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H&P - specialized test > specialized tests > Flashcards

specialized tests Flashcards

1
Q

Orthostatic Pulse & BP

A

Take BP supine, sitting, & standing.

Pulse ↑ of > bpm or systolic BP ↓ of > 20 mmHg from supine to standing is abnormal.

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2
Q

Palpate the temporal arteries

A

Find temporal artery pulse bilaterally

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3
Q

Auscultate the temporal arteries

A

Use the bell of the stethoscope. Perform bilaterally

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4
Q

Percuss the sinuses

A

Percuss frontal and maxillary sinuses

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5
Q

Transilluminate the sinuses

A
  • Perform if sinuses tender to palpation.
  • Can transilluminate the frontal &/or maxillary sinuses.
  • Dim the lights. Use a strong narrow light source. Visualization of a reddish glow is consistent with normal (air-filled) sinuses.
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6
Q

Perform cover-uncover test for strabismus

A

Test if corneal light reflexes are not symmetric. Cover good eye, poor eye will fixate on light. Uncover the good eye and the bad eye will deviate which is positive for strabismus

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7
Q

Test visual fields (CN II)

A

Ask patient to cover one eye and look at your nose with the other eye. Place two hands 2 feet apart, and lateral to patient’s eye. Wiggle your fingers and direct patient to inform you of which side they see your hands wiggling.

Used to detect lesions in the anterior and posterior visual pathway.

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8
Q

Weber (lateralization)

A
  • Perform if hearing is diminished.
  • Place a vibrating tuning fork on the top of the patient’s head. Ask the patient if he/she hears it on both sides equally or hears it on only 1 side.
  • If unilateral conductive hearing loss is present, sound lateralizes to impaired (“crummy”) ear.
  • If unilateral sensorineural hearing loss is present, sound lateralizes to good (“super”) ear.
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9
Q

Rinne (AC > BC is normal)

A
  • Perform if hearing is diminished.
  • Place vibrating tuning fork on mastoid bone, behind ear at level of canal. When the patient can no longer hear the sound, quickly place the tuning fork close to the ear canal & assess whether or not sound can be heard. If sound is heard, AC > BC which is normal.
  • If conductive loss present, BC > AC.
  • If sensorineural loss present, test is normal (AC > BC)
  • Bates for Weber & Rinne
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10
Q

Auscultate thyroid for bruits

A
  • Perform if thyroid enlarged.

* Use the diaphragm & the bell.

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11
Q

AC Joint Sprain
Mechanism of injury is an external force applied to lateral shoulder. Patient will describe a fall on an adducted shoulder or a collision into a wall.

A
  1. (+) point tender at AC joint with palpation
  2. (+) AC resisted extension test (AC Shear Test)
  3. (+) Tradition test is Cross Body Test which may also be included
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12
Q

Palpate AC joint

A

Find where the acromion meets the clavicle, then apply pressure. Production of pain is
(+) AC joint sprain

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13
Q

AC shear test

A

Elevate arm to 90 degrees of flexion. Patient is asked to resist horizontal adduction by pushing elbow into examiner’s hand. Pain felt at AC joint is (+) AC joint sprain

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14
Q

Cross Body Test

A

Elevate arm to 90 degrees of flexion and then add maximum arm adduction. Production of pain at AC joint is (+) for AC joint sprain

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15
Q

Anterior GH instability tests

A

Positive for cluster (3) suggests anterior GH instability

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16
Q

Apprehension Test

A

Patient in supine lying position. Adduct arm to 90 degree and add maximal external rotation in the GHJ. A (+) test is pain or fear of luxation. If pain is felt in the anterior side of GHJ then it will indicate subacromial impingement.

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17
Q

Relocation Test

A

Bring patient in apprehension test position with arm at maximal external rotation until pain is elicited, then add posterior glide to the GHJ. Test is positive is pain disappears

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18
Q

Release Test

A

Sebsequent test to the relocation test. Place patient in apprehension test position with added dorsal glide of humeral head and suddenly release the pressure. A positive test is elicited pain indicating secondary impingement.

