Inspect – Auscultate – Palpate – Percuss Grey Turner sign – purple discoloration at the flanks indicates bleeding or trauma within abdominal walls Ascites – abdominal swelling due to fluid accumulation Spider angioma – dilated surface arterioles and capillaries with a central star Cullen sign – bluish or purple discoloration around umbilicus indicating intra-abdominal bleeding 6 F’s – Fat, Feces, Fetus, Fluid, Fibroids, Flatulence Hernia is seen as a bulge in the abdominal wall Hepatomegaly – enlarged liver Splenomegaly – enlarged spleen Enlarged kidney may be due to a cyst, tumor, or hydronephrosis Test for Ascites: Test for shifting dullness and fluid wave test Test for appendicitis: Rebound tenderness in LLQ, Psoas sign – hyperextend, Obturator sign – rotate leg externally and internally, Hypersensitivity test Test for Cholecystitis: RUQ pain or tenderness Psoas sign – pain in RLG when hyperextended due to irritation of iliopsoas muscle due to appendicitis Obturator sign – pain in RLG when legs are rotated externally and internally due to irritation of obturator muscle due to appendicitis Murphy sign – pain when pressure is elicited on the right costal margin liver border, sign of inflammation of gallbladder Rovsing sign – pain in RLQ when there is pressure on LLQ, sign of appendicitis Blumberg sign – sign of peritoneal irritation READ ON ABNORMALITIES ASSESSING MUSCOSKELETAL
Bones provide structure and protection
206 bones make up the axial and appendicular skeleton Two types of bones: compact and spongy bone Periosteum – covers the bones; it contains osteoblasts and blood vessels Three types of muscle: skeletal, smooth, and cardiac Skeletal muscles are attached to bones via tendons Joints are where two bones meet Fibrous joints – immovable Cartilagous joints Synovial joints – contain synovial fluid that allow sliding movement Bones in synovial joints are joined by ligaments Bursae – small sacs filled with synovial fluid READ ON MAJOR JOINTS
Observe posture Posture is erect and comfortable
Observe gait Evenly distributed weight and movement Inspect and Palpate TMJ Snapping and clicking may be heard Test ROM Jaw has full ROM against resistance While client is sitting, No visible bone overgrowth, swelling, redness, tenderness inspect sternoclavicular joint Observe cervical, Cervical and lumbar are concave; thoracic is convex thoracic, lumbar curvature Palpate spinous process Non tender spinous processes, well developed, firm, smooth, nontender and paravertebral muscle muscles ROM of cervical spine Flexion and extension of cervical spine Test lateral bending 40 degrees Evaluate rotation 70 degrees ROM of lumbar spine Flexion of 75-90 degrees, hyperextension of 30, lateral bend of 35, rotation of 30 Test for back and leg pain Measure leg length Measure from anterior superior iliac spine upto medial malleolus crossing the knee; normal is equal or 1 cm apart Inspect and palpate the Symmetric, no swelling, redness, deformity arms ROM of shoulders Forward flexion of 180, hyperextension of 50, adduction of 50, abduction of 180, internal and external rotation of 90 Inspect elbows Symmetric, no deformities, redness, or swelling ROM of elbows Flexion of 160, hyperextension of 180, pronation and supination of 90, hyperextension of 5-10 Inspect wrist Wrist are symmetric, no redness or swelling Perform squeeze test Pain is tolerated ROM of wrist Flexion of 90, hyperextension of 70, ulnar deviation of 55, radial deviation of 20 Test for Carpal tunnel No tingling, numbness, or pain syndrome: Perform Phalen test Perform Tinel test No tingling or shocking sensation Observe for flick signal Test for thumb weakness Inspect hand and fingers ROM of hands and Abduction of 20, full adduction of fingers, flexion of 90, hyperextension fingers of 30. Normal thumb flexion is at 50 degrees While client is standing, inspect symmetry and shape of hips ROM of hips 90 hip flexion, 120 hip flexion with bent knees, 45-50 abduction, 20-30 adduction, 40 internal hip rotation, 45 external hip rotation, 15 hip hyperextension Inspect knees Perform bulge test Perform ballottement test ROM of knees Inspect position, alignment, shape, and skin of ankles and feet Palpate ankles and feet Assess metatarsophalangeal joint Perform squeeze test ROM of feet Dorsiflexion of 20, eversion of 20, inversion of 30, abduction of 10, adduction of 20, flexion and extension of 40 Chronic rheumatoid arthritis – swelling and thickening of carpal and phalanges joints
Osteoarthritis – nodules on dorsolateral aspect of phalanges joints
Boutonniere and swan neck deformities – flexion of proximal phalanges joint and hyperextension of distal phalanges joint
Ganglion – fluid filled cyst commonly in dorsum of wrist
Tenosynovitis – painful flexion of fingers
Thenar atrophy – seen in CTS
Acute gouty arthritis – phalanges joint of great toe is swollen
Flat feet – has no arch and may cause pain and swelling of foot surface
Callus – non painful thickened skin occurring at pressure points
Hallux valgus – lateral deviation of great toe
Corn – painful thickening of skin
Hammer toe – hyperextension of metatarsophalangeal joint with flexion of proximal interphalangeal
joint
Plantar warts – painful warts usually under callus
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