Physical examination in a psychiatric patient Flashcards by Bethan Williams

Sign associated with neurosyphilis and diabetes

Argyll-Robertson pupil

How well did you know this?

Not at all

Perfectly

Bilaterally small pupils which accommodate but do not react to bright light

Argyll-Robertson pupil

How well did you know this?

Not at all

Perfectly

Sign where there are multiple surgical scars due to factitious disorder

Checker-board abdomen

How well did you know this?

Not at all

Perfectly

Drug intoxication associated with constricted pupils

Opiates

How well did you know this?

Not at all

Perfectly

Conditions associated with dilated pupils

Stimulant abuse
Anxiety
Opiate withdrawal

How well did you know this?

Not at all

Perfectly

Eye sign associated with Wilson’s Disease

Kayser Fleischer ring

How well did you know this?

Not at all

Perfectly

Neck sign associated with thyroid disease or rarely with lithium use

Goitre

How well did you know this?

Not at all

Perfectly

Medical causes of gynaecomastia

Hyperprolactinaemia
Cirrhosis
Normal male puberty
Hypogonadism
Tumours including adrenal or testicular
Renal failure

How well did you know this?

Not at all

Perfectly

Medication associated causes of gynaecomastia

Oestrogen containing drugs e.g. goserelin
Spironolactone
Finasteride
Ketoconazole
Methadone

How well did you know this?

Not at all

Perfectly

Recreational drugs causing gynaecomastia

Marijuana
Amphetamines
Heroin

How well did you know this?

Not at all

Perfectly

Body hair seen in anorexia nervosa

Lanugo

How well did you know this?

Not at all

Perfectly

Disease causing lemon stick appearance

Cushing’s syndrome

How well did you know this?

Not at all

Perfectly

Eye signs seen in hyperthyroidism

Exophthalmos
Lid retraction
Lid lag
Orbital fat prolapse

How well did you know this?

Not at all

Perfectly

Disease classically associated with a mask-like face

Parkinson’s disease

How well did you know this?

Not at all

Perfectly

Diseases associated with parotid swelling

Bulimia nervosa

Mumps

How well did you know this?

Not at all

Perfectly

Sign seen in bulimia nervosa where there are callouses at the knuckles

Russell’s sign

How well did you know this?

Not at all

Perfectly

Medication causing Sialorrhoea (hypersalivation)

Clozapine

How well did you know this?

Not at all

Perfectly

Signs in infective endocarditis

Splinter haemorrhages
Osler nodes
Janeway lesions

How well did you know this?

Not at all

Perfectly

Tender, red, raised lumps typically found on the fingers and toes in infective endocarditis

Osler nodes

How well did you know this?

Not at all

Perfectly

Non-tender red lesions seen on the palms and soles of the feet in infective endocarditis

Janeway lesions

How well did you know this?

Not at all

Perfectly

More common side for a unilateral paraesthesia caused by hyperventilation

Left

How well did you know this?

Not at all

Perfectly

Usual distribution for paraesthesia caused by hyperventilation in a panic attack

Bilateral, upper limbs

How well did you know this?

Not at all

Perfectly

Minor physical anomaly associated with developmental disorders where there is a skin tag in front of the ear

Preauricular skin tag

How well did you know this?

Not at all

Perfectly

Syndrome occurring where there are lip pits and cleft lip/palate

Van der Woude syndrome

How well did you know this?

Not at all

Perfectly

Minor physical anomaly associated with developmental disorders where there are small white/grey spots in a ring around the pupil

Brushfield spots

Cranial nerve number I

Olfactory

Cranial nerve number II

Optic

Cranial nerve number III

Occulomotor

Cranial nerve number IV

Trochlear

Cranial nerve number V

Trigeminal

Cranial nerve number VI

Abducens

Cranial nerve number VII

Facial

Cranial nerve number VIII

Vestibulocochlear

Cranial nerve number IX

Glossopharyngeal

Cranial nerve number X

Vagus

Cranial nerve number XI

Accessory

Cranial nerve number XII

Hypoglossal

Main clinical examination technique for the olfactory nerve

Check sense of smell

Main clinical examination technique for the optic nerve

Visual acuity using Snellen charts Colour sight using Ishihara charts Visual fields Pupillary reflexes

