Module 5-6 Flashcards
1
Q
- According to evidence based dermatomal charts, which of the following is the
dermatome of the dorsal aspect of the big toe?
A. L3 B. L4 C. L5 D. S1 E. S2
A
C
2
Q
- What is the first type of sensation to be lost in peripheral neuropathy?
a. Light touch
b. Pain
c. Vibratory sense
d. Position sense
e. Temperature sense
A
C
3
Q
- Which of the following statements concerning deep tendon reflex testing is
TRUE?
a. In order to obtain valid and reliable findings, the patient should be relaxed
and the extremities should symmetrically positioned
b. Clonus associated with brisk deep tendon reflexes is considered a sign of
an upper motor neuron lesion
c. A finding of 2+ patellar reflexes bilaterally and 1+ achilles reflexes
bilaterally should always be considered an abnormal finding
d. a and b
e. All of the above
A
D
4
Q
- With respect to the motor system evaluation, a lesion in the corticospinal tract
will reveal?
a. Rigidity
b. Flacidity
c. Spastic hypertonia
d. Spastic hypotonia
e. Flacid hypotonia
A
C
5
Q
- Which of the following statements is CORRECT? An S1 nerve root lesion would
most likely be associated with weakness in:
a. Knee extension and ankle eversion
b. Knee extension and ankle inversion
c. Hip abduction and dorsiflexion of the big toe
d. Ankle plantar flexion and ankle inversion
e. Ankle plantar flexion and ankle eversion
A
E
6
Q
- A 55 year-old patient presents with right side frontal headaches that have been
progressively getting worse over the past 2 months. Your examination reveals a
loss of vision over a portion of both visual fields. Detailed evaluation reveals that
she has loss of vision in the temporal fields of both eyes (i.e. bitemporal
hemianopsia). The lesion is most likely?
a. In the visual cortex
b. In the optic radiation
c. In the optic nerve
d. In the optic chiasm
e. In the optic tract
A
D
7
Q
- Which of the following are you attempting to accomplish when performing the
confrontation test?
a. Asses for temporal field defects
b. Asses visual acuity
c. Asses the pupillary reflexes
d. Asses the eye’s ability to converge
e. Asses the eye’s ability to accommodate
A
A
8
Q
- You ask a patient to open his mouth and say “ah”, and watch his uvula deviate
to the right. This may indicate a lesion to which of the following nerves?
a. The right facial nerve
b. The right hypoglossal nerve
c. The right vagus nerve
d. The left hypoglossal nerve
e. The left vagus nerve
A
E
9
Q
- Which of the following list of examinations BEST describes the tests that should
be performed in order to conduct a complete examination of the facial nerve?
a. Observe and test the strength of the muscles of mastication, taste to the
anterior tongue, corneal reflex
b. Observe and test the strength of the muscles of facial expression, taste to
anterior tongue, corneal reflex
c. Observe and test the strength of the muscles of facial expression, taste to
anterior tongue, sensation to face
d. Observe and test the strength of the muscles of mastication, taste to the
anterior tongue, sensation to face
e. Observe and test the strength of the muscles of mastication, taste to the
posterior tongue, corneal reflex
A
B
10
Q
- You are examining a patient’s eyes and noting their light reflexes. On inspection
both pupils are equal in size and shape. When you test the light reflex of his
right eye, the direct and consensual reflexes are both very apparent. However,
when you test the left eye, both the consensual and direct reflexes are absent.
What can you say about this patient’s eyes?
a. The patient has a left oculomotor nerve palsy
b. The patient has a pathology of the left optic nerve
c. The patient has a pathology of the right optic nerve
d. The patient has Horner’s syndrome affecting the left eye
e. The patient has a right oculomotor nerve palsy
A
B
11
Q
- Abnormal two-point discrimination in all of the digits of the right hand would
MOST LIKELY be the result of?
a. A lesion in the sensory cortex
b. A lesion in the posterior column
c. A lesion of a single nerve root
d. A lesion in a single peripheral nerve
e. Either a or b
A
E
12
Q
- Which of the following statements concerning the gait associated with spastic
hemiparesis is CORRECT?
a. The patient’s trunk will lurch towards the involved side during weight
bearing
b. It is described as a staggering, unsteady wide based gait
c. The leg is swung from the hip in a semi-circle
d. The patient will need to watch the ground for guidance
e. The patient’s pelvis will tilt upwards on the opposite side during the
stance phase
A
C
13
Q
- Which of the following statements is CORRECT concerning the dimensions of
the lung?
