Quiz 3 Flashcards
correct position for prostate exam
Sims (side lying) position
digital rectal/prostate exam, what area of prostate palpating?
posterior aspect
what should normal prostate feel like
rubbery and smooth
how do you know rectal prolapse
see sliding of rectum, especially when straining during BM or bearing down
external hemorrhoid appearance
external= small mass, PINK or red/beefy normal. Purple/dark is concerning (thrombos hemorrhoid) and is more urgent, need hemorrhoidectomy
pts will feel like they’re sitting on something
internal hemorrhoid feeling/sx
blood in stool
rectum= soft mass inside/protrusion. Patient may feel like “grapes” are inside
HARD= concern
causes of rectal bleeding
- hemorrhoid
- cancer (change in bowel habits, pain, blood) need f/u
- fissures (from constipation, etc)
- colitis/inflammation/infection of bowel (Crohn’s, c-diff, etc. bleeding to be expected)
- GI bleed (lower= bright red, upper= black/tarry)
- medications (NSAIDs, ASA)
Tylenol, iron, thyroid supp. DO NOT cause bleeding
sequence of MSK exam
inspect, palpate, passive then active ROM, stability tests, specialized tests
normal changes with aging in MSK
-joint stiffness pain
-osteoarthritis risk
-increased bone resorption so not as much surface area= instability
decreased ROM
joint symmetry technique
INSPECT and compare both sides
assess for joint effusion
palpate
soft, spongy feeling
Tinel test
It is performed by lightly tapping (percussing) over the nerve on ulnar side to elicit a sensation of tingling or “pins and needles” in the distribution of the nerve.
Tells you if medial nerve is involved in carpal tunnel
Phalen test
inverse praying hands, if pt gets tingling then= compression of carpal tunnel nerve
Lachman test
stability testing that looked for ACL tear
characteristics of osteoarthritis
heberden nodes
distal joints
enlarged joints
characteristics of rheumatoid arthritis
buchards nodes
proximal joints
risk factors for OA
old age
family hx
vitamin D deficiency
smoking
obesity
previous joint injury (runners, overuse)
DECREASED risk w/ more active lifestyle (nonimpact,
not overuse bc overuse=risk)
tests that will look at meniscus
MRI
McMurrays
McMurray
internal & external rotation of knee to see if any laxity to test for meniscus tear
infant test for hip displasia
ortolani and barlow tests
dx plantar faciitis
pain to base of heel, bottom of arch
pain worse in MORNING before stretch ligament then worse right at night before bed
tests for rotator cuff tear
- Neers test (raise arm=tingling/pain)
- drop arm test (no strength to hold arm up against gravity)
- Hawkin’s test (can barely push against resistance when abduct shoulder)
decreased ROM
traumatic or atraumatic
reduced strength
tx= sling, rest, ROM/PT, maybe surgery
sx spinal stenosis
*pain w/ walking and standing upright
OA vs RA
OA= joint enlargement, localized weakness
RA= not overuse injury so doesn’t improve if rest joint, atrophy of muscles
scolioisis dx
bend over and look for lateral curvature of spine
when standing upright, shoulders will be uneven
red, swollen joint dx
infection (septic arthritis) vs gout
mobility is biggest difference. infection will COMPLETELY inhibit ROM, gout will be painful but will still move
SV fluid tap is most definitive to dx infection
gout
distal, small joints
uric acid
shoulder injury tests
empty can test (adduct test, thumbs down, reduced strength)
drop arm test
hawkins (abduct)
strength grading
0-5
- 0= no movement (paralysis)
1= movement but just flicker of muscle
2= movement not against gravity
3= movement against gravity
4= weakness against resistance
*5= full strength against resistance
ROM positions
flexion= towards body
extension= out from body
abduction= away from body
adduction= toward body
supination= upward (palms up)
pronation= downward
goals sports physical
risk of injury
CV (*murmur), MSK (bones/joints), *sensory (vision, hearing etc), congenital anomalies
NOT looking for= Nose, throat, focussed. (PND etc)
functional assessment older adult
ADLs (can they perform?)
make sure living conditions compatible with physical ability
GROSS motor movement not strength
DONT care about- able to move heavy boxes, etc. only basic ADLs
normal gait for older adult
slower, balance, field shoulder width apart, regular arm swing, even step
NOT shuffling
neuro sequence
NO auscultation, palpation, percussion
*inspect & special tests
#1 mental status, CN (2-12), sensation (upper/lower), strength (upper/lower), coordination (rapid alt. movements), reflexes, gait, skull & spine general inspection
CN
1= sensory (olfactory- smell something)
2= sensory (optic nerve- visual acuity/confrontation)
**3= motor (medial up/lateral down EOM)
**4= motor (trochlear (down/medial) EOM)
5= both motor/sensory (trigeminal- face sensation and chewing)
**6= motor (abducens, LATERAL*, EOM)
*7= both (facial nerve taste, motor *smile, raise eyebrows)
8= sensory (auditory)
9/10= both (gag reflex (not in awake adult), glossopharyngeal, vagus, uvula rises, swallowing, taste)
**11= motor (shoulder shrug, accessory)
12= motor (turn head against resist, hypoglossal move tongue side to side)
normal/abnormal neuro in aging
normal= sensory deficits (touch, taste, hearing, eyesight)
abnormal= motor and cognition deficits
testing equilibrium
*Romberg= stand w/ eyes closed, feet together, arms by side
should be able to keep balance without swaying
DTRs
upper= bicep, brachioradialus, tricep
lower= patellar, ankle
deficit in lumbar spine, where decreased DTR?
patellar
deficit in cervical spine where decreased DTR?
higher cervical= tricep/bicep
lower= brachioradialus
dermatome levels
sensory test & if concerned about CNS; most often unilateral
thumb= C6 radial aspect
2nd/3rd (middle) fingers= C7
ring finger/pinky= C8
proprioception-what is it and how to test
awareness of body position in space
have person close eyes, you move their toe up/down and see if they know position
graphesthesia
type of proprioception test
draw in palm and pt tells you what you drew
stereognosis
type of proprioception test
ID object in hand
2 point discrimination
how long it takes to feel two different points
concerning findings meningitis
neck pain
unable to touch chin to chest (*nuccal rigidity)
fever
n/v
HAs
altered mental status
kernig sign= lay flat, lift leg causes pain in neck
brudzinski sign= can’t flex knees and neck at same time, wont be able to, so lay flat lift head up and they will try to bend knees
straight leg test
spinal stenosis with radiculopathy (irritation of nerve root)
lumbar root irritation
lay flat, lift leg up, shooting pain down other side
tension HA
band like, tight, across head, squeezing
migraine
unilateral, n/v, photophobia, stabbing, throbbing, pulsing
cluster HA
behind one eye, severe pain, lacrimation
parkison’s s/s
shuffling gait
pill rolling finger movements
tremors
altered MS change older adult
*** have to r/o organic causes of altered mental status changes older adult (metabolic etc)
dementia r/o comes after
reflexes in pediatrics
normal= babinski (toes flare/opposite for adult), rooting reflex (stop 4 months), startle reflex
sequence of physical exam
head to toe
document by system
best way to get dx ddx
subjective & objective data, come up with dx and ddx, THEN order tests that confirm/refute, use test results to make ultimate dx
