Flashcards in Lab study guide for the last test Deck (159):
What is Lymphangitis?
red streaks in the skin
What is lymphedema?
edematous swelling due to excess accumulation of lymph fluid in the tissues
Where are the tonsillar lymph nodes?
= Parotid lymph nodes, at the angle of the mandible
Where are the submandibular lymphs nodes?
halfway between the angle of the mandible and the chin, on the inferior
boarder of the jaw line
What are the submental lymph nodes
midline behind the tip of the mandible
Where are the anterior cervical lymph nodes?
In front of the SCM
Where are the posterior cervical lymph nodes?
located on the anterior border of the trapezius and deep to the
What are Virchow's nodes?
Where are the epitrochlear lymph nodes?
proximal and posterior to the medial condyle of the humerus
Where are the superior superficial inguinal lymph nodes? Inferior superficial inguinal lymph nodes?
Superior = just over inguinal canal
Inferior = – deeper in the groin compared to the superior superficial
True or false: you need to have the knee flexed to assess the popliteal lymph nodes
What hand should you hold the pts arm with while inspecting their right axillary lymph nodes?
Right hand holds their arm,
Left hand inspects
What are the five surfaces that should be evaluated with inspecting the axillary lymph nodes?
2. Medial aspect along the rib cage
3. Lateral aspect along the upper surface of the medial humerus
4. Anterior wall along the pectoralis major and minor
5. Posterior wall along the border of the scapula
What is the technique for palpating the epitrochlear nodes?
Hold their hand up 90 degrees with your non-dominant hand
Circular motion between the tris and bis
What is the mnemonic for documenting lymph node findings?
PALS (P=primary site. A=All associated.
Lymph nodes that are Hard and discrete = ?
Lymph nodes that are Rapid enlargement and no signs of inflammation = ?
Lymph nodes that are Slow enlargement over weeks or months = ?
Lymph nodes that are Tender =
Lymph nodes that are Pulsatile = ?
probably an artery, dumb-dumb
Enlarge left sided supraclavicular node = ?
Thoracic or abdominal malignancy
What are the three areas that should be checked for pitting edema?
a. Dorsum of each foot
b. Behind each medial malleolus
c. Over the shins
What is the scale for pitting edema (range)?
Rate this edema: Slight, no visible distortion, disappears rapidly
Rate this edema: A little deeper pit, no real detectible distortion, disappears in 10 to 15 seconds
Rate this edema: Noticeable deep pit, lasts more than a minute, noticeable dependent swelling or fullness
Rate this edema: A very deep pit, lasts 2 to 5 minutes, dependent gross distortion
How long should you hold your finger in place to assess for pitting edema?
What part of the stethoscope do you use to listen for a bruit?
What does venous flow sound like on a doppler?
How should the probe of a doppler be held to auscultate a DP or PT pulse?
Hold the Doppler tip at an angle along the axis of blood flow to gain the best signal
True or false: Absence of dorsalis pedis pulse in the expected location may not be pathological
in all cases
True -- may branch elsewhere in the lower limb
When is Allen's test utilized?
specifically to test for patency of the ulnar artery prior to a radial artery puncture (in
arterial blood gas sampling) or the insertion of a radial arterial catheter.
When performing the Allen's test prior to obtaining an ABG, how long should a pt make a fist for prior to you occluding the ulnar and radial arteries? What is the normal result time?
Normal = 3-5 seconds
Jugular venous pulses are assessed as a clinical measure of what?
central venous pressure
The height of the pulsating column of blood in the left jugular vein measures what, specifically (think what part of the heart this corresponds to)?
The amount of blood
draining into the right atrium and is useful in measuring over hydration (hypervolemia) or
under hydration (hypovolemia)
In almost all cases, elevated jugular venous pressure is
indicative of what?
-An increased left ventricular end diastolic pressure
-Low left ventricular
What does the "a" wave of the jugular venous pulses correspond to?
rebound from right atrial systole
What does the "c" wave of the jugular venous pulses correspond to?
expansion of the underlying carotid artery
What does the "y" wave of the jugular venous pulses correspond to?
filling of the right atrium from the systemic veins while the tricuspid valve
What is the order of the jugular venous pulse waves?
a, c, y
What does a prominent jugular "a" wave represent?
increased resistance to right atrial contraction. This
is seen in tricuspid stenosis
What does an absent jugular "a" wave represent?
What do large jugular "v" waves represent?
tricuspid regurgitation and constrictive pericarditis
What angle should patients be at when assessing for JVD?
What conditions result in edema of the LE?
Venous Insufficiency, Thrombosis,
Deep Vein Thrombosis,
What conditions result in local swelling of the LE?
What conditions result in pallor of the LE?
What conditions result in redness of the LE?
What conditions result in varicosities of the LE?
What conditions result in thrombosis of the LE?
What conditions result in thickened skin of the LE?
What conditions result in Brownish discoloration of the LE?