a. Anteriorly, the apex of each lung rises to approximately 2 cm below the
inner third of the clavicle.
b. Posteriorly, the lower border of each lung lies at about the level of T10
during quiet respiration.
c. Anteriorly, the lower border of each lung crosses the 10
th rib at the midclavicular line
d. Laterally, the lower border of each lung crosses the 12
th rib at the midaxillary line
A
B
14
Q
- Which of the following examination findings is indicative of pulmonary edema?
a. Decreased tactile fremitus
b. Whispered words are heard loudly and more distinctly during auscultation
c. Vesicular sounds are heard over the involved area
d. A tympanic percussion note
e. A stridor
A
B
15
Q
- When examining a patient’s chest and lungs, which of the following examination
findings would MOST likely prompt you to refer the patient for further medical
consultation?
a. A resting respiratory rate of 12 per minute in a 2 year old child
b. Auscultating vesicular sounds over an adult’s left lower lung fields
c. A respiratory rate of 16 per minute in a resting older adult
d. The absence of egophony
e. A reasonant percussion note over an adult’s right upper lung regions
A
A
16
Q
- With respect to the chest and lung exam, which of the following statements
is/are CORRECT?
a. Auscultation is a sensitive tool for determining whether the underlying tissue
is air-filled, fluid-filled or solid
b. Increased breath sounds occur when a lung becomes congested with fluid
c. Bronchophony is present when air becomes trapped within the lung
d. Both a and c
e. All of the above
A
B
17
Q
- Which one of the following statements concerning the chest and thorax
assessment is TRUE?
a. Percussion is the most important examination technique for assessing air
flow through the tracheobronchial tree
b. Increased transmission of breath sounds indicates that there is a blockage
somewhere in the bronchial tubes
c. Tactile fremitus allows you to determine whether the underlying tissues are
air-filled, fluid filled or solid
d. Auscultation of an adult’s peripheral lung fields will normally reveal a
bronchial sound
e. In a healthy adult, when listening to the breath sounds in the lower lung
fields, it is normal for the inspiratory portion of breathing to last longer than
the expiratory portion
A
E
18
Q
- Which of the following examination findings is indicative of lobar pneumonia?
a. Decreased tactile fremitus
b. Vesicular sounds are heard over the involved area
c. Friction rubs are heard over the area
d. Whispered words are loud and clear during auscultation
e. A tympanic percussion note
A
D
19
Q
- Which of the following set of examination findings would be indicative of pleural
effusion?
a. Decreased breath sounds, apparently elevated diaphragm, dull percussion
b. Increased breath sounds, apparently elevated diaphragm, dull percussion
c. Increased breath sounds, decreased diaphragmatic excursion, hyperreasonant
percussion
d. Decreased breath sounds, apparently elevated diaphragm, hyperreasonant
percussion
e. Decreased breath sounds, decreased diaphragmatic excursion, reasonant
percussion
A
A
20
Q
- A 25-year-old type 1 diabetic accountant presents to the emergency room with
shortness of breath and states that his blood sugar was very high when measured at
home. The patient is diagnosed with metabolic ketoacidosis. What is the expected
pattern of breathing?
a. Hyperpnea
b. Tachypnea
c. Bradypnea
d. Obstructed
e. Cheyne-Stokes
A
A
21
Q
Read Case Scenario:
- What is the MOST LIKELY diagnosis?
a. Chronic obstructive lung disease
b. Acute bronchitis
c. Pneumonia
d. Atelectasis
e. Pneumothorax
A
ok
A
22
Q
Read Case Scenario:
- Which of the following list of signs would MOST LIKELY also be present during
examination of this 62-year-old patient’s lungs, further confirming your
diagnosis?
a. Egophony and Whispered Pectoriloquy
b. An apparently lower diaphragm on both sides, rhonchi are heard over
portions of all lung fields
c. An apparently lower diaphragm on both sides, dull percussion of the upper
lung fields
d. Egophony and an increased diagphragmatic excursion
e. Friction rubs and an apparently higher diaphragm on both sides
A
B
23
Q
- Atrophy would MOST LIKELY be a prominent feature of which of the following?
a. Cortical spinal tract disease
b. An upper motor neuron lesion
c. A radiculopathy
d. Cerebellar disease
e. Both a and c
A
C
24
Q
- Which of the following is the term used to describe weakness of one half of the
body?
