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Examinations > Peripheral nerves exam > Flashcards

Peripheral nerves exam Flashcards

1
Q

What is the first steps?

A

Introduce self
Ask name and DOB
Ask for permission + explain
Ask if they are in any pain?

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2
Q

What do you inspect the patient for in the general inspection?

A

Scars
Wasting
Involuntary movements
Fasciculations
Tremor

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3
Q

What do you check for after the general inspection?

A

Pronator Drift

Get them to put their arms out in front of them and close their eyes prone and supine for a few seconds and see if there is drift

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4
Q

What do you assess after pronator drift?

A

Tone
Ask them to let arms go floppy

Support arms and lift shoulder , below and wrist

Compare each side

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5
Q

What do you assess after tone?

A

Shoulder Strength

Get them to put arms up in front of them . Press down on shoulders and push up on them and tell them to resist

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6
Q

What do you assess after shoulder strength?

A

Elbow strength

Get them to put arms out transverse in front of them and press the back and front of their arms and get them to resist

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7
Q

What do you assess after elbow strength?

A

Wrist strength

Get the patient to put their arms out in front of them and cock their wrists back , resist your push

Then get them to place their wrists down and press on the other side

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8
Q

What do you asses after wrist strength?

A

Finger strength

Get them to place their hands out flat and press on their fingers

Then push against their index finger (abduction)

Then push against their pinky finger (abduction)

Then get them to turn their hands over and lift thumbs up, try to pull them down

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9
Q

What do you test after finger strength?

A

Biceps reflex

At the bottom of the biceps test with the tendon hammer

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10
Q

What do you test after the biceps reflex ?

A

Triceps reflex

Check at bottom of triceps muscle

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11
Q

What do you assess after triceps reflex?

A

Supinator reflex

Tap hammer onto fingers at supinator

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12
Q

What do you test after supinator reflex?

A

Light touch sensation

Get patient to close their eyes and lightly tap them with cotton wool on each dermatome, asking if them to say yes if they feel it, and if it is the same on both sides

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13
Q

What do you assess after light touch sensation?

A

Pin prick sensation

Repeat light touch with pinprick on each dermatome .Compare left to right. Get them to say yes each time

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14
Q

What do you assess after pinprick sensation?

A

Vibration

Use tuning fork and give them an example on chest what is will feel like

Test Distal Bony Prominence on finger and ask them to tell you when it stops vibrating

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15
Q

What do you do if the patient can’t feel the vibration at the DBP?

A

Asses more proximally until they can

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16
Q

What do you assess after Vibration?

A

Propioreception

Move patients thumb up and down and instruct them which one is which. Make sure to hold the finger at its base. Then get them to close their eyes and move their thumb up or down . Get them to tell you which way the thumb is move into

17
Q

What do you assess after proprioreception? ( upper limb )

A

Finger to nose test

Get patient to touch nose then touch your outstretched finger. Repeat on both sides

18
Q

What are you observing for with the finger to nose test?

A

Intention tremor ( cerebellar disease )

19
Q

What do you test after the finger to nose test?

A

Rapid Alternating Movement

Place on hand on top of the other and rapidly flip it round

Testing for Dysdiadokinesia

20
Q

What do you look for in a general inspection of the lower limb?

A

Symmetry
Wasting
Involuntary Movements
Fasciculations
Tremor

21
Q

What do you assess after l.limb general inspection?

A

Gait

Ask if they can walk unaided
Get patient to cross arms and stand up unaided
Get patient to walk

22
Q

What are you observing the gait for?

A

Speed
Symmetry
Balance
Arm Swing

23
Q

What do you examine after gait?

A

Tandem gait

Get them to walk one foot in front of the other

24
Q

What do you assess after tandem gait?

A

Walking on tip toes (Plantarflexion)
Walk on heels (Dorsiflexion )

25
Q

What do you assess after all the gaits?

A

Romberg test

Get patient to stand still and place arms either side of them in case they wobble

26
Q

What do you assess after Rombergs test?

A

Tone

Get patient to let leg go floppy
Leg roll ( at thigh )
Leg lift ( at knee)

27
Q

What do you assess after tone?

A

Ankle clonus

Lift lower leg up
Move ankle in circle then push foot towards patients body

28
Q

What do you assess after ankle clonus?

A

Strength

Get patient to lift leg up and push down

Get patient to push leg against the leg whilst you push up

Get patient to abduct their legs against your resistance and then addict against resistance

Get patient to bend thier leg up and push against your hand , which is below leg

Then get patient to bend leg and kick out against resistance

Ask patient to bring their toes towards themselves and push down

Then push feet down against your hand

Then push down on big toe and get them to resist

Then test ankle inversion

Then test ankle eversion

29
Q

What do you test after strength?

A

Knee jerk reflex

Get patient to let legs go floppy and then tap patella ligament with tendon hammer. Support leg from beneath thigh whilst you do this

30
Q

What do you do after the knee jerk reflex?

A

Ankle reflex

Put legs out to the side and relax.
Then tap the Achilles tendon

31
Q

What do you test after the ankle jerk reflex?

A

Plantar reflex

Run blunt neurotip against sole of foot from bottom to top , toes should curl

32
Q

What do you test after plantar reflex?

A

Light Touch Sensation

Get patient to close eyes
Use cotton wool
Use reference on sternal angle
Assess each dermatome

33
Q

What do you assess after light touch?

A

Pinprick touch

Using neurotip
Close eyes
Check both sides
Do each dermatome

34
Q

What do you do if neural sensation is reduced ?

A

Use neurotip to go up from toes upwards to check where sensation starts

35
Q

What do you assess after pinprick test?

A

Vibration

Show vibration of sternal angle

Test with tuning fork of distal phalange
Ask them to tell you when it stops

36
Q

What do you test after vibration ?

A

Proprioreception

Move their big toe up and down . Then get patient to close their eyes and tell you when you move it up or down

37
Q

What do you test after proprioreception? (Lower limb)

A

Coordination

Get patient to put ankle on knee, then run it down their legs, then back to their knee in a circle.

Then do the same thing on the other side

38
Q

What do you test after coordination?

A

Quick movement

Get patient to tap their feet against your hands as quickly as possible

Examinations (11 decks)

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