Examinations Flashcards
CN I?
Olfacotry - sense of smell
Damage = loss of smell
CN II?
Optic - vision (including detecting light)
Damage = reduced vision, loss of accomodation and loss of pupilary reflex
CN III?
Occulomotor - eye muscles and pupillary contraction
Damage = ptosis, eyes look down and out, dilated pupils
CN IV?
Trochlear - eye muscles
Damage = verticle diplopia (when looking down and inwards e.g. when reading or walking down stairs)
CN V?
Trigeminal (opthalmic, maxillary and mandibular branches) - sensation to the face and muscles of mastication
Damage = loss of corneal reflex, loss of facial sensation and difficulty chewing. Loss of jaw jerk in UMN lesion
CN VI?
Abducens - eye muscles
Damage = horizontal diplopia (when looking outwards), the eye will rest in adduction and can not be abducted
CN VII?
Facial - taste to the anterior 2/3rds of the tongue, muscles of facial expression and glands e.g. lacrimal/submandibular/sublingual glands
Damage = Paralysis of the facial musles on the ipsilateral side = facial weakness, mouth droop and flattening of the nasolabial fold. Also loss of taste to anterior tongue
If UMN damage = forehead sparring, if LMN damage = forehead paralysis
CN VIII?
Vestibulocochlear - hearing and balance
Damage = vertigo and nystagmus (if vestibular involvement), hearing loss and tinnitus (if cochlear involvement)
CN IX?
Glossopharygneal - taste to psoterior 1/3 of the tongue, sensory part of the gag reflex
Damage = loss of gag reflex, uvula deviates away from the damged side
CN X?
Vagus - muscles of speech, motor part of the gag refelx and parasympathetic innervation to the heart and GI system
Damage = Bouvine cough, uvula deviates away from the damged side
CN XI?
Accessory - Trapezius (allows shoulder shrugging) and sternocleidomastoid (allows the head to turn)
Damage = difficulty turning the head and shrugging the shoulders
CN XII?
Hypoglossal - tongue muscles
Damage = tongue deviates towards the damged side
What is Rinne’s test?
Place a tuning fork on the mastoid process until it is no longer heard then place it next to the external acoustic meatus.
Bone better than air = conductive hearing loss
Air and bone both decreased = sensorineual hearing loss
What is Weber’s test?
Place a vibrating tuning fork on the forehead in the midline
Conductive hearing loss = louder in abnormal ear
Sensorineural hearing loss = louder in normal ear
Describe the MRC grading of motor power?
5/5 = movement against gravity with full power against resistance
4/5 = movement against gravity with reduced power against resistance. 4-, 4 and 4+ = movement against slight, moderate and
strong resistance respectively
3/5 = movement against gravity only without applied resistance
2/5 = muscle contraction with active movement only when gravity is eliminated
1/5 = flicker of muscle contraction seen, no movement
0/5 = no muscle contraction
What would you expect to see in cerebellar dysfunction?
Dysarthria when saying repeated letters, intention tremor, nystagmus, uncoordination when attempting rapid repetitive movements, ataxia, wide stance and inability to walk toe to heel
Which nerve roots supply the lower limb reflexes?
Knee = L3/4 Ankle = L5/S1 Plantar = L5/S1/S2
Which nerve roots supply the upper limb refelxes?
Biceps = C5/6 Triceps = C7 Supinator = C6
What is normal chest expansion?
3-5cm
What do pectus excavatum and pectus carinatum mean?
Funnel chest and Pigeon chest
When might you feel parasternal heaves?
Ventircular hypertrophy (particularly left ventricular)
Which position do you put the patient in to best hear mitral stenosis and aortic regurgitation?
Mitral stenosis = roll the patient onto their left side
Mitral regurg = lean the patient forward
What causes pronator drift and ankle clonus?
UMN lesion
What is the Romberg’s test? What does it show?
The patient stands with their arms out in front and their hands supinated.
