Discussion Board: Finals Flashcards by Jade Ring

Causes of No or Diminished response for Evaluation of Deep Tendon Reflexes & Bicpes

Evaluation numbers

Calcium or Magnesium excesses
Hypothyroidism
Spina bífida
Guillain-Barré syndrome

0 or +1

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Hyperactive results for Evaluation of Deep Tendon Reflexes is caused by…

What is the Evaluation number

Spinal cord injury
Calcium and magnesium deficits
Hyperthyroidism

3+ and 4+

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To check ocular alignment

Inspect corneal light for symmetry by shining a light in the Nose is (This Test)

Hirschberg test

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Hirschberg test

Patient stares straight
Stand 12 - 15” away
Penlight on bridge of nose
Look for reflection in each eyes

Normal & Abnormal findings

Causes of abnormal findings

Normal: symmetric reflection in both cornea

Abnormal: assymetrical and “off center”

Cause: Weakened extraocular muscles

Esotropia = eye turned inward
Exotropia = eye turned outward
Hypertropia = eye turned upward
Hypotropia = eye turned downward

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Esotropia =
Exotropia =
Hypertropia =
Hypotropia =

Name of test associated with

Esotropia = eye turned inward
Exotropia = eye turned outward
Hypertropia = eye turned upward
Hypotropia = eye turned downward

Hirschberg

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Pupils (dilate / constrict) when looking at a near object

Pupils (dilate / constrict) when looking at a far object

Near = constrict

Far = Dilate

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the change in pupil size in the eye opposite to the eye to which the light is directed

Consensual reaction

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What are normal findings in the Consensual pupil reaction

Normal: pupils are subtle, mild anisocoria (unequal pupil size)

Pupil 3 - 5 mm in diameter

React briskly to light

Both pupils constrict consensually

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What are Abnormal findings in the Consensual pupil reaction

Cause of abnormal findings

Cause:

Optic nerve injury, oculomotor nerve damage, brain stem lesions (tumors), and barbiturates

Dilates
Bilateral: (Atropine, sever brain damage, profound hypoxia)
Unilateral: (Adie’s pupil, oculomotor never injury, benign anisocoria)

Small
Unilateral (Horners syndrome)
Bilateral Pinpoint, small, fixed and regular (Morphine, mitotic drops, pontine hemorrhage)
Argyle Robertson pupils

Shape
Irregular: (Iridectomy, argyle Robertson pupils)

Light reflex
Loss of direct light reflex: Afferent Limb (Blind eye, disease of retina or optical nerve) or Efferent Limb (Oculomotor nerve injury)

Loss of Consensual reflex: (Efferent Limb lesion of affected eye)

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Loss of muscle coordination (ataxia) is associated with a positive result from this test

It is also associated with a spinal disorder (polyneuropathy)

Romberg’s test

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_______ is a test that measures a persons sense of balance.

Specifically, the test assesses the function of the dorsal column of the spinal cord (the dorsal column is responsible for proprioception).[1]

The Romberg test

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The Romberg sign is said to be (negative / positive) in a patient who is able to stand with his feet placed together and eyes open but paradoxically sways or falls while closing his eyes.

Cause:
Potential neurological conditions. One condition may be cerebellar ataxia, determined by a lesion to the cerebellum.

Positive

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Plantar Reflex is looking for this _____ (sign)

Procedure: run tongue depressor along lateral side of foot and make a curve to the middle

Normal / abnormal findings

What is a positive sign

Causes

Babinski Reflex

Normal
<24 months: Dorsiflexion (upward) big toe and fanning of toes

Normal
>24 months. Plantarflexion (downward) with curling of toes

Abnormal:
Dorsiflexion (upward) big toe and fanning of toes

Positive = Abnormal

Cause: upper motor neuron disease

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Achilles Deep Tendon Reflexes

Procedure

Dangle foot, dorsiflex foot, tap Achilles Tendon with blunt hammer

Normal / abnormal findings

Cuases of abnormal findings

Normal: Contraction of the gastrocnemius muscle, Plantar flexion of the foot

Abnormal: Hypo/Hyperreflexia or Asymmetrical response

Causes: hypo LMN
Hyper UMN (Upper motor neuron)

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cerebrovascular accidents, amyotrophic lateral sclerosis,
primary lateral sclerosis,
multiple sclerosis,
Brown-Sequard Syndrome,
vitamin B12 deficiency.

