DOCSLIB.ORG

© in This Web Service Cambridge University Press Cambridge University Press 978-1-107-62554-9

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
© in This Web Service Cambridge University Press Cambridge University Press 978-1-107-62554-9 Cambridge University Press 978-1-107-62554-9 - Physical Examination for Surgeons: An Aid to the MRCS OSCE Edited by Petrut Gogalniceanu, James Pegrum and William Lynn Index More information Index Abbreviated Mental Test Score (AMTS), calcifications, 398 326 extraluminal gas, 397 abdomen soft tissues, 398 anatomical divisions, 35 abducens nerve testing, 332 bruits, 50–2 accessory nerve testing, 333 distension, 42 acellular dermal matrix (ADM), 94 emergency checklist, 457 Achilles tendon hernia location, 39–41 rupture assessment, 200 imaging, 47–8 See also abdominal acromioclavicular joint (ACJ), 142 x-ray injury, 419 CT, 48, 457–62 test, 147 MRI, 48 adenocarcinoma, parotid gland, 313 transabdominal ultrasound, 47 adnexal fullness, 106 inspection, 34–60 Adson’s test, 218 palpation, 34–7, 41–2 airway assessment, 474, 480, 491–3 percussion, 35 for intubation, 491–3 skin changes, 38 airway management, 474 ecchymosis causes, 50 Allen’s test, 215 abdominal aortic aneurysm (AAA), AMPLET, 479 208–11, 227, 461, 463 anaesthetic risk assessment, 21 history, 209 anal examination, 99–100 imaging, 211 Goodsall’s rule, 101 sign of imminent rupture, 464 angiogram, lower limb, 471–2 abdominal incisions, 61–8 ankle examination, 190–202 classification, 68 causes of pain, 201 abdominal pain movement assessment, 191, 195 anatomical origins, 43 Ottawa rule, 194 gynaecological causes, 53 palpation, 191, 193–4 inflammation, 44 skin changes, 192 non-surgical causes, 55 special tests, 191 surgical causes, 52 ankle joint, 195, See also ankle examination urine tests, 46 fractures, 443 visceral pain, 43 range of movement, 196 abdominal scars, 61–8 ankle x-ray, 444–8 easily missed scars, 68 anatomy, 444 abdominal x-ray, 47, 396–8 ankle–brachial pressure index (ABPI), 234 artefacts, 397 diabetic ulcers, 254 bowel gas pattern, 397 ankylosing spondylitis, 131 499 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-62554-9 - Physical Examination for Surgeons: An Aid to the MRCS OSCE Edited by Petrut Gogalniceanu, James Pegrum and William Lynn Index More information 500 Index anosmia, 334 auscultation, 11 anterior cruciate ligament (ACL) injury, abdomen, 35 184, 186 cardiac examination, 265–6 anterior drawer test groin, 70 ankle examination, 197 thorax, 259 knee examination, 148, 183 axilla, 91 anterior tibial pulse, 227 axillobifemoral bypass, 211 anus examination, 99–101 axillounifemoral bypass, 211 aorta aneurysm. See abdominal aortic Bartholin’s gland, 106 aneurysm (AAA); thoracic aortic Barton’s fracture, 427, 431 aneurysm basal cell carcinoma (BCC), 357 branches, 464 Battle’s incision, 64 CT examination, 463–8 bedside observations, 6 dissection, 464, 467 Bell’s phenomenon, 337 endoleaks, 467 benign paroxysmal positional vertigo endoprostheses, 464 (BPPV), 278 palpation, 45 Berry’s sign, 312 aphasia, 327 biceps muscle test, 148 apnoea test, 322 bicipital groove, 143 apprehension test, 148 bladder, CT examination, 470 arterial examination. See also abdominal bleeding risk assessment, 21 aortic aneurysm (AAA); carotid Boas’ sign, 49 artery examination bowel ischaemia, 397 lower limbs, 223–36 bowel obstruction, 397 arterial anatomy, 226 causes, 56 bruits, 233 large bowel, 399, 460 Buerger’s angle and test, 232 small bowel, 399, 460 bypass grafts, 228 brain CT, 451–4 causes of ischaemia, 236 brain death, 319–20 causes of pain, 235 branchial cyst, 314 investigations, 234 breast. See also mammography neurological examination, 234 causes of lumps, 96 skin changes, 223 chest x-ray and, 388 soft tissue