If they can not do this with their eyes open = cerebellar lesion
If they can with their eyes open but not with them closed = loss of proprioception
Describe the hemiplegic gait?
Patient lurches their upper body towards the unparalysed side to elevate the pelvis and swings the paralysed leg round. The plantar flexed foot of the paralysed leg scrapes the floor
Describe the apraxic gait?
Patient is slow and shuffling - stride lenght is markedly reduced and balance can be lost when turning - wide base.
Parkinsons gait is this but with additional loss of arm swing and with narrow base
Describe the steppage gait?
Foot drop forces the patient to flex the knee and lift the foot high to clear their toes from the ground
Describe the ataxic gait?
Wide base, patient sways when walking - this will be most pronouced on heel-to-toe walking
Describe the MRC power score?
5/5 = movement against gravity, full power against resistance 4/5 = movement against gravity and reduced power against resistance (4-,4 and 4+) 3/5 = movement against gravity only without applied resistance 2/5 = muscle contraction with active movment only when gravity is removed 1/5 = flicker of muscle contraction but no movement 0/5 = no muscle contraction
When is the forehaed sparred?
UMN lesions
What is Rinne’s test? What does it show?
Place the tuning fork on the mastoid process until sound is no longer hears, then move to the external acoustic meatus (it should be heard again).
Conductive hearing loss = sound is conducted better through bone and sound is not heard when placed next to the EMA
Sensorineural hearing loss = sound is reduced equally in air and bone
What is Webber’s test? What does it show?
Place the tuning fork on the forehead in the midline.
Conductive hearing loss = sound is louder in the abnormal ear
Sensorineural hearing loss = sound is louder in the normal ear
What can be seen on examination in cerebellar dysfunction?
Dysarthria (difficulty saying repeating letters or tongue twisters), dysmetris and intention tremor (tremor and overshooting in finger-nose test), nystagmus which is worse on looking towards the side of the lesion, ataxia, wide based stance and inability to walk heel-to-toe
How can you localise the lesion in cerebellar ataxia?
Vermis lesion = truncal ataxia
Cerebellum hemisphere lesion = ipsilateral limb ataxia
What bowel sounds can you hear that indicate pathology?
Tinkling bowel sounds = intestinal obstruction
No bowel sounds = peritonism
What sequence of exams should you do at the end of a GI exam?
ISHRUG Inguinal lymph nodes Stools Hernial orifices Rectal examination Urinalysis Genitalia
What movements of the shoulder are seen when:
- Putting your hands behind your head and pushing the elbows back
- Putting your hands behind your back
- Shoulder abduction and external rotation
2. Shoulder abduction and internal rotation
How can you asses joint effusion?
Patella tap (slide hand down the thigh towards the knee) Bulge test (slide hand around the knee)
What is Thomas’ test? What is a positive test?
Assesses for fixed flexion deformity of the contralateral hip by flexing the ipsilateral hip fully
+ve = the unflexed hip will lift off the bed. Indicates a fixed flexion deformity in the unflexed hip
What is Trendelenburg’s test? What is a positive test?
Assess abductor strength in the contralateral hip by lifiting the ipsilateral leg off the floor
+ve = the pelvis will drop on the side of the leg which is lifted off the ground. Indicates abductor pathology in the planted leg
Which muscles make up the hip abductors?
Gluteus medius, gluteus minimus, tensor fascia latae and sartorious
How can you test the cruciate ligaments?
Posterior draw test OR posterior sag test = PCL pathology
Anteror draw test = ACL pathology
How can you test the collateral ligaments?
Flex the knee to 20 degrees and apply a stress - look for gapping.
Varus stress which causes lateral gapping = lateral collateral damage
Valgus stress which causes medial gapping = medial collateral damage
What is McMurray’s test? What does it show?
Flex the hip to 90 degrees and maximally flex the knee. Internally or externally roatate the knee then extend the knee gradually.