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19
Q

Painful arc test

A

Ask patient so slowly abduct their arm with thumb pointing upward.
Pain at 60-120 degrees will be a positive sign of subacromial impingement syndrome

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20
Q

Hawkins-Kennedy

A

Flex the shoulder and elbow to 90 degrees with the palm facing down. Then, with one hand on the forearm and one on the arm, rotate the arm internally. Pain is a positive test for subacromial impingement syndrome

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21
Q

Modified Hawkins-Kennedy

A

flex the shoulder and elbow to 90 degrees with the palm facing down. Then, with one hand on the scapula, and the other on the forearm, internally rotate. A positive test indicates subacromial impingement syndrome

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22
Q

Neers

A

Press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other. Pain is indicative of subacromial impingement syndrome

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23
Q

Rotate Cuff Tear

A
  1. External rotation lag sign
  2. Drop arm -full tear
  3. Empty can test
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24
Q

External Rotational Lag sign

A

elbow PASSIVELY flexed to 90 degrees and positioned at at near maximum external rotation. Positive test - the arm will pull forward on its own

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25
Q

Drop Arm Test

A

Ask patient to actively abduct arm to 90 degrees and slowly lower it. If the patient cannot hold arm at 90 degrees or control the lowering of their arm, then test is positive.

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26
Q

Empty Can Test

A

Passively extend the arms to 90 degrees and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the patient to resist as you place downward pressure on the arms. Positive test is weakness during this maneuver indicating possible rotator cuff tear

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27
Q

Mills Test

A

Perform to access for lateral epicondylitis
Patient in standing position. Palpate the lateral epicondyle while passively pronating the forearm, flexing the wrist and extending the elbow. A positive test is reproduction of lateral elbow pain.

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28
Q

Stretch test (golfer’s elbow test)

A

Perform to access for medial epicondylitis
Patient in standing position. Palpate the medial epicondyle while passively supinating the forearm, extending the wrist and extending the elbow. A positive test is reproduction of medial elbow pain.

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29
Q

Allen test

A
  • Perform to check for arterial patency prior to arterial puncture for blood gas determination.
  • Occlude the pt’s radial & ulnar arteries. Release 1, then the other & check for return of blood flow to the hand (indicating patency).
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30
Q

Phalen’s test (flex wrist)

A
  • Perform if carpal tunnel is suspected.
  • Ask pt to flex hands at the wrist with dorsum of hands touching & hold for 30 seconds.
  • Pain or tingling in the hands suggests carpal tunnel syndrome.
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31
Q

Tinel’s sign (tap median nerve)

A
  • Perform if carpal tunnel is suspected.
  • Ask pt to extend wrists. Tap on median nerve.
  • Pain or tingling in the hands suggests carpal tunnel syndrome.
32
Q

Palpate anatomical snuff box

A

• Tenderness is consistent with fracture of the navicular (scaphoid) bone.

33
Q

Median Nerve Compression Test

A

• Elbow extended, forearm supinated and wrist flexed to 60 degrees; even constant pressure applied with 1 thumb over the median nerve directly distal to the carpal tunnel. Time before the development of parathesias/numbness is recorded of the median nerve distribution. Positive test is symptoms occurring within 30 seconds.

34
Q

Tactile fremitus [palpate (tactile) “99”]

A
  • Ask the pt to say “99” each time you press against his/her back / chest. Palpate for tactile fremitus using ulnar sides of the hands & compare lung fields.
  • ↑fremitus suggests consolidation (lung tissue filled with fluid – can occur with pneumonia).
  • ↓fremitus suggests COPD, pleural effusion, pneumothorax.
35
Q

Bronchophony (auscultate “99”)

A
  • Ask pt to say “99” each time you place your stethoscope.

* Louder, clearer sound is bronchophony & suggests consolidation.

36
Q

Egophony (auscultate “Eee…”)

A
  • Ask pt to say “Eee” each time you move place stethoscope.

* “Eee” sounding like “Ay” is egophony & suggests consolidation.

37
Q

Whispered pectoriloquy (whisper “99”)

A
  • Ask pt to whisper “99” each time you place your stethoscope.
  • Louder, clearer sound is whispered pectoriloquy & suggests consolidation.
38
Q

Chest expansion

A
  • Place thumbs at level of 10th ribs with fingers loosely grasping & parallel to lateral rib cage
  • Ask pt to inhale deeply & watch distance between thumbs as they move apart during inspiration.
  • Feel range of symmetry of rib cage as it expands & contracts.
  • Unilateral decrease in expansion may indicate underlying lung disease (e.g. fibrosis, lobar pneumonia)
39
Q

Percuss for diaphragmatic excursion (exhale/inhale)

A
  • Instruct pt to exhale completely & hold it. Then percuss for & mark level of dullness (boundary between resonant lung tissue & duller structures below the diaphragm, approximating the actual diaphragm).
  • Then ask pt to inhale completely & hold it. Percuss for & mark level of dullness.
  • Normal extent of diaphragmatic excursion is 5-6 cm.
  • “Diaphragmatic excursion is ___.”
40
Q

Auscultate for soft murmurs at base of heart

A
  • Best positioning for listening to soft murmurs at base of heart (aortic & pulmonic areas), e.g. aortic regurg
  • Ask pt to lean forward, exhale, & hold breath in expiration.
  • While pt is holding breath, auscultate at base of heart with diaphragm.
41
Q

Check for hepatojugular (abdominojugular) reflux

A
  • Alternative test for JVP.

