positive findings and indications Flashcards by Duke A

Pulse Rate
Normal Rate: 50-90 bpm

what are the positive findings and indications?

< 50bpm = Bradycardia: hypothyroidism, well trained athlete

> 90bpm = Tachycardia: hyperthyroidism, caffeine, nervousness,
exercise, hypertension

Pulse missing on one side =
Stenosis, blocked artery, TOS or intermittent
claudication

Arrhythmia = Decrease = hypervolemia, heart failure, aortic stenosis,
atherosclerosis
Increase = fever, exercise, hypothyroidism, anemia,
aortic regurgitation, Arteriosclerosis

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Respiratory Rate
Normal Rate: 12-20 rpm

what are the positive findings and indications?

< 50rpm =Bradypnea: old age, well trained athlete, diabetic
coma, increased intracranial pressure

> 90rpm =Tachypnea: hyperthermia, anxiety, restrictive lung
disease (COPD), elevated diaphragm, pleurisy

Hyperpnea (hyperventilation) = Rapid deep breathing caused by exercise, anxiety,
metabolic acidosis, brainstem damage

Orthopnea = Shortness of breath
Paroxysmal Nocturnal

Dyspnea = Shortness of breath after a period of sleep

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Temperature
Normal Rate: 96.4-99.1° F

what are the positive findings and indications?

< 96.4°F = Hypothermia: cold drink, old age, slow metabolism,
nutritional deficiency, hypothyroidism, hypoglycemia

> 99.1°F = Pyrexia (fever): emotion, infection, exercise, hot drink,
trauma, acute immune disorder, hyperthyroidism

> 106 °F = Hyperpyrexia

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Blood Pressure
Normal Rate: 120/80mmHg

what are the positive findings and indications?

20-139mmHg (systolic) or 80-
89mmHg (diastolic) = Pre-hypertension

140-159mmHg (systolic) or 90-
99mmHg (diastolic) = Stage 1 Hypertension: stress, obesity, high blood
viscosity, type II diabetes mellitus, high
cholesterol, atherosclerosis

> =160mmHg (systolic) or
=100mmHg (diastolic) = Stage 2 Hypertension

80-89mmHg = Pre-hypotension

< 90mmHg (systolic) or <
60/50mmHg (diastolic) = Hypotension: hypothyroidism, thin/small person

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Confrontation (CN2 - Optic)

what are the positive findings and indications?

Patient cannot see your fingers
when you do = Scotoma (blind spot), diminished peripheral
vision, glaucoma, macular degeneration, MS,
CN2 lesion, retinal disorder

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Cardinal Fields of Gaze (CN3 - Oculomotor, CN4 - Trochlear, CN6 - Abducens)

what are the positive findings and indications?

Nystagmus (eye has trouble
following the pen; staggering,
shaking) = Eye not following laterally – CN6: Abducens
(lateral rectus muscle)
Eye doesn’t go down and OUT (clinical test) –
CN4: Trochlear (superior oblique muscle)

Strabissmus (eye doesn’t follow)= in All directions – CN3: Oculomotor (med,
sup. Inf. Rectus, inf. Oblique muscles)
Lesion to eye muscle

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Accomodation (CN3 - Oculomotor - Medial Rectus muscle)

what are the positive findings and indications?

Eyes do no converge = Lesion to CN3 - Oculomotor

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Pupillary Light Reflex (CN2 - Optic, CN3 - Oculomotor)

what are the positive findings and indications?

Eye does not constrict = Damage to Edinger-Westphal Nucleus (tertiary syphilis) or CN3 - Oculomotor

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Levator Palpebrae Superioris (CN 3 - Oculomotor)

what are the positive findings and indications?

Any grade (1-5) less than 5, pain (ask) = CN3 – Oculomotor lesion

Right side is stronger = Left sided CN3 – Oculomotor lesion

Left side is stronger = Right sided CN3 – Oculomotor lesion

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Corneal Reflex (CN 5 – Ophthalmic Divison of Trigeminal: Sensory, CN 7 – Facial: Motor to Orbicularis Oculi)

what are the positive findings and indications?

One or both eyes fail to
blink= Afferent or sensory loss to CN5 (trigeminal)
Or Efferent or motor loss to CN7 (facial) to Orbicularis
Oculi Muscle

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Light test - Ophthalmoscope

what are the positive findings and indications?

No red reflex= cataracts

AV nicking/hemorrhaging = Retinopathy

Papilledema = Increased intracranial pressure

Increased cup to disc ratio (>1:2) = Glaucoma

Macular Degeneration = Old age

Cotton wool patches = Diabetes, hypertension

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Gross Hearing (CN 8 – Cochlear)

what are the positive findings and indications?

Patient fails to hear or Asymmetry = Hearing Loss (must do further tests)

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Weber’s Test (top of head, confirms Gross hearing)

what are the positive findings and indications?