Palpable/audiable/painful clicks on extension indicate a meniscal tear
On external roation = medial meniscal tear. On internal rotation = lateral meniscal tear
Which nerve is responsible for toe extension?
Deep peroneal/fibular nerve (they are the same nerve)
Which nerves are responsible for toe flexion, abduction and adduction.
Medial and lateral plantar nerves
Foot drop and loss of inversion implies damage to which nerve?
Common peroneal/fibular nerve (they are the same nerve)
Plantar flexion is lost on damage of which nerve?
Tibial nerve damage
Eversion is lost on damage of which nerve?
Superficial peroneal/fibular nerve (they are the same nerve)
What is the straight leg raise test? What does it indicate?
With teh patient supine lift the leg (keep the knee extended)
Pain in the leg or bak indicates a L4/L5/S1 nerve root lesion
What is the bowstring test? What does it indicate?
Carry out a straight leg raise. If the patient experiences pain flex the knee (this should reduce pain), then press in the popliteal fossa with the thumb.
Radiating pain/parastehsia indicates tension of the sciatic nerve
What is the femoral stretch test? What does it indicate
Lie the patient prone and flex each knee in turn.
Pain in the front of the thigh indicates L2-L4 root damage
What is the first movement lost in frozen shoulder?
External rotation
What is the painful arc? What does it indicate?
Ask the patient to abduct their arm from their side to the sky. Painful arc = pain from 60-120 degrees - this indicates roator cuff pathology
What are the rotator cuff muscels?
Supraspinatus, infraspinatus, teres minor and subscapularis
How does pathology in each of the roator cuff muscles present?
Resisted active abduction in the first 15 degrees or empty can test = supraspinatus
Resitsed active external roation = infraspinatus and teres minor
Resisted acitve internal rotation (lift off test) = subscapularis
What is the scarf test? What does it show?
Place the arm into forced adduction across the body with the shoulder at 90 degrees flexion.
Pain or tenderness over the Acromioclavicular joint indicates ACJ pathology
How do you confirm tennis elbow and golfers elbow?
Tennis elbow = pain in the lateral epicondyle when extending the wrist with the arm pronated
Glofers elbow = pain in the medial epicondyle when flexing the wrist with the arm supinated
What is Allen’s test?
Test the vascualr supply to teh hand (from the ulnar and radial arteries)
How can you test the median nerve?
Sensation over the median distribution Motor = palmar abduction (with the hand supinated ask the patient to point their thumb to the celing) Tinnels test (tap on the median nerve) and Phalens test (place the wrist in forced flexion) and Compression test (compress the carpal tunnel) - all should reproduce carpal tunnel symptoms
How can you test the ulnar nerve?
Sensation over the ulnar distrubution
Motor = ask the patient to cross their middle and index fingers. Ask the patient to grip paper between their thumb and index finger without flexing the thumb. Ask patient to abduct their fingers against resitance
How can you test teh radial nerve?
Sensation in the anatomical snuff box
Motor = wrist and finger dorisflexion against resisitance
What are the nerve roots of the radial, medial and ulnar nerves?
Radial = C5-T1 Median = C6-T1 Ulnar = C8-T1
What type of mass moves when swallowing? What type of mass moves when protruding the tongue?
Swallowing = thyroid mass
Tongue protrusion = thyroglossal cyst
What are the nerve roots of the sciatic and common peroneal nerves?
Sciatic = L4-S3
Common peroneal nerve is a branch of the sciatic nerve using nerve roots L4-S2
What do raises in ALT and ALP respectivley indicate?
ALT increase = hepatocellular injury
ALP increase = cholestasis
What do the ALT to AST ratios indicate?
ALT > AST = chronic liver disease
AST > ALT = cirrhosis and acute (alcoholic) hepatitis
What is Schober’s test?
Mark 10cm above and 5cm below the level of the posterior iliac spines. Ask the patient to lumbar flex - this gap should increase from 15 - 20cm
