NSG 464 FINAL EXAM 2025/26 ADVANCED PHYSICAL
ASSESSMENT QUESTION AND ANSWER EXAM INSIGHT
Osteoarthritis (OA)
Heberden Nodes (DIP joints) and Bouchard Nodes (PIP joints)
- hard and painless
- flexion and deviation deformities
- MCP rarely involved
- Radial deviation
Rheumatoid Arthritis (RA)
Symmetric deformity in PIP, MCP, wrist joints
- Tender, painful, stiff
- DIP, MCP, wrist
- Fusiform or spindle-shaped swelling of PIP joints
- Ulnar deviation
Pain Provocation Test
Positive: shoulder pain from 60-120 degrees
Nerve Impingement Sign
Press on scapula, raise patient's arm
Hawkins Impingement Sign
flex arm and shoulder 90• w/ palm down and rotate arm internally
-will compress greater tuberosity against coracoacromial ligament
External Rotation Lag Test
Flex arm 90 degrees with palm up, rotate into full external rotation
- Positive: unable to maintain external rotation; supraspinatus and infraspinatus disorder
Internal Rotation Lag Test
Ask pt to place dorsum of hand on low back, elbow flexed 90 degrees
- Lift hand off back, further internally rotating shoulder
- Positive: unable to hold this position; subscapularis disorder
,Drop Arm Test
Fully abduct arm to shoulder level and lower slowly
- Positive: weakness, supraspinatus rotator cuff tear or bicipital tendinitis
External Rotation Resistance Test
Adduct and flex arm 90 degrees with thumb turned up
- apply pressure to wrist
positive: infraspinatus disorder
Empty Can Test
Elevate arms to 90° in front of pt and internally rotate arms with thumbs pointing down; ask pt
to resist as you place downward pressure on arms
Positive for Rotator cuff tear if weakness present
Lateral Epicondylitis
tennis elbow, characterized by pain on the outer side of the forearm
Medial Epicondylitis
golfer's elbow, characterized by pain on the palm-side of the forearm
Colles fracture
fracture of the distal radius at the wrist
Scaphoid fracture
Anatomical Snuffbox > Radial artery here
Avascular necrosis, most commonly injured wrist bone
Thumb Abduction Test
Ask patient to raise the thumb straight up as you apply downward resistance
Positive test - weakness on thumb abduction
- Most sensitive carpal tunnel test
Tinel Test
Percussion on medial nerve
- Positive: aching and numbing, tingling
, Phalen's Sign
Hold backs of hands together with wrists in flexion for 60 seconds
- Positive: numbness/tingling
Sensation Test: median nerve
pulp of index finger
Sensation Test: ulnar nerve
pulp of 5th finger
Sensation Test: radial nerve
dorsal web space of thumb and index finger
Torticollis
head tilt due to shortening or spasm of one sternomastoid muscle
Spondylolithesis
forward slipping of a vertebra over a lower vertebra; may compress spinal cord
Scoliosis
lateral curvature of the spine
spina bifida
congenital defects in the lumbar spinal column caused by imperfect union of vertebral parts
Bulge Sign
Minor effusion
- Knee extended, apply pressure to "milk" fluid downward
- Tap knee behind patella
- Positive: fluid wave
Balloon Sign
ASSESSMENT QUESTION AND ANSWER EXAM INSIGHT
Osteoarthritis (OA)
Heberden Nodes (DIP joints) and Bouchard Nodes (PIP joints)
- hard and painless
- flexion and deviation deformities
- MCP rarely involved
- Radial deviation
Rheumatoid Arthritis (RA)
Symmetric deformity in PIP, MCP, wrist joints
- Tender, painful, stiff
- DIP, MCP, wrist
- Fusiform or spindle-shaped swelling of PIP joints
- Ulnar deviation
Pain Provocation Test
Positive: shoulder pain from 60-120 degrees
Nerve Impingement Sign
Press on scapula, raise patient's arm
Hawkins Impingement Sign
flex arm and shoulder 90• w/ palm down and rotate arm internally
-will compress greater tuberosity against coracoacromial ligament
External Rotation Lag Test
Flex arm 90 degrees with palm up, rotate into full external rotation
- Positive: unable to maintain external rotation; supraspinatus and infraspinatus disorder
Internal Rotation Lag Test
Ask pt to place dorsum of hand on low back, elbow flexed 90 degrees
- Lift hand off back, further internally rotating shoulder
- Positive: unable to hold this position; subscapularis disorder
,Drop Arm Test
Fully abduct arm to shoulder level and lower slowly
- Positive: weakness, supraspinatus rotator cuff tear or bicipital tendinitis
External Rotation Resistance Test
Adduct and flex arm 90 degrees with thumb turned up
- apply pressure to wrist
positive: infraspinatus disorder
Empty Can Test
Elevate arms to 90° in front of pt and internally rotate arms with thumbs pointing down; ask pt
to resist as you place downward pressure on arms
Positive for Rotator cuff tear if weakness present
Lateral Epicondylitis
tennis elbow, characterized by pain on the outer side of the forearm
Medial Epicondylitis
golfer's elbow, characterized by pain on the palm-side of the forearm
Colles fracture
fracture of the distal radius at the wrist
Scaphoid fracture
Anatomical Snuffbox > Radial artery here
Avascular necrosis, most commonly injured wrist bone
Thumb Abduction Test
Ask patient to raise the thumb straight up as you apply downward resistance
Positive test - weakness on thumb abduction
- Most sensitive carpal tunnel test
Tinel Test
Percussion on medial nerve
- Positive: aching and numbing, tingling
, Phalen's Sign
Hold backs of hands together with wrists in flexion for 60 seconds
- Positive: numbness/tingling
Sensation Test: median nerve
pulp of index finger
Sensation Test: ulnar nerve
pulp of 5th finger
Sensation Test: radial nerve
dorsal web space of thumb and index finger
Torticollis
head tilt due to shortening or spasm of one sternomastoid muscle
Spondylolithesis
forward slipping of a vertebra over a lower vertebra; may compress spinal cord
Scoliosis
lateral curvature of the spine
spina bifida
congenital defects in the lumbar spinal column caused by imperfect union of vertebral parts
Bulge Sign
Minor effusion
- Knee extended, apply pressure to "milk" fluid downward
- Tap knee behind patella
- Positive: fluid wave
Balloon Sign
