signs, tests and classifications

Question 1

rovsing’s sign

Answer 1

indicative of acute appendicitis

positive: palpation of the left lower quadrant of a person’s abdomen increases the pain felt in the right lower quadrant

Question 2

homan’s sign

Answer 2

test for deep vein thrombosis (DVT)

the patient will actively extend their knee which will then be raised to 10 degrees, then passively and abruptly dorsiflexes the foot and squeezes the calf with the other hand

positive: deep calf pain and tenderness

Question 3

chvostek sign

Answer 3

tests for hypocalcemia

positive: twitch of the facial muscles that occurs when gently tapping an individual’s cheek, in front of the ear (stimulating the facial nerve)

could also indicate kidney failure, acute pancreatitis, certain medications (e.g., bisphosphonates, proton pump inhibitors) or electrolyte imbalances, such as low levels of vitamin D and magnesium

Question 4

trousseau’s sign

Answer 4

indicator of low calcium levels in the blood

put a BP cuff on the patient for 2-3 minutes to block the brachial artery

positive: flexion of the wrist, the thumb, and the joints located between the palm of the hand and the fingers (i.e., metacarpophalangeal joints), along with the extension of the fingers

Question 5

mulder’s sign

Answer 5

test for Morton’s neuroma

positive: painful, palpable click when squeezing together metatarsal together (typically occurs between 3rd and 4th toes)

Question 6

grey-turner’s sign

Answer 6

a sign of retroperitoneal hemorrhage or pancreatitis

positive: blue discolouration/bruising of the flanks

Question 7

cullen’s sign

Answer 7

sign of acute pancreatitis

blue discolouration/bruising of the skin around the umbilicus

(caused by pancreatic enzymes that have tracked along the falciform ligament and digested subcutaneous tissues around the umbilicus)

Question 8

murphy’s sign

Answer 8

tests for gallbladder inflammation (cholecystitis)

positive: pain on inspiration whilst palpating the right upper quadrant

Question 9

prehn’s sign

Answer 9

used to determine whether testicular pain is caused by epididymitis or testicular torsion
performed by lifting one half of the scrotum

positive (epidiymitis): pain relieved
negative (testicular torsion): pain made worse

Question 10

simmon’s test

Answer 10

test for achilles tendon rupture

positive: no plantarflexion on squeezing rested calf

Question 11

coomb’s test

Answer 11

test for autoimmune haemolytic anemia

• direct Coombs’ test involves looking directly at red blood cells found in a sample of blood (aka direct antiglobulin test or DAT) and checks whether there are antibodies that have already attached themselves to RBC surface
• indirect Coombs’ test looks at the plasma (aka indirect antiglobulin test or IAT) and looks for antibodies in the bloodstream that aren’t attached to RBC’S but could

Question 12

schober’s test

Answer 12

used to determine if there is a decrease in lumbar spine range of motion (commonly due to ankylosing spondylitis)

1. mark the skin in the midline of the spine 5cm below and 10cm above the posterior superior iliac spine (or PSIS, this is approx L2)
2. ask the patient to touch their toes to assess lumbar flexion
3. measure the distance between the two lines

positive: < 20cm distance between 2 marks on flexion (less than 5cm increase)

Question 13

schirmer’s test

Answer 13

test to diagnose dry eye syndrome

done by placing a strip of filter paper in the patient’s lower lid with their eyes closed for 5 minutes, before removing it and measuring the moisture on each side

positive: <10mm of moisture

Question 14

FIT test

Answer 14

test to find early bowel cancer (faecal immunochemical test)

positive: faecal occult blood (FIT) >10 mcg Hb/g (doesn’t immediately confirm cancer as there are other causes of GI bleeding)

Question 15

lachman’s test

Answer 15

test for laxity or rupture of the anterior cruciate ligament (ACL)

with the knee flexed 30 degrees, use your dominant hand to pull the tibia forwards on the femur while the other hand stabilises the femur

positive: significant anterior movementof the tibia on the femur

Question 16

ipswich touch test

Answer 16

assess the extent of peripheral neuropathy
it consists of touching six toes and recording how many of the touches felt by the patient

Question 17

buerger’s test

Answer 17

used to assess the adequacy of the arterial supply to the leg
with the patient positioned supine, stand at the bottom of the bed and raise both of the patient’s feet to 45º for 1-2 minutes, then swing legs over the bed
positive: goes pale when raised and very red after swinging over the bed

Question 18

cough impulse test

Answer 18

test for varicose veins

place your hand over the saphenofemoral junction (2-3cm below and lateral to the pubic tubercle) and ask the patient to cough

positive: if you feel an impulse over the SFJ (indicates dilatation of the saphenous vein at the SFJ, suggesting varicose veins)

Question 19

perthe’s test

Answer 19

used to distinguish between venous valvular insufficiency in the deep, perforator and superficial venous systems

apply a tourniquet at the proximal mid-thigh level whilst the patient is standing and ask them to walk around the room (or continually alternate between standing on tip-toes and flat feet) for 5 minutes

positive: varicose veins remain distended ore become more distended (suggests a problem with the deep venous system)