Chronic Venous Insufficiency
What conditions result in warmth of the LE?
What conditions result in coldness of the LE?
Arterial Occlusion, Arterial
What is homan's test used for?
Tests for DVTs (but is neither specific nor sensitive)
What are the steps of checking for Homan's sign? What indicates a positive sign?
Flex knee slightly, and dorsiflex the foot. Positive if pain.
What is the pathogenesis of varicose veins?
Varicose veins result from incompetent vessel walls, incompetent valves, or
an obstruction of a proximal vein
What is a way to test for varicose veins that are not present right away?
have pt stand on toes 10 times in succession
What is the trendelenburg test used to assess?
assess for venous incompetence and can
be used to locate incompetent valves in the saphenous vein and communicating veins.
What are the steps of the trendelenburg test?
pt is supine. Raise their leg above their heart to allow for blood to drain. Occlude superficial thigh veins with hand, and have pt stand.
What is an abnormal finding for the Trendelenburg test?
a. Incompetent valve is present in the communicating veins when sudden refilling is
noted (color quickly returns to leg) before removal of pressure.
b. Incompetent valve is present in the saphenous vein when sudden additional refilling
takes place following the removal of pressure.
What is the order of examination for the upper limb and hip? (5)
4. Strength testing
5. Special testing
True or false: Normally, passive ROM exceeds active ROM by 5 degrees
How is muscle tone assessed?
by feeling resistance to stretch
Grade this muscle strength: No movement
Grade this muscle strength: Trace movement
Grade this muscle strength: Full motion, but not against gravity
Grade this muscle strength: Full motion against gravity but not resistance
Grade this muscle strength: Full motion against gravity and some resistance, but weak
Grade this muscle strength: Full motion against gravity and resistance
Weakness with pain suggests what type of issue?
Weakness without pain suggests what type of issue?
What are the four muscles of the rotator cuff?
4. Teres minor
How do you test for internal rotation of the arm?
hand behind the back
How do you test for external rotation of the arm?
place hand on the back of the neck
What is the subscapularis lift off test or Gerber’s test?
Have pt place hand on their back, then lift off away from the back. if cannot, then subscapularis prob
What is the empty can or Jobe's test?
Test for the supraspinatus muscle
i. Clinician stands in front of the patient and passively raises the arms to 90˚ in the
plane of the scapula (midway between forward flexion and sideways abduction).
ii. Arms are internally rotated with thumbs pointing down.
iii. Ask the patient to hold this position and resist attempts to push the arms downward.
What is the arm drop test, and what is it used for?
Used to evaluate for a large rotator cuff tear.
i. Ask patient to lift arm to abduct it up to shoulder level at 90⁰.
ii. Have the patient slowly lower the arm to his/her side
What is Neer's test, and what does it evaluate?
evaluates for shoulder rotator cuff impingement or tear
i. Examiner prevents scapular motion with one hand by pressing on the scapula.
ii. Using the other hand, raise the patient’s arm in forward flexion (up to 150⁰) while
depressing the scapula. This presses the greater tuberosity of the humerus against the
What is Yergason's test, and what is it used to assess for?
Evaluates forearm supination, and rotator cuff
i. Examiner stands in front of the patient and flexes his/her forearm to 90˚ at the elbow.
ii. Pronate the patient’s wrist.
iii. Ask the patient to supinate against resistance.
What is the carrying angle?
Angle between the humerus and the radius/ulna
What is tennis elbow?
What is golfer's/pitchers elbow?
What is the flexor digitorum superficialis test?
Hold other fingers down, have pt flex the finger in question at the PIP
What is the flexor digitorum profundus test?
Hold other fingers down, have pt flex the finger in question at the DIP
Phalen's test = ?
Place dorsum of the hands together (causing flexion of the wrist)
Tapping in any area, but classically over the median nerve, checking for carpal tunnel
What is the thomas test? What is it used for?
evaluation for hip flexion contracture
-The uninvolved flexed leg is held against the chest of the supine patient to flatten the
-The contralateral leg should stay extended.
What is the trendelenburg sign?
Asymmetry of the iliac crests when standing/walking may indicate gluteus minimus problem
What is the SLR used to test for?
Tests for sciatica. If pain down ipsilateral leg, positive. If pain in back, negative
What is the "opposite" of a swan neck deformity?
What is De Quervain's tendonitis?
TTP over the snuffbox d/t inflammation of retinaculum of the wrist
What is the Finkelstein test?
Place thumb in fist. Ulnar deviate wrist.
Tests for De Quervain's tendonitis
What is the term that describes when a person is disoriented x3, but has normal consciousness?
What is obtunded?
Pt will look at you when talking, but fall back asleep. No responses
What is stupor?
slow responses, simple motor or moaning to stimuli, arousable for short
periods of times
What is the AVPU mnemonic for alertness?
What is the range of scores for the glasgow coma scale?