Associated with…

UMN diseases

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Which vitamin may cause an abnormal findings in lower extremity DEEP TENDON REFLEXES

B12

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Knee effusion

Tests (2)

Positive sign: Floating or Bouncing of patella occurs Knee Joint Effusion (which test)

Press medial of patella, move hand in ascending motion. Firmly press lateral aspect of knee. Look at knee for bulges (describes this test)

Positive sign

Patellar tap (ballottement)/ Fluid displacement test (Bulge sign Test)

Patellar tap (Ballottement)

Fluid displacement (Bulge Sign Test)

Bulge noticed indicating effusion

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Light touch sensation (which nerve)

Abnormal findings;

Inequal muscle contraction
Pain / twitching

5 (trigeminal)

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Inability to feel tuning fork causes

Neuropathy caused by diabetes

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Phalens test involves putting dorsal side of hands together in front of body for 1 minute…

What is a positive Phalens test

Tinel’s test
Patient puts arm in a supination position and Examiner taps on median nerve on the wrist.

What are positive findings

Which disease are these two test associated with

Both

Positive: paresthesia (tingling), numbness, or electrical sensation

Carpal Tunnel Syndrome

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Proprioception, or kinesthesia, is

the sense that lets us perceive the location, movement, and action of parts of the body

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Evaluation of cerebellar function, balance/ coordination (lower 2 extremities)

Procedure: Supine, runs heel of foot down shin on opposite leg / repeat on otherside

Abnormal = unable to do test smoothly

Causes

Cerebellar disease ( affect nerve cells which control coordination & balance)

Disease exp. MS

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Evaluation of cerebellar function for balance and coordination (2 in lower extremities)

Heel to Toe walk

Abnormal: uncoordinated, Jerky movements / feet spread far apart

Causes

Cerebellar disease (affects nerve cells which control coordination and balance)

Disease exp. MS

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Transillumante Sinus

Place light source on cheekbone just below the eye with head tilted back.
Reddish glow in mouth means (normal, air-filled sinus

Which Sinus is this checking

Put light below eyebrow and look for red glow, which describes normal findings for which sinus

Maxillary

Frontal

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Rinne test aims to compare sound perception of bone conduction vs air conduction in hearing Procedure: Tuning fork on mastoid process Ask patient to report when they cannot hear the sound. Repeat with fork in front of ear Normal: 2:1 ratio of sound heard in front of ear. Abnormals (2)

Conductive hearing loss: Bone Conduction > Air Conduction Sensorineural hearing loss: Air Conduction is longer than Bone but less than a 2:1 ratio

Evaluation of cerebellar function for balance and coordination (2 upper extremities) Name them Disease

Tap thighs with rapid pronation and supination Both arms out: Alternatively touch index finger to nose Touch each finger to thumb Arms out touch nose then touch examiners finger Ataxia, multiple system atrophy, Creutzfeldt-Jacob disease, MS

Patient looking at distant object then closely at your finger is testing for this

Accommodation

Shining light in one eye while accessing the other eyes pupils is called this type of response

Consensual

Pupils should dilate when looking at a distant object and constrict when looking at a close object is called

Accommodation

P E R R L A

Pupils Equal Round React Light Accommodation

Anisocoria is... Can be caused by...

Anisocoria (unequal pupil size) Local eye medication, amblyopia (lazy eye), unilateral sympathetic or parasympathetic pupillary pathway damage

Mydriasis is... Caused by....

Mydriasis (pupils >6mm) Atropine eye drops Midbrain lesions Hypoxia Oculomotor damage Acute-angle glaucoma

Miosis is... Caused by....

Miosis (pupils <2mm) Pilocarpine eye drops

anisocoria

Unequal pupil size

Webers test Tuning fork in middle of skull Ask which ear the sound is louder Normal: Both the same Abnormal:

Lateralization (sound is heard better) The affected (bad ear) is lateralized = Conductive hearing loss Lateralization to unaffected (good ear) = sensorineural hearing loss

Weber Sensoryneuro hearing loss Sound laterizes to unaffected ear Say in plain English

In sensoryneuro hearing loss. The tone is heard better in good ear

Weber Conductive hearing loss The sound laterizes to affected ear Say in plain English