a. Hypotonia
b. Paraplegia
c. Hemiplegia
d. Hemiparesis
e. Quadriplegia
A
D
25
25. Which of the following findings is associated with a transection of the left side of
the spinal cord at the T10 level?
a. Decreased or absent superficial abdominal reflexes in the left lower
quadrant of the abdomen; Babinsky present on the right
b. Decreased or absent superficial abdominal reflexes in the right upper
quadrant of the abdomen; Babinsky present on the right
c. Decreased or absent superficial abdominal reflexes in the left upper
quadrant of the abdomen; Babinsky present on the left
d. Decreased or absent superficial abdominal reflexes in the left lower
quadrant of the abdomen; Babinsky present on the left
e. Decreased or absent superficial abdominal reflexes in the right upper
quadrant of the abdomen; Babinsky present on the left
D
26
26. Ptosis can be present with injury to which one of the following nerves?
a. Optic
b. Oculomotor
c. Trochlear
d. Both a and b
e. All of the above
B
27
27. A central lesion (eg. UMNL) involving the facial nerve would produce which of
the following?
a. Sensory loss on the entire half of the contralateral side of the face
b. Weakness of the entire half of contralateral side of the face
c. Weakness of the entire half of ipsilateral side of the face
d. Weakness of the lower half of the contralateral side of the face
e. Weakness of the lower half of the ipsilateral side of the face
D
28
o confused state, memory loss, disoriented
o speech production and understanding
o loss of vision (hemianopsia)
o hemiparesis/sensory loss—weakness on one side
o use Mental status (from history), Confrontation, Posture and gait, Rhomberg, Pronator drift, Motor/reflex, sensory*, discriminative, tone (spasticity)
Cortex - sensory, motor
29
o problems with involuntary movements
o resting tremor (i.e. Parkinson’s)
o rigidity (increased tone)
o use posture + gait observation, tone
basal ganglia
30
o active tremor
o ataxia
o dystmetria—lack of coordination (undershoot/overshoot)
o dysdiadochokinesis—uncoordinated movements, problem w/ rapid alternating movements
o use Posture, gait and observation, Rhomberg (eyes open and closed), Rapid alternating, point-to-point
cerebellum
31
o diplopia, facial sensory loss, facial weakness, hearing loss, dysphagia, etc.
o mild hemiparesis/sensory loss
o use History (clues for vision, hearing, balance, etc.), CN examination, Rhomberg, gait, pronator drift, Motor/reflex, sensory*
brain stem
32
o spastic paraplegia (ipsilateral)
o sensory deficit (ipsilateral touch, contralateral pain/temp)
o incontinence
o combinatinion of either UMNL or LMNL
o ipsilateral lesion tract has already cross over in medulla
i.e. touch (pain + temp are contralateral)
o use rhomberg, gait, pronator drift, M/S/R, saddle anesthesia
Spinal Cord—contains tracts, neurons + cell bodies for motor neurons
33
o weakness, hyporeflexia, fasciculations, (LMNL)
o hyperreflexia, spasticity, Babinsky (UMNL)
o dysphagia, dysarthria, tongue fasc (CNs)
o use Observation, Tone and reflexes, Muscle strength, Reflexes, CN testing
Motor pathways
34
o radicular: motor/sensory loss specific to a dermatome/myotome
o mononeuropathy: motor/sensory loss specific to a peripheral nerve (i.e. CTS)
o polyneuropathy: glove and stocking sensory loss, diabetes (loss of sensation of whole extremity)
Peripheral Nerves
35
o weakness, decreased DTR
o often CN involvement
o i.e. Myasthenia Gravis dysarthria, dysphagia, diplopia (also in CVA)
o use CN screen (dysarthria, dysphagia, diplopia – ddx MG from CVA), Motor strength, reflexes
NMJ
36
o proximal weakness (symmetrical)
o may have decreased DTR
o normal sensation
o use Motor strength (proximal), DTR
Muscle
37
```
o confused state, orientation, speech, memory
o hemiparesis
o Rhomberg
o Pronator drift
o Confrontation
o Reflexes
o Motor strength and tone
o Sensory
```
o History confused state, orientation, speech, memory
o Gait hemiparesis
o Rhomberg balance issues
o Pronator drift corticospinal projections
o Confrontation hemianopsia
o Reflexes UMNL
o Motor strength and tone hemiparesis - fine movements
o Sensory sensory loss – extinction
38
Lateral Spinothalamic Tract (2)
2X
pain and temperature
39
Anterior Spinothalamic Tract (1)
crude touch (perceived as light touch but without accurate locatization
40
Posterior Column (3)
proprioception, vibration, light touch
41
Spinal cord lesion at T5 - how would light touch, proprioception, pain, temperature be affected?
