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Patient Assessment Exam 3
Terms in this set (292)
Liver, gallbladder, duodenum, hepatic flexure of colon
Appendix, cecum, bowel
Spleen, Lower pole of L kidney, bowel
Descending & sigmoid colon, L ovaries
epigastric region organs
Stomach & pylorus, liver, pancreas
Umbilical region organs
CVA percussion/Lloyd's punch
sign on physical examination when assessing for hydronephrosis and pyelonephritis in a patient with flank pain
the provider places one hand on the costovertebral angle and then strikes the hand sharply
positive= pain in the presence of distention of the kidney capsule or inflammation
normal abdominal aorta width
if 5 cm or wider, let surgeon know immediately-->AAA
what quadrant do you start to palpate the liver
Right LOWER quadrant
Hypogastric region organs
Bladder, uterus, ovaries
Indications of renal disorders
Suprapubic pain, dysuria, decreased urine stream, polyuria, nocturia, hematuria, flank pain
Causes of polyuria
High fluid intake
Renal medulla disorder
increased frequency and urgency of urination during the night
Difficult to localize
Happens when hollow abdominal organs are unusually distended or forcefully contract
visceral pain in the RUQ suggests
liver distention (hepatitis)
Associated symptoms of severe visceral pain
Sweating, pallor, restlessness, nausea & vomiting
from inflammation of overlying peritoneum (sharp, precisely localized, aggravated by movement/coughing)
pain from the biliary tree (liver) may be referred to the?
right shoulder or right posterior chest
pain from pleurisy/acute MI may be referred to which location?
Pt's often ________ when experiencing parietal pain.
Moving or coughing can aggravate pain
Pain felt at distant sites, which is innervated at same spinal levels
3 months of non-specific upper abdominal discomfort that isn't a structural abnormality or PUD
Causes of epigastric pain
Causes of RLQ pain
Inflammatory bowel dz
Small bowel obstruction
Ruptured ovarian follicle
Causes of LLQ pain
Inflammatory bowel dz
Ruptured ovarian follicle
Large bowel obstruction
Associated w/ involuntary spasm of the stomach, diaphragm, & esophagus
Dysfunction in swallowing mechanism
Less than 2 weeks
More than 4 weeks
T/F: Nocturnal diarrhea is normal on occasion
False--nocturnal diarrhea is usually pathologic
What will you hear during percussion of the belly?
Less than 3 bowel movements per week
Tympanic belly sounds due to air in intestines
where do you palpate if you suspect a UTI, where do you assess for tenderness?
assess for tenderness over the costovertebral angles
Prostatic pain is sometimes felt in the ________ and the _________.
perineum & rectum
Kidney pain is usually produced by ______________.
Distention of renal capsule
Bruit heard in RUQ would be due to what artery?
Palpation of liver
L hand behind pt at R 11th & 12th ribs, press forward
R hand on pt's RUQ, gently press in and up
Do not attempt to palpate a spleen in a pt with ________ or __________.
Mono or sickle cell anemia.
With suspicion of UTI w/ abdominal tenderness, assess for tenderness by ....
Knocking on costovertebral angle
Palpation of kidneys
Pt's left side, place R hand below 12th rib and lift. Press L hand against LUQ.
Not normally palpable.
Abnormal accumulation of fluid in abdominal cavity
Quick jabbing motion that will displace fluid in an ascitic belly
Ballottement (fluid test)
Referred rebound tenderness in LLQ
pos sign (pain) = appendicitis
Internal rotation of pt's leg, pain indicates a positive sign
pos sign = appendicitis
Pressure on pt's R knee as they try to lift their R leg off of the table
pos sign = appendicitis
gastroesophageal reflux disease
inflammation of the appendix, which is usually acute and caused by blockage of the appendix followed by infection
Pain in RLQ with appendicitis
LLQ and may be cramping at first then steady; usually in sigmoid or descending colon.