changes, 224 focused systemic examination, 91 symptoms of disease, 225 implants, 93 tests, 224 inspection, 90 upper limbs, 212–13 lump assessment, 90 Allen’s test, 215 Paget’s disease, 93 arteriovenous fistula, 86, 88, 246 palpation, 90 complications, 88 post-mastectomy reconstruction, steal syndrome, 88 94 ascites scars, 91 causes, 57 breast cancer screening, 408 shifting dullness, 58 Brudzinski’s neck sign, 325 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-62554-9 - Physical Examination for Surgeons: An Aid to the MRCS OSCE Edited by Petrut Gogalniceanu, James Pegrum and William Lynn Index More information Index 501 bruits, 50–2, 233 movement assessment, 132–3 carotid, 204, 206 scars, 341 Buerger’s angle, 232 Spurling’s test, 133–4 Buerger’s test, 232 trauma patients, 474 burns, 367–70 cervical spine immobilisation, 474 acute, 368 cervical spine injuries, 138–9, 416 burn centre transfer criteria, 370 common fractures, 416 depth estimation, 369 unstable fractures, 417 life-threatening emergencies, 370 cervical spine x-ray, 416 management guidelines, 369 AP view, 415 size estimation, 370 bone, 415 cervix examination, 106 callosities, 192 chauffeur’s fracture, 432 candidiasis, vaginal, 105 chest CT, 455–6 cardiac examination, 264–9 airway, 455 cardiac scars, 267 circulation and mediastinum, 456 cardiac symptoms, 265 diaphragm, 456 differentiation of murmurs, 267 lungs, 456 preparation for, 265 chest drain, 258, 475 carotid artery endarterectomy (CAE) chest examination. See thorax scars, 204–5 examination carotid artery examination, 203–4 chest x-ray, 386–95 bruits, 204 abdominal pain and, 47 causes of, 206 airway, 387 neurological deficit, 205 bones, 388 causes of, 206 breast, 388 palpation, 203 circulation, 388 carotid bifurcation, 204 danger areas, 388 pulsatile neck mass causes, 207 diaphragm, 388 stenosis, 205 foreign objects, 389 carotid–carotid bypass, 267 Chevrier’s test, 242 carotid–subclavian bypass, 216, 267 chevron incision, 65 carpal fractures, 431 Chilaiditi’s sign, 388 carpal tunnel compression, 380 chondrodermatitis helicis nodularis, 274 examination for, 380 chronic liver disease, signs of, 29 cauda equina syndrome (CES) chronic venous disease, 239, See also assessment, 346 venous system examination CEAP classification, 239 chronic venous hypertension, 237 cerebral perfusion assessment, 475 claudication, 18 cervical lymphadenopathy, 259 arterial versus neurogenic, 225 cervical spine examination, 130–1, See clay shoveler’s fracture, 416 also spine injury assessment clonus, 345 bony contours, 132 closed kinetic chains, 128 causes of cervical pain, 137 cognitive function assessment, 326–7 initial observations, 131 Coleman block test, 196 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-62554-9 - Physical Examination for Surgeons: An Aid to the MRCS OSCE Edited by Petrut Gogalniceanu, James Pegrum and William Lynn Index More information 502 Index Colles’ fracture, 427, 431 infections, 488 colostomy, 80 kidney function, 488 common femoral artery assessment, 468 lines, tubes and drains, 488 computed tomography (CT), 449–50 nutrition, 488, 490 abdomen, 48, 457–62 Crohn’s disease, 27 extra-abdominal changes, 462 crural vessels, 233 intestines, 458, 460–1 cubital tunnel compression, 380 pelvic viscera, 458 Cullen’s sign, 50 peritoneum, 458 Cusco’s speculum, 104 retroperitoneum, 458, 461–2 cyanotic limb causes, 221 upper abdominal organs, 458–60 aorta, 463–8 DeBakey classification of aortic brain, 451–4 dissection, 467 chest, 451–4 deep venous thrombosis, 245 general principles, 459 prophylaxis in critically ill patients, 487 head, 456–9 dental examination, 305, See also KUB (kidneys, ureter, bladder), 469–70 intra-oral examination lower limb angiogram, 471–2 dental occlusion, 305 reconstruction, 450 