Clinical assessments

Chadwick sign

A bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow. It can be observed as early as 6 to 8 weeks after conception and its presence is an early sign of pregnancy

Setting-Sun sign

A clinical phenomenon encountered in infants and young children with raised intracranial pressures . It consists of an up-gaze paresis with the eyes appearing driven downward. The lower portion of the pupil may be covered by the lower eyelid, and sclera may be seen between the upper eyelid and the iris.

De Musset's sign

A condition in which there is rhythmic nodding or bobbing of the head in synchrony with the beating of the heart, in general as a result of aortic insufficiency whereby blood from the aorta regurgitates into the left ventricle due to a defect in the aortic valve.

Romberg's sign

A diagnostic sign of diseases of the nervous system consisting of a swaying of the body when the feet are placed close together and the eyes are closed

Battle's sign

A discoloration behind the ear in the line of the posterior auricular artery, often associated with a basilar skull fracture.

Babinski Sign

A sign of a problem in the central nervous system Occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out.

Cullen sign

Bluish discoloration around the umbilicus sometimes associated with intraperitoneal hemorrhage, especially after rupture of the uterine tube in ectopic pregnancy; similar discoloration occurs in acute hemorrhagic pancreatitis.

Neer's Test

Commonly used in orthopedic examinations to test for subacromial impingement.

Lhermitte's sign

Electric-like shocks spreading down the body on flexing the head forward; seen mainly in multiple sclerosis but also in compression and other cervical cord disorders.

Goodell's sign

It is a significant softening of the vaginal portion of the cervix from increased vascularization which is an indication of pregnancy.

Morton's Test

Morton's Neuroma: Patient lies supine. Squeeze metatarsal heads together. Positive sign: pain

Brudzinski's sign

One of the physically demonstrable symptoms of meningitis. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

McBurney's Sign

Positive tenderness and severe pain when the appendix area(point at right side of the abdomen that is one-third of the distance from the anterior superior iliac spine to the umbilicus) is palpate indicates appendicitis.

Homan's Sign

Used as a sign of deep vein thrombosis. A positive sign is present when there is pain in the calf on forceful and abrupt dorsiflexion of the patient's foot at the ankle while the knee is extended

Mallampati Score

Used to predict ease of intubation (anesthesia); Score ranges from I-IV. Classes I and II are associated with relatively easy intubation while classes III and IV are associated with increased difficulty.

NEXUS criteria for C-spine imaging

used to determine presence of cervical spine injuries: (N.S.A.I.D) Neuro deficient: no focal neurological deficit Spinal tenderness (midline): no posterior midline cervical tenderness Altered mental status/level of consciousness: patient is alert and oriented to person, place, time, and event Intoxication: no evidence of intoxication Distracting injury: no painful distracting injuries (e.g., long bone fracture) cervical spine is determined stable if NSAID criteria are met

Seldinger technique

A medical procedure performed during central line placement to obtain access to blood vessels and other hollow organs. The technique: the desired vessel or cavity is punctured with a sharp hollow needle called a trocar. A round-tipped guidewire is then advanced through the lumen of the trocar, and the trocar is removed. A "sheath" or blunt cannula can now be passed over the guidewire into the cavity or vessel. After passing a sheath or tube, the guidewire is withdrawn. Upon completion of the desired procedure, the sheath is withdrawn.

Obturator sign

A sign of appendicitis or other peritoneal inflammation. The internal rotation of the right leg with the leg flexed to 90 degrees at the hip and knee and a resultant tightening of the internal obturator muscle may cause abdominal discomfort indicative of appendicitis.

Kernigs sign

A sign of meningitis; This sign is positive if the patient cannot extend the leg at the knee when the thigh is flexed because of stiffness in the hamstrings

ASA PS classification system

A system for assessing the fitness of cases before surgery. In 1963 the American Society of Anesthesiologists (ASA) adopted the five-category physical status classification system; a sixth category was later added. These are: Healthy person. PS1. Mild systemic disease. PS2. Severe systemic disease. PS3. Severe systemic disease that is a constant threat to life. PS4. A moribund person who is not expected to survive without the operation. PS5. A declared brain-dead person whose organs are being PS6. removed for donor purposes.

Guaiac Test

A test for blood in urine or feces using a reagent containing guaiacum that yields a blue color when blood is present

Hawkins-Kennedy Test

A test used in the evaluation of orthopedic shoulder injury. The patient is examined while sitting with their shoulder flexed to 90° and their elbow flexed to 90°. The examiner grasps and supports proximal to the wrist and elbow to ensure maximal relaxation, the examiner and the patient then quickly rotate the arm internally.Pain located below the acromioclavicular joint with internal rotation is considered a positive test result

Tinel's Sign

A way to detect irritated nerves. It is performed by lightly tapping (percussing) over the nerve to elicit a sensation of tingling or "pins and needles" in the distribution of the nerve.

Stellwag's sign

Infrequent or incomplete blinking, a sign of Graves' disease.

GCS Scale

Glasgow Coma Scale; A scale for measuring level of consciousness, especially after a head injury, in which scoring is determined by three factors: amount of eye opening, verbal responsiveness, and motor responsiveness

Rovsings sign

If palpation of the left lower quadrant of a person's abdomen increases the pain felt in the right lower quadrant, the test is positive and may have appendicitis.

Greys-turners sign

Refers to bruising of the flanks, the part of the body between the last rib and the top of the hip. The bruising appears as a blue discoloration and is a sign of retroperitoneal hemorrhage, or bleeding behind the peritoneum. This takes 24-48 hours to develop, and can predict a severe attack of acute pancreatitis.