Associated with fever, constipation, nausea, vomiting, abdominal mass with rebound tenderness
Gently picking up fold of skin along abdominal wall.. should not elicit pain
Hook R hand under costal margin & have pt take a deep breath. Sharp increase in tenderness w/ sudden stops in inspiratory effort indicates positive sign.
Murphy's sign of acute cholecystitis
irritable bowel syndrome
Intermittent pain x 12 weeks of preceding 12 months w/ relief from defecation, change in frequency of bowel movements, or change in form of stool linked to luminal/mucosal irritants that alter motility, secretion, and pain sensitivity
How to assess for ventral hernias
Have the pt do a sit-up and the hernia will become more apparent (If its a mass in the abdomen wall)
Abdomen vs. Abdomen wall mass
Mass in abdominal wall will be more apparent with sit-up
Mass in abdomen may be covered up by abdominal muscles
Acute vs chronic musculoskeletal pain/problems
(length of time)
Acute less than 6 weeks
Chronic greater than 12 weeks
Articular disease descriptions
No appreciable movement
True hip pain is located where
In the groin
Ball & socket, convex surface
Shoulder, hip, knee
Disc shaped synovial sacs that ease joint action
Flexion & extension all in one plane
Elbow, interphalangeal joints
Movement of 2 articulating surfaces
Condylar, concave or convex
decreased movement or joint stiffness
SITS muscle under acromion process
SITS muscle posterior to supraspinatus
SITS muscle posterior & inferior to supraspinatus
SITS muscle that is not palpable (inserts on the lesser tubercle)
Test - pt touches their opposite scapula with an overhead and under arm reach
Apley's scratch test
Difficulty suggest rotator cuff tear/adhesive bursitis
Test - provider presses on pt's scapula while raising their arm
Then compress the greater tuberosity against the acromion
Neers impingement sign
Pain suggests rotator cuff tear/subacromial impingement
Test - Provider compresses greater tuberosity against the coracoacromial ligament
Flex pt's shoulder and elbow to 90* w/ palms facing down
One hand supports upper arm & elbow while other arm rotates pt's shoulder internally
Hawkins impingement sign
Pain suggests rotator cuff tear or supraspinatus impingement
Test - Elevate the pt's arm to 90* & internally rotate arms w/ thumbs pointing down
Have the pt resist as you apply downward pressure
Empty Can Test
(Supraspinatus strength test)
Weakness suggests rotator cuff tear
Test - Have pt place arms at their side and flex elbow to 90*
Have the pt press arms outward w/ forearms as you apply resistance
Infraspinatus strength test
Weakness suggests infraspinatus injury
Test - Flex pt's forearm to 90* at elbow and pronate pt's wrist while applying resistance
Forearm supination test
Test - Have pt grasp their thumbs in a fist and move toward midline in ulnar deviation
de Querverian's tenosynovitis
Positive pain sign of finklestein test
Test - Have pt rest hands on table with palms up
Tap lightly over median nerve as it passes through carpal tunnel
Burning or pain is a positive sign
Test - Have pt press the dorsal surfaces of their hands together
Numbness or tingling in median nerve is a positive sign for carpal tunnel
Emergent scrotal pain
Cancer, testicular torsion, epididymitis
Normal findings upon palpation of epididymis
Non-tender, cord-like, and nodular
NEVER perform a rectal exam on a pt with .....