* Apply firm pressure to the RUQ and observe for JVD.

42
Q

Percuss for L. border of heart

A
  • Perform to check heart size when point of maximum impulse (PMI) is not palpable.
  • Dullness extending to the L. of the MCL suggests cardiomegaly.
43
Q

Auscultate for low-pitched murmurs & S3 &S4 heart sounds at apex of heart

A
  • Ask pt to roll onto his/her L. side (L. lateral decubitus position).
  • Auscultate apex of heart with the bell
44
Q

Shifting dullness

A
  • Shifting dullness – Percuss abdomen while patient supine & note border of dullness; then percuss abdomen while pt is lying on one side & note border of dullness
  • A “shift” in the border of dullness indicates ascites is present
45
Q

Fluid wave

A
  • Fluid wave – Ask patient to stabilize his/her mid-abdomen with his/her hand; then tap on one side of the abdomen & feel for a transmitted impulse on the other side
  • Detecting an impulse indicates ascites is present
46
Q

Rebound tenderness

A
  • Rebound tenderness – press down on tender area & quickly release.
  • Pain with release of pressure suggests peritonitis.
47
Q

Rovsing’s sign

A
  • Rovsing’s sing – Press deeply in the LLQ, then quickly release.
  • Pain in the RLQ with release of pressure suggests appendicitis.
48
Q

Psoas Sign

A
  • Psoas sign – While patient is supine, ask him/her to flex is R. hip against resistance (which tenses the iliopsoas muscle).
  • Pain in the RLQ is a positive psoas sign – suggests appendicitis.
49
Q

Obturator Sign

A
  • Obturator sign – While patient is supine – passively flex his/her knee & rotate his/her hip internally.
  • Pain in the RLQ is a positive obturator sign – suggests appendicitis.
50
Q

Murphy’s sign

A
  • Curl fingers under edge of R. costal margin or at lower liver edge & ask patient to take a deep breath.
  • The patient interrupting inspiration due to pain in the RUQ is a positive Murphy’s sign – suggests GB inflammation.
51
Q

Straight leg raise (SLR) – active & passive

Include the flip test if SLR is equivical

A
  • Perform to evaluate for sciatica or radiculopathy.
  • Patient is supine & leg is raised (hip flexed) followed by dorsiflexion of the foot
  • Pain down the leg is a positive SLR – suggests sciatica / radiculopathy.
52
Q

Slump Test

A

• Patient is sitting at edge of exam table. After each progression of this test, assess for reproduction of pain. First, patient to slump, then chin to test, apply load to crown of head, raise lower leg of affected side, as patient to continue the load to crown of head while dorsiflexing foot.

53
Q

Hoover Test

A

• Patient is supine. Passively hold the heel of each foot in palm of your hand. Legs/feet at level of the hip. Ask patient to actively raise affected leg. If patient unable to raise leg and there is a downward pressure in the palm of the hand of the contralateral leg-positive test for radiculopathy. If there is no downward pressure, negative for radiculopathy. Tests for malingering complaint

54
Q

Assess stability of the pelvis

A

• Patient is supine; apply hands to lateral pelvis & push toward table.

55
Q

FabER test (Patrick’s)

A

 Supine position. Cross affected leg over the other knee. Fixate the opposite ileum and slowly lower the test leg down to the treatment table.
(+) test leg remains above the opposite leg
Affected SI joint

56
Q

Bulge sign

A
  • Sweep along the medial & lateral side of the knee & observe for a fluid “bulge.”
  • The presence of fluid (a bulge) indicates that an effusion is present.
57
Q

Ballottement of patella

A
  • Slide one hand down patient’s distal thigh toward to move fluid toward the patella, then push patella downward.
  • A boggy sensation suggests that an effusion is present.
58
Q

Valgus stress test (tests MCL)

A

• Stabilize the lateral knee & apply lateral pressure to ankle/foot noting any pain or MCL laxity.

59
Q

Varus stress test (tests LCL)

A

• Stabilize the medial knee & apply medial pressure to ankle/foot noting any pain or LCL laxity.

