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Adv Patho & Pharm 2018 > Adv Health Assessment > Flashcards

Adv Health Assessment Flashcards

1
Q

Trendelenberg sign

A

stand on one foot, + if opposite hip drops down to hold position; “lurch,” pt walks bending over weak hip

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2
Q

Whispered pectoriloquy

A

Ask the patient to whisper a sequence of words such as “one-two-three”, and listen with a stethoscope. Normally, only faint sounds are heard. However, over areas of tissue abnormality, the whispered sounds will be clear and distinct.

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3
Q

antalgic gait

A

gait that develops as the patient tries to avoid pain while walking

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4
Q

Bronchophony

A

Ask the patient to say “99” in a normal voice. Listen to the chest with a stethoscope. The expected finding is that the words will be indistinct. Bronchophony is present if sounds can be heard clearly.

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5
Q

Mouth

A

Inspect
say “ah”
lift tongue (CN 4)
stick out tongue (CN 7)

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6
Q

apprehension sign

A

pt supine, makes L with arm, try to externally rotate shoulder past 90 deg, pt will object; indicates instability of shoulder joint

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7
Q

Obturator sign

A

patient lying down, flex right leg at hip and knee and internally rotate hip; increased RLQ pain in acute appendicitis

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8
Q

Murphy’s sign

A

ask the patient to breathe out and then gently placing the hand below the costal margin on the right side at the mid-clavicular line; Ginny’s way: press on right MCL under rib cage as patient breathes in, if acute gb inflammation will have interrupted inspiration

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9
Q

FABER (Flexion Abduction External Rotation)

A

Pt supine, put hip in “figure 4” position (one leg “Indian style”) +if knee points up, - if can push knee parallel to table without pain.

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10
Q

pelvic compression test

A

pt supine, outward pressure to inner aspects of ASIS, then hands at iliac crests and inward pressure to hips; + if pain/ symptoms at sacroiliac joint

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12
Q

Nose

A

Inspect
Patency of each nostril
Speculum exam

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13
Q

Phalen’s test

A

for carpal tunnel; upside down prayer hands, + if pain/numb/tingling in thumb and first two fingers

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14
Q

Tinel’s test

A

for carpal tunnel; tap/press over middle of wrist at base of hand; paresthesia in fingers can be elicited in CTS

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15
Q

eversion

A

sole of foot away from midline

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16
Q

inversion

A

sole of foot toward midline

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17
Q

Neuro

A
  • Remaining CNs: Puff cheeks, clench teeth, raise eyebrows
  • RAMs: finger to thumb, toe taps; alternating nose touches, heel to shin
  • Sensory: Soft vs. Sharp
  • Graph/Stereo
  • Reflexes: triceps, biceps, brachioradialis, patellar, Achilles, Babinski
  • Spine: bend back, twist, side bends, touch toes/Scoliosis check
  • Gait: Walk away to assess gait, return heel to toe, tiptoes, walk on heels
  • Romberg/Pronator drift
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18
Q

Diaphragmatic excursion

A

ask patient to exhale and hold it, percusses down starting below the scapula until sounds change from resonant to dull, mark the spot. Then the patient takes a deep breath in and holds it, percuss down again, marking the spot where the sound changes from resonant to dull again. Then measure the distance between the two spots. Repeat on the other side, is usually higher up on the right side. Should be 2-5 cm, if less, PNA, PTX, etc.

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20
Q

Empty can test

A

pt holds “can” and internally rotates wrist, hold position against resistance; if pain, shoulder issue

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22
Q

Respiratory

A 
Inspect (while palpating thyroid)
Palpate spine
Tactile Fremitus "99"
Thoracic Expansion
Percuss lungs
Auscultate lungs
(check CVAT)
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23
Q

Allen’s test

A

test for perfusion of upper extremeties; raise hand and occlude ulnar and radial artery; open each individually and ensure reperfusion

24
Q

Kernig’s sign

A

Pt supine, lift their leg and flex knee, if that causes back/neck pain it’s +

25
Q

tests for acute appendicitis

A

Psoas, Obturator, Aaron’s

25
Q

talar tilt test

A

to test for injury to the lateral ligaments of the ankle; hold leg steady and hold heel, thumb on lateral ligaments; invert foot (tip to midline.) Grade laxity.

