Clinical skills Flashcards
(16 cards)
Parkinsonian gait
The patient has rigidity and bradykinesia. They will be stooped with the head and neck forward, with flexion at the knees. The upper extremity is also in flexion with the fingers usually extended. They walk with slow little steps known as marche a petis pas (walk of little things).
They may have difficulty initiating steps. They may show an involuntary inclination to take accelerating steps (known as festination).
This is seen in Parkinsons disease or any other condition causing parkinsonism, such as side effects from drugs.
Cerebellar / ataxic gait
Most commonly seen in cerebellar disease, this gait is described as clumsy, staggering movements with a wide-based gait. While standing still, the patient’s body may swagger back and forth and from side to side, known as titubation. Patients will not be able to walk from heel to toe or in a straight line. The gait of acute alcohol intoxication will resemble the gait of cerebellar disease. Patients with more truncal instability are more likely to have midline cerebellar disease at the vermis.
Sensory gait
As our feet touch the ground, we receive proprioceptive information to tell us their location. The sensory ataxic gait occurs when there is loss of this proprioceptive input. In an effort to know when the feet land and their location, the patient will slam the foot hard onto the ground in order to sense it. A key to this gait involves its exacerbation when patients cannot see their feet (i.e. in the dark). This gait is also sometimes referred to as a stomping gait since patients may lift their legs very high to hit the ground hard. This gait can be seen in disorders of the dorsal columns (B12 deficiency or tabes dorsalis) or in diseases affecting the peripheral nerves (uncontrolled diabetes). In its severe form, this gait can cause an ataxia that resembles the cerebellar ataxic gait.
Hemiplegic gait
The patient stands with unilateral weakness on the affected side, arm flexed, adducted and internally rotated. Leg on same side is in extension with plantar flexion of the foot and toes. When walking, the patient will hold his or her arm to one side and drags his or her affected leg in a semicircle (circumduction) due to weakness of distal muscles (foot drop) and extensor hypertonia in lower limb. This is most commonly seen in stroke. With mild hemiparesis, loss of normal arm swing and slight circumduction may be the only abnormalities.
Neuropathic / High stepping gait
Seen in patients with foot drop (weakness of foot dorsiflexion), the cause of this gait is due to an attempt to lift the leg high enough during walking so that the foot does not drag on the floor. If unilateral, causes include peroneal nerve palsy and L5 radiculopathy. If bilateral, causes include amyotrophic lateral sclerosis, Charcot-Marie-Tooth disease and other peripheral neuropathies including those associated with uncontrolled diabetes
Auscultation
Auscultation is the process whereby you listen to sounds within a patient’s body using a stethoscope.
Key areas where auscultation is used: lungs, heart, abdomen.
Palpation
Palpation is the process of using your hands to examine a patient’s body to gain information about their condition or disease, often used to determine a diagnosis.
Key areas that are palpated: muscles and bones, abdomen, and lymph nodes.
Percussion
Percussion is a diagnostic practice used to determine the density, position and size of underlying tissues and organs. The middle phalange of the middle finger of the non-dominant hand is placed on the surface of the patient’s body, and is struck with the distal phalange of the middle finger of the dominant hand, producing a resonant sound.
Key areas that are percussed: lungs, heart and abdomen.
Pulse
Measuring a pulse is actually measuring the heart rate of the patient. When the heart contracts it sends a surge of blood through the arteries which stretch and recoil as the wave travels through them, this is known as a pulse
Normal heart rate
Adult: between 60 to 100 bpm
Child: between 70 to 120 bpm
Elderly & Athletes: 40 to 60
Volume
The power of the pulse is dependant on the stroke volume of the heart
Character
Refers to how slowly or quickly the pulse achieves its power
Rhythm
Patient heart beats can be too fast (tachycardias >100), or too slow (bradycardias <60) or with an irregular pattern.
E.g. Regular – a regular and continuous pulse (a normal pulse)
Regularly irregular – a regular but intermittent pulse (e.g. sinus arrhythmia)
Irregularly irregular - a regular and intermittent pulse (e.g. atrial fibrillation)
Blood pressure
When the heart pumps blood it creates pressure in the arteries, and this is known as blood pressure. Systolic pressure is created when the left ventricle pumps blood around the body (contracting pressure), and diastolic pressure is the resistance from arteries from the blood flow (relaxing pressure)
Normal blood pressure
120 / 80
