Clin Assess

Question 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

Answer 1

Level of consciousness

Question 2

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

Answer 2

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

Question 3

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

Answer 3

X-ray!

Question 4

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

Answer 4

Alert

Question 5

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

Answer 5

Lethargic

Question 6

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

Answer 6

Obtunded

Question 7

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

Answer 7

Stuporous

Question 8

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

Answer 8

Comatose

Question 9

Patients with a Glasgow coma scale score of 3-8

Answer 9

Coma

Question 10

3 components of Glasgow coma scale?

Answer 10

Eye opening, motor response, verbal response

Question 11

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

Answer 11

Pupils in comatose patients

Question 12

No pupillary reaction to light

Answer 12

Problem in midbrain (structural lesion or compression)

Question 13

Constricted or dilated pupils

Answer 13

Metabolic/toxic exposure

Question 14

Two meningeal signs

Answer 14

Brudzinski’s sign and Kerning’s sign

Question 15

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

Answer 15

Brudzinski’s sign

Question 16

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

Answer 16

Kernig’s sign

Question 17

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

Answer 17

Asterixis

Question 18

What does Asterixis test for?

Answer 18

If mental function is impaired and may indicate metabolic encephalopathy

Question 19

Smell

Answer 19

CN I

Question 20

Visual acuity, visual fields, and fundoycopic exam

Answer 20

CN II

Question 21

Pupillary reactions (direct and consensual)

Answer 21

CN II, III

Question 22

Extraocular movements (including convergence)

Answer 22

CN III, IV, VI

Question 23

Corneal reflexes, facial sensation (3), clench teeth

Answer 23

CN V

Question 24

Facial movements

Answer 24

CN VII

Question 25

Hearing (whispered voice)

Answer 25

CN VIII

Question 26

Swallow, say "ah", and gag reflex

Answer 26

CN IX, X

Question 27

Voice and speech

Answer 27

CN V, VII, X, XII

Question 28

Shoulder and neck movements

Answer 28

CN XI

Question 29

Tongue symmetry and position

Answer 29

CN XII

Question 30

Tests for lateralization

Answer 30

Weber test

Question 31

Lateralizes to impaired ear

Answer 31

Positive Weber for conductive hearing loss

Question 32

Lateralizes to good ear

Answer 32

Positive Weber test for sensorineural hearing loss

Question 33

Tests for air and bone conduction

Answer 33

Rinne test

Question 34

AC>BC

Answer 34

Positive Rinne for sensorineural hearing loss

Question 35

BC=AC or BC>AC

Answer 35

Positive Rinne if conductive hearing loss

Question 36

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

Answer 36

Spasticity

Question 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)

Answer 37

Rigidity

Question 38

Marked floppiness (eg Guillain-Barre & spinal shock)

Answer 38

Flaccidity

Question 39

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

Answer 39

Paratonia

Question 40

Deltoid and biceps (shoulder abduction and elbow flexion)

Answer 40

C5

Question 41

Bicep flexion and wrist extensors

Answer 41

C6

Question 42

Triceps, wrist flexors and finger extensors

Answer 42

C7

Question 43

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

Answer 43

C8

Question 44

Interossei muscles ONLY

Answer 44

T1

Question 45

Head

Answer 45

C1-C2

Question 46

Diaphragm, breathing

Answer 46

C3-C4

Question 47

Hip flexion

Answer 47

L2

Question 48

Knee extension

Answer 48

L3

Question 49

Ankle dorsiflexion

Answer 49

L4

Question 50

Great toe extension

Answer 50

L5

Question 51

Ankle plantar flexion, ankle eversion, hip extension

Answer 51

S1

Question 52

Knee flexion

Answer 52

S2

Question 53

Patient extends both arms and pushes against a wall

Answer 53

Winging of Scapula

Question 54

Do this test if shoulder muscles seem weak or atrophic

Answer 54

Winging of scapula

Question 55

If medial border of scapula juts backwards

Answer 55

Positive winging of scapula

Question 56

What can a winging of the scapula suggest?

Answer 56

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

Question 57

When do you test straight-leg raise?

Answer 57

If patient has low back pain with lumbosacral radiculopathy

Question 58

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

Answer 58

Positive SLR

Question 59

What is noted in rapid alternating movements in cerebellar disease?

Answer 59

dysdiadochokinesis

Question 60

What is noted in gait in cerebellar disease?

Answer 60

ataxia

Question 61

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

Answer 61

Romberg test

Question 62

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

Answer 62

Test for Pronator drift

Question 63

What does Pronator drift test?

Answer 63

Proprioception

Question 64

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

Answer 64

Discriminative sensations to test the sensory cortex

Question 65

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

Answer 65

Discriminative sensations for sensory cortex

Question 66

Ankle reflex

Answer 66

primary S1

Question 67

Knee reflex

Answer 67

L2, L3, L4

Question 68

Brachioradialis reflex

Answer 68

C5, C6

Question 69

Biceps reflex

Answer 69

C5, C6

Question 70

Triceps reflex

Answer 70

C6, C7

Question 71

At what DTR level would you test for clonus?

Answer 71

4+

Question 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

Answer 72

Clonus

Question 73

What can positive clonus indicate?

Answer 73

Central nervous system disease

Question 74

Lesion in lower motor neuron

Answer 74

hypofunction

Question 75

Lesion in upper motor neuron

Answer 75

hyperfunction

Question 76

What nerves innervate above umbilicus?

Answer 76

T8, T9, T10

Question 77

What nerves innervate below umbilicus?

Answer 77

T10, T11, T12

Question 78

What can an absent abdominal reflex indicate?

Answer 78

central or peripheral nerve disorder

Question 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

Answer 79

Babinski response

Question 80

What nerves does Babinski test?

Answer 80

L5, S1

Question 81

Positive if dorsiflexion of great toe

Answer 81

Babinkski

Question 82

What does positive Babinski indicate?

Answer 82

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

Question 83

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

Answer 83

Cauda equina lesins (S2, S3, S4)