Discussion Board: Finals Flashcards
Causes of No or Diminished response for Evaluation of Deep Tendon Reflexes & Bicpes
Evaluation numbers
Calcium or Magnesium excesses
Hypothyroidism
Spina bífida
Guillain-Barré syndrome
0 or +1
Hyperactive results for Evaluation of Deep Tendon Reflexes is caused by…
What is the Evaluation number
Spinal cord injury
Calcium and magnesium deficits
Hyperthyroidism
3+ and 4+
To check ocular alignment
Inspect corneal light for symmetry by shining a light in the Nose is (This Test)
Hirschberg test
Hirschberg test
Patient stares straight
Stand 12 - 15” away
Penlight on bridge of nose
Look for reflection in each eyes
Normal & Abnormal findings
Causes of abnormal findings
Normal: symmetric reflection in both cornea
Abnormal: assymetrical and “off center”
Cause: Weakened extraocular muscles
Esotropia = eye turned inward
Exotropia = eye turned outward
Hypertropia = eye turned upward
Hypotropia = eye turned downward
Esotropia =
Exotropia =
Hypertropia =
Hypotropia =
Name of test associated with
Esotropia = eye turned inward
Exotropia = eye turned outward
Hypertropia = eye turned upward
Hypotropia = eye turned downward
Hirschberg
Pupils (dilate / constrict) when looking at a near object
Pupils (dilate / constrict) when looking at a far object
Near = constrict
Far = Dilate
the change in pupil size in the eye opposite to the eye to which the light is directed
Consensual reaction
What are normal findings in the Consensual pupil reaction
Normal: pupils are subtle, mild anisocoria (unequal pupil size)
Pupil 3 - 5 mm in diameter
React briskly to light
Both pupils constrict consensually
What are Abnormal findings in the Consensual pupil reaction
Cause of abnormal findings
Cause:
Optic nerve injury, oculomotor nerve damage, brain stem lesions (tumors), and barbiturates
Dilates
Bilateral: (Atropine, sever brain damage, profound hypoxia)
Unilateral: (Adie’s pupil, oculomotor never injury, benign anisocoria)
Small
Unilateral (Horners syndrome)
Bilateral Pinpoint, small, fixed and regular (Morphine, mitotic drops, pontine hemorrhage)
Argyle Robertson pupils
Shape
Irregular: (Iridectomy, argyle Robertson pupils)
Light reflex
Loss of direct light reflex: Afferent Limb (Blind eye, disease of retina or optical nerve) or Efferent Limb (Oculomotor nerve injury)
Loss of Consensual reflex: (Efferent Limb lesion of affected eye)
Loss of muscle coordination (ataxia) is associated with a positive result from this test
It is also associated with a spinal disorder (polyneuropathy)
Romberg’s test
_______ is a test that measures a persons sense of balance.
Specifically, the test assesses the function of the dorsal column of the spinal cord (the dorsal column is responsible for proprioception).[1]
The Romberg test
The Romberg sign is said to be (negative / positive) in a patient who is able to stand with his feet placed together and eyes open but paradoxically sways or falls while closing his eyes.
Cause:
Potential neurological conditions. One condition may be cerebellar ataxia, determined by a lesion to the cerebellum.
Positive
Plantar Reflex is looking for this _____ (sign)
Procedure: run tongue depressor along lateral side of foot and make a curve to the middle
Normal / abnormal findings
What is a positive sign
Causes
Babinski Reflex
Normal
<24 months: Dorsiflexion (upward) big toe and fanning of toes
Normal
>24 months. Plantarflexion (downward) with curling of toes
Abnormal:
Dorsiflexion (upward) big toe and fanning of toes
Positive = Abnormal
Cause: upper motor neuron disease
Achilles Deep Tendon Reflexes
Procedure
Dangle foot, dorsiflex foot, tap Achilles Tendon with blunt hammer
Normal / abnormal findings
Cuases of abnormal findings
Normal: Contraction of the gastrocnemius muscle, Plantar flexion of the foot
Abnormal: Hypo/Hyperreflexia or Asymmetrical response
Causes: hypo LMN
Hyper UMN (Upper motor neuron)
cerebrovascular accidents, amyotrophic lateral sclerosis,
primary lateral sclerosis,
multiple sclerosis,
Brown-Sequard Syndrome,
vitamin B12 deficiency.
