Pregnancy most likely diagnosis

The patient has not had a menstrual cycle in 4 months she has experienced symptoms consistent with early pregnancy, such as nausea and fatigue. Intermittent spotting can occur during pregnancy. Intermittent spotting can be caused by vaginal or urinary tract infections, or sexual intercourse. Upon physical examination, the cervix will appear bluish and at the stage of development of our patient, may be more difficult to locate, secondary to being positioned more posteriorly. Also, upon physical...

Range Of Motion And Maneuvers

Ankylosing Spondylitis

The neck is the most mobile portion of the spine, remarkable for its seven fragile vertebrae supporting the 10- to 15-pound ball of the head. Flexion and extension occur primarily between the skull and C1 (the atlas), rotation at C1-C2 (the axis), and lateral bending at C2-C7. Limitations in range of motion may reflect stiffness from arthritis, pain from trauma, or muscle spasm such as torticollis. Ask the patient to perform the following maneuvers, and check for smooth, coordinated motion...

Palpation

With your thumbs, palpate the anterior aspect of each ankle joint, noting any bogginess, swelling, or tenderness. Feel along the Achilles tendon for nodules and tenderness. Palpate the heel, especially the posterior and inferior calcaneus, and the plantar fascia for tenderness. Localized tenderness in arthritis, ligamentous injury, or infection of the ankle Rheumatoid nodules tenderness in Achilles tendinitis, bursitis, or partial tear from trauma Bone spurs may be present on the calcaneus pain...

The Musculoskeletal System Multiple Choice

A 42-year-old female office worker presents to your clinic complaining of awakening with an exquisitely tender, red, swollen right knee. She has never had this occur before and has had no history of trauma or recent illness. She has no significant past medical history. A family history reveals that her father had similar problems in middle age. On exam, she has a red, warm, tender right knee with decreased range of motion. Tapping the fluid in the knee showed no signs of infection indicating a...

Spinous Process Tenderness

Palpation The Kidneys

From a sitting or standing position, palpate the spinous processes of each vertebra with your thumb. In the neck, also palpate the facet joints that lie between the ceivical vertebrae about 1 inch lateral to the spinous processes of C2-C7. These joints lie deep to the trapezius muscle and may not be palpable unless the neck muscles are relaxed. In the lower lumbar area, check carefully for any vertebral step-offs to determine if one spinous process seems unusually prominent (or recessed) in...

Palpation Of Arthritis

Joint Inflammation Palpation

At the wrist, palpate the distal radius and ulna on the lateral and medial surfaces. Palpate the groove of each wrist joint with your thumbs on the dorsum of the wrist, your fingers beneath it. Note any swelling, boggi-ness, or tenderness. Guarded movement suggests injury. Poor finger alignment is seen in flexor tendon damage. Diffuse swelling in arthritis or infection localized swelling or ganglia from cystic enlargement. See Table 15-6, Swellings and Deformities of the Hands (pp. 529-531). In...

What Is Axillary Fold

Epitrochlear Nodes

To examine the left axilla, ask the patient to relax with the left arm down. Help by supporting the left wrist or hand with your left hand. Cup together the fingers of your right hand and reach as high as you can toward the apex of the axilla. Warn the patient that this may feel uncomfortable. Your fingers should lie directly behind the pectoral muscles, pointing toward the midclavicle. Now press your fingers in toward the chest wall and slide them downward, trying to feel the central nodes...

Interviewing and the Health History

The health history interview is a conversation with a purpose. As a clinician, you will draw on many of the interpersonal skills that you use every day, but with unique and important differences. Unlike social conversation, in which you express your own needs and interests with responsibility only for yourself, the primary goal of the clinician-patient interview is to improve the well-being of the patient. At its most basic level, the purpose of conversation with a patient is threefold to...