(name the condition and the symptoms)
Symptoms of acute prostatitis:
-irritative urinary tract symptoms (frequency, urgency, pain w/ urination)
-perineal and lower back pain
Test - Pt supine, grasp their heel and flex knee
With heel grasped, turn lower leg internally and externally while extending leg
Mcmurray test for meniscal & lateral meniscal tears
positive= clicking w/ knee movement
Test - Pt's knee flexed 15* and externally rotated
Grasp distal femur w/ one hand, proximal tibia w/ other hand
Move tibia forward and femur downward
Lachman test for ACL stability
positive= significant forward excursion (ACL tear)
what condition presents with joint pain and a target lesion
Pain that is localized to only one joint
Pain that involves several joints
Pain around the joint
4 cardinal features of inflammation
edema, warmth, erythema, w/ associated pain or tenderness
black, tarry stools; feces containing blood from small intestine or above
bright red/maroon stool
contains blood from cecum or below
Light, clay-colored stools
common in obstructive jaundice and viral hepatitis
Causes of painful jaundice
infectious in origin: hepatitis A and cholangitis
Causes of painless jaundice
Cancer of the pancreas or duodenum = obstructing bile duct
Begin screening for osteoporosis at age ....
Optimal standard for measuring bone density that looks at the lumbar spine and femoral neck
Osteoporosis T score
Less than -2.5
Osteopenia T score
-1.0 to -2.5
Risk assessment calculator for fractures
Calcium and vitamin D recommendations for 19-50 y/o
Calcium - 1000
Vitamin D - 600
Calcium and vitamin D recommendations for 51-70 y/o MALE
Calcium - 1000
Vitamin D - 600
Calcium and vitamin D recommendations for 51-70 y/o FEMALE
Calcium - 1200
Vitamin D - 600
Calcium and vitamin D recommendations for over 70 y/o
Calcium - 1200
Vitamin D - 800
Food fear w/ abdominal pain and a slightly distended, non-tender abdomen indicates ...
Chronic diarrhea typically indicates ...
Non-Infectious disease such as ulcerative colitis and Crohn's disease
Conjugated bilirubin is seen in ...
Viral hepatits, cirrhosis, biliary cirrhosis
Moderate drinking (Men & Women)
Women - 1 or less drinks/day
Men - 2 or less drinks/day
Binge drinking (Men & Women)
Women - More than 3 drinks/ occasion
Men - More than 4 drinks/occasion
Unsafe drinking (Men & Women)
Women - more than 3 drinks/day & more than 7 drinks/week
Men - More than 4 drinks/day & more than 14 drinks/week
Signs of peritonitis
Voluntary contraction of the abdominal wall, accompanied by grimace
Involuntary reflex contraction of abd wall from peritoneal inflammation
Pain expressed after the provider pulls their hand away
Hooking technique is often used in ___________ patients.
Periumbilical or upper abdominal cramping can indicate a ...
Small bowel obstruction
Lower abdominal or generalized cramping
the term for onset of menses is
Pain w/ menses
Typically aching, cramping in lower abdomen or pelvis
Emotional, behavioral, physical symptoms 5 days before cycle for 3 consecutive cycles
Bleeding 6 months or more after cessation of menses
Menopause is the absence of menses for _________ consecutive months.
Typically occurs between ages ___ and ___.
48 and 55 y/o
Symptoms of menopause
Erratic cyclical bleeding
How will ROM be affected with articular disease?
Both active and passive ROM will be affected
How will ROM be affected with extra-articular disease?
Active ROM will be limited
If patient presents with non-inflammatory symptoms with repetitive use of the joint, what conditions should you consider for your diagnosis?
Bursitis and tendonitis
What 2 symptoms would signal a possible infectious cause of joint pain?
High fever and chills
The USPSTF finds that risks and benefits for recommending routine osteoporosis scans in men is insufficient. (T or F)
Calcium supplements for osteoporosis can increase risk of ...
Cardiovascular dz and kidney stones
Grade B recommendation to provide exercise or physical therapy to prevent falls among at-risk, community dwelling adults aged ___ or older.
Fibrocartilaginous structure that surrounds the glenoid and provides stability to the humeral head
Decreased joint movement and stiffness is associated w/ _________ pain.
NEXUS criteria for establishing low probability of cervical spine injury
Normal alertness, No C-spine tenderness, No neurologic defects, No intoxication, No painful distracting injury
Canadian C-Spine rule
Age, mechanism of injury, low risk factors allowing assessment of ROM, testing neck rotation
How would you palpate the subacromial bursae, subdeltoid bursae and the SITS muscles?