relevance to nose and sinus virtual colonoscopy, 450, 459 examination, 285 conductive hearing loss, 337 tooth notation, 304 consciousness level assessment, 322–4, dermatome testing, 342, 345 477 desmoid tumours, 40 consent form, 24–5 diabetes coracoclavicular ligament injury, 419 arterial investigations, 234 corns, 192 critically ill patients, 487 cortical localising features, 328 dial test, 185 Cottle’s manoeuvre, 283 diaphragm, 388, 456 cough reflex, 495 DIEP (deep inferior epigastric artery cough sign, 43–4 perforator) flap, 95 cranial nerve deficits, trauma patients, digital rectal examination, 76, 100 303 cauda equina syndrome assessment, 346 cranial nerve examination, 333 diplopia, 336 critically ill patients, 11, 485–90 Dix–Hallpike manoeuvre, 278 abdomen examination, 487 Dolan’s lines, 412 airway assessment, 485, 489 dorsalis pedis pulse, 227 blood transfusion, 490 drug history (DH), 17 breathing and ventilation, 485, 489 Dunphy’s sign, 43 cardiovascular assessment, 486 Dupuytren’s contracture, 375 diabetes, 487 scars, 376 DVT prophylaxis, 487 dysphasia assessment, 327 fluid balance, 487 gastrointestinal assessment, 487 ear examination, 271–80, 297 haemorrhage, 488 flexible nasendoscopy, 277 history, 485 hearing tests, 272, 276 © in this web service Cambridge University Press www.cambridge.org Cambridge University Press 978-1-107-62554-9 - Physical Examination for Surgeons: An Aid to the MRCS OSCE Edited by Petrut Gogalniceanu, James Pegrum and William Lynn Index More information Index 503 otoscopy, 271, 274 fever, differential diagnosis, 331 patient positioning, 272 fibula fractures, 443 pinna abnormalities, 273 finger assessment, 373 Ehlers–Danlos syndrome, 361 deformities, 375 elbow examination, 152–3 finger clubbing, 256 special tests, 153 causes, 32 elbow x-ray, 424–5 fitness for surgery, 21–2 anatomy, 424 Fitzpatrick classification of skin colour, bony ossification centres in children, 357 425 flaps, 362–6 fractures, 424–5 classification, 363–4 elephant trunks of Rogers, 413 free flaps, 365 Elevated Arm Stress Test (EAST), 220 common cutaneous donor sites, 365 endovascular aneurysm
Load more

Recommended publications
  • Effusion =S Fluid in Pleural Space (Outside of Lung) Fremitus - Pathophysiology • Fremitus: – Increased W/Consolidation (E.G
    General Part Head and Neck Cardiovascular Abdomen Lung Muscles Lung Exam • Includes Vital Signs & Cardiac Exam • 4 Elements (cardiac & abdominal too) – Observation – Palpation – Percussion – Auscultation Pulmonary Review of Systems • All organ systems have an ROS • Questions to uncover problems in area • Need to know right questions & what the responses might mean! Exposure Is Key – You Cant Examine What You Can’t See! Anatomy Of The Spine Cervical: 7 Vertebrae Thoracic: 12 Vertebrae Lumbar: 5 Vertebrae Sacrum: 5 Fused Vertebrae Note gentle curve ea segment Hammer & Nails icon indicates A Slide Describing Skills You Should Perform In Lab Spine Exam As Relates to the Thorax • W/patient standing, observe: – shape of spine. – Stand behind patient, bend @ waist – w/Scoliosis (curvature) one shoulder appears “higher” Pathologic Changes In Shape Of Spine – Can Affect Lung Function Scoliosis (curved to one side) Thoracic Kyphosis (bent forward) Observation • ? Ambulates w/out breathing difficulty? • Readily audible noises (e.g. wheezing)? • Appearance →? sitting up, leaning forward, inability to speak, pursed lips → significant compromise • ? Use of accessory muscles of neck (sternocleidomastoids, scalenes), inter-costals → significant compromise / Make Note of Chest Shape: Changes Can Give Insight into underlying Pathology Barrel Chested (hyperinflation secondary to emphysema) Examine Nails/Fingers: Sometimes Provides Clues to Pulmonary Disorders Cyanosis Nicotine Staining Clubbing Assorted other hand and arm abnormalities: Shape, color, deformity
