TROUVAILLES ET ASTUCES
IV. AIDE A L'EXAMEN CLINIQUE - HINTS FOR CLINICAL
- Mouillez votre abaisse-langue! - Wet
- Comment examiner un patient
- Otoscopie chez l'enfant - Ear Exam
- Respire! - Take A Deep Breath
- Comment diagnostiquer une sciatique -
Testing for Lumbosacral/Sciatic Radiculopathy
- Torsion ou épididymite? - Prehn's Sign
- Profondeur du coma - Consciousness
- Détermination du niveau de conscience -
Evaluating Level of Consciousness
- Débusquer un simulateur de coma -
Identifying a Phony LOC Patient
- Aide à la mesure de la pression
artérielle - Easier blood pressure
- Comment peser un patient très lourd? -
Weighing Heavier Patients
- Où est le col? - 'Pop!' Goes The Cervix
- Comment recycler un condom - Cervical
- Mettez-le sous microscope -
Pediculosis Pubis Diagnosis
- Surveillance d'une lésion cutanée -
Skin lesion measurement
- Mesure d'une papule
d'intradermo-réaction - Checking for Induration
- Ressortez votre diapason! - Get Out
The Tuning Fork
- Comment mesurer le foie - Finding the
- Piquer-toucher - Assessing Pin-prick
4.1 Mouillez votre abaisse-langue! - Wet tongue depressor
Most patients, especially youngsters, don't like having a
wooden tongue depressor placed in their mouth on the tongue. So, I dip
the tongue depressor briefly in a glass of water to moisten it before
using and it then "blends" right into the tongue surface. It works
great and, I suppose for very young patients, you might even use some
sugar free beverage.
Leonard R. Schaer, BA, MD,
Alamo, CA, Medscape, 3.9.99
4.2 Comment examiner un patient chatouilleux?
Demandez au patient d'appuyer légèrement avec sa main sur la
vôtre lorsque vous le palpez; cela diminuera sa sensibilité au
Harry Goldstein, MD, Netanya,
Israel, Medscape, 17.9.99
4.3 Otoscopie chez l'enfant - Ear Exam Child Diversion
To distract a pediatric patient during an otoscopic exam, have
the child cover one ear with his or her hand while you shine a light in
the other ear, and challenge the patient to not "let the light out"
through the covered ear. Ask a parent to check "if any light comes out"
to divert the child's attention further.
Joseph E. Healy, PA-C, Hartford,
4.4 Respire! - Take A Deep Breath
For a child who refuses to take a deep breath during a lung
examination, simply blow on a tissue and then ask the child to imitate
ENS Robert Vincent Rodezno, USN,
PA, Havelock, NC
4.5 Comment diagnostiquer une sciatique - Testing for
If I suspect a lumbosacral/sciatic radiculopathy but the
standard straight leg raising test is equivocal or negative, then I
simultaneously perform foot dorsiflexion (braggard's test) and great
toe extension (Sicard's sign) along with the SLR test. This combination
of procedures will certainly bring out any symptoms of
Charles A. Sallahian, DC, New
York, NY, Medscape, 17.9.99
4.6 Torsion ou épididymite? - Prehn's Sign
To differentiate between epididymitis and testicular torsion
for a patient presenting with acute testicular pain, perform the
Prehn's sign. With the patient lying in a supine position, cup the
scrotum and move it on to the abdomen. If the pain dissipates, diagnose
as epididymitis; if the pain worsens, diagnose as testicular torsion.
Geoff Carlson, PA-S, Bellmawr, NJ
4.7 Profondeur du coma - Consciousness
Rapidly assess the level of consciousness by looking at the
Alert = Eyes opening spontaneously
Drowsy = Eyes opening on verbal commands only
Stuporous = Eyes opening on painful stimuli only
Comatose = Eyes not opening to any stimuli
Mohammed S. Akram, MD,
4.8 Détermination du niveau de conscience - Evaluating
Level of Consciousness
Persons presenting to emergency rooms sometimes feign loss of
consciousness. One simple and humane way to evaluate level of
consciousness is to raise and position the patient's hand directly
above his or her nose. Drop the hand. An unconscious patient will have
no self-protective mechanism intact and the hand will strike the nose.
