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Practical CSA > #1 > Flashcards

#1 Flashcards

1
Q

Cranial Nerve Exam

A
  1. Sense of smell (CN1)
  2. Cardinal Fields of Gaze (CNII, IV, VI)
  3. Accommodation (CN III)
  4. Peripheral Vision (CN II)
  5. Facial Expression (CN VII)
  6. Tongue Deviation (CN XII)
  7. Trap/SCM muscle Test (CN XI)
  8. Whisper Test (CN VIII)
  9. Direct & Consenual Light (CN II, III)
  10. Say “ah” (CN IX, X)
  11. Bite the Stick (CN V)
  12. Sensation - Light/Sharp (CN V)
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2
Q

External Eye Exam

A
  1. Gross eval of eyes and surrounding area
  2. Gross alignment of eyes (PERRLA)
  3. Cornea
  4. Iris and Pupil (PERRLA)
  5. Lacrimal Apparatus
  6. Eyelid Position (droop, bulge, inversion/eversion)
  7. Eyelid and margins
  8. Conjunctiva and sclera
  9. Anterior Chamber (penlight from side)
  10. Palpebral conjunctiva with penlight
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3
Q

Evaluation of the fundus (4 steps)?

A
  1. Red Reflex (from 6-18” at 15 degree angle)
  2. Optic Disc (1:2)
  3. Vessels in all 4 quadrants (small and light arterioles and large and dark veins)
  4. Anterior Chamber
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4
Q

How to use a snellen chart

A
  1. Patient 20 feet away
  2. One eye covered at a time, then both together
  3. Do not put pressure on the closed eye
  4. Record the smallest line that the patient can read at least half
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5
Q

How do you perform the corneal reflection test (Hirschberg)?

A
  1. Pen light 1 foot away from side of eye, pointing to bridge of nose (perpendicular)
  2. Reflection should fall slightly nasally from center of cornea and same location in each eye
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6
Q

Sensation of the face and head

A

V1: Ophthalmic nerve (nose, forehead top of head)
V2: Maxillary nerve (bottom of nose and zygomatic area
V3: Mandibular nerve (chin, side of face in front of ear, not angle of jaw)
C2: Greater Occipital Nerve (occipital lobe to ear)
C3: Lesser Occipital Nerve (behind ear)
C4: Spinal Nerve (back of neck and angle of jaw)

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7
Q

Ear Exam

A
  1. Palpation of pinna and surrounding structures
  2. Otoscopic exam (traction UP and BACK in adults and DOWN and BACK in kids)
  3. Inspect Auditory Canal (discharge, furuncles, swelling, inflammation, hair)
  4. Tympanic Membrane
  5. Pneumatic otoscopy
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8
Q

Dix-Hallpike Maneuver

A
  1. Instruct patient to keep eyes open but not fixed gaze
  2. Patient seated with leg extended and head in 45 degrees rotation
  3. Patient quickly laid down and head in 20-30 degrees of extension
  4. Observe eyes for 45 seconds for nystagmus
  5. If negative repeat on other side
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9
Q

Epley’s Maneuver

A
  1. Sitting upright with head and neck rotated 45 degrees to side of issue (determined by dix-hallpike)
  2. Patient placed supine with 20-30 degrees of extension. Maintain position until symptoms cease
  3. Head and neck slowly rotated to opposite side. Keep extension
  4. Patients body is slowly rotated so that face is facing down towards ground
  5. Slowly rotate head back to neutral and then into sitting position
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10
Q

Swivel Chair test

A
  1. Patient seated in swivel chair with eyes closed, rotates head rapidly
  2. Stabilize patient head with traction, patients eyes closed. Patient rotates body from side to side
  3. If step one provokes = vestibular, step two provokes = cervicogenic
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11
Q

External mouth and nose exam

A
  1. External nares: swelling, trauma, patency, symmetry
  2. Color and texture of lips
  3. Lesions?
  4. Evaulate breath
  5. Nasal vestibule
  6. Oral cavity (gingivae, teeth, tap on teeth, tongue, hard palate, pharynx)
  7. Sinuses: palpate, percuss, transilluminate (maxillary, frontal)
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12
Q

Flexion-Distraction

A
  1. Safety: check table
  2. Patient on table: stand on good leg, drag self on, maintain neutral pelvis
  3. Place patient ASIS on thoracic piece (better too high than too low)
  4. Turn table on and assess. Do not let table swing >2 inches or 15 degrees below point of tension
  5. Distract/flex patient on table. Use the 50% rule
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13
Q

What areas should you goad when treating with flexion/distraction?