Associated with…
UMN diseases
Which vitamin may cause an abnormal findings in lower extremity DEEP TENDON REFLEXES
B12
Knee effusion
Tests (2)
Positive sign: Floating or Bouncing of patella occurs Knee Joint Effusion (which test)
Press medial of patella, move hand in ascending motion. Firmly press lateral aspect of knee. Look at knee for bulges (describes this test)
Positive sign
Patellar tap (ballottement)/ Fluid displacement test (Bulge sign Test)
Patellar tap (Ballottement)
Fluid displacement (Bulge Sign Test)
Bulge noticed indicating effusion
Light touch sensation (which nerve)
Abnormal findings;
Inequal muscle contraction
Pain / twitching
5 (trigeminal)
Inability to feel tuning fork causes
Neuropathy caused by diabetes
Phalens test involves putting dorsal side of hands together in front of body for 1 minute…
What is a positive Phalens test
Tinel’s test
Patient puts arm in a supination position and Examiner taps on median nerve on the wrist.
What are positive findings
Which disease are these two test associated with
Both
Positive: paresthesia (tingling), numbness, or electrical sensation
Carpal Tunnel Syndrome
Proprioception, or kinesthesia, is
the sense that lets us perceive the location, movement, and action of parts of the body
Evaluation of cerebellar function, balance/ coordination (lower 2 extremities)
Procedure: Supine, runs heel of foot down shin on opposite leg / repeat on otherside
Abnormal = unable to do test smoothly
Causes
Cerebellar disease ( affect nerve cells which control coordination & balance)
Disease exp. MS
Evaluation of cerebellar function for balance and coordination (2 in lower extremities)
Heel to Toe walk
Abnormal: uncoordinated, Jerky movements / feet spread far apart
Causes
Cerebellar disease (affects nerve cells which control coordination and balance)
Disease exp. MS
Transillumante Sinus
Place light source on cheekbone just below the eye with head tilted back.
Reddish glow in mouth means (normal, air-filled sinus
Which Sinus is this checking
Put light below eyebrow and look for red glow, which describes normal findings for which sinus
Maxillary
Frontal
Rinne test aims to compare sound perception of bone conduction vs air conduction in hearing
Procedure:
Tuning fork on mastoid process
Ask patient to report when they cannot hear the sound.
Repeat with fork in front of ear
Normal: 2:1 ratio of sound heard in front of ear.
Abnormals (2)
Conductive hearing loss: Bone Conduction > Air Conduction
Sensorineural hearing loss: Air Conduction is longer than Bone but less than a 2:1 ratio
Evaluation of cerebellar function for balance and coordination (2 upper extremities)
Name them
Disease
Tap thighs with rapid pronation and supination
Both arms out: Alternatively touch index finger to nose
Touch each finger to thumb
Arms out touch nose then touch examiners finger
Ataxia, multiple system atrophy, Creutzfeldt-Jacob disease, MS
Patient looking at distant object then closely at your finger is testing for this
Accommodation
Shining light in one eye while accessing the other eyes pupils is called this type of response
Consensual
Pupils should dilate when looking at a distant object and constrict when looking at a close object is called
Accommodation
P
E
R
R
L
A
Pupils
Equal
Round
React
Light
Accommodation
Anisocoria is…
Can be caused by…
Anisocoria (unequal pupil size)
Local eye medication, amblyopia (lazy eye), unilateral sympathetic or parasympathetic pupillary pathway damage
Mydriasis is…
Caused by….
Mydriasis (pupils >6mm)
Atropine eye drops
Midbrain lesions
Hypoxia
Oculomotor damage
Acute-angle glaucoma
Miosis is…
Caused by….
Miosis (pupils <2mm)
Pilocarpine eye drops
anisocoria
Unequal pupil size
Webers test
Tuning fork in middle of skull
Ask which ear the sound is louder
Normal: Both the same
Abnormal:
Lateralization (sound is heard better)
The affected (bad ear) is lateralized = Conductive hearing loss
Lateralization to unaffected (good ear) = sensorineural hearing loss
Weber
Sensoryneuro hearing loss
Sound laterizes to unaffected ear
Say in plain English
In sensoryneuro hearing loss.