Lateralization to bad/impaired ear = Conductive hearing loss due to obstruction (ex: wax), otitis media, tympanic membrane rupture

Lateralization to good ear = Sensory neural hearing loss (CN8 - Cochlear) due to presbycusis (old age regeneration), excessive loud noise, cochlear damage, otitis interna

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Renee’s Test (Bone conduction vs. air conduction,
confirms Weber’s)

what are the positive findings and indications?

Bone conduction > or = air conduction (Example: 4:1) = Conductive hearing loss

Bone conduction < air conduction overall time is diminished w/2:1 ratio intact (Example: 2:1) = Sensory neural hearing loss

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Otoscope

what are the positive findings and indications?

Absence of cone of light = Intracranial pressure

Redness in canal (w/ purulent effusion) = Otitis Media: acute (no pain), externa (pain)

Bony exostoses around perimeter = Swimmer’s Ear (common in children)

Perforated tympanic membrane = Trauma caused by sharp object put into ear

Amber Fluid behind eardrum =Serous effusion

Large chalky white patch= tympanosclerosis

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Cervical Palpation – Lymph Nodes: 
Pre-auricular
Post-auricular
Occipital
Tonsillar
Submandibular
Submental
Anterior/superficial cervical
Posterior
Deep cervical (tilt head to relax SCM)
Supraclavicular (sentinel)

what are the positive findings and indications?

Enlarged, warm, tender = Active infection

Not warm, non-tender, rubbery = Past infection

Hard, fixed, non-tender, not warm = Malignancy, cancer

Rubbery, warm, non-tender, larger than 1cm = lymphoma

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Cervical Palpation – Other Glands
Submandibular
Parotid

what are the positive findings and indications?

Enlarged Parotid Gland = MUMPS

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Gag Reflex (CN9 - Glossopharyngeal, CN10 - vagus)

what are the positive findings and indications?

No elevation upon touch = Afferent CN9 (Glossopharyngeal) Lesion

Asymmetrical elevation of palate
upon touch – uvula deviates away
from side of lesion = Efferent CN10 (Vagus) lesion on side that didn’t
elevate (opposite uvula deviation)

One side non-response = Vagus lesion (CN 10) motor

Bilateral non-response = Glossopharyngeal lesion (CN 9) sensory

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Vernet-Rideau (CN 10 - Vagus)

what are the positive findings and indications?

Deviation of uvula to one side = Lesion of CN 10

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Nose Palpation and Rhinoscopy

what are the positive findings and indications?

Redness, pale/blue mucosa, nasal polyps= Allergies, infection/inflammation

Deviated septum = trauma

Perforated septum = drug use (Cocaine)

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Motor to CN5 – Trigeminal (“Bite Test”)

what are the positive findings and indications?

< 5 = CN5 lesion

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Sensory to CN5 –Trigeminal (“Sharp vs. Dull”)

what are the positive findings and indications?

Cannot sense = Anesthesia

Oversensitivity = Hyperesthesia

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Muscles of Facial Expression (CN 7 – Facial)

what are the positive findings and indications?

Study These Flashcards

Asymmetry, muscle weakness = Damage to Facial nerve, Bell’s Palsey

Spinal Accessory (CN11)

what are the positive findings and indications?

Study These Flashcards

< 5 = CN11 lesion

Hypoglossal Nerve (CN 12) what are the positive findings and indications?