60
Q

Anterior drawer sign

A
  • Perform to test for ACL tears/rupture
  • Patient is supine with knee flexed 900. Stabilize foot & pull proximal tib/fib toward you.
  • Laxity suggests ACL tear.
61
Q

Posterior Drawer Sign

A
  • Perform to test for PCL tears/rupture
  • Like ant. drawer, except push proximal tib/fib toward patient.
  • Laxity suggests PCL tear.
62
Q

Lachman’s test

A
  • Perform to test for ACL tears/rupture
  • Place the patient’s knee in 150 flexion. Grasp the distal femur with 1 hand & the upper tibia with the other.
  • Move the femur back & the tibia forward.
  • Laxity suggests ACL tear.
63
Q

McMurray’s test

A
  • Perform to assess for meniscal tears
  • Flex the patient’s knee and, with 1 hand, palpate the joint line. Hold the heel of the foot in your other hand.
  • To test for medical meniscal tear – Laterally rotate the foot, then extend the leg.
  • To test for lateral meniscal tear – Medially rotate the foot, then extend the leg.
  • A palpable click or pain at the joint line is a positive McMurray’s test – suggests meniscal tear.
64
Q

Thessaly test

A

Perform to assess for meniscal lesions
Patient in standing position with support while bearing weight on the injured leg. Flex knee 5 degrees and rotate over tibia 3 times and assess for complaint of pain along the joint line. May further flex to 20 degrees and repeat rotation.
https://www.youtube.com/watch?v=ebraZ4jM36A

65
Q

Homan’s sign

A
  • May perform when DVT is suspected.
  • Dorsiflex foot. Pain in the calf is a positive Homan’s sign – may be present with a DVT.
  • Note – a negative Homan’s sign does not rule out DVT.
66
Q

Anterior drawer (tests for ligament stability)

A
  • Stabilize distal tibia. Grasp posterior calcaneus & pull forward.
  • Laxity suggests ligament injury/tear.
67
Q

Thompson Test

A
  • Perform to assess for Achilles rupture
  • Patient is prone with feet hanging freely off the edge of the exam table. Squeeze the calf 2-4 times and observe for planter flexion of the foot. Absence suggests Achilles rupture.
68
Q

Rapid alternating movements

(tests cerebellar function)

A
  • Instruct patient to rapidly pronate & supinate his/her hand onto his/her thigh or ask him/her to tap the floor rapidly with his/her foot.
  • Test bilaterally. Slow but coordinated movements suggest cerebral disease. Uncoordinated movements suggest cerebellar disease.
69
Q

Primary Sensory Function (temp, vibration, proprioception)

A
  • Use tuning fork to determine if patient can sense vibration. Compare sides.
  • Gently hold the patient’s finger or toe on its lateral or medial side, then move it up and down. Ask patient to identify the direction of movement.
70
Q

Test corticol Sensory Function (sterogenosis, graphesthesia, 2-point discrimination, and extinction)

A
  • Ask patient to identify an object placed in his/her hand.
  • Write letter or # in the palm of patient’s hand & ask him her to identify it.
  • Use 2 ends of a paperclip or 2 wooden ends of a Q-tip. Ask patient whether or feels 1 object or two.
  • Touch patient in the same place on both sides of his body & ask if he/she detects 1 or 2 touches.
71
Q

ankle clonus

A
  • Dorsiflex foot to see if it “beats.” If it does, clonus is present.
  • Clonus is associated with hyperreflexia (4+) & UMN disease.
72
Q

cremasteric reflex

A
  • Stroke proximal medial thigh; observe for testicles rising which is normal.
  • Cremasteric reflex may be absent with: testicular torsion, UMN or LMN disorders, spine injury L1-L2, ilioinguinal nerve injury during hernia repair.
73
Q

Kernig sign

A
  • Flex the patient’s knee & hip, then straighten the leg.
  • Back pain & resistance to straightening is a positive Kernig’s sign. If the finding is bilateral, suggests meningeal irritation (e.g. due to meningitis)
74
Q

Brudzinski Sign

A
  • Patient is supine. Flex his/her neck.
  • Hip & knee flexion during the maneuver is a positive Brudzinski’s sign – suggests meningeal irritation (e.g. due to meningitis)
75
Q

Nuchal rigidity

A

• Test for ease of neck flexion, extension, & rotation. Rigidity suggests meningeal irritation (e.g. due to meningitis)

H&P - specialized test (1 decks)

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