to dullness and mark it.
Measure the distance . Verbalize, “normal span of liver is 6-12cm”.

Question 23

Test CN1

Answer 23

Nostril patency and smell.
Occlude one nostril, eyes closed, use 2 scents in total. Do other nostril.

Question 24

Test for motor components of CN V

Answer 24

Trigeminal nerve, muscles of mastication.
Temporalis and masseter=jaw clenching
Pterygoids=lateral jaw movement
Open and close mouth. Protrude and retract jaw. Slide side to side. Clench jaw.

Question 25

Test CN X (uvula and soft palate)


Answer 25

Have the patient say “ahh” and watch for the symmetric rise of the soft palate and uvula at the midline.

Question 26

Test CN XI Spinal accessory


Answer 26

Both hands on shoulderand shrug against resistance. Turn head against resistance in both directions.

Question 27

Test CN XII Hypoglossal

Answer 27

Have patient stick out their tongue. Verbalize normal finding, ”Tongue remains midline.”

Question 28

Demonstrate testing and ROM of shoulder

Answer 28

A. Have patient mimic you doing:
Abduction=180º like rainbow
Adduction=50º hand to chest
Internal rotation=hand to bottom of scapula. State if limited or full movement.
External rotation=Touch back of head (apley’s scratch maneuver). State if limited or full movement.
Forward flexion raise straight arm=180º
Extension=50º like reaching arm back

Question 29

Perform Lochman’s test

Answer 29

Verbalize, “Assess ACL integrity.”
Ask which side is injured and do uninjured side first.
Have the patient flex their knee to 15 degrees. Grasp the distal femur with one hand and the proximal tibia with the other hand. Put thumb on tibia and on the joint line. Move the tibia forward and the femur backward 1. Verbalize that you are looking for laxity
A. Estimate the degree of laxity
If no laxity verbalize, “firm endpoint” or no laxity.
If have laxity verbaize “suggest ACL tear”.

Question 30

Perform Thompson test

Answer 30

Pt in prone position with ankle over edge of table or knee flexed
Squeeze gastroc and soleus complex. Verbaliz, “Lack of plantar flexion is likely ruptured Achille’s tendon”

Question 31

Test for ROM of digits

Answer 31

Verbalize, “Assess median nerve disorder.”
DIP flex 90, ext to 10
PIP flex to 100, ext to 10
MCP flex to 90, ext to 45
Thumb: Flexion aross palm, extsion back out, abduction upwards, adduction thumbs down

Question 32

Test CVA tenderness

Answer 32

Ball of hand over CVA and thumb on CVA with ulnar surface.

Verbalize positive test, ”Pain elicited commonly with kidney infection. Can also happen in MSK pain.”

Question 33

Rapid motor neuron UE exam

Answer 33

Have patient do and verbalize: 
Elbow flexion=C5 
Elbow extension=C7 
Wrist extension=C6 
Finger flexion and thumb opposition=C8 
Little finger abduction=T1

Question 34

Rapid motor neuron LE exam

Answer 34

Have PT do and verbalize
Hip flexion=L2 
Knee extension=L3 
Ankle Dorsiflexion=L4
Great toe extension =L5 
Ankle plantar flexion =S1

Question 35

Perform straight leg raise test

Answer 35

Patient must be supine. Tests for herniated disc. Start with unaffected side. Raise the leg passively, flexing at the hip to 80 degrees. At the point where the patient experiences pain, lower the leg to 30º and dorsiflex the foot to stretch the sciatic nerve. Hamstring pain only in post thigh. Sciatic pain goes down leg.
Verbalize the reason for the test, “To reproduce back and/or leg pain” Verbalize positive test, ”Pain in posterior thigh only indicates tight hamstrings. Pain radiating down leg indicates sciatica.”

Question 36

Well leg straight raise test

Answer 36

Lay supine and raise unaffected leg.

Back or sciatic pain on affected side=herniated disc in lumbar region