Question 20

tap test

Answer 20

special test for varicose veins, assesses the lower limb venous valve competency

apply pressure to the saphenofemoral junction (SFJ) and tap the distal varicose vein

positive: thrill (suggests incompetent valve between VV and SFJ)

Question 21

brodie-trendelenburg test

Answer 21

used to determine the competency of the valves in the superficial and deep veins of the legs in patients with varicose veins

Question 22

finkelstein test

Answer 22

a test used in the diagnosis De Quervain’s Tendonitis

Question 23

barlow’s test

Answer 23

test to identify congenital posterior sublimation or dislocation in infants

Question 24

ortolani’s test

Answer 24

used to detect the presence of a dislocated hip in CDH (congenital diaphragmatic hernia)

Question 25

garden’s classification

Answer 25

hip fracture classification (stage I-IV)

Question 26

mason’s classification

Answer 26

radial head fracture classification (type I-IV)

I - non-displaced or minimally displaced (<2mm), no mechanical block to rotation

II - displaced >2mm or angulated, possible mechanical block to forearm rotation

III - comminuted and displaced, mechanical block to motion

IV - radial head fracture with associated elbow dislocation

Question 27

weber’s classification

Answer 27

ankle fracture classification (A-C)
A - below the level of the syndesmosis
B - at the level of the syndesmosis
C- above the level of syndesmosis

Question 28

salter-harris classification

Answer 28

growth plate fractures classification (I-V)

Question 29

gustillo-anderson’s classification

Answer 29

method of classifying open fractures (type I-IIIc)

Type I - wound ≤1 cm, minimal contamination or muscle damage

Type II - wound 1-10 cm, moderate soft tissue injury

Type IIIa - wound usually >10 cm, high energy, extensive soft-tissue damage, contaminated, adequate tissue for flap coverage (all farm injuries are automatically at least gustillo IIIa)

Type IIIb - extensive periosteal stripping, wound requires soft tissue coverage (rotational or free flap)

Type IIIc - vascular injury requiring vascular repair, regardless of degree of soft tissue injury

most accurate way to grade open fratures is by intra-operative examination

Question 30

fontaine classification

Answer 30

classification of peripheral artery disease or lower limb ischaemia (stage 1-4)

Stage 1 is asymptomatic disease

Stage 2a is intermittent claudication when walking more than 200 m

Stage 2b is intermittent claudication when walking less than 200 m

Stage 3 is rest pain

Stage 4 is tissue necrosis or gangrene

Question 31

hinchley’s classification

Answer 31

used to describe perforations of the colon due to diverticulitis

Question 32

TNM staging

Answer 32

• used to stage cancer
• describes the size of the tumor, whether it has spread to lymph nodes, and if it has metastasized
• T -size of the tumour, with numbers 1 to 4 (1 for small, 4 for large)
• N - lymph nodes, with numbers 0 to 3 (0 means no lymph nodes have cancer, 3 means many do)
• M - metastases or whether the cancer has spread to another part of the body, with numbers 0 or 1 (0 means it has not spread, 1 means it has)

Question 33

duke’s

Answer 33

• used for staging bowel cancer
  has 4 stages
• Stage A - cancer is in the innermost layers of the bowel wall
• Stage B - cancer has spread through the muscle layer of the bowel wall
• Stage C - cancer has spread to nearby lymph nodes
• Stage D - cancer has spread to other parts of the body

Question 34

ann arbour’s

Answer 34

• used for staging lymphomas
• Stage I - cancer is in one lymph node or one area of a lymph node
• Stage II - cancer is in two or more lymph node areas on the same side of the diaphragm (the muscle beneath the lungs that helps breathing) or cancer has grown into nearby organs
• Stage III - cancer is in lymph node areas on both sides of the diaphragm, including the spleen
• Stage IV - cancer has spread to other organs or tissues, such as the bone marrow or liver

Question 35

gleason’s

Answer 35

• used to grade prostate cancer (staged by TNM)
• the Gleason score will be made up oftwo numbersadded together for the total score
• the first number is the grade of the most prevalent pattern in the biopsy
• the second number is the grade of the second most prevalent pattern in the biopsy

Question 36

royal marsden

Answer 36

• used to stage testicular cancer
• Stage 1 – isolated to the testicle
• Stage 2 – spread to the retroperitoneal lymph nodes
• Stage 3 – spread to the lymph nodes above the diaphragm
• Stage 4 – metastasised to other organs

Question 37

debakey’s and stanford

Answer 37

used to classify aortic dissection, based on the location of the dissection

Question 38

rutherford

Answer 38

classification of lower extremity ischemia in peripheral arterial disease

Question 39

ceap

Answer 39

clinical, etiological, anatomical, pathophysiological

classification of venous disease