LOSS OF:
```
pain and temperature - contralateral
crude touch - ipsilateral
light touch - ipsilateral
vibration - ipsilateral
proprioception - ipsilateral
```
42
o Monosynaptic in arms and legs
o All components need to be intact (sensory nerve fibres, spinal cord synapse, motor nerve fibers, neuromuscular junction and muscle fibres)
o abnormal reflex can help you to locate a pathological lesion b/c reflex involves specific spinal segments + sensory and motor fibres
DTF
43
• Vigor of contraction—graded on the following scale
```
o 0
o 1+
o 2+
o 3+
o 4+
```
o 0 No evidence of contraction
o 1+ Decreased, but still present (hypo-reflexive)
o 2+ Normal
o 3+ Brisker than normal, possibly but not necessarily indicative of disease
o 4+ Very brisk, hyperactive with clonus (repetitive shortening of the muscle after a single stimulation)
44
If you have to use the Jendressik maneuver the get a reflex - how would you grade the reflex?
MAX 1+ GRADING
45
State the levels:
```
Biceps
BR
Triceps
Patellar tendon
Achilles
```
```
Biceps - C5
BR - C6
Triceps - C7
Patellar tendon - L2-4
Achilles - S1
```
46
What medical condition can lead to slow relaxation of the Achilles reflex?
hypothyroidism
47
T or F: Disorders in the sensory limb will prevent or delay the transmission of the impulse to the spinal cord resulting reflex to be diminished or completely absent
T - ie. diabetic peripheral neuropathy
48
T or F: Abnormal lower motor neuron function does result in decreased or absent reflexes.
F - it does
49
T or F: Severe disease of the NMJ or the muscle itself will result result in a loss of reflexes, as disease at the target organ (i.e. the muscle) precludes movement
T
50
Decreased DTR w/ intact sensation....occurs w/ lesion of the ______ horn cells
anterior
51
Superficial Abdominal Reflexes
Above umblicus innervation (3)
Below umblicus innervation (3)
Why would you conduct this test?
What is normal?
UMNL or LMNL?
T8, T9, 10
T10, T11, T12
suspecting central cord lesion above L spine - corticospinal tracts
umbilicus moves towards the stimulus
UMNL OR LMNL
52
Cremastric refelx
Testing which levels?
L1-L2
elevation of the testes
53
When would the anal reflex be absent?
CES (cauda equina)
54
Plantar response
What levels are you test?
UMNL or LMNL?
Positive test if?
Toes = FL
L4-S2
UMNL
55
Babinski response
UMNL or LMNL?
UMNL
abnormal after 1.0-1.5 y/o
56
Hoffman's sign - what condition are you testing for?
UMNL- CSM = cervical spondylotic myelopathy
Note: there is a dynamic H-sign too
57
Chaddock’s Foot Sign
Stroking behind lateral malleolus (posterior to anterior) --> looking for DF
58
Schaeffer’s sign
o Squeeze Achilles tendon
| o (+) sign for UMNL = accompanying extension of big toe
59
Oppenheim Reflex
o DF of big toe elicited by irritation downward on the medial side of the tibia
o (+) = UMNL
60
In what case would you find a decrease detection of vibration?