Tongue deviation = Deviates to same side as lesion Muscle test (pressure using tongue) = Lesion on weak side

``` Dermatomes C5 lateral bicep C6 thumb C7 pointer and middle fingers (both sides!) radial nerve dorsal, median nerve ventral C8 pinky and ring finger T1 medial biceps (arms straight out) L1 inguinal ligament L2 medial thigh L3 above knee cap L4 below knee to big toe L5 side of foot, pinky toe S1 back of calf ``` what are the positive findings and indications?

Anesthesia, hypoesthesia = Hyposensitivity, Hypoalgesia | Peripheral neuropathy, Radiculopathy

Tromner’s- flick up what are the positive findings and indications?

Clawing of fingers or adduction of thumb = Corticospinal Tract lesion

Hoffman’s- flick down what are the positive findings and indications?

Clawing of fingers or adduction of thumb = Corticospinal Tract lesion

Rosselimos- hammer on MCP heads what are the positive findings and indications?

Flexion of all digits = Corticospinal Tract lesion

Babinski Sign what are the positive findings and indications?

Extension of great toe, abduction of little toes (babinski’s sign) = Corticospinal Tract lesion

Oppenheim’s- medial tibia with knuckles what are the positive findings and indications?

Babinski’s sign = Corticospinal Tract lesion

Chaddocks lateral malleolus what are the positive findings and indications?

Babinski’s sign = Corticospinal Tract lesion

Schaeffer’s Sign- foot hanging, squeeze Achilles what are the positive findings and indications?

Babinski’s sign = Corticospinal Tract lesion

Gordon’s- squeeze calf what are the positive findings and indications?

Babinski’s sign = Corticospinal Tract lesion

Ganda- 4th toe into flexion what are the positive findings and indications?

Babinski’s sign = Corticospinal Tract lesion

Mendel Bechterew- tap outside of foot (Cuboid) what are the positive findings and indications?

Babinski’s sign = Corticospinal Tract lesion

Dorsal columns (2 point discrimination, vibration and joint position sense) what tests would you do?

Statognosis- ability to recognize up or down position of joint Test at least 2 fingers and 2 toes Arthrostesia- move the finger in diff. directions Graphesthesia- discern shapes, letters, numbers, etc Stereognosis- Identify household objects inability to correctly discern = posterior column dysfunction

Jaw Jerk what are the positive findings and indications?

Jaw Jerk = a)Hypo: LMN or trigeminal nerve dysfunction b) Hyper: UMN or corticobulbar tract dysfunction

Upper Extremity myotomes C5-Deltoid (axillary), Biceps brachii (musculocutaneous) C6-Wrist Extensor Group(deep radial), Brachioradialis (radial) C7-Triceps brachii (radial), Wrist Flexor Group(medial), Finger Extensors (radial) C8- Finger Flexors (FD superficialis and profunda) (median) T1- Palmar and Dorsal Interossei (ulnar) ; PAD, DAB

Positive (+) finding anything less than 5/5 on one side compared to the other. Indication = radiculopathy of respective level, peripheral neuropathy, individual muscle pathology

Lower extremities myotomes: L1/ L2- Illiopsoas (Femoral nerve) L2/L3- Quadriceps Group (Femoral nerve) L4- quads (femoral) and Tibialis Anterior (deep peroneal) L5- Extensor Hallicus Longus(Deep peroneal nerve), Extensor Digitorum Longus/ brevis(Superficial fibular nerve), Gluteus Medius (Superior gluteal nerve) S1- Gastrocnemius, Peroneus Longus and Brevis (Superficial peroneal nerve)

Positive (+) finding anything less than 5/5 on one side compared to the other. if grade is

dermatomes what are the positive findings and indications?

Anesthesia or Hypoesthesia = Hyposensitivity Hypoalgesia Peripheral neuropathy Spinal Radiculopathy Unilateral Hypoesthesia = Spinal Radiculopathy

C5 DTR | Biceps Reflex

Hyporeflexia - C5 spinal radiculopathy or lesion to musculocutaneous nerve Hyperreflexia (Clonus: violent/spastic paralysis)= lesion of corticospinal tract Clonus: violent/spastic paralysis

C6 DTR | Brachioradialis reflex

Hyporeflexia = C6 spinal radiculopathy or lesion to radial nerve Hyperreflexia = Lesion of corticospinal tract on involved side

C7 DTR triceps

Hyporeflexia = C7 spinal radiculopathy or Radial neuropathy Hyperreflexia = Lesion of corticospinal tract on involved side

L4 DTR patellar knee jerk

Hyporeflexia = L4 spinal radiculopathy or femoral neuropathy Hyperreflexia = Lesion of corticospinal tract on involved side

L5 DTR semitendinosus

Hyporeflexia = L5 spinal radiculopathy or sciatic neuropathy Hyperreflexia = Lesion of corticospinal tract on involved side

S1 DTR achilles tendon

Hyporeflexia= S1 spinal radiculopathy or peripheral neuropathy Hyperreflexia = Lesion of corticospinal tract on involved side

What tests do we do to test the posterior columns?

``` Light Touch (Anterior SpinoThalamic Tract) Vibration Sense (Pallesthesia) Statognosis Arthrostesia Graphesthesia Stereognosis ```

Vibration Sense (Pallesthesia) what are the positive findings and indications?

apallesthesia- lesion to fasciculus cuneatus (T6 &above) or fasciculus gracilis (T7 & below)

Statognosis what are the positive findings and indications?

inability to discern whether the joint is up or down = fasciculus cuneatus (T6 & above), fasciculus gracilis (T7 & below)

Arthrostesia what are the positive findings and indications?

inability to distinguish anarthrostsia-inability to sense joint moving or not = fasciculus cuneatus (T6 & above), fasciculus gracilis (T7 & below)

Graphesthesia what are the positive findings and indications?

Agraphesthesia: Patient cannot determine shape = fasciculus cuneatus (T6 & above), fasciculus gracilis (T7 & below)

Stereognosis what are the positive findings and indications?

Astereognosis: Patient cannot determine what the object is = fasciculus cuneatus (T6 & above), fasciculus gracilis (T7 & below)

Superficial Abdominal Reflexes what are the positive findings and indications?

No deviation = adipose tissue, baby, | above umbilicus: UMN of corticospinal tract (T7-T9) below umbilicus: LMN (T10-T12)

Beevor’s Sign what are the positive findings and indications?

Deviation to one side if asymmetrical muscle weakness = lesion to T7-T12 spinal nerves ** the problem is diagonal from the positive sign. ex) if theres a deviation in lower right quadrant; the problem is in upper left spinal nerve) T7-9= upper; T10-12= lower

positive findings and indications Flashcards

(55 cards)