    [Show full text]
  • HEENT EXAMINIATION ______HEENT Exam Exam Overview
    HEENT EXAMINIATION ____________________________________________________________ HEENT Exam Exam Overview I. Head A. Visual inspection B. Palpation of scalp II. Eyes A. Visual Acuity B. Visual Fields C. Extraocular Movements/Near Response D. Inspection of sclera & conjunctiva E. Pupils F. Ophthalmoscopy III. Ears A. External Inspection B. Otoscopy C. Hearing Acuity D. Weber/Rinne IV. Nose A. External Inspection B. Speculum/otoscope C. Sinus areas V. Throat/Mouth A. Mouth Examination B. Pharynx Examination C. Bimanual Palpation VI. Neck A. Lymph nodes B. Thyroid gland 29 HEENT EXAMINIATION ____________________________________________________________ HEENT Terms Acuity – (ehk-yu-eh-tee) sharpness, clearness, and distinctness of perception or vision. Accommodation - adjustment, especially of the eye for seeing objects at various distances. Miosis – (mi-o-siss) constriction of the pupil of the eye, resulting from a normal response to an increase in light or caused by certain drugs or pathological conditions. Conjunctiva – (kon-junk-ti-veh) the mucous membrane lining the inner surfaces of the eyelids and anterior part of the sclera. Sclera – (sklehr-eh) the tough fibrous tunic forming the outer envelope of the eye and covering all of the eyeball except the cornea. Cornea – (kor-nee-eh) clear, bowl-shaped structure at the front of the eye. It is located in front of the colored part of the eye (iris). The cornea lets light into the eye and partially focuses it. Glaucoma – (glaw-ko-ma) any of a group of eye diseases characterized by abnormally high intraocular fluid pressure, damaged optic disk, hardening of the eyeball, and partial to complete loss of vision. Conductive hearing loss - a hearing impairment of the outer or middle ear, which is due to abnormalities or damage within the conductive pathways leading to the inner ear.
    [Show full text]
  • CASE REPORT 48-Year-Old Man
    THE PATIENT CASE REPORT 48-year-old man SIGNS & SYMPTOMS – Acute hearing loss, tinnitus, and fullness in the left ear Dennerd Ovando, MD; J. Walter Kutz, MD; Weber test lateralized to the – Sergio Huerta, MD right ear Department of Surgery (Drs. Ovando and Huerta) – Positive Rinne test and and Department of normal tympanometry Otolaryngology (Dr. Kutz), UT Southwestern Medical Center, Dallas; VA North Texas Health Care System, Dallas (Dr. Huerta) Sergio.Huerta@ THE CASE UTSouthwestern.edu The authors reported no A healthy 48-year-old man presented to our otolaryngology clinic with a 2-hour history of potential conflict of interest hearing loss, tinnitus, and fullness in the left ear. He denied any vertigo, nausea, vomiting, relevant to this article. otalgia, or otorrhea. He had noticed signs of a possible upper respiratory infection, including a sore throat and headache, the day before his symptoms started. His medical history was unremarkable. He denied any history of otologic surgery, trauma, or vision problems, and he was not taking any medications. The patient was afebrile on physical examination with a heart rate of 48 beats/min and blood pressure of 117/68 mm Hg. A Weber test performed using a 512-Hz tuning fork lateral- ized to the right ear. A Rinne test showed air conduction was louder than bone conduction in the affected left ear—a normal finding. Tympanometry and otoscopic examination showed the bilateral tympanic membranes were normal. THE DIAGNOSIS Pure tone audiometry showed severe sensorineural hearing loss in the left ear and a poor speech discrimination score. The Weber test confirmed the hearing loss was sensorineu- ral and not conductive, ruling out a middle ear effusion.
