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Flashcards in Clin Assess Deck (83)
1

Reflects patient's capacity for arousal or wakefulness, determined by level of activity that patient's can be aroused to perform in response to stimuli from examiner

Level of consciousness

2

What should you not do if patient in stupor or coma?

Do not dilate pupils and do not flex neck if any question of trauma to head or neck

3

What can you do to evaluate for head or neck trauma?

X-ray!

4

Using normal tone of voice, patient's arousal intact; responds fully & appropriately

Alert

5

Using loud tone of voice, patient appears drowsy but opens eyes and responds then falls asleep

Lethargic

6

Shake patient gently; patient opens eyes, but responds slowly, somewhat confused

Obtunded

7

Apply painful stimulus to arouse patient from sleep, cereal responses slow/absent, unresponsive when stimulus ceases

Stuporous

8

Unarousable with eyes closed after repeated painful stimuli, no response to environment

Comatose

9

Patients with a Glasgow coma scale score of 3-8

Coma

10

3 components of Glasgow coma scale?

Eye opening, motor response, verbal response

11

Small or pinpoint pupils, large pupils, mid position fixed pupils, one large pupil

Pupils in comatose patients

12

No pupillary reaction to light

Problem in midbrain (structural lesion or compression)

13

Constricted or dilated pupils

Metabolic/toxic exposure

14

Two meningeal signs

Brudzinski's sign and Kerning's sign

15

Positive if flexion of both hips & knees is noted when neck is flexed

Brudzinski's sign

16

Positive if pain & increased resistance is noted to straightening the knee after hip and knee are flexed

Kernig's sign

17

Patient extends both arms with hands cocked up. Positive if sudden, brief, nonrhymic flexion of hands and fingers

Asterixis

18

What does Asterixis test for?

If mental function is impaired and may indicate metabolic encephalopathy

19

Smell

CN I

20

Visual acuity, visual fields, and fundoycopic exam

CN II

21

Pupillary reactions (direct and consensual)

CN II, III

22

Extraocular movements (including convergence)

CN III, IV, VI

23

Corneal reflexes, facial sensation (3), clench teeth

CN V

24

Facial movements

CN VII

25

Hearing (whispered voice)

CN VIII

26

Swallow, say "ah", and gag reflex

CN IX, X

27

Voice and speech

CN V, VII, X, XII

28

Shoulder and neck movements

CN XI

29

Tongue symmetry and position

CN XII

30

Tests for lateralization

Weber test

31

Lateralizes to impaired ear

Positive Weber for conductive hearing loss

32

Lateralizes to good ear

Positive Weber test for sensorineural hearing loss

33

Tests for air and bone conduction

Rinne test

34

AC>BC

Positive Rinne for sensorineural hearing loss

35

BC=AC or BC>AC

Positive Rinne if conductive hearing loss

36

Increased tone; rate-dependent, increasing with rapid movement (e.g. stroke)

Spasticity

37

Increased resistance throughout ROM, not rate-dependent; "lead pipe rigidity." Rachetlike jerkiness with flexion/extension of wrist or forearm "cogwheel rigidity" (e.g. parkinsonism)

Rigidity

38

Marked floppiness (eg Guillain-Barre & spinal shock)

Flaccidity

39

Sudden change in tone with passive ROM (e.g. dementia)

Paratonia

40

Deltoid and biceps (shoulder abduction and elbow flexion)

C5

41

Bicep flexion and wrist extensors

C6

42

Triceps, wrist flexors and finger extensors

C7

43

Finger flexors and interossei muscles (aB and aD duction of fingers)

C8

44

Interossei muscles ONLY

T1

45

Head

C1-C2

46

Diaphragm, breathing

C3-C4

47

Hip flexion

L2

48

Knee extension

L3

49

Ankle dorsiflexion

L4

50

Great toe extension

L5

51

Ankle plantar flexion, ankle eversion, hip extension

S1

52

Knee flexion

S2

53

Patient extends both arms and pushes against a wall

Winging of Scapula

54

Do this test if shoulder muscles seem weak or atrophic

Winging of scapula

55

If medial border of scapula juts backwards

Positive winging of scapula

56

What can a winging of the scapula suggest?

Weakness of serratus anterior muscle, seen in muscular dystrophy or injury to long thoracic nerve

57

When do you test straight-leg raise?

If patient has low back pain with lumbosacral radiculopathy

58

Pain radiates into ipsilateral leg (foot dorsiflexion can further increase leg pain)

Positive SLR

59

What is noted in rapid alternating movements in cerebellar disease?

dysdiadochokinesis

60

What is noted in gait in cerebellar disease?

ataxia

61

Stand with feet together and eyes open, then close eyes for 30-60 secs, only minimal sway should occur

Romberg test

62

Stand for 30 seconds with arms straight forward, palm up and eyes closed. Then tap arms briskly downward

Test for Pronator drift

63

What does Pronator drift test?

Proprioception

64

If touch and position sense are intact, what type of testing should you proceed to?

Discriminative sensations to test the sensory cortex

65

stereognosis, graphesthesia, two-point discrimination, point localization, and extinction

Discriminative sensations for sensory cortex

66

Ankle reflex

primary S1

67

Knee reflex

L2, L3, L4

68

Brachioradialis reflex

C5, C6

69

Biceps reflex

C5, C6

70

Triceps reflex

C6, C7

71

At what DTR level would you test for clonus?

4+

72

Dorsiflex and plantar flex foot a few times then sharply dorsiflex food and hold - look and feel for rhythmic oscillations between dorsiflexion and plantar flexion

Clonus

73

What can positive clonus indicate?

Central nervous system disease

74

Lesion in lower motor neuron

hypofunction

75

Lesion in upper motor neuron

hyperfunction

76

What nerves innervate above umbilicus?

T8, T9, T10

77

What nerves innervate below umbilicus?

T10, T11, T12

78

What can an absent abdominal reflex indicate?

central or peripheral nerve disorder

79

Stroke lateral aspect of sole from heel to ball of foot, curving medially across the ball and note the movement of the great toe

Babinski response

80

What nerves does Babinski test?

L5, S1

81

Positive if dorsiflexion of great toe

Babinkski

82

What does positive Babinski indicate?

CNS lesion in corticospinal tact, unconscious states from drugs/alcohol intoxication, postictal period after seizure

83

Loss of reflex contraction of the anal reflex may indicate what?

Cauda equina lesins (S2, S3, S4)