By passively extending the humerus (Lift the elbow posteriorly)
Most common rotator cuff injury occurs in the _____________ muscle.
Primary rotator cuff muscle used during internal rotation of the shoulder
Primary rotator cuff muscles used during external rotation of the shoulder
Infraspinatus & Teres minor
What is tennis elbow?
Tenderness distal to the lateral epicondyle
What is golfers elbow?
Tenderness distal to the medial epicondyle
Flexion of the elbow uses what muscles?
Biceps brachii, brachialis, brachioradialis
Extension of the elbow uses what muscles?
Supination of the elbow uses what muscles?
Biceps brachii, supinator
Pronation of the elbow uses what muscles?
Pronator teres & pronator quadratus
Patient complains of paresthesia, aching of the wrist, and weakness of fingers.
What tests can you perform to determine whether this is carpal tunnel syndrome?
Thumb abduction, tinel test, and phalen test
A fluid wave or bulge between the patella and the femur is a positive test for __________.
A balloon sign would indicate a major effusion
Pain upon applying valgus stress to the knee indicates a _______ injury.
Medial collateral ligament (MCL)
Pain upon applying varus stress indicates a _______ injury.
Lateral collateral ligament (LCL)
Anterior and Posterior Drawer Test
Test to assess stability, laxity and function of the ACL and PCL (anterior and posterior cruciate ligaments)
Ant= Pull the tibia forward and observe if it slides forward (like a drawer) from under the femur
Post=Push the tibia posteriorly and observe the degree of backward movement in the femur.
Positive=Movement forward/backward (ACL or PCL injury)
A football player comes into your clinic after an injury and is complaining of knee pain and weakness.
What tests could you perform to rule out an ACL or PCL injury?
Lachman test - Significant forward excursion indicates an ACL tear
Anterior drawer sign - Significant forward movements indicates an ACL tear
Posterior drawer sign - Significant movement posteriorly indicates a PCL tear
The parietal and visceral layers of the tunica vaginalis form a potential space. Abnormal fluid in this space is called a _____________.
BP elevated over 140/90 before 20 weeks gestation
BP elevated over 140/90 after 20 weeks gestation
BP elevated over 140/90 after 20 weeks w/ protein in the urine
What to do in the case of labial swelling?
Assess bartholin glands located @ 4 & 8 oclock
Wide billed speculum
Narrow billed speculum
Cardiac changes during pregnancy
Erythrocyte mass increases
Plasma volume increases
Cardiac output increases
Systemic vascular resistance & pressure fall
MSK changes during pregnancy
Weight gain & hormone relaxin
Ligamentous laxity in SI joints & pubic symphysis
The uterus is easier to palpate after _________ weeks.
As the uterus enlarges it rotates to the ________ side to accommodate the _________ and ________.
Sigmoid & Recutm
What to do on a pt's first pregnancy visit?
Confirm pregnancy w/ lab tests
Assess mom's health
Counsel mom to ensure healthy preg.
Nutrition recommendations for pregnancy
Folic acid (essential to prevent neural tube defects)
Naegels rule for EDD
First day of last menstrual period
+ 1 week
- 3 months
+ 1 year
Should be able to auscultate fetal HR with doptone around _______ weeks.
Should be able to start using fetoscope around _______ weeks
Normal fetal HR for
First week of pregnancy vs term
1st week - 150's-160's
Term - 120's -140's
Fetal movements can be felt around _____ weeks.
Cervix is fully dilated at _______.
Gravid cervix looks bluish ( ________ sign) and softens ( ________ sign)
Chadwicks sign & Hegar sign
Frequency of visits during pregnancy
2nd trimester - 32 weeks
32 weeks - 36 weeks
36 weeks - delivery
Seen once (Full H&P and lab work)
2nd trimester - 32 weeks
Seen every month
32 weeks - 36 weeks
Seen every 2 weeks
36 weeks - delivery
Seen every week
(Pregnancy) Genetic screenings done at _________.