Main clinical examination technique for the oculomotor nerve

Eye movements - elevation, adduction, depression in abduction Eyelid elevation Pupillary reflex

Main clinical examination technique for the oculomotor nerve

Eye movements - elevation, adduction, depression in abduction Eyelid elevation Pupillary reflex

Eye abnormality seen with a third cranial nerve lesion

Down and out

Main clinical examination technique for the trochlear nerve

Eye movements - depression in inversion

Eye abnormality seen in a fourth cranial nerve lesion

Upwards

Main clinical examination technique for the facial nerve

Facial movement | Taste for front 2/3 of the tongue

Main clinical examination technique for the trigeminal nerve

Sensation to the face | Chewing

Three branches of the trigeminal nerve

Ophthalmic Maxillary Mandibular

Main clinical examination technique for the abducens nerve

Eye movements - abduction

Eye abnormality seen in a sixth cranial nerve lesion

Eye turned inwards

Main clinical examination technique for the vestibulocochlear nerve

Balance - Romberg test | Hearing - Rinne/Weber tests

Main clinical examination technique for the glossopharyngeal nerve

Taste to the back 1/3 of the tongue | Sensation to the soft palate

Main clinical examination technique for the vagus nerve

Cough | Vocal cord movements

Main clinical examination technique for the accessory cranial nerve

Head turning | Shoulder shrugging

Main clinical examination technique for the hypoglossal cranial nerve

Tongue movements

Cranial nerve test where a vibrating tuning fork is held against the forehead in the middle of the face

Weber test

Cranial nerve test where a vibrating tuning fork is held at the mastoid bone, and then in front of the ear

Rinne test

Weber test result in normal hearing

Sound heard equally loudly bilaterally

Weber test result in conductive hearing loss

Sound louder in the abnormal ear

Weber test result in sensorineural hearing loss

Sound louder in the normal ear

Positive (normal) Rinne hearing test

Sound continues when the fork is moved from the bone to the air

Negative (abnormal) Rinne test

Sound does not continue when the tuning fork is moved from the mastoid to the air

Type of hearing loss associated with an abnormal Rinne test

Conductive hearing loss

Direction in which patients with poor vestibular function fall in a Romberg's test

Forwards to the side of the poor vestibular function

Testing for poor vestibular function in which cold or warm water is poured into an ear to elicit nystagmus

Caloric testing

Normal results in caloric testing in unilateral poor vestibular function

Cold water - nystagmus to the opposite side | Warm water - nystagmus to the same side