Thompson's Test

This test is performed when making the diagnosis of a torn Achilles tendon. To perform this test, the patient should lie face-down on the examination table. The feet extend farther than the end of the bed. The examiner then squeezes the calf muscle. This motion, in a normal patient, should cause the toes to point downward as the Achilles pulls the foot. In a patient with a ruptured Achilles tendon, the foot will not move, this is a positive test.

Murphy's Sign

Typically seen in acute cholecystitis. Performed by asking the patient to breathe out and then gently placing the hand below the approximate location of the gallbladder. The patient is then instructed to breathe in. Normally, during inspiration, the abdominal contents are pushed downward as the diaphragm moves down (and lungs expand). If the patient stops breathing in (as the gallbladder is tender and, in moving downward, comes in contact with the examiner's fingers) and winces with a 'catch' in breath, the test is considered positive.

McMurray Sign

Used to Assess medial or lateral meniscus tear How to Perform -Supine -hip & knee maximally flexed (knee to chest) -Medial Meniscus Test: +You palpate the medial joint line & stabilize the knee with one hand +You grab the foot with the other hand +You then EXTERNALLY ROTATE the tibia and extend the knee (allowing the knee to sway outward during extension) -Lateral Meniscus Test: +You palpate the lateral joint line & stabilize the knee with one hand +You grab the foot with the other hand +You then INTERNALLY ROTATE the tibia and extend the knee (allowing the knee to sway inward during extension) Positive Test: -Medial: + audible and/or palpable, painful snap/click occurs as the femur passes over damaged portion of the meniscus -Lateral: + clicks without pain or joint line tenderness may represenent normal variant Positive Test May Indicate: -Medial or Lateral Meniscal Tear

Lachman's Test

Used to assess anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) sprain or rupture How to Perform -Supine -Patient's knee flexed 30 degrees (you can rest it on your thigh) -Anterior Test: + You stabilize the femur just proximal to the patella with one hand + With the other hand you pull the tibia anteriorly -Posterior Test: + You stabilize the femur just proximal to the patella with one hand + With the other hand you push the tibia posteriorly Positive Test: -pain with excessive motion of tibia anteriorly or posteriorly without firm end-point (normal is < 5mm motion) Positive Test May Indicate: -Positive Anterior Test: Anterior Cruciate Ligament Sprain/Rupture -Positive Posterior Test: Posterior Cruciate Ligament Sprain/Rupture

Anterior Drawer

Used to assess anterior cruciate ligament sprain or rupture How To Perform: -Supine -Patient's knee flexed to 90 degrees, foot on the table -You stabilize the leg with by resting your knee on the dorsum of the foot (or sitting on it?) -You then place your hands behind the proximal tibia and PULL the proximal tibia anteriorly Positive Test: -Pain or excess motion (normal is < 5mm of anterior motion) +grade the motion from +1 to +3 Positive Test May Indicate: -anterior cruciate ligament (ACL) sprain or rupture

Adduction Stress Test (Varus Stress)

Used to assess lateral collateral ligament sprain or rupture How to Perform -Supine -legs straight, quads relaxed, knee in neutral (0 degrees) -Grasp the patient's ankle between your legs -With one hand just above the knee press laterally -With the other hand below the knee press medially -You bend at the knees, which will make the patient's knee flex -Repeat the above varus stress with patient's knee flexed 30 degrees -Estimate the medial joint space and evaluate the stiffness of motion Positive Test: -pain or increased motion/gapping (normal is no motion) +grade motion/gapping from 1+ (no instability) to 4+ (severe instability) Positive Test May Indicate: -Positive Test in Neutral (0 degrees) +LCL: superficial and deep LCL sprain/rupture PLUS ACL, PCL, or posterior lateral capsule sprain/rupture -Positive Test in 30 degrees flexion: +LCL: superficial LCL sprain/rupture PLUS posterior lateral capsule sprain/rupture

Abduction stress test (Valgus Stress)

Used to assess medial collateral ligament (MCL) sprain or rupture How to Perform -Supine -legs straight, quads relaxed, knee in neutral (0 degrees) -Grasp the patient's ankle between your legs -With one hand just above the knee press medially -With the other hand below the knee press laterally -You bend at the knees, which will make the patient's knee flex -Repeat the above valgus stress with patients knee flexed 30 degrees -Estimate the medial joint space and evaluate the stiffness of motion Positive Test: -pain or increased motion/gapping (normal is no motion) +grade motion/gapping from 1+ (no instability) to 4+ (severe instability) Positive Test May Indicate: -Positive Test in Neutral (0 degrees) +MCL: superficial and deep MCL sprain/rupture PLUS ACL, PCL, or posterior medial capsule sprain/rupture -Positive Test in 30 degrees flexion: +MCL: superficial MCL sprain/rupture PLUS PCL or posterior medial capsule sprain/rupture

Apley's Compression Test

Used to assess meniscal lesions How To Perform -Prone -Patient's knee flexed to 90 degrees -You apply downward force just proximal to the ankle causing axial compression of the tibia -Then alternately interally and externally rotate the tibia and reapply axial compression Positive Test: -pain, crepitus, popping, clicking, locking with compression or rotation especially when relieved with Apley's Distraction Test Positive Test May Indicate: -meniscal lesion

Posterior Drawer Test

Used to assess posterior cruciate ligament sprain or rupture How To Perform: -Supine -Patient's knee flexed to 90 degrees, foot on the table -You stabilize the leg with by resting your knee on the dorsum of the foot (or sitting on it?) -You then place your position your hands with both thenar eminences on the anterior proximal tibia and PUSH the proximal tibia posteriorly Positive Test: -Pain or excess motion (normal is < 5mm of anterior motion) +grade the motion from +1 to +3 Positive Test May Indicate: -posterior cruciate ligament (PCL) sprain or rupture

Talar Tilt

Used to test for injury to the lateral ligaments of the ankle.