Special Tests

Question 0

Normally muffled, indistinct
Check for fluid or solid tissue in alveoli

Ex pna, acetectasia, tumors

Answer 0

Bronchophony

Stethoscope
Pt says 99

Question 1

Vibrations thru bronchial tree

• decreased with effusion, COPD, obstructed bronchus, fibrosis
• increased with pna

Answer 1

Tactile fremitus

Use ulnar side of hands down back, pt says 99

Question 2

When voice sounds are louder with a nasal quality, E sounds like A
- happens with consolidation of lung tissue, pna, atelectasis, tumor

Answer 2

Egophony

Stethoscope
Pt says “eeeeeee”

Question 3

A whisper can be heard more loudly through consolidated lung tissue

• normally soft and indistinct
• compare normal area to abnormal area

Answer 3

Whispered pectoriloquy

Stethoscope
Pt whispers “99”

Question 4

Used to identify level of diaphragm

Answer 4

Diaphragmatic excursion

Pt fully exhale and hold breath- percussion downward to hear change to dullness- mark spot

Pt takes breaths and hold at max inspiration- percussion down and mark again

Measure difference btwn marks, should be 5-6 cm

Question 5

Most commonly used to check for ulnar patency prior to radial artery puncture for blood gas determination

Answer 5

Allen’s test

Occlude both arteries, make fist, open hand and release ulnar artery. Check blood flow to hand

Question 6

Hand pain or tingling suggests carpal tunnel syndrome

Answer 6

Tinel’s sign

Tap median nerve on wrist

Question 7

Lean forward exhale

Answer 7

Listen for aortic or pulmonic regurg murmurs

Have pt exhale and hold breath, listen with diaphragm

Question 8

Measure jugular venous distension

Answer 8

Indicates vol overload, esp in right heart

Normal is 9 cm or less

Question 9

Hepatojugular reflux

Answer 9

Check for right sided fluid overload

Visualize upper jugular venous pulse, push on liver, if increase then vol overload

Question 10

Percuss left border of cardiac dullness

Answer 10

If PMI can’t be palpated check left border which is normally at or medial to mid claviclular line
Percuss lateral to medial to find border

Question 11

Shifting dullness

Answer 11

Checking for excessive fluid or ascites in abd cavity
Percuss abd while supine going midline to lateral and mark where changes to dull, then do same with pt laying on side to see if spot changes

Question 12

Fluid wave

Answer 12

Test distended abd to distinguish btwn dilated loops of bowel, fluid, fat
Pt hand in middle, tap abd

Question 13

Sign indicating peritoneal irritation

Press hand slowly and deeply into abdomen and quickly release

Answer 13

Rebound tenderness

Question 14

Positive sign is indicator of acute appendicitis

Raise right leg against resistance, pt is supine

Answer 14

Psoas sign

Appendix is near Psoas so flexing it would increase appendix pain

Question 15

Sign of appendicitis

Flex pt leg and hip and knee and internally rotate knee

Answer 15

Obturator sign

This muscle is also near appendix

Question 16

Positive in acute appendicitis

Press slowly and gently in LLQ and quick release to see if pain in right quadrant

Answer 16

Rovsing sign

Question 17

Murphy’s sign

Answer 17

Positive could be inflammation of GB or liver

Can do indirect fist percussion to check for difference in pain from left to right

Question 18

Check for sciatic nerve impingement

Answer 18

Straight leg raise

Question 19

Test for effusion or fluid on the knee

Answer 19

Bulge sign

Use back of hand to sweep on medial and lateral sides of knee to see if fluid gets pushed around

Question 20

Supine pt, leg extended, slide hand down thigh to push fluid toward knee, push of patella

Answer 20

Ballotment of patella

Question 21

Valgus

Answer 21

Flex knee 15-20 degrees

Put lateral pressure on knee to test MCL

Question 22

Varus

Answer 22

Flex knee 15-20 degrees

Put medial pressure on knee to test LCL

Question 23

Anterior and posterior drawer sign

Answer 23

Test the anterior cruciate ligament
Sit of feet and apply anterior pressure to test for laxity in ACL
Posterior pressure to test for PCL laxity

Question 24

Check for tear in medial or lateral meniscus

Answer 24

Supine pt, flex hip and knee, hold heel and knee, rotate laterally then medially and extend leg to check for clicks

Question 25

Lachman's test

Answer 25

Test for anterior cruciate ligament | Lift leg 15 degree angle pull btwn hands above and below knee and look for laxity

Question 26

Look for deep vein thrombophlebitis | Lift leg and dorsiflex foot, if painful is positive

Answer 26

Homan's sign

Question 27

Anterior draw sign on ankle

Answer 27

Push on leg, pull on heel | Look for increased movement

Question 28

Check for dystietokokinesia

Answer 28

Rapid alternating movement Can be pronate and supinate hands, foot tapping, fingers to thumb

Question 29

Moving distal part of finger up and down and have pt close eyes and tell you which direction it's been moved

Answer 29

Propioception

Question 30

Test for cortical sensory fxn

Answer 30

Stereognosis | Have pt identify small object in their hand

Question 31

Two point discrimination

Answer 31

Ability to tell one point from two, lesion in parietal cortex can mess this up Pt close eyes and poke with two sharp things, tell if one or two points

Question 32

Way of checking for intact parietal lobe sensory fxn | Test to see if pt can feel touch on both sides of body at once and have PT tell you where you're touching

Answer 32

Extinction, double simultaneous Do two forearms, cheek and arm, and switch Deficit will be on opposite side of lesion

Question 33

Ability to identify and number written on Palm of hand | Test for parietal lobe fxn

Answer 33

Graphesthesia | Write a number on pts palm

Question 34

Ankle clonus Check upper motor neuron injury

Answer 34

When DVT reflexes are hyperactive you check this Involuntary foot up and down Have pt relax leg with knee flexed, flex up and down a couple times then quickly dorsiflex to see if movement

Question 35

Indication of meningeal irritation Pt supine with hip and knee flexed, then extend knee to see if hurts

Answer 35

Kernig sign

Question 36

Sign of meningeal irritation Supine pt, lift head toward chest Positive in involuntary flexion of hips and knees

Answer 36

Brudzinski sign