15 - 18 weeks
Ultrasounds done at _________.
(Pregnancy) diabetes screening done at ___________.
24 - 28 weeks
What 2 changes contribute to an enlargement of the breasts during pregnancy?
Increased vascularity and glandular tissue hyperplasia
When would you perform a rectovaginal exam?
Screening for colorectal cancer in women over 50
To assess pelvic pathology
Tetanus (Tdap) should be administered at ____ to ____ weeks.
27 to 36 weeks
UNSAFE vaccines during pregnancy
MMR, polio, varicella
SAFE vaccines during pregnancy
Pneumococcal, meningococcal, & hepatitis
Perform a rectovaginal swab for group B strep between __________ and _________ weeks
35 to 37 weeks
Transmission of Hepatitis A is typically via ....
How to prevent?
Frequent hand washing and Hep A virus
People at increased risk for Hep B
Multiple sex partners
People with exposure to blood
People with HIV
People in high risk settings
Recommendations for Hep B vaccine?
Universal vaccine for all infants and vaccines for high-risk adults
How is Hep C typically transmitted?
Is there a vaccine?
Percutaneous exposure (blood)
Grade A recommendations for colorectal cancer screening (Adults 50-75 y/o)
Fecal occult blood testing annually
Sigmoidoscopy every 5 years
Colonoscopy every 10 years
Recommendations for colorectal cancer screening (Adults 76-85 y/o)
Do not screen routinely
Recommendations for colorectal cancer screening (Adults over 85)
Do not screen
USPSTF gives a grade A recommendation for HIV screening of all persons aged ____ to ____ and all ___________.
15 - 65 years
All pregnant women
How to test for a varicocele?
Have the pt valsalva
This will cause an increase in diameter of spermatic cord due to dilated spermatic veins
Variocele will also resolve in supine position
Congenital displacement of urethral meatus on the inferior surface of the penis
Palpable, non-tender, hard plaques found just beneath the skin on dorsum of penis
Often associated w/ painful, crooked erections
How to differentiate between a scrotal hernia and a hydrocele
Hydrocele will illuminate and you will be able to palpate above the mass
Small firm testis (Smaller than 2cm)
Condition that causes absence of cremasteric reflex
Greatest risk factor for cervical cancer
Persistant infection w/ high risk HPV subtypes (HPV 16 or 18)
Additional risk factors for cervical cancer
Multiple sex partners
Failure to undergo screening
Begin screening for cervical cancer at age ...
End screening after age ...
Risk factors for ovarian cancer include
BRCA 1/2 gene mutation
Prostate cancer screening techniques
Prostate-specific antigen (PSA) - Tests for glycoprotein that can be elevated by cancer
Digital rectal exam
BMI and weight gain recommendations for pregnancy (BMI <18.5)
BMI and weight gain recommendations for pregnancy (BMI 18.5 - 24.9)
BMI and weight gain recommendations for pregnancy (BMI 25 - 29.9)
BMI and weight gain recommendations for pregnancy (BMI 30+)
An audible or palpable crunching during movement of tendons or ligaments over bone or areas of cartilage loss
click or pop
rope-like bundles of collagen fibrils that connect bone to bone
collagen fibers connecting muscle to bone
midline back pain
suggests a musculoligamentous injury, disc herniation, vertebra collapse, spinal cord metastases
Off the midline back pain
assess for Muscle strain
Renal conditions-Pyelonephritis or stones
Red flags for low back pain
Age < 20 yrs or > 50 yrs
* Hx of cancer
* Unexplained weight loss, fever, or decline in general health
* Pain lasting more than 1 month or not responding to treatment
* Pain at night or present at rest
* Hx of IV drug use, addiction, or immunosuppression
* Presence of active infection or HIV infection
* Long-term steroid therapy
* Saddle anesthesia, bladder or bowel incontinence
* Neurologic symptoms or progressive neurologic deficit
age at onset of menses
pain with menses, often with bearing down, aching or cramping sensation in the lower abdomen or pelvis
Premenstrual Syndrome (PMS)
a cluster of emotional, behavioral, and physical symptoms occurring 5 days before menses for 3 consecutive cycles
Absence of menses
Abnormal uterine bleeding
bleeding between menses; includes infrequent, excessive, prolonged, or postmenopausal bleeding
less than 21-day intervals between menses
Intermenstrual bleeding (bleeding between regular menses)
bleeding during or after sexual intercourse
(suggests cervical polyps or cancer. In older women, suggests atrophic vaginitis)
absence of menses for 12 consecutive months, usually occurring between ages 48 and 55 years, median age 51 (& progressing through several stages of erratic cyclical bleeding)
stages of variable cycle length (erratic cyclical bleeding), often with vasomotor symptoms like hot flashes, flushing, & sweating represent this.