A
  1. Paravertebral bladder meridian points (T12-S1)
  2. Iliolumbar ligaments
  3. Origin of glut medius (dollar sign area?)
  4. Belly of TFL and IT band down to knee
  5. Posterior knee
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14
Q

How long/often should you do flexion distraction during treatment? goading?

A

Goading
4-5 Reps in 20 seconds
Goading
Repeat 2x more times

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15
Q

Definition of “true” orthostatic hypotnension

A
  1. Standing induced symptoms of lightheadedness, dizziness or blurred vision
  2. Persistent fall of systolic/diastolic BP of more than 20/10 mmHg within 3 minutes of assuming upright position
  3. Some authors include a rise in BP to be indicative
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16
Q

Ankle arm index (peripheral arterial disease)

A

Index = ankle BP/arm BP

Normal range is 1.0-1.3

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17
Q

Posterior tibial artery evaluation

A
  1. Behind medial melleolus

2. Congenitally absent in 2% of population

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18
Q

Where can you hear S1 sounds best

A
  1. Closure of Mitral and Tricuspid valves (atrioventricular)
  2. Start of ventricular systole
  3. Best heard at apex (on left 5th intercostal space)
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19
Q

Where can you best hear S2 sounds?

A
  1. End of ventricular systole
  2. Closure of aortic and pulmonic valves
  3. Best heard at base of heart in R/L 2nd intercostal space
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20
Q

Systolic murmurs

A
  1. Aortic stenosis (midsystolic)
  2. Mitral regurgitation (early)
  3. Mitral valve prolapse
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21
Q

Diastolic murmurs

A
  1. Aortic regurgitation (early)

2. Mitral stenosis (middiastolic: longer duration)

22
Q

What do malignant lymph nodes feel like?

A
  1. Hard/indurated
  2. not moveable
  3. Not pain sensitive
  4. no discrete margins
  5. Larger than 1cm
23
Q

What do hyperplastic lymph nodes feels like (most common)?

A
  1. Firm
  2. moveable
  3. non-tender
  4. Discrete margins
  5. Less than 1 cm
24
Q

What is included in a lung exam?

A
  1. History (what are you looking for?)
  2. Inspection (evidence of difficulty breathing?)
  3. Palpation (upper thoracic spine/ribs, tactile fremitus, costovertebral angle tenderness, thoracic excursion)
  4. Percussion (for distended kidney capsule, SPs for ligamentous damage, changes in lung density)
  5. Auscultation
25
Q

Definition of respiratory distress

A
  1. Increased respiratory rate >30 per minute
  2. Increased HR >120 per minute
  3. Excessive use of accessory muscles of respiration
  4. Inability to speak d/t SOB
  5. Diaphoresis
26
Q

Digital clubbing is associated with _____

A

Advanced chronic bronchitis (classically). Can also be associated with: lung tumors, bronchiectasis, lung abscess, empyema, intersitital fibrosis, cirrhosis, heart disease (cyanotic)

27
Q

Presentation of classic lobar pneumonia

A
  1. history of cold/URTI followed by sudden onset of fever (101.3F) and chills
  2. Diaphoresis
  3. Productive cough with mucopurulent sputum
  4. Bronchial breath sounds (soft snoring)
28
Q

What are signs of classic lobar pneumonia?

A
  1. Decreased intensity of normal breath sounds
  2. Possible pleuritic chest pain
  3. Increased tactile fremitus
  4. Decreased exursion
  5. Dullness to percussion (consolidation)
29
Q

Pancoast tumor presentation

A
  1. Sudden onset of neck/shoulder/upper rib/arm pain
  2. middle age (40 -60)
  3. Male
  4. Smoker
  5. Possible Horner syndrome
30
Q

Abdominal exam

A
  1. Inspection: skin, veins, contour, symmetry, umbilicus
  2. Auscultation: active bowel sounds, arterial bruits
  3. Percussion (start away from site of pain)
  4. Palpation (superficial and deep)
  5. Abdominal aorta
31
Q

