Lab final Flashcards
(36 cards)
pt complains of difficulty swallowing and change ability to taste coffee, beer and dark unsweetened chocolate. At times it seems like the pt heart’s is racing
perform appropropriate CN
(IX) Glossopharyngeal and (X) Vagus
1. note any hoarseness of voice
2. Uvula reflex ( watch for symmetrical rising of soft palate) ( unilateral paralysis- one of palate does not rise and uvula deviates to normal side)
A: Glossopharyngeal
I: Medulla
E: Vagus
3. Gag reflex - gagging upon touching back of throat
A: Glossopharyngeal
I: Medulla
E: Vagus
4. Swallow while palpating thyroid
5. Ask about bitter taste on back of 1/3 of tongueA pt complains of pain and tingling along left lateral forearm, thumb, and first finger. He notices some weakness in elbow flexion and wrist extension.
State nerve root and perform muscle test
- nerve root = C6
- Disc level = C5
- Wrist extension= ext. carpi radialis longus and brevis and ext carpi ulnaris (radial n)
- Reflex= Brachioradialis
- Sensory = C5, C6, C7
pt complains of headache with stiffness of neck and fever
st and perform ortho test
- Kernig
- positive= pt unable to straighten leg and/or pain in neck
- indicates = meningeal irritation ( meningitis)
pt complains his hand going numb and cold when held above head
st and perform ortho test
- wright hyperabduction
- Positive= pain and/or paresthesia, decreased or absent pulse, pallor
- compression of axillary artery by coracoid pec minor or carotid process (TOS)
pt complains of severe posterior thigh pain
- Straight leg Raiser
- Positive- pain in posterior thigh
indicates= pain occurring between 30-70 = discogenic sciatic radiculopathy - pain occurring beyond 70= tight hamstrings
pt complains dizziness and loss of balance when turning and looking over left shoulder. additionally, pt complains of difficulty hearing with left ear when on the phone
st and perform CN
- VII (vestibulo- cochlear)
1. Finger Rub
2. Whisper
3. Rhine ( place fork against mastoid bone - ask when no longer heard - then hold near ext canal then ask till not heard
Normal: air conduction persists twice as long as bone conduction
Abnormal: conduction deafness: air conduction is absent , equal or less to bone conduction
Abnormal : Sensorineural deafness: air conduction and bone conduction are both absent or decreased
4. Webber- place handle of fork on midline of skull and ask to compare the intensity of the ears - normal: sound equal in both ears
- conductive deafness: sound materializes to bad ear
- sensorineural deafness: sound materializes to good ear
5.Fukuda step test
6. Barany whirling chair
7. Hallpike Dix
8. vestibulo- ocular
A pt complains of tingling sensations running down the inside of his right leg and foot, with weakness of knee extension and ankle that rolls outward
state and perform nerve root
- Nerve Root = L4
- Disc Level = L3
- foot dorsiflexion and Inversion = tibialis anterior ( deep fibular n)
- Reflex = Patella
- Dermatomes= L3, L4, L5
A pt complains of a weakness of thumb opposition with tingling in the first 3 fingers
state and perform ortho test
- Phalen
- positive = reproduction of pain and/ or parasthesia in the median nerve distribution area ( 1,2,3 and lateral 1/2 of 4th digit)
- median neuritis, possible carpal tunnel syndrome
pt complains of radiating pain into his left arm when he turns to look to the right
- Cervical compression test
- positive= exacerbation of localized cervical pain with or without a radicular component
- indicates= foraminal enchroachment or facet pathology . If there is a radicular component it would indicate nerve root compression as well
pt complains of lateral chest pain when laterally flexing
- schepelman’s sign
- positive- pain of concave side = intercostal neuritis
- pain on convex side = fibrous inflammation of pleura
pt presents in your office with sharp stabbing pain on the right side of his face. he states that when he chews he feels weakness in the right side of the mouth
state and perform CN
- Trigeminal V
- Clench teeth: palpate masseter and temporalis ( and relaxed)
- pain discrimination ( sharp dull) 3x3
- Light touch ( cotton ball) 3x3
- Corneal reflex - should see blinking/ tearing
A: trigeminal
I: POns
E: Facial - Oculocardiac Reflex: decrease pulse
A: trigeminal
I: Medulla