    [Show full text]
  • Meniscus Injury
    Introduction Role of menisci • Medial meniscus lesions are more common than 01 lateral meniscus because it is attached to the improving articular capsule that make it less mobile thus it cannot congruency and increasing easily to accommodate the abnormal stresses. the stability of the knee • In increasing age – gradual degeneration and change in the material properties of the menisci Meniscus controlling the complex thus splits and tears are more likely that usually associated with osteoarthritic articular damage or rolling and gliding actions of chondrocalcinosis. Injury the joint • In younger people - meniscal tears are usually the result of trauma, with a specific injury identified in distributing load during the history. movement Tear of Meniscus Pathology Pathology • Usually, meniscus more likely to tear along its Vertical tear Horizontal tear length than across its width because the Bucket-handle tear usually ‘degenerative’ or due to repetitive minor trauma meniscus consists mainly of circumferential the separated fragment remains attached front complex with the tear pattern lying in many collagen fibres held by a few radial strands. and back planes The torn portion can sometimes displace towards may be displaced or likely to displace • The meniscus is usually torn by a twisting the centre of the joint and becomes jammed If the loose piece of meniscus can be displaced, it between femur and tibia acts as a mechanical irritant, giving rise to force with the knee bent and taking weight. This causes a block to movement with the patient recurrent synovial effusion and mechanical describing a ‘locked knee’ symptoms • In middle life, tears can occur with relatively posterior or anterior horn tears Some are associated with meniscal cysts little force when fibrotic change has the very back or front of the meniscus is It is also suggested that synovial cells infiltrate into the vascular area between meniscus and restricted mobility of the meniscus.
    [Show full text]
  • Bates' Pocket Guide to Physical Examination and History Taking
    Lynn S. Bickley, MD, FACP Clinical Professor of Internal Medicine School of Medicine University of New Mexico Albuquerque, New Mexico Peter G. Szilagyi, MD, MPH Professor of Pediatrics Chief, Division of General Pediatrics University of Rochester School of Medicine and Dentistry Rochester, New York Acquisitions Editor: Elizabeth Nieginski/Susan Rhyner Product Manager: Annette Ferran Editorial Assistant: Ashley Fischer Design Coordinator: Joan Wendt Art Director, Illustration: Brett MacNaughton Manufacturing Coordinator: Karin Duffield Indexer: Angie Allen Prepress Vendor: Aptara, Inc. 7th Edition Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2007, 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1995, 1991 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appear- ing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia PA 19103, via email at [email protected] or via website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Bickley, Lynn S. Bates’ pocket guide to physical examination and history taking / Lynn S.