In Conductive hearing loss Sound is heard better in bad ear

Sensorineuro hearing loss Problem

Auditory nerve or cochlea

Conductive hearing loss 2 types ( Air & Bone conduction) Problem

Sound waves cannot pass through outer and middle ear

Positive rinne test is (good or bad) Describe it

Good 2:1 ratio of Air Conduction to Bone Conduction hearing

Inability to feel monofilament can be a sign of

Peripheral nerve damage from DM

6 cardinal field of gaze Abnormal findings Cause: Congenital/ Acquired

Nystagmus involuntary eye movement which may cause the eye to rapidly move from side to side, up and down, or in a circle, and may slightly blur vision. Congenital: neurological problem, albinism / cataracts Acquired: stroke, MS, trauma, anti-epilepsy drugs

To test the medial meniscus, Examiner externally rotates the knee, then slowly extends the patient's leg To test the lateral meniscus, Examiner internally rotates the knee, then slowly extends the patient's leg Name this test

McMurray test

Glasgow Coma Scale 3 parts: Eye response, Verbal, Motor Eyes opening 4 3 2 1

4 Spontaneously 3 To speech 2 To pain 1 No response

Glasgow Coma Scale 3 parts: Eye response, Verbal, Motor Verbal: 5 4 3 2 1

5 Oriented to time, place, person 4 Confused 3 Inappropriate words 2 Incomprensible sounds 1 No response

Glasgow Coma Scale 3 parts: Eye response, Verbal, Motor Motor: 6 5 4 3 2 1

6 obeys commands 5 moves to localized pain 4 flexion withdrawal from pain 3 abnormal flexion (decorticate) 2 abnormal extension (decerebrate) 1 no response

Glasgow Coma Scale 15 = Best Response 8 or less = 3 / totally unresponsive

Comatose client

Evaluation Deep tendon Strike 2" above wrist and knee is called these areas Abnormal findings/ causes

Brachioradialis & Patellar Hyper / hypoactive response Hyperactive: Spinal Cord injury, ALS, MS, PARKINSON, Calcium/ Magnesium deficits, Hyperthyroidism Hypoactive: Calcium/ Magnesium excesses, Hypothyroidism, Spina bífida, Gullian-Barre Syndrome

Popping or clicking heard while palpating TMJ is an abnormal sign True or False

False It is only abnormal in the presence of other symptoms. ie. Pain

creputus

Creeky joint

How to set a goniometer

Place 0 setting over middle of joint in neutral position. Move distal joint through ROM

Normal ROM for elbow

flexion lie between 130° and 154° and extension between –6° and 11°.

Causes of decreased ROM Increased

Decreased: arthritis, fluid in joints, contracture of muscle, lig, capsule Increased; connective tissue disruption, lig tear, facture

Kernig's sign Procedure: Supine, hip and knee flexed 90° knee slowly extended upward by Examiner. It is considered positive if... Which disease is it looking for

Positive if pain worsens in head / neck Meningitis

Brudzinski Sign Procedure: Supine, pull on back of neck. Normal Abnormal What is a positive result. Is positive good or bad Associated Disease

Normal: no pain or resistance Abnormal: flexion of hips and knees Positive: Flex of hips and knees Positive result is bad Meningitis

Contracture

condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.

Which test, test for? 1. unilateral conductive and sensorineural hearing loss 2. Air conduction vs bone conduction hearing test

1. Weber 2. Rinne

Name the 2 test associated with meningitis

Kernig = supine, extend legs towards head. Brudzinski = pull on back if neck, knees and hips flex = Positive sign

Describe 2 test for carpal tunnel syndrome

Phalens: Dorsal side of hands touch for 1 minute Tinel's: Tap on median nerve

Impaired balance or coordination, can be due to damage to brain, nerves, or muscles.

Ataxia

Paitent and Examiner both cover 1 eyes (opposite) Extend hand to prefiery and slowly bring it midline. Paitent should see object same time as Examiner Repeat with 4 directions Superior Inferior Temporal Nasally What are the normal values for these findings If patient cannot see pencil at same time as Examiner _____ is suspected

Superior = 50° Inferior = 70° Temporal = 90° Nasally = 60° Peripheral field loss

Corneal flight reflex for symmetry is aka

Hirschberg

The Romberg test determines if your balance issues are related to the function of your _____

dorsal column

There are two balance related issues ie. Which part of the body is responsible for the following balances 1. Doing Heel to Toe & Heel to Shin 2. Romberg

1. Cerebellar 2. Dorsal Column

Discussion Board: Finals Flashcards

(64 cards)