posterior column (light touch, proprioception, vibration)
PERIPHERAL NEUROPATHY
61
Name the 5 discriminative sesnation tests
stereogenosis - if positive, perform others; ID object by feeling it
graphesthesia
2-pt discrimination
Pt localization ("point to where I just touched you")
Extinction (simultaneously stimulate corresponding areas on both sides of the body and then ask where the patient feels your touch)
62
rate dependent and worsens at the extremes of motion (CST diseases)
Spasticity - muscle tone
63
not rate dependent and present throughout range of movement (Basal ganglia diseases)
Rigidity - muscle tone
64
```
PARESIS
PARALYSIS
HEMIPLEGIA
PARAPLEGIA
QUADRIPLEGIA
```
PARESIS: weakness
PARALYSIS: absence of strength
HEMIPLEGIA: paralysis of one half of body
PARAPLEGIA: paralysis of the legs
QUADRIPLEGIA: paralysis of all four limbs
65
Muscle strength grading
* 0
* 1
* 2
* 3
* 4
* 5
* 0 - No muscular contraction detected
* 1 - Barely detectable flicker or trace of contraction
* 2 - Active movement of body part, no gravity
* 3 - Active movement against gravity
* 4 - Active movement against gravity; some resistance
* 5 - Active movement against full resistance w/o evident fatigue
66
* Biceps
* Triceps
* Wrist Extension
* Wrist Flexion
* Finger Flexion
* Finger Adduction
* Thumb Opposition
* Knee Extension
* Ankle Inversion
* Ankle DF
* Ankle PF
* Ankle Eversion
* Biceps (C5,6)
* Triceps (C6,7)
* Wrist Extension (C6)
* Wrist Flexion (C7)
* Finger Flexion (C8)
* Finger Adduction (T1)
* Thumb Opposition (C8,T1)
* Knee Extension (L4)
* Ankle Inversion (L4)
* Ankle DF (L5)
* Ankle PF (S1)
* Ankle Eversion (S1)
67
Beevor's sign
Abnormal if?
upward excursion of the umbilicus while doing a "sit up"
68
GAIT OBSERVATION:
UE: held rigidly in a semi-flexed position, fixed to torso
LE: rigid, extended and foot is plantar flexed. Leg is swung from the hip in a semicircle
Foot drag
SPASTIC HEMIPARESIS
69
GAIT OBSERVATION
Weakness of abductor muscles
During the stance phase, the weakened abductor muscles allow the pelvis to tilt down on the opposite side.
To compensate, the trunk lurches to the weakened side to attempt to maintain a level pelvis throughout the gait cycle.
TREDELENBURG
70
GAIT OBSERVATION
```
Basal ganglia diseases
Stooped posture
Flexion of head, arms, hips and knees
Slow getting started
Short, shuffling steps
Festination (involuntary speeding up)
Pill-rolling tremor
```
PARKINSON'S HYPOKINETIC
71
GAIT OBSERVATION
Staggering, unsteady, wide-based
Difficulty with turns
Cannot stand with feet together
CEREBELLAR ATAXIA
72
GAIT OBSERVATION
Seen m.c. in foot drop due to L5 nerve root
Drag feet or left them high with knees flexed and bring feet down with a “slap”
Look as though they are walking up stairs
STEPPAGE
73
GAIT OBSERVATION
Loss of position sense
Wide based and unsteady
Feet wide apart, bring feet down with a double tapping sound
Watch ground for guidance
Gait and posture worsens with eyes closed
SENSORY ATAXIA
74
GAIT OBSERVATION
Spinal cord diseases causing bil LE spasticity
Cerebral palsy
Stiff gait, short steps
Thighs cross forward on each other with each step
Appear to be walking through water
SCISSORS
75
DDx loss of position sense (+ve rhomberg’s) from......
cerebellar ataxia
76
What does the pronator drift test check?
coordination and position sense
cerebellar = arm overshoots
position sense = inability to correct
77
Rapid alternating movements: slow, uncoordinated, clumsy movement
o Slow, uncoordinated, clumsy movement = DYSDIADOCHOKINESIS
78
Point-topoint movements tests for?
dysmetria - overshooting, clumsy, unsteady, slow
79
What does CASE test look for?
o 1. Cognitive abilities: alert, understands questions, responds appropriately, memory, attention span, judgment
o 2. Appearance: grooming and hygiene, emotional status, manner and affect
o 3. Speech + Language: voice quality, articulation, comprehension of instructions, aphasia
o 4. Emotional Stability: mood and feelings, thought process progressing logically towards a goal
80
What other test can be used to look at cognitive function?
Folstein's MMSE
o 11 questions that can be completed in 5 to 10 minutes
o Assesses ORIENTATION, ATTENTION AND CALCULATION, IMMEDIATE AND SHORT-TERM RECALL and LANGUAGE, WRITING AND DRAWING
81
DANs
5 D
A
3 N
diplopia, dysarthria, dysphagia, drop attacks, dizziness
ataxia
numbness, nystagmus, nausea
82
ANOSMIA
what is it?
what are some causes?
ANOSMIA = loss of smell
Common Causes:
• smoking, aging, cocaine use
• Sinus conditions
• trauma to cribriform plates (head trauma or blow to nose
• Frontal lobe lesion (SOL?) will cause unilateral loss of smell
83
Ophthalmoscope exam: looking for what?