    [Show full text]
  • Current Audiometric Tests for the Detection of Functional Hearing Loss
    CURRENT AUDIOMETRIC TESTS FOR THE DETECTION OF FUNCTIONAL HEARING LOSS by JOAN PHYLLIS COOPER X^^ Be A., Union College, 1965 A MASTER'S REPORT submitted in partial fulfillment of the J requirements for the degree MASTER OF ARTS Department of Speech KANSAS STATE UNIVERSITY Manhattan, Kansas 1963 Approved by: Ma j or ? ro re s s or . bo 11 C6£ TABLE OF CONTENTS Chapter Page I , Introduction .••••••••••••••••••«••• • • • 1 Definitions ....?................«« •••••••• 2 II. Tests for Functional Hearing Loss 4 General Behavior in the Clinical Evaluation 4 The Ear, Nose, and Throat Examination 9 Pure-tone Audiometry 12 Saucer-shaped Audiograms 14 False-alarm Responses During Pure-tone Audiometry ...................... c 17 Inappropriate Lateralization ,« 17 Bone Conduction Audiometry 20 Speech Audiometry ••••••••••••••••• • 22 Speech Discrimination ••••••••••• 22 Speech Reception Threshold ........ ............... 23 Errors During Measurement of Spondee Threshold ... 2 3 Inappropriate Lateralization 26 Pure-tone Stenger Test 26 Modified (Speech) Stenger Test 29 Doerf ler-Stewart Test 30 Lombard Test ............ o 36 De layed Auditory Feedback ., 39 Psychogalvanic Skin Resistance Test 45 Modification of EDR Test , . .. 50 Bekesy Type V Tracing ......... o ..... ....... ... s ...... 51 c ^ . iii Chapter Page ( II. Rainville Test 5S Sensorineural Acuity Level Test ..... 59 Lipreading Test .....«•..•.<.«•......,....•............ 61 The Variable Intensity Pulse Count Method 62 Rapid Random Loudness Judgments ..................... c 63 Middle Ear
    [Show full text]
  • Comparison of the Thesslay Test and Mcmurray Test: a Systematic
    py & Ph ra ys e i th c Alexanders et al.,Physiother Rehabil 2016, 1:1 a io l s R y e Journal of DOI: 10.4172/2573-0312.1000104 h h a P b f i o l i l t a ISSN:a 2573-0312 t n i r o u n o J Physiotherapy & Physical Rehabilitation Research Article Open Access Comparison of the Thesslay Test and McMurray Test: A Systematic Review of Comparative Diagnostic Studies Jenny Alexanders1*, Anna Anderson2, Sarah Henderson1 and Ulf Clausen3 1Sport, Health and Sciences Department, The University of Hull, Washburn Building, Cottingham Road, Hull, United Kingdom 2Leeds Teaching Hospitals, Beckett Street, Leeds, LS9 7TF, United Kingdom 3Dr Hill and Partners, Beverly Health Practice, Manor Road, Hull, HU17 7BZ, United Kingdom Abstract Background: The Thessaly test is a relatively recently developed meniscal test; therefore research compared to other meniscal tests is somewhat limited. In addition, a systematic review comparing the Thessaly’s test with a long standing test such as the McMurray test has not been previously conducted. Objective: To systematically identify and appraise all empirical studies comparing the diagnostic accuracy of the Thessaly test and McMurray test. Procedure: Eligible studies were identified through a rigorous search of ScienceDirect, CINAHL Plus, Pubmed, PEDro, EMBASE and Cochrane Library from January 2004 until August 2014. Full English reports of studies investigating the accuracy of the Thessaly test and McMurray test. Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) scores were completed on each selected article. Results: The Thessaly test reported to have higher diagnostic accuracy values (61-96%) compared to the McMurray test (56-84%).
    [Show full text]
  • Physical Esxam
    Pearls in the Musculoskeletal Exam Frank Caruso MPS, PA-C, EMT-P Skin, Bones, Hearts & Private Parts 2019 Examination Key Points • Area that needs to be examined, gown your patients - well exposed • Understand normal functional anatomy • Observe normal activity • Palpation • Range of Motion • Strength/neuro-vascular assessment • Special Tests General Exam Musculoskeletal Overview Physical Exam Preview Watch Your Patients Walk!! Inspection • Posture – Erectness – Symmetry – Alignment • Skin and subcutaneous tissues – Swelling – Redness – Masses Inspection • Extremities – Size – Deformities – Enlargement – Alignment – Contour – Symmetry Inspection • Muscles – Bilateral symmetry – Hypertrophy – Atrophy – Fasciculations – Spasms Palpation • Palpate bones, joints, and surrounding muscles for the following: – Heat – Tenderness – Swelling – Fluctuation – Crepitus – Resistance to pressure – Muscle tone Muscles • Size and strength affected by the following: – Genetics – Exercise – Nutrition • Muscles move joints through range of motion (ROM). Muscle Strength • Compare bilateral muscles – Strength – Symmetry – Equality – Resistance End Feel Think About It!! • The sensation the examiner feels in the joint as it reaches the end of the range of motion of each passive movement • Bone to bone: This is hard, unyielding – normal would be elbow extension. • Soft–tissue approximation: yielding compression that stops further movement – elbow and knee flexion. End Feel • Tissue stretch: hard – springy type of movement with a slight give – toward the end of range of motion – most common type of normal end feel : knee extension and metacarpophalangeal joint extension. Abnormal End Feel • Muscle spasm: invoked by movement with a sudden dramatic arrest of movement often accompanied by pain - sudden hard – “vibrant twang” • Capsular: Similar to tissue stretch but it does not occur where one would expect – range of motion usually reduced.