Post menopausal bleeding
bleeding occurring 6 months or more after cessation of menses
How many consecutive cycles must symptoms occur to be considered PMS?
3 consecutive cycles
How many months after cessation of menses is considered postmenopausal bleeding?
6 or more months
How long of a duration must amenorrhea occurs to be classified as menopause?
12 consecutive months (1 year)
Normal age for menarche for girls in U.S.
What is another way to say when a patient's menses began?
Age at menarche
last menstrual period (when did it start?)
prior menstrual period (the one before LMP)
What is secondary dysmenorrhea?
pain with menses WITH an organic cause. (Causes include endometriosis, adenomyosis, pelvic inflammatory disease (PID), & endometrial polyps).
What are the 3 criteria for diagnosis of PMS?
1) symptoms/signs 5 days prior to menses for 3 consecutive cycles
2) cessation of symptoms/signs within 4 days after onset of menses
3) interference with daily activities
What is a common cause of secondary amenorrhea?
Define what is included for documentation of Gravida Para Notation
G= total number of pregnancy
P= outcome of pregnancy
Full term, Premature. Abortion, Miscarriage, Living
What are the important areas in an external pelvic examination?
Mons pubis, Labia Majora and Minora, Urethral Meatus, Clitoris, Vaginal Introitus, Perineum
What are the important areas in an internal pelvic examination?
Vagina, Vaginal Wall, Cervix, Uterus, Ovaries, Pelvic Muscles, Rectovaginal Wall
A bulge near the external inguinal ring suggests what?
Direct Inguinal Hernia
A bulge near the internal inguinal ring suggests what?
Indirect Inguinal Hernia
What is an incarcerated hernia?
-when its connects cannot be returned to the abdominal cavity (cannot be reduced)
-especially warrant surgical eval
-10x more common with indirect hernias
What is a strangulated hernia?
when the blood supply to the entrapped contents is compromised.
Suspect this in presence of tenderness, nausea, & vomiting & consider surgical intervention
Radicular gluteal and posterior leg pain in the S1 distribution that increases with cough or valsalva
Masseter,lateral & Medial Pterygoid,Temporalis
Abducts arm; Runs above the glenohumeral joint to the greater tubercle of humerus
Laterally rotates shoulder; Cross the glenohumeral joint posteriorly to the greater tubercle of humerus
laterally rotates shoulder;Cross the glenohumeral joint posteriorly to the greater tubercle of humerus
ROM of shoulder
flexion/extension, abduction/adduction, internal/external rotation
- tests acromioclavicular joint
- have patient adduct the arm across the chest
- pain is a positive test
- indicates inflammation or arthritis of the acromioclavicular joint
Drop Arm Test
Ask patient to stand with the arm fully abducted at the shoulder level and then slowly lower it to their side.