Test used to elicit ataxia

Heel toe walking

Cerebellar signs

``` Ataxia Hypotonia Intention tremor Past pointing Dysdiadokokinesis Dysarthria ```

Sign of meningism where flexion of the neck causes flexion of the knees and hips

Brudzinski sign

Sign of meningism where there is spasm if the knee is extended while the hip is flexed

Kernig sign

Sign suggestive of lower lumber nerve root irritation where the passive flexing of the hip while in the supine position causes pain

Straight-leg raising sign/Lasègue sign

Sign suggestive of upper lumbar nerve root irritation where there is pain on the passive hyper-extension of the hip while in the prone position

Reverse straight leg raise sign

Neurological signs which do not point to a lesion in a specific area

Soft neurological signs

Neurological sign where there are small quivering of the muscles

Fasciculations

Neurological sign where there are brief, jerky movements of the wrists on holding the arms out with the palms facing outwards

Asterixis

Slow, writhing spasms along the long axis of the limbs or the whole body

Athetosis

Semi-purposeful movements of the limbs affecting multiple joints; more peripheral than central

Chorea

Violent flinging movements of half of the body

Hemiballismus

Area of brain generally affected when primitive reflexes are seen in an adult

Diffuse cerebral damage, particularly in the frontal lobes

Primitive reflex where the arms jerk out and the head and legs extend on a sudden change of position

Moro reflex

Primitive reflex where the baby's head is turned to one side, and the arm on the side the head is turned straightens while the other arm bends at the elbow

Asymmetrical tonic neck reflex

Normal abdominal reflex

A line is drawn away from the umbilicus along a diagonal line, and the umbilicus is drawn towards the direction the line is drawn

Normal cremasteric reflex

Scratching the medial thigh in males causes elevation of the ipsilateral testis

Normal plantar reflex

Plantar flexion of the great toe on drawling a line up the sole of the foot

Positive Babinski sign

Dorsiflexion of the great toe on drawing a line up the sole of the foot

Spinal root of the biceps reflex

C5, C6

Spinal root of the brachioradialis reflex

Spinal root of the triceps reflex

Spinal root of the patellar reflex

L2-4

Spinal root of the Achilles reflex

Lesions causing exaggerated tendon reflexes

UMN lesions

Lesions causing lack of tendon reflexes

LMN reflexes

Condition associated with frontal baldness

Myotonic dystrophy

Condition associated with ash leaf spots

Tuberous sclerosis

Condition associated with moles and dimples along the spine

Spina bifida occulta

Condition associated with Coast of Maine hyperpigmented skin lesions

McCune-Albright syndrome

Conditions associated with Café-au-lait spots

Neurofibromatosis, tuberous sclerosis

Condition associated with axillary freckling

Neurofibromatosis

Type of dysarthria characterised by a strained and hoarse voice with hypernasality, often with swallowing and drooling difficulties

Spastic dysarthria

Type of dysarthria characterised by a small tongue

Hypotonic dysarthria

Type of dysarthria characterised by loudness, tremor and irregularity

Ataxic dysarthria

Lesions associated with spastic dysarthria

UMN lesions

Lesions associated with hypotonic dysarthria

LMN lesions

Lesions associated with ataxic dysarthria

Cerebellar lesions

Type of dysarthria characterised by a quiet, breathy, monotone voice

Hypokinetic dysarthria

Type of dysarthria characterised by strained hoarseness and speech arrests

Hyperkinetic dysarthria

Lesions associated with hyperkinetic dysarthria

Basal ganglia lesions

Type of dysarthria characterised by sudden loss of voice, normal vocal cord movement and normal examination

Hysterical aphonia

Type of gait characterised by a paralysed leg which appears longer due to an extended knee, associated with a clenched hand on the ipsilateral side

Hemiparetic gait

Condition associated with a hemiparetic gait

Stroke

Type of gait characterised by a staggering, wide based gait

Ataxic gait

Area of lesion associated with an ataxic gait

Cerebellar

Type of gait characterised by very short steps

Shuffling gait

Type of gait characterised by progressively shorter steps due to acceleration while walking

Festinating gait

Condition associated with festinating gait

Parkinson's disease

Type of gait characterised by exaggerated steps, as if climbing stairs while walking on the flat

High stepping gait/neuropathic gait/equine gait

Condition associated with a high stepping gait

Chronic peripheral neuropathies

Type of gait characterised by a broad base, and the dropping of the pelvis on the side of the leg being raised, leading to a compensatory body swing forward

Waddling gait

Conditions associated with waddling gait

Proximal myopathy Congenital hip dislocation Pregnancy at near term

Type of gait characterised by over adduction and rigidity in the legs, causing the knees to rub together, as well as plantar flexion of the ankle causing forced tip toe walking

Scissoring gait

Condition associated with a scissoring gait

Spastic paraplegia

Type of gait characterised by the inability to lift the feet off the floor

Magnetic gait

Condition associated with magnetic gait

Normal pressure hydrocephalus

Conditions associated with absent ankle jerks and upgoing plantars

Subacute combined degeneration of the cord Neurosyphilis Friedrich's ataxia

Term for pupillary asymmetry

Anisocoria

Term for the denial of illness

Anosognosia

Lesion associated with anosognosia

Right frontoparietal lesion

Sign characterised by the upward deviation of the umbilicus when an attempt is made to sit up from the supine position due to lower abdominal paralysis

Beevor sign

Condition characterised by ipsilateral spastic paralysis and loss of position sense below the level of the lesion, hyperreflexia, and contralateral loss of pain and temperature sensation

Brown Sequard syndrome

Electrolyte abnormality causing Chvostek sign

Hypocalcaemia

Electrolyte abnormality causing Trousseau's sign

Hypocalcaemia

Sign characterised by facial spasm on the ipsilateral side when the cheekbone is tapped

Chvostek sign

Sign characterised by carpal spasm when a blood pressure cuff is tightened

Trousseau sign

Sign to test for brainstem integrity in a comatose patient where the head is moved quickly from side to side while the eyes are held open

Doll's eye manoeuver

Sign elicited in the doll's eye manoeuver if the brainstem is intact

Both eyes deviate to the opposite side to the direction the head is being turned

Condition associated with high foot arches, kyphoscoliosis, cerebellar signs, impaired joint position, cardiomyopathy and optic atrophy

Friedrich's ataxia

Sign associated with Duchenne's muscular dystrophy, where someone attempts to stand up by climbing up their own legs with their arms

Gower sign

Condition associated with a dilated pupil that reacts poorly to light, and absent patellar and Achilles reflexes

Holmes-Adie syndrome

Signs of horner's syndrome