    [Show full text]
  • Copyrighted Material
    Index Page numbers in italics denote fi gures, anion gap 263 Baker’s cyst 100, 104 those in bold denote tables. ankle swelling 195–8 bamboo spine 189 ankle-brachial pressure index 70–1 basal cell carcinoma 77 abdominal aortic aneurysm 145 ankylosing spondylitis 179, 189 basic life support 282–5 abdominal distension 143–7, 145 antalgic gait 25, 42, 94 Behçet’s disease 181 abdominal examination 10–19 anti-tuberculosis drugs 223 benign paroxysmal positional vertigo abdominal masses 17–18, 17 antiepileptics 223 173 abdominal pain 137–42 antihypertensives 223 benign prostatic hypertrophy 57 acute 138 anxiety berry aneurysm 33 chronic 139 faintness 175 biceps tendonitis 81 investigations 139–40 palpitations 120 bleeding diathesis 149 origin of 140–1, 141 tremor 169 blood gas analysis see arterial blood gas abducens nerve 34 aortic dissection 116 analysis abscess 193 aortic regurgitation 3 Boerhaave’s syndrome 149 breast 54 aortic stenosis 3 Bouchard’s nodes 90 perianal 57 aorto-enteric fi stula 149 bowel cancer see colorectal cancer acidosis apex beat 4 bowel obstruction 144, 146 metabolic 263, 265 Apley’s test 102 brachial plexus 85 respiratory 264 apologising 237 brain natriuretic peptide 6 acoustic neuroma 34, 175 appendicectomy 218 breaking bad news 208–10 acquired immunodefi ciency syndrome apraxic gait 25 SPIKES framework 209 see HIV/AIDS arterial blood gas analysis 262–6, 264–5 breast abscess 54 acromioclavicular joint arterial examination 68–72 breast examination 53–5 arthritis 81 arterial ulcer 70 description of lumps 55, 55 Scarf test
    [Show full text]
  • Examination of the Knee
    Examination of the Knee The Examination For every joint of the lower extremity always begin with the patient in standing IN STANDING INSPECTION 1. Cutaneous Structures: Look for Erythema, scarring, bruising, and swelling in the following areas: a. Peripatellar grooves b. Suprapatellar bursa c. Prepatellar bursa d. Infrapatellar tendon e. Anserine bursa f. Popliteal fossa 2. Muscle & Soft Tissue: a. Quadriceps atrophy b. Hamstring atrophy c. Calf atrophy 3. Bones & Alignment: a. Patella position (Alta, Baha, Winking, Frog eyed), b. Varus or Valgus alignment c. Flexion contracture or Genu recurvatum RANGE OF MOTION - ACTIVE Standing is the best opportunity to assess active range of motion of the knee. 1. Ask the patient to squat into a deep knee bend. Both knees should bend symmetrically. 2. Ask the patient to then stand and extend the knee fully – lock the knee. The knee should straighten to 0 degrees of extension. Some people have increased extension referred to as genu recurvatum. GAIT 1. Look for a short stance phase on the affected limb and an awkward gait if a concomitant leg length discrepancy 2. Look for turning on block 3. Screening 1. Walk on the toes 2. Walk on the heels 3. Squat down – Active Range of Motion testing SPECIAL TESTS 1. Leg Length Discrepancy a. Look at patients back for evidence of a functional scoliosis b. Place your hands on the patients Iliac crests looking for inequality which may mean a leg length discrepancy IN SITTING NEUROLOGIC EXAMINATION 1. Test the reflexes a. L4 – Quadriceps reflex VASCULAR EXAMINATION 1. Feel for the posterior tibial artery SUPINE POSITION INSPECTION 1.