26
Q

Thompson’s test

A

test for Achilles tendon rupture; squeeze calf and watch foot, should plantar flex slightly

28
Q

Finklestein’s test

A

for DeQuervain’s tenosynovitis/Gamer’s thumb; pt places arm thumb up on table with wrist hanging over table; pain at styloid process with gravity; active movement down or passive down is +

28
Q

Straight leg raise test

A

with pt supine, have them raise their straightened leg @ the hip; pain indicates sciatic, nerve root irritation or disk issue

29
Q

Eyes

A 
Inspect
Visual Acuity
Cardinal Fields
Fishbowl
Accomodation
Pupils
Fundoscopic Exam
30
Q

Psoas sign

A

have patient lying down, lift right left against resistance-abd pain in RLQ if there is appendicitis

31
Q

Hornblower’s test

A

same position as apprehension only pt is seated and they try to externally rotate shoulder; pain indicates impingement

32
Q

JVD

A

have pt turn head to side; place one stick perpendicular to sternum; use another to measure highest point of internal jugular wave-measure where they cross

34
Q

Head

A

Inspect
Palpate (skull, hair, facial bones, conjunctivae, TMJ)
Percuss sinuses

35
Q

Buerger’s test

A

test for perfusion of lower extremities; raise leg
assessment of arterial sufficiency.
Buerger’s test is used in an assessment of arterial sufficiency. In a limb with a normal circulation the toes and sole of the foot stay pink, even when the limb is raised by 90 degrees. In an ischemic leg, elevation to 15 degrees or 30 degrees for 30 to 60 seconds may cause pallor.

35
Q

Brudzinski’s sign

A

Pt supine, flex patients neck they will flex knees and hips

37
Q

varus

A

position of the joint when the distal segment of the bone is angled toward the midline (bow legs)

38
Q

Ears

A

Inspect
Palpate
Whisper test
Otoscope

39
Q

Rovsing’s sign

A

in acute appendicitis: pain in RLQ with palpation of LLQ

39
Q

Scapular winging

A

have patient extend arms and push forward onto a flat surface if scapulae wing out could have thoracic nerve damage or serratus muscle weakness

40
Q

Neck

A

Inspect
Palpate lymph nodes
Palpate thyroid (inspect back also)

41
Q

Rinne test

A

strike a tuning fork and places it on the mastoid bone
When pt can no longer hear the sound, they signal
Move the tuning fork next to ear canal.
When pt can no longer hear that sound, once again signal
Record the length of time you hear each sound–air conduction should be 2x bone conduction (should hear 2x longer than they could feel.)
If conductive hearing loss, the bone conduction is heard longer than the air conduction sound.
If sensorineural hearing loss, air conduction is heard longer than bone conduction, but may not be twice as long.

42
Q

McMurray test

A

pt supine, grasp knee and heel, knee at 90deg. Passively externally rotate tibia while straightening leg (valgus force, tests lateral meniscus); then passively internally rotate knee while straightening leg (varus force, tests medial meniscus); pain, pops or clicks if meniscus tears

43
Q

Egophony

A

While listening to the chest with a stethoscope, ask the patient to say the vowel “e”. Over normal lung tissues, the same “e” (as in “beet”) will be heard. If the lung tissue is consolidated/fibrotic/compressed, the “e” sound will change to a nasal “a” (as in “say”).

44
Q

Cardiac

A

Inspect chest
Palpate APETM
Auscultate with diaphragm
Auscultate with bell (including carotids for bruit)
Ausc with diaphragm lying down
Ausc with bell lying down
Ausc Aorta, Renals, Iliacs, Femorals (also bowel sounds)
Peripheral pulses (brachials, radials, femorals, popliteals, DP/PT

45
Q

Abdomen

A 
Inspect 
(already ausc with cardiac)
Percuss 4 quadrants
Percuss liver and spleen
Light palpation
Deep palpation
Palpate liver and spleen
46
Q

Aaron’s sign

A

epigastric pain with continuous pressure over Mc Burney’s point–>acute appendicitis

48
Q

valgus

A

position of a joint when the distal segment of the bone is angled away from the midline of the body (knock-knee)

49
Q

Weber test

A

strike tuning fork and place in center of upper forhead; patient should hear equally on both sides; Conductive loss will cause the sound to be heard best in the abnormal ear; Sensorineural loss will cause the sound to be heard best in the normal ear.

49
Q

Cozen’s test

A

test for lateral epicondylitis (tennis elbow) ; pt holds elbow at 90deg flexion, makes fist with wrist fully flexed; examiner stabilizes elbow and asks pt to extend wrist against their resistance; + if pain in lat epi with test

49
Q

Lachman’s test

A

for ACL tear; pt supine, flex knee slightly, stabilize femur; pull lower leg anteriorly quickly to see if can displace femur

49
Q

anterior drawer test

A

for ACL tear; pt supine, bend knee with foot on table, sit on foot; hold knee with fingers in pop space and thumbs on front; pull forward, will feel laxity in joint

Adv Patho & Pharm 2018 (5 decks)

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