E: Vagus - Light touch : ant 2/3 tongue, inside cheeks, hard palate toothpick
pt complains of numbness on the back of the left calf and side of the left foot. He also states that when he tries to use the clutch in his car his left foot doesn’t seem to be able to press very hard
Name and preform nerve root
nerve root = S1
disc level = L5
- plantar flexion= Gastrocnemius and Soleus ( tibial n)
- plantar flexion and Eversion = Peroneus longus and brevis ( superficial peroneal n)
- Hip extension= Gluteus maximus ( inferior gluteal n)
- Reflex : achilles
- Dermatome : L5, S1, S2
pt complains of radiating pain down the posterior thigh and leg
- Straight leg raiser
- Positive = pain in the posterior thigh
- indicates: pain occurring between 30 and 70 degrees = discogenic sciatic radiculopathy
- pain occurring beyond 70 degrees = tight hamstrings
a pt complains of radiating pain when he coughs, sneezes or strains
- Valsalva
- positive = pain radiating from the site of lesion, usually recreating complaint of lumbar or cervical spine pain
- indicates= space occupying lesion ( disc pathology)
- pt complains of forefoot pain when wearing tight fitting shoes
- Morton’s test
Postive= sharp pain in forefoot
indicates= Metatarsalgia or neuroma
- pt presents in your office with complaint of eye pain in bright light. he states that his peripheral vision seems to be decreased
- state and preform CN
- optic n II
1. inspect structures of the eye
2. inspect the optic fundi with opthalamascope
3. visual acuity
- reading print
- Shapes/ colors
4. Confrontation test - bring object into view from 8 different sides
5. Direct light reflex
- A: Optic n (II)
- I: midbrain
- E: Oculomotor
6. Indirect Light Reflex
- A: Optic N
- I : medulla
- E: Oculomotor
7. Accommodation
- A: optic nerve
- I : Occipital Cortex
- E: Oculomotor n
pt complains of left shoulder pain. he think it may be related to the weakness he has been experiencing in his left arm when he does curls in the gym
- Nerve root : C5
- Disc Level: C4
- Shoulder abduction: Deltoid ( axillary)
- Forearm Flexion: Biceps ( musculocutaneous n.)
- Reflex: Biceps
Dermatome C4, C5, C6
pt complains of tingling in the hands while ….
Adson
- positive = paind and/or paresthesia, decreased or absent pulse, pallor
- indicates = compression of neuromuscular bundle by scalenus antics or cervical rib
pt. complains of weak abdominal muscles during crunches
- Milgram
- positive= inability to perform test
- Indicates = weak abdominal muscles or space occupying lesion
pt. complains of pain at the medial malleolus going into the medial foot
tinel foot
- positive = parasthesia radiating into the foot
- Indicates= tarsal tunnel syndrome
- pt complains that his face is dropping on the left side and he is unable to taste anything like sweet tea, lemon ginger herbal tea. He think the loss of taste is related to recent difficulty he has smelling anything but the strongest scents
- Facial
- inspect for asymmetry
- eyebrows up, eyes close tight, show teeth, puff cheeks, smile, frown
- changes in taste of sweet salty or sour on ant 2/3 tongue
- Olfactory
- check for blockages in nose
- occlude 1 nostril at a time
- do you smell anything , can you identify the smell
- check for blockages in nose
pt complains that he is having difficulty “face- booking” he types with great difficulty due to finger weakness and also notice numbness on the medial surface of his right hand finger 4 and 5
- nerve root C8
- Disc level C7
- Finger flexion: flexor digitorum superficialis and profundus, lumbricals ( median and ulnar nerve)
- Reflex: none
- Dermatome : C7, C8, T1
pt has radiating pain from straining
- Kemp Test
- Reproduction of sciatic pain while leaning toward affected side= lateral disc bulge
- while leaning towards the affected size= medial bulge
- pt presents with a complaint of double vision whenever he looks to the left. Upon examination you notice a larger pupil on the right, and right eye ptosis
- Oculomotor (III)
- Direct light
- A: optic
- I: Midbrain
- E: Oculomotor
- Indirect Light
A: Optic
I : Midbrain
E: Oculomotor
- Accommodation
A: optic
I: occipital cortex
E: oculomotor
- check for ptosis - Abducens
- extraocular movements with 6 cardinal fields of gaze
- Trochlear= down and in
- Abducens= lateral
- oculomotor= all other fields
- extraocular movements with 6 cardinal fields of gaze