If they cannot hold their arm up at shoulder level, or if they cannot control the lowering of their arm (dropping it instead of lowering it) = positive Drop-Arm Test
Supraspinatus RCT or bicipital tendinitis
-Medial and lateral epicondyles of humerus
-Olecranon process of ulna
Swelling over the olecranon process suggests...
Tenderness distal to the epicondyle is common in _____ and less common in ______ (elbow)
common in lateral epicondylitis (tennis elbow)
less common in medial epicondylitis (golfer's/pitcher's elbow)
ROM for elbow
flexion, extension, supination, pronation
Anatomy of hand and wrist
Abnormal finger alignment suggests...
flexor tendon damage
thenar and hypothenar eminence
Fat pads on palm.
Thenar atrophy indicates...
Medial Nerve Compression--Carpal tunnel syndrome
Hypothenar atrophy indicates...
Ulnar nerve compression--cubital tunnel syndrome
tenderness over the distal radius after a fall suggests...
Anatomic snuffbox tenderness - what kind of fracture?
Swan neck deformity
hyperextension of PIP joint and flexion of DIP joint
Persistent flexion of the PIP joint with hyperextension of the DIP joint
Hard nodules or enlargements
of the distal interphalangeal (DIP)
joints of the fingers
hard nodules or enlargements of the proximal interphalangeal (PIP) joints of the fingers
ROM of wrist
flexion, extension, ulnar deviation, radial deviation
flexion, extension, abduction, adduction
ROM of Thumb
flexion, extension, abduction, adduction, opposition
2 finger squeeze
check for symmetry of strength
positive sign= decreased strength (weakness of finger flexors or intrinsic muscles of the hand)
normal spine curvatures:
-cervical spine: ___
-thoracic spine: ___
-lumbar spine: ___
superficial landmark for posterior superior iliac spines
skin dimpling above gluteal cleft
Vertebral step offs in the lumbar area indicates...
tenderness over SI joint is common in what conditions?
sacroiliitis and ankylosing spondylitis
ROM of neck
flexion, extension, rotation, lateral bending
ROM of spine
flexion, extension, lateral bending, rotation
Deformity of the thorax on forward bending, especially differences in height of the scapulae, suggests
ROM of hip
ROM of knee
flexion and extension
Anatomy of the knee
tenderness over the patella tendon or the inability to extend the knee suggests...
partial or complete patella tendon tear
Occurs with very small effusion
With knee extended, push down on the suprapatellar pouch, displacing the fluid downward
* Would feel a fluid shift from side to side
Positive= a fluid wave or bulge on the medial side between the patella and fem
For major effusions.
Place thumb and index finger or your right hand on each side of the patella; with the left hand, compress the suprapatellar pouch against the femur. Feel for fluid entering the spaces next to the patella under your right thumb and index finger.
Positive= a palpable returning fluid wave into the suprapatellar pouch
Ballotement of Patella
For major effusions
* Compress suprapatellar pouch sharply against the femur watching for fluid returning to the suprapatellar pouch
Positive = a fluid wave returning into the pouch
compression of the calf muscle while observing for plantar flexion to assess the stability of the Achilles tendon
positive= no movement of foot (achilles tendon rupture)
ROM of ankle and foot
plantar flexion, dorsiflexion, inversion, eversion
Anatomy of Ankle and Foot
Ligaments of the ankle
anterior talofibular ligament (ATFL)
calcaneofibular ligament (CFL)
where is it located and what is the test for it?
inflammation of the nerve typically between the 3rd and 4th metatarsals
palpate over the 3rd and 4th metatarsal heads on the plantar surface
positive sign= burning/tingling (nerve impingement)
how do you assess for scrotal fluid accumulation?
located at 4 and 8 o'clock along the posterior introitus
check for labial swelling here
rectovaginal exam is used to test for?
a retroverted uterus
What is the fundal height at 20 weeks?
Prostate anatomy and DRE
small round organ that lies at the base of the bladder encircling the urethra
sits anterior to the recum; feel for the peripheral zone with a dip (median sulcus) during Digital Rectal Exam
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