What does WIIPEEP stand for?
Wash hands Introduce yourself Identify the patient Permission to examine Explain the task ahead Expose the area to be examined Position the patient
Sound of percussion over normal lungs?
Low pitch and high amplitude
Sound of percussion over hyperinflation of the lung?
Sound of percussion over reduction of air or increase of fluid?
Dull, short note
Sound of percussion over the anterior abdomen where the is air in the bowel loops?
Sound of percussion over air outside the bowel in the abdomen?
Tympanic (there is no hypertympany)
These areas are normally dull
Sound of percussion over fluid in the abdomen?
Short, dull note
What do you examine using percussion?
What do you examine using auscultation?
What do you use the bell for?
Low pitch sounds
What do you use the diaphragm for?
High pitch sounds
What is significant weight loss?
5% or more within 6 months or 10% or more over 1 year
Describe spastic hemipareisis gait
Associated with lesions in the Corticospinal tract (i.e. stroke)
One arm immobile and close to side (elbow, wrist, IP joints flexed)
Leg extended, plantar flexion of the foot
When walking, patient drags the foot (scraping the toe) or circles it stiffly outward and forward (circumduction)
Describe steppage gait
Associated with foot drops, secondary to LMN disease
Patients drag their feet or lift them high, with knees flexed
Bring them down with a slap onto the floor
Appears to be walking up stairs
Unable to walk on their heels
Describe scissors gait
Associated with bilateral spastic paresis of the legs
Gait is stiff
Legs advance slowly, thighs cross forward on each other
Steps are short
Patient appears to be walking in water
Describe parkinsonian gait
Associated with basal ganglia defects of Parkinson's disease Posture is stooped Head and neck forward and hips/knees slightly flexed Arms are flexed at elbows/wrists Slow in getting started Steps are short and shuffling Decreased arm swinging Patient turns around stiffly "All in one piece"
Describe cerebellar ataxia gait
Associated with disease of the cerebellum or associated tracts
Gait is staggering, unsteady, wide based
Exaggerated difficulty on the turns
Double failure on the Romberg
Describe sensory ataxia gait
Associated with loss of proprioception
Gait is unsteady and wide based
Patients throw feet forward and outward and bring them down
First on the heels and then on the toes - double tapping sounds
Watch the ground for guidance
Positive Romberg sign
Staggering gait worsens with eyes closed
Describe the gait of older age?
Associated with aging
Speed, balance and agility decrease with aging
Steps become short, uncertain and shuffling
Legs may be flexed at hips and knees
Cane can bolster lost confidence
Loss of the voice, due to larynx or its nerve supply
alteration in volume, quality and pitch of the voice
Disease of the muscles involved in formulating words (lips, tongue, pharynx or palate)
Problems producing or understanding language
With percussion, which finger is on the surface?
The pleximeter finger
With percussion, which finger does the tapping?
The plexor finger
What do you listen for during inspection
Listen for any foot slapping during walking (foot drop). Listen for noisy breathing or stridor.
Patient looks acutely ill
in painful distress (facial
expression) or respiratory distress (dyspnea, respiratory
pattern); diaphoretic; looks pale; excessive sweating;
dehydrated (depressed fontanels in babies and loss of skin
turgor in children and adults
Patient looks chronically ill:
cachectic and emaciated
(nutritional status); evidence of significant weight loss
(wasting of the Temporalis muscles of the head and
interossei muscles in the hand, sunken eyes). Significant
weight loss is 5% or more of body weight within 6 months
and 10% or more over I year. Patient looks pale
Antalgic gait (pain related)
Short stance phase and extended swing phase on the affected limb. site of pain: Foot – foot contact ground abnormally e.g. on side of foot Knee – stiff knee (no flexion or extension Hip – coxalgic gait Extension is limited towards the end of stance (normal 20degrees) Lateral lurch in stance phase with arm abducted
Weak abductor function (G medius and minimus) Abductors supports the opposite pelvis during single limb stance Pelvis drops to opposite side on walking When bilateral it is called waddle gait
Weak Gluteus maximus
Weakness causes excessive hip flexion To counteract - abnormal backward trunk lean during early stance Center of gravity behind hip Demands of hip extensors lessened
Weak Quads Gait
A. Patient leans forward at hip Center of gravity displaced forwards and in front of knee Knee forced into extension (hyperextension) B. Place hand above the knee to support leg by preventing buckling
Arm flexed, adducted and internally rotated, fingers
flexed. Leg on same side in extension with plantar
flexion of the foot and toes. When walking, the patient
will hold his or her arm to one side and drags his or
her affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop) and
extensor hypertonia in lower limb
Spasticity in all extremities,
Flexion at hip and knees; thighs in adduction at hip;
Ankles extended and feet internally rotated;
Forearm in midguard position.
Walk with a narrow base, thighs rub against each other, legs dragged in semicircle (circumduction),
Toes scraping the floor with each advancing step,
In some, the knees tend to slide over each other like the blades of a pair of scissors
Back pain posture. (radicular)
Gets up by pushing up with the arms, stiff back, flat lumber curvature, avoid putting weight on the painful leg Flexion of trunk Gait otherwise normal
Huntington’s Disease and
other forms of chorea,
athetosis or dystonia.
Gait abnormality accompanied by associated movements The patient will display irregular, jerky, involuntary movements in all extremities. Walking may accentuate their baseline movement disorder.
Truncal obesity -
Long limbs -
Large jaw, frontal
puffy face, dull look
thinning of scalp
hair, acne plethora
Up-slanting palpebral fissure, flat nasal bridge, loose nuchal skin, open mouth
web neck, low posterior hairline, low-set posteriorly rotated ears, shield chest
Grave’s disease face
are due to turbulent
and fast flow
Seperation of nail from nail bed