OPTIC ATROPHY (white optic disc, small vessels are absent)
PAPILLEDEMA (normal vision, optic disc swelling and pink
GLAUCOMA - enlarged physiological cup
84
Hemianopsia: loss of ½ visual field or entire field
Lesion of the optic nerve
Lesion of the optic chiasm
Lesion of the right optic tract/radiation
Complete lesion of the right optic nerve
Lesion of the optic nerve = unilateral blindness
Lesion of the optic chiasm = bitemporal hemianopsia
Lesion of the right optic tract/radiation = left homonymous hemianopsia
Complete lesion of the right optic nerve = loss of BOTH NASAL AND TEMPORAL fields;; visual fields of only that eye (unilateral loss of vision);; lesion defined as being ANTERIOR to optic chiasm
85
CN III
5 muscles?
Parasympathetic function?
Normal pupil size?
SR, IR, MR, IO, LPS
pupillary CONSTRICTION
3-5 mm
86
Corneal reflex
Sensation
Motor
sensation = CN V
motor = CN VII
87
Facial nerve
Bell's palsy (4)
Peripheral vs central lesion
C - lower quarter, contralateral
P - whole side affected (upper quad = bilateral innervation; lower quad = contralateral innervation
droopy corner of lip, flat nasolabial fold, inability to close eye, whole face droop
88
Weber - laterialization
Conductive hearing loss
Sensorineural hearing loss
Conductive sound is BETTER in BAD ear
Sensorineural sound is BETTER in GOOD ear
89
Rinne Test
Conductive hearing loss
Sensorineural hearing loss
Conductive transmission of sound better through BONE
| Sensorineural transmission of sound better through AIR
90
Gag reflex (2 cranial nerves)
CN 9, 10
91
CN IX: Tongue deviation
CN X: Uvula deviation
To which side?
Tongue = points to same side as lesion (tongue is a push muscle)
Uvula = points to opposite side of lesion (intact side)
92
During quiet respiration; lower border of tongue is at T __
T10
93
TACHYPNEA
What is it?
Causes?
```
• TACHYPNEA—rapid shallow
o Causes
Restrictive lung disease
Pleuritic chest pain—classically by anything that irritates pleura (inflammation, tumor, trauma); can also refer to breathing that occurs after injury to ribs/muscles/nerves, or due to muscle spasm
Elevated diaphragm
```
94
HYPERNEA
What is it?
Causes?
```
• HYPERPNEA—rapid deep breathing
o Causes
Exercise
Anxiety
Metabolic acidosis (Kussmaul breathing)
```
95
BRADYPNEA
What is it?
Causes?
• BRADYPNEA—slow breathing
o Causes
Diabetic coma + Drug-induced
Increased intracranial pressure
96
CHEYNE-STOKES
What is it?
Causes?
• CHEYNE-STOKES—Periods of deep breathing alternate with periods of apnea
o Normal in children < 4 and elderly
o Causes
Heart failure (L)
Uremia
Brain damage involving both cerebral hemispheres
Drug induced
97
OBSTRUCTIVE
What is it?
Causes?
```
• OBSTRUCTIVE—Manifested by prolonged expiration (resistance to air flow is increased during expiration)
o Causes
Asthma
Chronic Bronchitis
COPD
```
98
History for lung pathology (5 signs)
cough
chest pain
dyspnea - laboured breathing
wheezing
hemoptysis - coughing up blood
99
Barrel, Funnel (excavatum)
Pigeon (carinatum)
ok
100
What is fremitus?
palpable vibrations transmitted through bronchopulmonary tree to the chest wall while pt is speaking
101
Unilateral decrease/delay in chest expansion - causes?
chronic fibrosis, pleural effusion, lobar pneunomia, bronchial obstruction
102
Tactile fremitus:
Absent/decreased fremitus when? (2)
Asymmetric decreased fremitus when? (3)
Asymmetric increased fremitus when?
soft or higher pitched voice + COPD, effusion
effusion, pneumothorax, neoplasm
pneumonia, consolidation (more solid lung)
103
When you are doing percussions on the thorax, when you hear more dull and hyperresonant...what are you thinking about?
dull with consolidation and pleural thickening
| hyperresonant/tympanic with increased/trapped air (within or outside of lung)
104
Most important test to assess air flow through tracheopulmonary tree
auscultation
105
Breathing sounds:
Vesicular
Vesicular
```
o (most of lung fields)
o Soft (intensity), low pitch
o insp. > exp.