``` Ptosis Anhydrosis Miosis Enophthalmos Loss of ciliospinal reflex ```

Tumour causing horner's syndrome

Pancoast tumour

Sign where the abnormal pupil dilates as a swinging light moves towards it from the normal side

Marcus Gunn pupil

Condition associated with a Marcus Gunn pupil

Afferent pupillary defect

Painful, asymmetric peripheral neuropathy with damage to at least two separate nerve areas

Mononeuritis multiplex

Causes of mononeuritis multiplex

``` Diabetes Vasculitis Amyloidosis Tumours Autoimmune disorders Paraneoplastic syndromes ```

Sign associated with chorea where someone cannot sustain a grip

Milkmaid's grip

Sign characterised by continued blinking with repeated glabellar taps (normally there is extinction of the reflex)

Myerson's sign

Condition associated with Myerson's sign

Parkinson's disease

Triad of optic neuritis

Loss of vision Eye pain Dyschromatopsia (decrease in the perception of colours)

Heat or exercise induced vision loss

Uhthoff sign

Sign characterised by an unsteady tongue when it is protruded out of the mouth, associated with chorea

Trombone tongue

Signs associated with an UMN lesion

Rigidity Hypertonia Hyperreflexia Mild atrophy from disuse

Signs associated with a LMN lesion

Atonia or hypotonia Loss of tendon reflexes Atrophy Fasciculations

Lesion causing a bulbar palsy

LMN lesion of cranial nerves IX - XII

Lesion causing a pseudobulbar palsy

Bilateral UMN lesions of the lower cranial nerves

Signs of a bulbar palsy

Wasted, fasciculating tongue Nasal speech Lack of jaw jerk Lack of gag reflex

Signs of a pseudobulbar palsy

Stiff tongue Donald-duck speech Exaggerated jaw jerk Emotional lability

Causes of a bulbar palsy

``` MND Polio Botulism Myasthenia Gravis Muscular dystrophy ```

Causes of a pseudobulbar palsy

MND MS Multi-infarct dementia Severe head injury

Area of brain lesion suggested by anomic dysphasia

Dominant temporo-parietal lesion

Failure to recognise an object despite normal visual input

Visual agnosia

First sign to improve when thiamine is given to a patient with Wernicke's encephalopathy

Ophthalmoplegia

Area of brain lesion suggested by poor visuospatial ability

Parietal lobe

Inability to read

Alexia

Area of brain lesion suggested in alexia without agraphia

Posterior cerebral territory (usually dominant)

Test used to identify patients with conversion disorder, where the patient is unable to lift their affect limb, but when lifting their unaffected limb against resistance is able to push down with their affected limb

Hoover's test

Area of brain lesion suggested by poor categorisation

Frontal lobe

Area of brain lesion suggested by poor error correction

Frontal lobe

Area of brain lesion suggested by a spastic hemiparesis

Contralateral frontal lobe

Hemisphere of brain lesion suggested by constructional apraxia

Right

Signs seen in a senile pupil

Sluggish light and accommodation reflex

Reductions in cognitive abilities seen in healthy aging

Motor speed Visuospatial skills Attention span New learning ability

Most common type of tremor

Benign essential tremor

Type of tremor which can be improved by alcohol and beta blockers

Benign essential tremor

Type of tremor which is not associated with pathology, which mostly affects the hands and which slowly progresses