What are the three areas that are tested in the glasgow coma scale?
What are the four levels of eye opening in the glasgow coma scale?
3= to voice
What are the five levels of verbal response in the glasgow coma scale?
5 = normal
4 = disoriented
3 = inappropriate
2 = incomprehensible
What are the six levels of motor response in the glasgow coma scale?
6 = normal
5= localized to pain
4= withdraws to pain
3 = flexes to pain
2 = extends to pain
1 = none
What are the three components of a mini-cognition test?
Three words again
The mini-mental status exam is useful for helping to diagnose what?
How do you test immediate memory?
Say numbers, ask pt to repeat
How do you test recent memory?
Test recall of 4-5 objects after 10 minutes
SIGE-CAPS = ?
How do you test CN I?
Occlude nostril, identify smells
Which chart is used for far distances: snellen or rosenbaum?
What type of patient may have a problem with accommodation?
Which is more likely to suggest a CN V problem: a unilateral or bilateral lesion?
How do you test for innervation to the face?
have pt close eyes and tell difference between sharp and soft end of a q-tip
What are the usual five steps to test CN VII motor function?
(a). Wrinkle forehead by raising eyebrows.
(b). Squeeze eyes shut.
(c). Puff cheeks.
(d). Smile and show teeth.
(e). Purse lips and blow out
What are the three tests that can be used to assess CN VIII?
Which two nerves are needed for swallowing to be intact?
CN IX, X
Which taste is utilized for testing CN IX?
Weakness of the SCM and trapezius on opposite sides may indicate an upper motor neuron lesion on which side?
The side of the SCM weakness
How do you test CN XII strength?
Have pt push tongue against cheek. You resist
What are the two tests for rapid alternating movements?
Finger to thumb
What are the three tests of LE (point to point) movements?
Finger to nose
Heel to shin
What are the three tests of balance?
What are the four tests of gait and stance?
a. Walking without shoes
b. Tandem walk
c. Walking on heels and toes
d. Pronator drift
Ability to perform rapid alternating movements evaluates what?
cerebellar function of
Ability to perform the finger-thumb test evaluates what?
cerebellar function of the
Normal rapid alternating movements is called what?
Ability to perform the palm up/palm down test evaluates what?
Cerebellar function of the ipsilateral side
True or false: it is okay to test the palm up/down test together
False, according to the manual
What is the term that this class wants you to use for FNF?
What does dysmetria (found through the FNF) suggest?
What is the FNF test according to this manual?
The field sobriety test one
Ability to perform the heel-to-shin test evaluates what?
Cerebellar function of the ipsilateral side
Patients with vestibular dysfunction are likely to fall
toward or away the side of the lesion with a Romberg test
Toward (remember, cerebellar tracts are ipsilateral)
What does pronator drift test for (which tract, which side)?
Tests for contralateral lesions of the corticospinal tract and position sense.
What does graphesthesia,
Stereognosis, and two-point discrimination test?
Dorsal columns / medial lemniscus pathways
How do you assess the spinothalamic (and DCs) pathways?
Sharp end of a Q-tip alternating with soft end
Where should a tuning fork be placed when assessing for vibration?
Over bony prominences
How do you test proprioception?
Have them close their eyes, and move a joint (starting from fingers/toes, going upward)
Graphesthesia is carried by which spinal pathway?
What is the grading for DTRs? What is normal?
0-4, with 2 being normal
What is are the spinal levels that innervate the biceps reflex?
What is are the spinal levels that innervate the brachioradialis reflex?
What is are the spinal levels that innervate the triceps reflex?
Where should the arm be placed with the brachioradialis reflex?
resting on pts leg
Where should the arm be placed with the biceps reflex?
Palm down, on your forearm
What are the spinal levels that are tested for the calcaneal tendon reflex?
When should you check for clonus?
When DTRs are hyperactive
What is the test for clonus?
Briskly dorsiflex the foot with your hand while maintaining foot in flexion.
What is the scale used for superficial reflexes?
positive or negative
Spinal levels for the babinski sign?
L5 and S1
What is the correct stroke for the Babinski test?
Heel, move laterally, then medially to the ball of the foot (like an "S")
Spinal levels for the cremasteric reflex?
L1 and L2
How do you test for the abdominal reflexes?
Lightly stroke the abdomen from the top of each quadrant diagonally toward the
What is Brudzinski's sign?
Flexion of the neck elicits flexion of the hips
What is Kernig's sign?
While the patient is supine, passively flex the hip to 90 degrees while the knee is flexed to 90 degrees.
b. Gently extend the knee past 90 degrees while keeping the hip flexed.
Bilateral leg pain with Kernig's sign suggests what? Unilateral?
Bilateral = meningeal irritation
Unilateral = nerve compression
What are the 10 sites tested in the Monofilament test?
Just below each of the above
Dorsum of the foot
For Mcmurrays testing, how do you test the medial meniscus?