A patient feigning unconsciousness will deflect the hand away from the
4.9 Débusquer un simulateur de coma - Identifying a Phony
Patients who feign a decreased level of consciousness (LOC)
may subject themselves to painful and unnecessary testing methods (eg,
sternal rubs). To determine whether a patient is faking a decreased
LOC, lightly brush the eyelash and eyelid and wait for the reflexive
blink. Once caught "playing possum," the patient will become more
willing to interact.
Mark J. Bell, PA, Simi Valley,
4.10 Aide à la mesure de la pression artérielle - Easier
When taking manual manometric blood pressure in a very ill
patient or edematous patient, the auscultory systolic sound could be
too soft to be audible or too weak for palpation. Simultaneous pulse
oxymeter connection to the respective finger allows the first detection
of the pulse as the blood pressure cuff is deflated.
Abu Dzarr, MD, Malaysia, Medscape, 17.9.99
4.11 Comment peser un patient très lourd? - Weighing
To weigh a patient who is too heavy for the standard office
scale, use two scales. Ask the patient to place one foot on each scale
and then stand still. The measurements from the two scales added
together provide an accurate weight.
Ronald A. Berry, RN, MS, FNP,
4.12 Où est le col? - 'Pop!' Goes The Cervix
Usually a "difficult" cervix is posterior and retroflexed.
When performing a Pap smear on a patient whose cervix is difficult to
visualize, have the woman lift her hips and place her hands under her
buttocks. The cervix will quickly "pop" into view without pain.
Barbara J. Runquist, FNP,
4.13 Comment recycler un condom - Cervical Visualization
If while doing a pelvic exam/pap smear you have trouble
visualizing the cervix due to lax vaginal tissues falling into the
speculum, apply a condom over the speculum, then cut the tip off. This
works especially well with a large speculum.
Elizabeth Carroll, FNP,ARNP, St.
4.14 Mettez-le sous microscope - Pediculosis Pubis
When you are trying to diagnose pediculosis pubis (phthiriasis
inguinalis) but you cannot see any nits and a Wood's lamp is
unavailable, take a piece of transparent tape and press it on the area
of suspected infestation. Then place the tape on a slide for
examination under the microscope.
Jennifer Angotti, CRNP,
4.15 Surveillance d'une lésion cutanée - Skin lesion
To observe a skin lesion over time, gently place a piece of
transparent tape over the lesion and outline its border. You can then
remove the tape and place it in the patient's chart as a permanent and
reproducible replica of the lesion's size and shape.
Richard Moore, RPA-C, Stamford,
4.16 Mesure d'une papule d'intradermo-réaction - Checking
When evaluating a tuberculosis skin test, take a ballpoint pen
and lightly mark toward the site of injection on four sides. If an
induration is present, the pen will stop before reaching the site.
Measurement is easy from pen mark to pen mark.
Sarah Burnside, PA-C, Warsaw, Ill
4.17 Ressortez votre diapason! - Get Out The Tuning Fork
Use your tuning fork to localize a suspected fracture in a
patient presenting with an acute musculoskeletal injury. The patient
will have a heightened pain response from the vibration of the tuning
fork when placed over the fractured region.
Maria Bartley, PA-C,
4.18 Comment mesurer le foie - Finding the Liver Margin
When you are unable to locate the liver margin, place the
diaphragm of your stethoscope on the lowest anterior rib on the
patient's right. Beginning in the right lower quadrant, scratch with
your fingernail along the abdominal wall in the direction of the
stethoscope. When you have reached a solid viscus, the sound will be
magnified greatly. This method may also be used on the left side to
locate the spleen.
Warren J. Stoffey, MS, PA-C,
4.19 Piquer-toucher - Assessing Pin-prick Sensation
Ever needed to assess pin-prick sensation and not had a
suitably blunted pin at hand? Hypodermic needles should never be used,
owing to the fact that they are intrinsically designed to puncture
skin. Instead, break a tongue depressor obliquely and use the resulting
sharp points to assess this modality of sensation.
Dave Pothier, Cape Town, South