Benign essential tremor

Type of tremor described as a 'pill-rolling tremor'

Parkinsonian

Type of tremor which is slow and coarse, and gets worse with intentional movement

Cerebellar/intention tremor

Type of tremor which is variable and improves with distraction

Psychogenic tremor

Type of tremor which is present in all normal people when maintaining a posture

Physiologic

Most coarse type of tremor

Cerebellar/intention tremor

Finest type of tremor

Physiologic

Features common in non-epileptic seizures compared to seizures

``` Longer duration Gradual onset and fluctuating course Eyes closed Safe fall Recall of the event ```

Features common in epileptic seizures compared to non-epileptic seizures

``` Sudden onset Incontinence (can occur in non-epileptic seizures too) Automatisms Biting of tongue or inside of mouth Amnesia for the event ```

Sustained muscle contractions which cause twisting movements or the maintenance of abnormal postures

Dystonia

Sudden involuntary (and not suppressible) jerks of a muscle or group of muscles

Myoclonus

Loss or absence of voluntary muscle movements

Akinesia

Slowness of movement seen in Parkinson's disease

Bradykinesia

Subjective feeling of inner restlessness

Akathesia

General term referring to problems with voluntary movements, or the presence of involuntary movements

Dyskinesia

Triad of features present in Parkinsonism

Tremor Rigidity Bradykinesia

Involuntary but somewhat suppressible stereotyped motor movement or vocalisation

Tic

Involuntary, rhythmic, alternating movement of one or more body parts

Tremor

Condition in which psychogenic polydipsia most commonly occurs

Schizophrenia

Features of sleep associated with typical depression

``` Decreased total sleep time Early morning wakening Prolonged sleep onset latency Increased wakening through the night Increased REM time Decreased slow wave sleep ```

Most typical sleep effect of depression

Early morning wakening

Dilation effect of mydriatic agents on Argyll Robertson pupils

Poor

Sign seen in Wilson's disease where there is a greenish central disc in the eye with spoke like yellow radiations

Sunflower cataract

Test used to investigate the cause of ataxia

Romberg test

Physical findings in hypothyroidism

``` Hair loss Bradycardia Periorbital puffiness Dry skin Coarse, brittle hair Myxoedema Hyporeflexia Tremor ```

Findings in hyperthyroidism

Hair loss Tachycardia Tremor Brisk reflexes

Test used during testing of visual fields where the patient's visual field is compared with the examiner's

Confrontation

Clinical features of acute cocaine intoxication

``` Increased temperature Labile BP and tachycardia Behavioural changes - euphoria, anxiety, agitation, paranoia Teeth grinding Dry mouth Dilated pupils ```

Clinical features of cocaine overdose

``` As for intoxication Rigidity and myoclonus Seizures Arrhythmias and ACS Hyperthermia induced rhabdomyolysis, renal failure or cerebral oedema ```

Clinical features of cocaine withdrawal

``` Vivid and unpleasant dreams Hypersomnia or insomnia Increased desire for sleep Irritability and anxiety Increased appetite Cravings ```

Clinical features of opiate overdose

Decreased level of consciousness Pinprick pupils Reduced respiratory rate

Clinical features of opiate withdrawal

``` Nausea, vomiting, diarrhoea Abdominal cramps Restless legs and muscle aches Anxiety Yawning Piloerection Coryzal symptoms and eye watering Pupillary dilation Tachycardia, hypertension ```

Clinical features of benzodiazepine overdose

Sleepiness Slurred speech Impaired balance and motor function Diplopia Paradoxical agitation, anxiety, hallucinations In severe cases coma, respiratory depression, hypotension, hypothermia, bradycardia

