Clinical Examination Techniques Quiz

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What is the normal heart rate range for 95% of the healthy population?

50-95 bpm

What is the purpose of Castelle's sign in the context of palpation?

To detect splenomegaly

During spleen percussion, what does dullness upon deep breath suggest?

Positive Castelle's sign and splenomegaly

What is the normal characteristic of the thyroid during inspection?

No enlargement, symmetrical, moves with swallowing

What is the pronator drift test used to assess?

Upper motor neuron function

A positive Romberg sign indicated:

Sensory ataxia (loss of balance when eyes are closed)

Which examination allows visualization of the retina, optic disc, and vasculature?

Ophthalmoscopic examination

What is the normal color of the tympanic membrane during otoscopic examination?

Light-gray or shiny pearly-white

What is the purpose of the pronator drift test?

Assess upper motor neuron function

What defines bradycardia?

Heart rate less than 50bpm

What is pulse deficit typically associated with?

Atrial fibrillation

What does assessing pulse equality involve?

Determining if the pulse amplitude is similar on both sides of the body

Where is S1 and S2 sounds best heard?

S1 - Apex, mitral value and S2 - Aortic or Pulmonic areas, Erb's

Where should blood pressure be measured?

In the left arm

What does significant differences in blood pressure between arms indicate?

Obstructions or other issues

What is the normal jugular venous pressure measurement?

Less than 3cm above the sternal angle

What is the typical respiration rate?

12 to 20 breaths per minute

What does tachypnea refer to?

Increased respiratory rate

What is Kussmaul breathing characterized by?

Deep, sighing respiratory patterns and potential pathologies such as acidosis

What are the classic triad of symptoms in Horner's syndrome (loss of sympathetic innveration)? (Pupillary response to light and accommodation)

Ptosis, miosis, anhidrosis

What do hypoactive (less than 5 sounds/min) bowel sounds indicate?


What might absent bowel sounds indicate?


What is McBurney’s point tenderness used for?

Suspected appendicitis

What are shifting dullness and fluid wave tests used to assess for?


What can a rounded, symmetrical abdomen with bulging flanks be a sign of?


What is the normal liver span on the midclavicular line?


What is the normal liver span on the midsternal line?


What is a characteristic of a healthy liver?

Sharp, regular, and smooth edge

What do different types of crackles and their characteristics indicate?

Various underlying conditions such as congestive heart failure, chronic bronchitis, and bronchiectasis

What is the significance of pleural friction and dullness in lung auscultation?

Pleural friction occurs due to inflammation, resembling crackling sounds, and dullness may indicate masses or solid tissue in the lungs

What are egophony, bronchophony, and whispered pectoriloquy used for in lung auscultation?

To assess lung consolidation and distinguish normal from abnormal lung sounds

What can hyperresonance in lung percussion indicate?

Abnormally long and low pitched - can be caused by emphysema, pneumothorax, COPD

What are reflexes, such as deep tendon reflexes (DTR) and plantar reflex, used to test?

Spinal nerve function and identify pathology findings such as lower motor neuron lesions

What can absent reflexes indicate?

Pathology findings related to lower motor neuron lesions and spinal nerves

What does a positive Babinski's sign indicate?

A sign of upper motor lesions in the central nervous system (CNS)

What does gait assessment, including walking, tandem walking, and toe walking, observe?

Balance, posture, and coordination

What does a 2+ pulse rhythm indicate?

Easy to palpate or not easily obliterated with pressure (normal)

What can be assessed using the H-test?

Extraocular movements

What is the typical technique for light abdominal palpation?

Circular motions

What is the significance of hyperactive (more than 35 sounds/minute) bowel sounds?


Which test is used to assess upper motor neuron function?

Pronator drift test

What is the purpose of otoscopic examination?

Visualize the external ear canal and tympanic membrane

What is jugular venous pressure evaluated to estimate?

Pressure in the right atrium

What can Cheyne-Stokes breathing indicate?

Heart failure or during sleep

What does regular irregular rhythm, predictable pattern of missed beats means in heart rate?

Sinus arrhythmia

Loud S1 indicates:

Mitral stenosis or hyperdynamic state (fever, exercise)

What does a wide S2 splitting, a wide fixed S2 and paradoxical S2 mean respectively?

Wide splitting - pulmonic stenosis, Wide fixed - right ventricle failure, Paradoxical - aortic stenosis

S3 vs S4 sound

S3 - early diastole gallop (congestive heart failure), S4 - hypertension

Jugular venous pressure is greater the 3cm what does this indicate?

An increased diastolic pressure - heart or lung disease where ascites or edema is present

What does wheezing in the lungs indicate?

Asthma, COPD

What is Rhonchi?

Low pitched, continuous, snoring quality (secretion in the airway)

Dullness vs tympanic membrane sounds

Dullness means there is a solid mass while tympanic is just air

What does consolidation in the lungs suggest?