Ely’s test

A
  1. For hip lesions, irritation of iliopsoas, lumbar nerve root irritation
  2. Patient prone, heel to opposite buttock
32
Q

Hibb’s test

A
  1. SI lesions

2. Patient prone, stabilize opposite PSIS, pull leg out

33
Q

Lumbar Segmental Instability Test

A
  1. Patient prone over end of table, feet supported on floor
  2. Doc pushes PA thru lumbar spine with muscles relaxed
  3. Patient lifts feet off ground and doc repeats
  4. Improvement with contraction suggests instability
34
Q

Nachlas’ Test

A
  1. SI or lumbosacral disorder
  2. Patient prone
  3. Doc brings heel to ipsilateral buttock
35
Q

Prone extension test

A
  1. Patient actively extends back with arms at sides
  2. Doc provides overpressure, patient resists
  3. Patient stabilizes on arms with back muscles relaxed and doc provides Pa force thru spine
36
Q

Positions for quadrant test

A
  1. Patient flexed forward, flexed laterally and rotated to side of pain
  2. Stay flexed forward and laterally flex and rotate to opposite side
  3. Extend and laterally flex and rotate away from pain
  4. Extend and laterally flex and rotate towards pain (Kemp’s)
37
Q

Adson’s

A

Patients head to affected side!

38
Q

Halstead (reverse adson’s)

A

Patients head to non-affected side

39
Q

Wright’s/Hyperabduction

A
  1. Find pulse in both arms when at patients side (with slight extension)
  2. Abduct arms until pulse becomes weak or stops
  3. Recreation of CC pain or radial pulse disappears = positive
40
Q

Eden’s/Costoclavicular

A
  1. Tell patient to let you know if they experience any PAIN, NUMBNESS, TINGLING in arms
  2. Extend patients arms and then tell patient to adopt military posture
  3. Patient sticks chin out and neck forward and adds valsalva
41
Q

Radial Nerve Tension Test

A
  1. Shoulder depression
  2. Elbow extension
  3. Glenohumeral internal rotation
  4. Wrist and Finger flexion
  5. Thumb flexion and adduction, wrist ulnar deviation
  6. Glenohumeral abduction
  7. Structural differentiation (release different parts)
  8. Sensitizing movements (head and neck)
42
Q

Ulnar Nerve Tension Test

A
  1. Shoulder depression
  2. Wrist and finger extension
  3. Elbow flexion
  4. Glenohumeral external rotation then abduction
  5. Structural differentiation
  6. Sensitizing movements
43
Q

Cyriax Release

A

Passive shoulder girdle elevation while doc looks for arm symptoms. Hold for at least 1 minute but not more than 3

44
Q

Brudzinski’s sign

A
  1. Meningeal irritation/inflammation
  2. Supine patient, doc passively flexes neck
  3. Positive test = hip or knee flexion
45
Q

Cozen’s Test

A
  1. Lateral epicondylitis, extensor tendons
  2. Patient in Waiter’s position
  3. Doc supports elbow and contacts dorsum of hand with overpressure
46
Q

Mills’ Test

A
  1. Lateral epicondylitis, common extensor tendon

2. Passively fully extend and pronate elbow while flexing the wrist

47
Q

Reverse Cozen’s

A
  1. Medial epicondylitis
  2. Elbow flexed 45-90, wrist flexed and ulnarly deviated
  3. Doc applies overpressure
48
Q

Reverse Mill’s

A
  1. Medial epicondylitis, carpal tunnel

2. Fully extends elbow, wrist and fingers (passive)

49
Q

Elbow flexion/hyperflexion test

A

Elbow flexed (not wrist!!) hold for three minutes to check for ulnar nerve issues in the cubital tunnel

50
Q

Elbow fracture screen

A
  1. humerus (shaft, medial/lateral supracondylar ridges, medial/lateral epicondlyes)
  2. Ulna (styloid, ridge, olecranon)
  3. Radius (styloid, shaft, head)
  4. Torsion (IR/ER, pronation/supination)
  5. AROM
51
Q

Shoulder fracture screen

A
  1. humerus (shaft, medial/lateral supracondylar ridges, medial/lateral epicondlyes)
  2. Scapula (spine, coracoid, acromion, inferior angle, medial/lateral borders)
  3. Clavicle
  4. Torsion (IR/ER)
  5. AROM

Practical CSA (1 decks)

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