Tests 1

Question 1

What is the Weber Test? What is normal weber test?

Answer 1

Test for lateralization
Place the base of the lightly vibrating tuning fork firmly on top of the patients head or on the mid forehead. Normal is vibration heard in the midline or equal lateralization.

Question 2

What do you hear in a conductive hearing loss with Rinne and Weber Test?

Answer 2

Conductive Hearing loss:

Rinne Test: Abnormal in affected ear (AC

Question 3

What do you hear in a sensorineural hearing loss with Rinne and Weber Test?

Answer 3

Sensorineural hearing loss:
Rinne Normal, Weber lateralized in the good ear

Rinne Test: Normal or positive in both ears (AC > BC)
Weber Test: Sound lateralizes to the good/unaffected ear.

MNEMONIC: Weber and Rinne has Bad conduct and good, normal senses.

Bad Conduct: In conductive loss, Weber sound lateralizes to the Bad/affected ear, and AC

Question 4

What is Rinne Test and what is normal?

Answer 4

Rinne Test: compares air conduction (AC) and bone conduction (BC).
Place the base of a lightly vibrating tuning fork on the mastoid bone, behind the ear and level with the canal. When the patient can no longer hear the sound, quickly place the fork close to the ear canal and ascertain whether the sound can be heard again. Here the “U” of the fork should face forward, thus maximizing its sound for the patient. Pt. should be able to hear it. Normally the sound is heard longer through air conduction than through bone conduction (AC > BC).

Question 5

Which part of ear does the Conductive hearing loss involve?

Answer 5

External canal or middle ear

cerumen impaction, ear plugs, fluid in middle ear, wearing of head phones

Question 6

Which part of ear does sensorineural hearing loss involve?

Answer 6

Inner ear, 8th CN

hereditary hearing loss, presbycusis, noise exposure, Meniere’s disease, Acoustic tumors, Trauma.

Question 7

WEBER, RINNE TEST

Mnemonic

Answer 7

Normally:
Weber doesn’t lateralize, and both ears have +Rinne (AC>BC).

Conductive loss:
Weber lateralizes to BAD ear, - Rinne in BAD ear

Sensorineural loss:
Weber lateralizes to GOOD ear, + Rinne in both ears (normal AC > BC)

MNEMONIC: Weber and Rinne has Bad conduct and good, normal senses.

Bad Conduct: In conductive loss, Weber sound lateralizes to the Bad/affected ear, and AC

Question 8

Weber Lateralizes Left & Rinne both ears AC > BC =

a. sensorineural loss Right ear
b. sensorineural loss Left ear
c. conductive loss on the right
d. conductive loss on the left

Answer 8

senorinerual loss Right ear

If RINNE is both positive think sensorineural always and WEBER is the opposite.

MNEMONIC: Weber and Rinne has Bad conduct and good, normal senses.

Bad Conduct: In conductive loss, Weber sound lateralizes to the Bad/affected ear, and AC

Question 9

Weber Lateralizes Right & Rinne both ears AC > BC =

a. sensorineural loss Right ear
b. sensorineural loss Left ear
c. conductive loss on the right
d. conductive loss on the left

Answer 9

sensorineural loss Left ear

If RINNE is both positive think sensorineural always and WEBER is the opposite.

MNEMONIC: Weber and Rinne has Bad conduct and good, normal senses.

Bad Conduct: In conductive loss, Weber sound lateralizes to the Bad/affected ear, and AC

Question 10

Rinne Left BC>AC & Weber’s lateralized to the left =

a. sensorineural loss Right ear
b. sensorineural loss Left ear
c. conductive loss on the right
d. conductive loss on the left

Answer 10

conductive loss on the left

Since Rinne is not positive on both, it is a conductive loss. and Rinne tells us it is LEFT.

MNEMONIC: Weber and Rinne has Bad conduct and good, normal senses.

Bad Conduct: In conductive loss, Weber sound lateralizes to the Bad/affected ear, and AC

Question 11

Rinne Right BC>AC & Weber’s lateralized to the right =

a. sensorineural loss Right ear
b. sensorineural loss Left ear
c. conductive loss on the right
d. conductive loss on the left

Answer 11

conductive loss on the right

Since Rinne is not positive on both, it is a conductive loss. and Rinne tells us it is RIGHT.

MNEMONIC: Weber and Rinne has Bad conduct and good, normal senses.
Bad Conduct: In conductive loss, Weber sound lateralizes to the Bad/affected ear, and AC

Question 12

Which tuning fork is easier to hear?

a. 512Hz tuning fork.
b. 128Hz
c. 256Hz tuning forks

Answer 12

512Hz tuning fork.

Greater the number, easier it is to hear.

Question 13

To assess vibration sensation in neurological examinations.

a. 512Hz tuning fork.
b. 128Hz
c. 256Hz tuning forks

Answer 13

b. 128Hz tuning forks

Question 14

512 Hz Tuning Fork inability to hear indicates

a. at least 20 - 30 db Loss
b. at least 10 - 15 db Loss

Answer 14

a. at least 20 - 30 db Loss

Question 15

256 Hz Tuning Fork inability to hear indicates

a. at least 20 - 30 db Loss
b. at least 10 - 15 db Loss

Answer 15

b. at least 10-15 db Loss

Question 16

What tests are done to detect Appendicitis?

