Physical Assessment

assignment

Under supervision:d.thuraya Edrees

Prepared By: Manar saeed
 Contents

1. Cyanosis
2. Whisper test
3. Tuning fork
4. Romberg test
5. Allen’s test
6. Homan’s sign test
 1. Cyanosis
What is Cyanosis:
Cyanosis refers to a bluish-purple hue to the skin. It is
most easily seen where the skin is thin, such as the lips,
mouth, earlobes and fingernails.
Cyanosis indicates there may be decreased oxygen
attached to red blood cells in the bloodstream. It may
suggest a problem with the lungs or heart. Cyanosis is a
finding based on what is seen, not by a laboratory test.

Symptoms of cyanosis:
Cyanosis is seen in the skin, nail beds, or mucous
membranes. If cyanosis is seen only in the limbs it
is termed acrocyanosis or peripheral cyanosis. This
is common in young infants and is a part of normal
physiology.
However, central cyanosis affects the whole body.
This is seen in the mucous membranes and tongue.
This usually means a potentially serious and life-
threatening disease is lying underneath and
.requires immediate evaluation
Major systems that may be affected include the
respiratory system, blood, heart or cardiovascular
.system and the central nervous system
 Types of Cyanosis:

“Acrocyanosis” refers to cyanosis found in the

extremities, particularly the palms of the hands and
the soles of the feet. It can also be seen on the
skin around the lips. Acrocyanosis is often normal
in babies, as long as no cyanosis is present in the
central part of the body. Children may have
acrocyanosis when they are cold (such as
swimming in cold water) but it should resolve once
they are warmed up.

“Central cyanosis” refers to cyanosis found on

“central” parts of the body, including the mouth,
head and torso. Central cyanosis is never normal in
the newborn period and is almost always linked to
a lower amount of oxygen in the blood. It could be
due to a problem of the heart, lungs or blood.
 2. Whisper test
The whisper test [2] is a simple hearing test used in
primary care [3].
To do a whisper test, the examiner should briefly
explain the test. The clinician should stand at arm’s
length behind the seated patient (to prevent lip-
reading). Each ear is tested individually starting with
the better ear. The patient’s other ear canal should
be occluded with gentle finger pressure on the
tragus while rubbing the tragus in a circular motion
to mask sound. The examiner should exhale before
whispering to limit whisper loudness. A series of
three letters and numbers is whispered (e.g. 2 B 8)
and the patient asked to repeat them. If all three
numbers and letters are repeated correctly the test
is passed; if not repeated correctly a second group
of (different) numbers and letters is then whispered.
Correctly repeating three out of the possible six
letters and numbers is deemed a pass. The other ear
is then tested in the same way using different
letter/number combinations. Workers failing the
.whisper test require pure tone audiometry
 What should you use it for?

The whisper test has a number of

limitations and is not recommended for
use in occupational health practice as
validated and standardized tests are
available, e.g. ‘Hearing Check’ (Figure 1).
The whisper test is not standardized (one
systematic review found eight eligible
studies which used six different
techniques) [2], it takes time to master the
technique and there are concerns
regarding its reproducibility [3],
particularly in primary care settings. It
may, however, be of use in resource-poor
environments with limited access to
audiometry or the Internet.
 Methods:
To examine the patient/child, the examiner stands at an arm
distance (60 cm) behind the patient to avoid the chance of
lip or face reading. Since the sound can be perceived by
both ears simultaneously hence it is mandatory to mask the
nontest ear. It was done by occluding the external auditory
canal by the index finger of the nontest side hand and
continuously rotating in pendular motion and generating a
rubbing sound. The patient is explained to repeat the words
loudly. It was necessary to give a demo/trial to every child.
In trial, initially at the place of whisper, conversation was
used followed by whisper test. Test always started with
consonants as they are of high frequency followed by
vowels. Whisper is done after full quiet expiration to ensure
a quiet voice. At least three sets of either numerals/letter or
spondee words were used. If more than 80% were correct it
was treated as passed. Every time different combinations of
numerals/letters or spondee words were used.

