NR 4621Physical Exam & Clinical Maneuvers: Ascites Shifting Dullness
≥3 cm and Fluid Wave for abdominal fluid, Appendicitis assessment
via Rovsing, Psoas, Obturator, and Cough tests, Shoulder evaluation
with Neer and Hawkins Impingement signs, Empty Can and Drop Arm
tests for rotator cuff integrity, Elbow/Wrist assessment using Tinel
and Phalen signs for ulnar and median neuropathy, Knee effusion via
Bulge and Ballottement tests, Meniscus injury with McMurray,
Ligamentous integrity via Valgus/Varus, Anterior/Posterior Drawer
and Lachman tests, Ankle anterior drawer for ATFL injury, Cortical
sensory evaluation including Stereognosis, Graphesthesia, Two-Point
Discrimination, Point Localization, and Extinction, Meningeal irritation
via Brudzinski and Kernig signs Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Ascites: test for shifting dullness
This maneuver is performed with the patient supine. Percuss across the abdomen as for flank dullness,
with the point of transition from tympany to dullness noted. The patient then is rolled on his/her side
away from the examiner, and percussion from the umbilicus to flank area is repeated.
Positive test: When ascites is present, the area of dullness will shift to the dependent site. The area of
tympany will shift toward the top.
Note: The shift in zone of tympany with position change will usually be at least 3 cm when ascites is
present.
Ascites: test for fluid wave
Force of tap - feel the shock wave
Appendicitis: cough
, Appendicitis: Rovsing sign
Referred rebound pain in the right lower quad when pressing deeply in the L lower quad and releasing
pressure quickly -positive indicates Appendicitis
Appendicitis: Psoas sign
R/O Appendicitis - Have pt lift Right leg straight up, flexing at the hip - then push down over the lower
part of the right thigh -
as the person tries to hold the leg up - when test is negative - person feels no change - when pt feels
pain in Right lower quadrant test is positive
Appendicitis: obturator sign
Passively flex
right hip and knee
then internally
rotate the hip
= pain indicates positive for appendicitis
Neer Impingement sign
Neer's Test - with one hand the examiner depresses the patient's affected side scapula, with the other
hand the examiner then internally rotates the patient's arm , then bring the arm up to 90degrees, if
there is pain it indicates a positive test
Indicates subacromial impingement syndrome.
Hawkin Impingement sign
Patient sitting with arm at 90 degrees forward elevation and elbow flexed to 90 degrees
≥3 cm and Fluid Wave for abdominal fluid, Appendicitis assessment
via Rovsing, Psoas, Obturator, and Cough tests, Shoulder evaluation
with Neer and Hawkins Impingement signs, Empty Can and Drop Arm
tests for rotator cuff integrity, Elbow/Wrist assessment using Tinel
and Phalen signs for ulnar and median neuropathy, Knee effusion via
Bulge and Ballottement tests, Meniscus injury with McMurray,
Ligamentous integrity via Valgus/Varus, Anterior/Posterior Drawer
and Lachman tests, Ankle anterior drawer for ATFL injury, Cortical
sensory evaluation including Stereognosis, Graphesthesia, Two-Point
Discrimination, Point Localization, and Extinction, Meningeal irritation
via Brudzinski and Kernig signs Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Ascites: test for shifting dullness
This maneuver is performed with the patient supine. Percuss across the abdomen as for flank dullness,
with the point of transition from tympany to dullness noted. The patient then is rolled on his/her side
away from the examiner, and percussion from the umbilicus to flank area is repeated.
Positive test: When ascites is present, the area of dullness will shift to the dependent site. The area of
tympany will shift toward the top.
Note: The shift in zone of tympany with position change will usually be at least 3 cm when ascites is
present.
Ascites: test for fluid wave
Force of tap - feel the shock wave
Appendicitis: cough
, Appendicitis: Rovsing sign
Referred rebound pain in the right lower quad when pressing deeply in the L lower quad and releasing
pressure quickly -positive indicates Appendicitis
Appendicitis: Psoas sign
R/O Appendicitis - Have pt lift Right leg straight up, flexing at the hip - then push down over the lower
part of the right thigh -
as the person tries to hold the leg up - when test is negative - person feels no change - when pt feels
pain in Right lower quadrant test is positive
Appendicitis: obturator sign
Passively flex
right hip and knee
then internally
rotate the hip
= pain indicates positive for appendicitis
Neer Impingement sign
Neer's Test - with one hand the examiner depresses the patient's affected side scapula, with the other
hand the examiner then internally rotates the patient's arm , then bring the arm up to 90degrees, if
there is pain it indicates a positive test
Indicates subacromial impingement syndrome.
Hawkin Impingement sign
Patient sitting with arm at 90 degrees forward elevation and elbow flexed to 90 degrees