    [Show full text]
  • Primary Care Assessment of Suspected Stroke-TIA Pathway
    Primary Care Assessment of Rapid onset of new neurological deficit or symptom Suspected Stroke/TIA Rapid means over seconds or minutes, or rarely, hours Exclude/ treat Click for hypoglycaemia more info Perform face, arm, speech test (FAST) • Has the person’s face fallen on one side? Can they smile? • Can they raise both arms and keep them there? • Is their speech slurred? FAST positive FAST negative See pathway Negative, but history Primary Care Risk of FAST positive now Stratification of Suspected resolved TIA Upper or Lower Motor Neurone Sparing of the forehead, and possibly maintenance of spontaneous smiling = UMN Quick assessment Facial nerve weakness lesion. Lower Motor Neurone Leg weakness YES for other neurological only? Whole of one side affected, including the facial weakness forehead = LMN lesion. This could be caused by a deficit brainstem stroke in which case it would be Diplopia squint 3rd, 4th, accompanied by other signs such as tremor, 6th ataxia, vertigo and horizontal gaze palsy Weakness 11th of Rapid onset of other shoulder elevation, NO Upper Motor Neurone motor symptoms or Other cranial nerves ninging of scapula, (sparing of forehead) signs weakness of head turning See pathway Deviation of tongue or Management of uvula 12th nerve Suspected Stroke Numbness or altered Exclude peripheral nerve sensation or dermatomal pattern Rapid onset sensory Click for more symptoms or signs info Sensory inattention Comprehension difficulties may be for the spoken or written word or for both or for one language only Speech difficulties
    [Show full text]
  • SIMMONDS TEST:  Patient Is Prone  Doctor Flexes the Patients Knee to 90 Degrees  Doctor Squeezes the Patient’S Calf
    Clinical Orthopedic Testing Review SIMMONDS TEST: Patient is prone Doctor flexes the patients knee to 90 degrees Doctor squeezes the patient’s calf. Classical response: Failure of ankle plantarflexion Classical Importance= torn Achilles tendon Test is done bilaterally ACHILLES TAP: Patient is prone Doctor flexes the patient’s knee to 90 degree Doctor dorsiflexes the ankle and then strikes the Achilles tendon with a percussion hammer Classical response: Plantar response Classical Importance= Intact Achilles tendon Test is done bilaterally FOOT DRAWER TEST: Patient is supine with their ankles off the edge of the examination table Doctor grasps the heel of the ankle being tested with one hand and the tibia just above the ankle with the other. Doctor applies and anterior to posterior and then a posterior to anterior sheer force. Classical response: Anterior or posterior translation of the ankle Classical Importance= Anterior talofibular or posterior talofibular ligament laxity. Test is done bilaterally LATERAL STABILITY TEST: Patient is supine Doctor grasps the tibia with one hand and the foot with the other. Doctor rotates the foot into inversion Classical response: Excessive inversion Classical Importance= Anterior talofibular ligament sprain Test is done bilaterally MEDIAL STABILITY TEST: Patient is supine Doctor grasps the tibia with one hand and the foot with the other Doctor rotates the foot into eversion Classical response: Excessive eversion Classical Importance= Deltoid ligament sprain Test is done bilaterally 1 Clinical Orthopedic Testing Review KLEIGER’S TEST: Patient is seated with the legs and feet dangling off the edge of the examination table. Doctor grasps the patient’s foot while stabilizing the tibia with the other hand Doctor pulls the ankle laterally.
    [Show full text]