If failed to identify whisper/conversation test, the test was

repeated at a distance of 30 cm (1 feet). Again if failed then
repeated at a distance of 15 cm (6 inches). All these
children were evaluated by audiometry and a comparative
chart was made for future assessment of hearing loss in
decibels. The same way test is repeated by
consonants/vowels to assess the frequency-specific loss.
 Hundred percent identification by whisper suggest that
there is no hearing loss, unable to hear suggest a
hearing loss above 30 dB to be confirmed by PTA. The
speech discrimination score (Pass rate) drops means
there is sensorineural deafness. The higher failure rate
with vowel is directed toward low frequency and
consonants for higher frequency. The consonants are
more sensitive to distortion than vowels. If the hearing
deteriorates in noisy surrounding and at a higher volume
it directs toward cochlear and retrocochlear pathology
3.Tuning Fork :

A tuning fork is a metal fork that

has a specific frequency, used in
the teaching of acoustics in physics
and the study of resonance.
several of these calibrated forks
(that is, each of them gives a
specific frequency) are also used to
tune musical instruments such as
pianos and stringed instruments.
 A tuning fork, usually a fork with a
frequency of 512 Hz (that is, 512
vibrations per second ) is used to check
people's hearing ability . There is also
another fork with a lower frequency, the
frequency of which is 128 vibrations per
second and is called C-128 for a hearing
test at low frequencies .
 4.Romberg Test :

This test is based on the fact that a person needs at

least two of the following sensations to be able to
balance while standing: proprioception (the ability to
know the position of a person's body in a vacuum),
vestibular functions (knowing the position of a person's
head in space), vision (which is used to monitor and
adjust changes in body position).
The doctor asks the patient to stand upright standing
on his feet together and close his eyes, the Doctor
stands next to the patient as a precaution to prevent
him from falling to the ground and causing harm to
himself, then the doctor observes the patient's
movement in comparison with something vertical that
the doctor puts behind the patient (such as the corner
.).of the room, windows, etc
 The Romberg sign is considered positive if a wobble
occurs, this Wobble is often irregular and the patient
can fall, but the main feature of the Romberg test is
that the patient is unbalanced when closing his eyes .
The scientific basis of this test is based on the fact that
balance comes as a result of the cooperation of several
nervous systems, namely the proprioception, the input
of the vestibular system responsible for balance, and
. vision
 5.Allen Test :
A medical examination or medical marker used in the
physical examination of arterial blood flow to the hands.
It is named after the American cardiologist Edgar Van
Allen, who developed the original version of the test in
1929 .
The original test proposed by Allen is performed as
follows :
The patient is asked to clench his hands tightly for one
minute at a time .
Pressure is applied to both radial arteries
simultaneously in order to close them (stopping the
flow of blood for an
instantaneous period) .
Then the patient quickly opens the fingers of both
hands,
and The Examiner compares the two colors, the color of
the initial pallor should turn pink .
If the color returns as shown, Allen's test
is considered normal. If the color fails to
return, the test is considered abnormal
and indicates that the feeding of the hand
through the ulnar artery is insufficient, [2]
this suggests that it may not be safe to
insert the cannula into the radial artery .
6. Homans Sign Test

Homan’s sign test also called dorsiflexon

sign test is a physical examination
procedure that is used to test for Deep
Vein Thrombosis (DVT). A positive
Homan’s sign in the presence of other
clinical signs may be a quick indicator of
DVT. Clinical evaluation alone cannot be
relied on for patient management, but
when carefully performed, it remains
useful in determining the need for
additional testing (like D-dimer test,
ultrasonography, multidetector helical
computed axial tomography (CT), and
pulmonary angiography)
 1.In performing this test the patient will
need to actively extend his knee.
2.Once the knee is extended the
examiner raises the patient’s straight leg
to 10 degrees, then passively and
abruptly dorsiflexes the foot and
squeezes the calf with the other hand.
3.Deep calf pain and tenderness may
indicate presence of DVT.
 References
https://www.cincinnatichildrens.org/health/c/cyanosis

http://www.patient.co.uk/doctor/Cyanosis.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2598396/
http://www.ncbi.nlm.nih.gov/books/NBK367/
http://www.umm.edu/ency/article/001104.htm
http://physicalexamination.org/?q=node/29

https://indianjotol.org/article.asp?issn=0971-
7749;year=2022;volume=28;issue=2;spage=103;epage=106;aulast=Taneja;t
ype=3

https://www.ncbi.nlm.nih.gov/books/NBK507816/
https://my.clevelandclinic.org/health/diagnostics/22901- romberg-test
https://en.wikipedia.org/wiki/Tuning_fork
https://geriatrics.ucsf.edu/sites/geriatrics.ucsf.edu/files/20 18-
06/whispertest.pdf