Clinical Examination of Ascites

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Questions and Answers

What is indicated by an asymmetrical wear pattern on a patient's shoes?

Healthy foot function

Possible abnormal gait (correct)

Normal foot structure

Excellent footwear fit

Which observation may suggest the presence of hallux valgus?

Misalignment of the first metatarsophalangeal joint (correct)

Absence of bunions

Even wear on both shoes

Straight alignment of the big toe

What does the observation of toe clawing indicate?

Possible neurological issues (correct)

Proper foot function

Foot flexibility

Requirement for custom orthotics

What characteristic of pes planus is observed when a patient stands on tiptoes?

Flat feet will correct if supple Signup and view all the answers

What would irregularities in heel alignment suggest?

Potential valgus or varus deformities Signup and view all the answers

What does increased stepping height during gait analysis indicate?

Possible foot drop condition Signup and view all the answers

What does pain on resisted external rotation typically indicate?

Infraspinatus / teres minor tendonitis Signup and view all the answers

What does an inability to perform the Gerber lift off test indicate?

Damage to the subscapularis muscle Signup and view all the answers

Which of the following examinations is NOT part of the completion process after an assessment?

Perform physical therapy Signup and view all the answers

Which clinical action is associated with assessing the function of the subscapularis muscle?

Internal rotation against resistance Signup and view all the answers

What is suggested if there is a loss of power during resisted external rotation?

Tear in the infraspinatus / teres minor ligament Signup and view all the answers

Which of the following investigations might be suggested if indicated during a shoulder examination?

X-ray / MRI Signup and view all the answers

What finding suggests the presence of ascites during percussion?

Dullness shifting from the midline Signup and view all the answers

Which bowel sound indicates possible bowel obstruction?

Tinkling sounds Signup and view all the answers

Where should you auscultate for aortic bruits?

Just above the umbilicus Signup and view all the answers

What should you do before concluding the examination?

Perform a hernia examination last Signup and view all the answers

What is the recommended initial action when starting an examination?

Introduce yourself and state your role Signup and view all the answers

What is the significance of absent bowel sounds during auscultation?

Suggests possible ileus or peritonitis Signup and view all the answers

What should be assessed if there are signs of obstruction during the examination?

Perform a digital rectal examination Signup and view all the answers

What would you likely hear during auscultation in a patient with normal bowel activity?

Gurgling sounds Signup and view all the answers

What would increased stepping height in a patient's gait potentially indicate?

Foot drop Signup and view all the answers

Which observation is NOT typically associated with knee inspection?

Temperature of the foot Signup and view all the answers

Which area is inspected for potential Baker's cysts or popliteal artery aneurysm?

Popliteal fossa Signup and view all the answers

Palpation of which structure might suggest Osgood Schlatter disease?

Tibial tuberosity Signup and view all the answers

What is assessed through the observation of a patient's gait?

Presence of muscle wasting Signup and view all the answers

Which factor would indicate a possible inflammation or infection when assessing a knee joint?

Increased temperature Signup and view all the answers

During the knee examination, which deformity is characterized by inward angling of the knees?

Valgus deformity Signup and view all the answers

When evaluating the knee joint posteriorly, which condition is NOT searched for?

Soft tissue effusion Signup and view all the answers

What is the normal range of motion (ROM) for knee flexion?

0-140º Signup and view all the answers

During passive movement assessment, what should be observed for in addition to the range of motion?

Signs of crepitus Signup and view all the answers

Which step is NOT part of the anterior drawer test procedure?

Inspect for evidence of anterior sag Signup and view all the answers

What does significant movement during the anterior drawer test suggest?

Anterior cruciate ligament laxity or rupture Signup and view all the answers

When testing the lateral collateral ligament (LCL), which directional force is applied with the right hand?

Outward Signup and view all the answers

For a proper passive assessment of knee hyperextension, what should be noted?

Angle greater than 10 degrees Signup and view all the answers

What is a critical factor to ensure during the anterior drawer test?

The patient should remain relaxed Signup and view all the answers

What indicates damage to the lateral collateral ligament during assessment?

Lateral aspect of the joint opening up Signup and view all the answers

Study Notes

Abdominal Examination Techniques

Presence of fluid (ascites) changes dullness to resonance upon percussion.
Percussion from midline outward can reveal shifting dullness if ascites is present.
Auscultation for bowel sounds:
- Normal: gurgling
- Abnormal: tinkling indicates potential bowel obstruction
- Absent sounds suggest ileus or peritonitis.
Aortic and renal bruits should be auscultated just above the umbilicus, both midline and laterally.

Completing the Examination

Important steps: thank the patient, wash hands, summarize findings, and recommend further assessments.
Check hernial orifices for signs of obstruction.
Consider performing a digital rectal examination for potential upper GI bleed.
External genitalia examination may be appropriate depending on the patient’s condition.

Ankle and Foot Examination Overview

Wash hands, introduce self, confirm patient details, and explain the examination process.
Ensure patient consent and expose both legs from the knee down.
Assess gait for normal heel strike, symmetrical motion, and step height.

Visual Inspection of Feet and Ankles

Look for symmetry, toe alignment (hallux valgus), bunions, clawing, scars, calluses, and swelling.
Shoe inspection reveals asymmetrical wear indicating gait issues.
Observe foot arches for flat (pes planus) or high arched (pes cavus) feet, correcting under pressure.

Knee Joint Examination

Inspect anteriorly for scars, swellings, and deformities, and assess for leg length discrepancies.
Look posteriorly for asymmetry and popliteal swellings.
Evaluate temperature and palpate knee and surrounding structures to check for tenderness.

Range of Motion Assessment

Active movements: observe knee flexion (norm: 0-140°) and extension.
Passive movements assess crepitus and restrictions.
Special tests include anterior/posterior drawer tests for ligament integrity.

Collateral Ligament Testing

Assess lateral collateral ligament (LCL) through stress testing.
Monitor for pain or joint instability indicating possible injury.

Completeness of the Exam

Recap findings, wash hands, and suggest additional investigations like imaging if indicated.
Consider full neurovascular examination and assessment of adjacent joints.

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Description

This quiz covers the clinical examination techniques for assessing the presence of fluid in the abdomen, particularly focusing on the percussion and auscultation methods for detecting ascites. Participants will learn how to identify shifts in dullness and normal bowel sounds during the examination.