o no gap
o generally louder in lower posterior and upper anterior lung fields
```
106
Breathing sounds:
Bronchovesicular
o (first, second ICS and interscapularly)
o medium, moderate
o insp. = exp
o may be a gap
107
Breathing sounds:
Bronchial
o Loud, high
o exp. > insp.
o Gap
108
Added sounds - discontinuous
Fine vs. coarse crackles
```
o i) Fine Crackles (Late inspiratory)
High pitched (softer and gurgly)
very brief
Begin in lower lung fields
Possible causes: HF, interstitial lung disease
```
o ii) Coarse Crackles (Early inspiratory)
Low pitched (louder and coarser)
not as brief
early inspiration and possibly expiration
higher lung fields
Possible causes: chronic bronchitis, asthma, pneumonia
109
Added sounds - continuous
Ronchi
Wheeze
Friction rub
o i) Ronchi
suggest secretions obstructing the larger airways (i.e. bronchi)
low pitched, snoring, rumbling.
occur in both inspiration and expiration.
often cleared by coughing (suggest thick secretions).
possible causes include bronchitis, inflammation due to tumor
o ii) Wheeze
suggest the presence of an airway that is narrowed nearly to the point of closure
high pitched, hissing or whistling
occur in both insp. and exp (usually louder).
possible causes include asthma, chronic bronchitis, COPD, HF (generalized), foreign body, tumor (localized)
Inspiratory wheeze = termed stridor (partial obstruction of larynx or trachea and demands immediate attention)
o iii) Friction Rub
suggests inflamed, thickened pleural surfaces rubbing together (ie. pleuritis, pericarditis) - localized
resemble long crackles occurring together
grating, low pitched, sometimes machine-like quality
occurs in both insp. and exp.
110
When bronchial or bronchiovesicular breath sounds are heard? What do you do?
do the spoken/whispered word tests
99, 99, 99, 99
eeeeeeeeeee
whisper 99
111
```
Inspection/palpation—Less movement on involved side
•Tactile Fremitus—decreased
•Percussion—resonant or dull
•Auscultation:
o Faint sounds
o Crackles, wheeze
o TVS are negative
```
CONSOLIDATED LOBE, PARTIAL OCCLUSION
112
```
•Inspection/palpation:
o deviated trachea
o asymmetrical movement
•Tactile Fremitus:
o decreased
•Percussion:
o hyperresonant/tympanic
•Auscultation:
o decreased breath sounds
o pleural rub (?)
o negative T.V.S.
```
pneumothorax
113
```
•Inspection/palpation:
o tracheal dev
o asym. movement
•Tactile Fremitus:
o decreased
o May be increased at upper edge
•Percussion:
o dull/flat
o apparent elevation of diaphragm
•Auscultation:
o decreased B.S.
o bronchial at upper edge
o friction rub (?)
o neg. T.V.S.
```
pleural effusion
114
```
•Inspection:
o obstructive breathing
o cyanosis, barrel chest
o cough (productive)
•Palpation:
o decreased chest movement
o Pulsus paradoxus
•Tactile Fremitus:
o Decreased
•Percussion:
o hyperresonant
o loss of cardiac dullness
o low diaphragm
•Auscultation:
o decreased B.S. (patchy)
o scattered coarse crackles
o wheezes, rhonchi
```
OBSTRUCTIVE LUNG DISEASE
115
T or F: Spasticity only in anti-gravity muscles, where as rigidity is in all muscles
T
116
Muscle tone is controlled by what (1)
Basal ganglia
117
Intentional tremor vs. Resting tremor
Intentional = cerebellum; resting = BG
118
glove and stocking syndrome
Polyneuropathy of peripheral nerves
119
example of mononeuropathy
CTS - median nerve
120
S/S of myasthenia gravis
Fatigability, decreased DTR
121
For the anal and cremastric superficial reflex - do you stroke toward or away?
Away; abdominal is towards
122
Best 2 tests for testing the sensory cortex
Point localization and extinction
123
Rhombergs - eyes open - testing more of.....versus eyes closed
Open - cerebellum; closed - sensory
124
Pro actor drift is a .....
Corticospinal tract test
125
Thumb rolling test is a
CST
126
Pupillary constriction - CN 2 or 3
CN 2 - afferent; CN 3 - efferent
