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74 Cards in this Set
- Front
- Back
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Lung boundaries
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Superior: 3-4 cm above medial end of clavicle
Inferiorly: rib 6 at midclavic line, rib 8 at midaxillary, T9-12 posteriorly |
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Referred shoulder pain can mean? (3)
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CAD
Pulmonary tumors Gallbladder disease |
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Grading of strength (0-5)
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5 - Normal
4 - Complete range of motion against gravity w/ some but not full resistance 3 - Complete range of motion against gravity 2 - Complete range of motion w/ gravity eliminated 1 -Muscle contraction but no joint motion 0 - No muscle contraction |
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Bruits
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Murmur like sounds
Turbulent flow indicative of > 50% occlusion |
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Functions of rotator cuff muscles
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Supraspinatus - abduction
Infraspinatus + Teres minor - external rotation Subscapularis - internal rotation |
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Sternal angle of louis marks 4 spots
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Rib 2
Bifurcation of trachea Carina T4 |
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Ratio of abduction for shoulder joint
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2:1 glenohumeral:scapulothoraicic
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6 Steps of muscoskeletal exam
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Inspection
Palpation Range of motion (active/passive) Muscle strength tests Integrated function Special tests |
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Apley scratch test
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Test for all shoulder range of motion
1. Reach behind head to touch superior medial angle of opposite scapula (external rotation and abduction) 2. Reach in front of chest and touch opp acromion (internal rotation and adduction) 3. Reach down and behind back to touch inferior angle of scapula (Internal rotation and adduction) |
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Oblique fissure
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Separates lower lobes
Rib 6 @ midclavic to rib 5 @ midaxillary, posteriorly to T3 |
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Shoulder arc test
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Test full shoulder ROM
Abduct arms to 90 Turn palms up Continue to abduct Pain 60-120 deg: subacromial (impingement) Pain >120 deg: acromioclavicular |
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Location of right atrium
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Rib 3-5 right of sternum
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C5 dermatome
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Lateral aspect of deltoid
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Horizontal fissure
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Separates upper and middle lobes
Sternal border of rib 4 to midaxillary rib 5 |
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T1 dermatome
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Medial aspect of arm
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T4 dermatome
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Line drawn between nipples
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Diaphragm location
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At end of expiration:
Rib 5 anteriorly T9 posteriorly |
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Impingement test
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Rotator cuff and tendons
Internally rotate arm w/ thumb facing outward then flex arm Pain = positive |
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Location of heart apex
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5th intercostal space at mid clavicular line
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Apprehension test
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Shoulder instability prone to anterior dislocation
Lay supine, abduct shoulder 90 deg, externally rotate, and attempt to further rotate Apprehension -> positive |
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Tactile fremitus (decreased vs increased)
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Place hands on chest to feel vibrations
Increased vibrations -> fluid in lung Decreased vibrations -> pleural fluid |
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FABER and Patrick tests
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FABER (Flexion ABduction External Rotation)
Supine, flex knee on affected side to 90deg and place foot on opposite knee - pain in groin indicates hip joint path. Patrick's - push knee down - sacroiliac pain indicates path. |
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Percussion sounds in lungs
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Resonant - air, normal lung
Dullness - fluid (normal liver) Hyperresonant - too much air (emphysemic lung) |
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Empty can test
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Supraspinatus function
Abduct arm 90 deg and rotate to empty can, resist abduction Pain = positive |
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Location of heart base
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2nd intercostal space to right and left of sternum
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Subscapularis lift-off
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Subscapularis function
Internally rotate arm behind back w/ dorsum of hand on small of back Lift dorsum off back against resistance Inability to lift = positive |
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4 normal breath sounds
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Bronchial - loud/high pitched, over sternum
Vesicular - soft/low pitched, over lung Tracheal - harsh/high pitched, over trachea Bronchovesicular - mix of bronchial/vesicular heard over carina and mainstem bronchi |
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Biceps vs brachioradialis vs triceps reflexes (nerve roots?)
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Biceps - C5
Brachioradialis - C6 Triceps - C7 |
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What nerve roots does patellar reflex test?
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L2-L4
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Rales/crackles (when, character, cause)
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Inspiratory
Intermittent, non musical Caused by opening of collapsed distal airways and alveoli |
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Aortic ausculatory area
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2nd IC space, right sternal border
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Hand dermatomes
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C6 - thumb
C7 - middle finger C8 - ring and small fingers |
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Wheezes (when + where)
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Expiratory
Bronchi |
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How to test collateral ligaments?