Clinical features of benzodiazepine withdrawal

``` Multiple features including: Anxiety, irritability and panic attacks Confusion Insomnia Weight loss Diarrhoea, nausea and retching Muscle twitching Photophobia Dilated pupils Tachycardia ```

Clinical features of cannabis intoxication

``` Euphoria Altered sense of time and mind Poor concentration and short term memory Increased appetite Anxiety, hallucinations, paranoia, psychosis Red eyes and sometimes dilated pupils ```

Clinical features of cannabis withdrawal

``` Irritability Anxiety Insomnia Decreased appetite Low mood Abdominal pain Tremors Sweating Headache Fever ```

Clinical features of alcohol withdrawal

``` Tremor Insomnia Agitation Seizures Hallucinations Sweating Disorientation Autonomic instability Nausea and vomiting ```

Clinical features of ecstasy intoxication

``` Euphoria Dilated pupils Dehydration Hyperthermia Tachycardia and hypertension Nausea, vomiting and diarrhoea Clenching of jaw ```

Clinical features of ecstasy overdose

``` Labile BP Hyperreflexia Confusion, paranoia, agitation Muscle rigidity Hyperpyrexia ```

Sign where the pupils constrict and then widely dilate due to raised intracranial pressure

Hutchinson pupil

Gait seen in hip dysplasia or other strucural abnormalities

Pigeon gait

Gait seen in Friedreich's ataxia

Stomping gait

Clinical features of amphetamine intoxication

``` Tachycardia or bradycardia Labile BP Pupillary dilation Sweating or chills Nausea and vomiting Euphoria, anxiety, paranoia (in amphetamine induced psychosis) ```

Clinical features of amphetamine withdrawal

``` Cravings Low mood Increased appetite Increased or decreased movement Change in sleep patterns Lucid dreams ```

Type of lesion which causes pronator drift

Upper motor neurone lesion

Type of gait characterised by a long swing phase and short stance phase on one side

Antalgic gait

Symptom associated with an antalgic gait

Pain on weight bearing

Percentage of patients with autism who also have macrocephaly

20%

Features of a lower motor neurone lesion

``` Weakness Marked atrophy Fasciculations Decreased tone Decreased reflexes ```

Features of an upper motor neuron lesion

``` Weakness Mild atrophy only Increased tone Increased reflexes Upgoing plantars (Babinski) Clonus ```

Weakness of one side of the body

Hemiparesis

Paralysis of one side of the body

Hemiplegia

Apraxia where there is an inability to plan and complete motor tasks, and to convert an idea into action. May have retained ability to complete the task if not consciously thinking about it or may do the wrong thing e.g. try to brush their hair with a razor.

Ideomotor apraxia

Type of apraxia where someone is unable to brush their teeth when asked to. If handed a toothbrush with toothpaste on they may try to perform the wrong action.

Ideomotor apraxia

Type of apraxia where there is an inability to conceptualise and complete multistep tasks. May complete tasks in the wrong order e.g. putting on shoes before socks

Ideational apraxia

Type of apraxia where someone is unable to make a slice of buttered toast, even though they can repeat each single step when shown by others

Ideational apraxia

Type of apraxia where there is an inability to make fine or delicate movements

Limb kinetic apraxia

Type of apraxia where there is an inability to copy a picture or combine parts of something to form something whole

Constructional apraxia

Type of apraxia where there is an inability to control eye movements properly

Oculomotor apraxia

Psychiatric condition where there is a deficit in smooth eye tracking

Schizophrenia

Percentage of patients with Wernicke's who have the classic triad of symptoms

10%

Physical signs that can point towards a metabolic or toxic cause of altered mental state

Asterixis Tremor Myoclonic jerks

Eye sign which is pathognomic of multiple sclerosis

Bilateral internuclear ophthalmoplegia

Features of internuclear ophthalmoplegia

Impaired adduction | Abducting nystagmus

Length of time post traumatic amnesia should last with a mild head injury

Less than one hour

Length of time post traumatic amnesia should last with a moderate head injury

1 hour to 24 hours

Length of time post traumatic amnesia should last with a severe head injury

More than 24 hours

Level of lesion associated with pronator drift

UMN lesion

Physical examination in a psychiatric patient Flashcards

(240 cards)