Transmission of higher frequency vocal vibrations which enhances the clarity and resonance of the words that are spoken

Dysdiadochokinesis = Slow, irregular, awkward movements that may indicated cerebellar/basal ganglia disease Dysmetria = Finger/heel overshoot or undershoot target Intension tremor = Involuntary rhythmic muscle contractions during a directed and purposeful motor movement Pronator drift = Arm pronates or drift downwards when it should remain supine

Hemiplegic gait = Weakness or paralysis on one side Diplegic gait = Bilateral and symmetrical leg movement Neuropathic gait = High-stepping with foot drop/instability (PNS damage) Myopathic gait = Waddling, wide stance, muscle disorder

Choreiform gait = Irregular and involuntary movements (Huntington disease) Ataxic gait = Dysfunction in cerebellum, instability, veering off Parkinsonians gait = Parkinson's small shuffle steps, reduced arm swinging Sensory gait = Sensory deficit, cautious

Aniosocria = Asymmetric pupil size RAPD (Relative afferent pupillary defect) = Damage to the optic nerve, defect in direct response Adie's (Tonic) Pupil = None or sluggish response to light Agryll Robertson Pupil = Pupil's do not constrict to light but will constrict with accommodation

Pathological optic cupping = Abnormal enlargement of central area of disc Optic disc edema = Swelling of optic disc Arterio-venous nicking = Compression of veins at crossing Cotton wool spots = White fluffy lesions on retina

Emboli and infarcts = Dislodge debris in vessels Roth spot = Retinal hemorrhage with white or pale center Acute otitis media = infection of fluid accumulation in the middle ear Otitis media with effusion = accumulated fluid in the middle ear without inflammation

Cholesteatoma = Abnormal collection of keratinized squamous epithelium Shifting dullness can indicate = Heart failure Tender liver = Inflammation or congestion Firm or irregular borders = diseased liver, cirrhosis

Goiter = Enlarged thyroid, move upwards with swallowing and goes back to resting after Supraclavicular small palatable lymph nodes = Malignancy in abdominal cavity Lymphadenopathy = Swelling of lymph nodes

Study Notes

Clinical Examination Techniques: Lung Auscultation, Reflexes, and Cerebellar Function

  • Lung auscultation provides information about the presence of consolidation, wheezing, rhonchi, crackles, pleural friction, and dullness in different lung regions.
  • Different types of crackles (fine and coarse) and their characteristics indicate various underlying conditions such as congestive heart failure, chronic bronchitis, and bronchiectasis.
  • Pleural friction (rub) occurs due to inflammation, resembling crackling sounds, and dullness may indicate masses or solid tissue in the lungs.
  • Techniques such as egophony, bronchophony, and whispered pectoriloquy are used to assess lung consolidation and distinguish normal from abnormal lung sounds.
  • Hyperresonance in lung percussion can be caused by conditions like emphysema, pneumothorax, and COPD, affecting vocal vibrations and clarity.
  • Reflexes, such as deep tendon reflexes (DTR) and plantar reflex, are used to test spinal nerve function and identify pathology findings such as lower motor neuron lesions.
  • Absent reflexes can indicate pathology findings related to lower motor neuron lesions and spinal nerves.
  • The Babinski's sign, indicating a positive plantar reflex, can be a sign of upper motor lesions in the central nervous system (CNS).
  • Cerebellar function tests, including dysdiadochokinesis, finger-to-nose, and heel-to-shin tests, are used to assess motor coordination and cerebellar function.
  • Gait assessment, including walking, tandem walking, and toe walking, is used to observe balance, posture, and coordination.
  • Detailed instructions for performing each clinical examination technique, such as lung auscultation, reflex testing, and cerebellar function tests, are provided, including patient positioning and specific actions for each test.
  • Normal and abnormal findings for each clinical examination technique are described, allowing for the identification of potential pathology and the assessment of patient health.

Clinical Assessment of Cardiopulmonary Function

  • Bradycardia is characterized by a heart rate of less than 50bpm, while tachycardia is defined by a heart rate exceeding 100bpm.
  • Pulse deficit occurs when there is a difference of 2bpm or more between the radial and apical pulse rates, typically associated with atrial fibrillation.
  • Assessing pulse equality involves determining if the pulse amplitude is similar on both sides of the body.
  • Heart sounds, such as S1 and S2, provide crucial information about cardiac function and can indicate specific pathologies.
  • Blood pressure should be measured in the left arm, and significant differences between arms may indicate obstructions or other issues.
  • Jugular venous pressure is evaluated to estimate pressure in the right atrium, with a normal measurement being less than 3cm above the sternal angle.
  • Respiration rate is typically 12 to 20 breaths per minute, with variations in breathing patterns indicating potential pathologies.
  • Different breath sounds, such as vesicular, bronchial, and bronchovesicular, are assessed to evaluate lung function.
  • Chest percussion is used to diagnose lung abnormalities and is performed on the posterior and anterior chest.
  • Tachypnea refers to an increased respiratory rate, while bradypnea denotes a decreased rate, which may be indicative of various health conditions.
  • Kussmaul breathing is characterized by deep, sighing respiratory patterns, often associated with increased tidal volume and potential pathologies such as acidosis.
  • Cheyne-Stokes breathing involves crescendo-decrescendo respirations followed by a period of apnea and is typically observed in conditions like heart failure or during sleep.

Test your knowledge of clinical examination techniques with a focus on lung auscultation, reflexes, and cerebellar function. Explore the assessment of lung sounds, reflex testing for spinal nerve function, and evaluation of motor coordination. Learn about normal and abnormal findings to identify potential pathology and assess patient health.

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