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Valgus - apply lateral pressure, tests MCL
Varus - apply medial pressure, tests LCL |
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Phalen's sign
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Carpel tunnel syndrome
Place dorsal aspects of hands together, point fingers down, flex wrists 90 deg for 60sec No paresthesia = negative |
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Stridor (when and where)
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Inspiratory
Upper airway (turbulent flow) |
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Finkelstein test
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Tenosynovitis in wrist
Make fist with fingers wrapped around thumb and deviate hand in ulnar direction Pain over APL and EPB = positive |
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Pulmonic ausculatory area
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2nd IC space, left sternal border
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Myotome for wrist extenion vs flexion
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Extension C6
Flexion C7 |
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Pleural rubs
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Inspiratory and expiratory
Creaking leather Caused by rough/thick pleura |
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Egophany (indicates?)
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E to A change
Indicates consolidation area (fluid-filled) |
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Tricuspid ausculatory area
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Lower left sternal border
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Whispered pectoriloquy
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Amplification of whisper heard through consolidated lung
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Lung consolidation (differential and a few findings)
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Pneumonia or atelectasis
Increased fremitus Dull Increased bronchial sounds Egophony Increased pectoriloquy Rales |
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Mitral ausculatory area
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Cardiac apex (5th IC space and mid clavicular line)
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Pleural effusion (differential and a few findings)
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Fluid b/w lung and chest
Decreased fremitus Dull Absent breath sounds Pleural rub |
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McMurray test
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Torn meniscus
Hold heel and flex hip and knee, apply valgus pressure and roate leg, then varus . . .listen for click |
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COPD findings (4)
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Prolonged expiration w/ accessory muscle use
Hoover's sign (lower rib cage pulled in on inspiration) Hyperresonant Decreased bronchial sounds |
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Distension of external jugular vein (4 causes)
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Heart failure, obstruction of SVC, enlarged supraclavicular lymph nodes, increased intrathoracic pressure
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Foot dermatome
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Saphenous - medial S2
Superficial peroneal - dorsum L4/5 Sural - lateral S1 |
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Rebound tenderness
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Peritoneal sign, indicator of peritoneal irritation
Bump edge of table Ask patient to touch Should elicit pain |
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Jugular venous pulsations (4)
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a wave - increase in RA pressure due to RA contraction
(Just before S1) c wave - w/ first heart sound due to bulging of TC valve into RA x descent - decrease in RA pressure due to atrial relaxation v wave - increase in RA pressure due to filling up w/ blood from IVC (corresponds w/ carotid pulse) y descent - decrease in RA pressure due to opening of tricuspid valve at end of systole |
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Rovsing's Sign
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For appendicitis
Push on LLQ and if pain present on RLQ or at McBurney's point -> positive |
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Achilles reflex (elicits what movement, which nerve roots?)
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S1-S2
Plantar flexion of ankle |
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Obturator sign
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For inflammation, appendicitis, peritoneal irritation
Flex leg at hip with knee bent and rotate internally Pain if positive |
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Central venous pressure (normal and measurement)
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Add 5 mmHg to jugular venous pressure
Normal is 7-8 |
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Psoas sign
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Intra-abdominal inflammation, appendicitis, psoas abscess
Lying on unaffected side, passively extend affected side Pain is positive Appendicitis produces positive right psoas test |
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Murphy's sign
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For acute cholecystitis
Palpate liver head on deep inspiration If patient stops inspiration due to pain -> present sign |
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Point of maximal impulse (timing and location)
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Movement of LV against chest wall
Location: 5th IC space at MCL Timing: after S1 but not thru S2 |
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Testicular pain/masses suggest . .
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Testicular torsion
Epididymitis Hydrocele/varicocele |
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Crossed straight leg raise
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Raise opposite leg experiencing
If reduction of pain in opposite leg, pos for sciatica |
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Splitting of S2
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A2 normally precedes P2 and with inspiration the gap is widening
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Kernig test
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Meningeal irritation
Supine, flex leg at hip and knee If pain is elicited as knee is extended, + |
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What does hearing S3 indicate?
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Volume overload to LV
CHF |
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Brudzinski test
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Mengineal irritation
Supine, flex pt's neck Lift legs off bed to reduce pain is pos |
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What does hearing S4 indicate?
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Stiff non-compliant ventricle, pressure overload
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Adams forward bend test
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Scoliosis
Bend forward, look for assymetry |
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Systolic clicks
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Opening of pathologically deformed valve
Ejection click - early in systole due to opening of defective semilunar valve |
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Hoover test
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Malingering
Supine Ask pt to raise leg while holding both feet and notice downward force on opp. leg |
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Diastolic snap
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High pitched sharp sound due to opening of defective AV valve
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Presbyopia
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Difficulty focusing near because of reduced accommodation
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C5 myotome
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Shoulder abduction
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C8 myotome
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Finger flexion
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T1 myotome
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Finger abduction
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