The tone is heard better in good ear
Weber
Conductive hearing loss
The sound laterizes to affected ear
Say in plain English
In Conductive hearing loss
Sound is heard better in bad ear
Sensorineuro hearing loss
Problem
Auditory nerve or cochlea
Conductive hearing loss
2 types ( Air & Bone conduction)
Problem
Sound waves cannot pass through outer and middle ear
Positive rinne test is (good or bad)
Describe it
Good
2:1 ratio of Air Conduction to Bone Conduction hearing
Inability to feel monofilament can be a sign of
Peripheral nerve damage from DM
6 cardinal field of gaze
Abnormal findings
Cause: Congenital/ Acquired
Nystagmus
involuntary eye movement which may cause the eye to rapidly move from side to side, up and down, or in a circle, and may slightly blur vision.
Congenital: neurological problem, albinism / cataracts
Acquired: stroke, MS, trauma, anti-epilepsy drugs
To test the medial meniscus, Examiner externally rotates the knee, then slowly extends the patient’s leg
To test the lateral meniscus, Examiner internally rotates the knee, then slowly extends the patient’s leg
Name this test
McMurray test
Glasgow Coma Scale
3 parts: Eye response, Verbal, Motor
Eyes opening
4
3
2
1
4 Spontaneously
3 To speech
2 To pain
1 No response
Glasgow Coma Scale
3 parts: Eye response, Verbal, Motor
Verbal:
5
4
3
2
1
5 Oriented to time, place, person
4 Confused
3 Inappropriate words
2 Incomprensible sounds
1 No response
Glasgow Coma Scale
3 parts: Eye response, Verbal, Motor
Motor:
6
5
4
3
2
1
6 obeys commands
5 moves to localized pain
4 flexion withdrawal from pain
3 abnormal flexion (decorticate)
2 abnormal extension (decerebrate)
1 no response
Glasgow Coma Scale
15 = Best Response
8 or less =
3 / totally unresponsive
Comatose client
Evaluation Deep tendon
Strike 2” above wrist and knee is called these areas
Abnormal findings/ causes
Brachioradialis & Patellar
Hyper / hypoactive response
Hyperactive: Spinal Cord injury, ALS, MS, PARKINSON, Calcium/ Magnesium deficits, Hyperthyroidism
Hypoactive: Calcium/ Magnesium excesses, Hypothyroidism, Spina bífida, Gullian-Barre Syndrome
Popping or clicking heard while palpating TMJ is an abnormal sign
True or False
False
It is only abnormal in the presence of other symptoms. ie. Pain
creputus
Creeky joint
How to set a goniometer
Place 0 setting over middle of joint in neutral position.
Move distal joint through ROM
Normal ROM for elbow
flexion lie between 130° and 154° and extension between –6° and 11°.
Causes of decreased ROM
Increased
Decreased: arthritis, fluid in joints, contracture of muscle, lig, capsule
Increased; connective tissue disruption, lig tear, facture
Kernig’s sign
Procedure: Supine, hip and knee flexed 90° knee slowly extended upward by Examiner.
It is considered positive if…
Which disease is it looking for
Positive if pain worsens in head / neck
Meningitis
Brudzinski Sign
Procedure: Supine, pull on back of neck.
Normal
Abnormal
What is a positive result.
Is positive good or bad
Associated Disease
Normal: no pain or resistance
Abnormal: flexion of hips and knees
Positive: Flex of hips and knees
Positive result is bad
Meningitis
Contracture
condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.
Which test, test for?
- unilateral conductive and sensorineural hearing loss
- Air conduction vs bone conduction hearing test
- Weber
- Rinne
Name the 2 test associated with meningitis
Kernig = supine, extend legs towards head.
Brudzinski = pull on back if neck, knees and hips flex = Positive sign
Describe 2 test for carpal tunnel syndrome
Phalens: Dorsal side of hands touch for 1 minute
Tinel’s: Tap on median nerve
Impaired balance or coordination, can be due to damage to brain, nerves, or muscles.
Ataxia
Paitent and Examiner both cover 1 eyes (opposite)
Extend hand to prefiery and slowly bring it midline.
Paitent should see object same time as Examiner
Repeat with 4 directions
Superior
Inferior
Temporal
Nasally
What are the normal values for these findings
If patient cannot see pencil at same time as Examiner _____ is suspected
Superior = 50°
Inferior = 70°
Temporal = 90°
Nasally = 60°
Peripheral field loss
Corneal flight reflex for symmetry is aka
Hirschberg
The Romberg test determines if your balance issues are related to the function of your _____
dorsal column
There are two balance related issues
ie. Which part of the body is responsible for the following balances
- Doing Heel to Toe & Heel to Shin
- Romberg
- Cerebellar
- Dorsal Column