Answer 16

1. Pain at McBurney’s point.
2. Positive Psoas sign
3. Positive Obturator sign
4. rebound tenderness
5. Rovsings sign or Blumberg sign

Labs:
Elevated WBC 10,000 to 20,000
ESR elevated

US in children
CT in adults

Question 17

What is Rovsings sign and where is it found?

Answer 17

What is Rovsings sign and where is it found?
Rovsing’s sign—pain RLQ with left-side pressure; highly indicative of appendicitis in
children and adults

Question 18

What is Mcburney’s point and what does pain here indicate

Answer 18

McBurney’s point: 1/3rd or halfway between umbilicus and anterior superior iliac crest. Pain at this point or tenderness when palpating indicates appendicitis.

Question 19

What is psoas sign and what does a positive test result indicate?

Answer 19

Pain at RLQ with right thigh extension.
The patient is asked to lie on the unaffected side and extend the other leg at the hip against the resistance of the examiner’s hand. A positive psoas sign is abdominal pain with this maneuver indicating appendicitis

Question 20

What is rebound tenderness and what does it indicate?

What is the other name for it?

Answer 20

Rebound tenderness: Where pain is felt on the release of applied pressure upon the abdomen in the RLQ, felt on peritonitis and appendicitis

Also known as Blumberg sign: pain on release.

Question 21

What is Obturator sign and what does it indicate?

Answer 21

Obturator sign—rotating thigh may produce
pain in RLQ (think of orbiting/rotating)
Appendicitis

Question 22

What is a positive trendenlenburg’s sign and what does it indicate?

Answer 22

Asking child to stand on affected side causes a pelvic tilt, the unaffected side is lower. There is a dip in hip on affected side. Positive in Slipped capital femoral epiphysis (SCFE), Legg-Calve Perthes and Developmental dysplasia.

Question 23

Phren’s Sign:

Answer 23

Positive prehn’s sign is a comforting measure.

It shows discomfort of scrotum is decreased with elevation of the testes. It is seen in epididymitis only.

Question 24

Auspitz’s sign

Answer 24

Pinpoint bleeding when psoriatic scale is removed. Mostly on the knees. example of a plaque which is more than 1 cm with raised lesion, same or different color from surrounding skin, can result from a coalescence of papillose.

Question 25

Cerebellar function tests

Answer 25

``` It tests for balance and coordination Romberg test: Finger to nose test Heel to shin test Rapidly Alternating Movement Evaluation Gait and Tandem Walking ```

Question 26

Romberg test

Answer 26

Evaluates proprioception ( sense of position of self and movement) and cerebellar function (tests for balance and coordination) Ask the patient to stand feet together, eyes closed and arms at the side. Postive Romberg: If the patient has a loss of balance, there is likely to be lesion in the cerebellum

Question 27

Finger to Nose test (FNT)

Answer 27

Pt. alternately points from his nose to the examiners finger. Checks for cerebellar function and proprioception Dysmetria is the clinical term for the inability to perform point-to-point movements due to over or under projecting ones fingers.

Question 28

Heel to shin test

Answer 28

The patent runs the heel of one foot along the shin of the opposite leg. The heel to shin test is a measure of coordination and may be abnormal if there is loss of motor strength, proprioception or a cerebellar lesion. If motor and sensory systems are intact, an abnormal, asymmetric heel to shin test is highly suggestive of an ipsilateral cerebellar lesion.

Question 29

Gait is evaluated by having the patient walk across the room under observation. Gross gait abnormalities should be noted. Tandem Gait: Next ask the patient to walk heel to toe across the room, then on their toes only, and finally on their heels only. Normally, these maneuvers possible without too much difficulty.

Answer 29

Gait is evaluated by having the patient walk across the room under observation. Tandem Gait: Next ask the patient to walk heel to toe across the room, then on their toes only, and finally on their heels only. Normally, these maneuvers possible without too much difficulty. Be certain to note the amount of arm swinging because a slight decrease in arm swinging is a highly sensitive indicator of upper extremity weakness. Also, hopping in place on each foot should be performed. Walking on heels is the most sensitive way to test for foot dorsiflexion weakness, while walking on toes is the best way to test early foot plantar flexion weakness. Abnormalities in heel to toe walking (tandem gait) may be due to ethanol intoxication, weakness, poor position sense, vertigo and leg tremors. These causes must be excluded before the unbalance can be attributed to a cerebellar lesion. Most elderly patients have difficulty with tandem gait purportedly due to general neuronal loss impairing a combination of position sense, strength and coordination. Heel to toe walking is highly useful in testing for ethanol inebriation and is often used by police officers in examining potential "drunk drivers".

Question 30

Rapidly Alternating Movement Evaluation

Answer 30

Rapidly Alternating Movement Evaluation Ask the patient to place their hands on their thighs and then rapidly turn their hands over and lift them off their thighs. Once the patient understands this movement, tell them to repeat it rapidly for 10 seconds. Normally this is possible without difficulty. This is considered a rapidly alternating movement. Dysdiadochokinesis is the clinical term for an inability to perform rapidly alternating movements. Dysdiadochokinesia is usually caused by multiple sclerosis in adults and cerebellar tumors in children. Note that patients with other movement disorders (e.g. Parkinson's disease) may have abnormal rapid alternating movement testing secondary to akinesia or rigidity, thus creating a false impression of dysdiadochokinesia.