General physical examination

Question 1

What is Battle sign?

Answer 1

Battle sign is suboccipital bruising that may be seen with basilar skull fractures.

Question 2

What are Racoon Eyes?

Answer 2

“Racoon eyes” are the appearance of bruising (dusky bluish discoloration) around the eyes that is restricted within the margin of the eyelids

*It is a hint of possible basilar skull fracture.

Question 3

What is papilledema?

Answer 3

Papilledema is swelling of the optic nerve head due to obstruction of venous outflow from the eyes

*Usually due to increased intracranial pressure.

Question 4

Define Myelopathy.

Answer 4

Myelopathy is damage to the spinal cord for any reason.

Question 5

Define radiculopathy.

Answer 5

Radiculopathy is damage to one or more nerve roots for any reason.

Question 6

What is radiculitis?

Answer 6

Radiculitis is irritation or inflammation of one or more nerve roots.

Question 7

What is Lhermitte’s symptom?

Answer 7

Lhermitte symptom is an “electrical sensation” radiating down the back and/or into the arms and legs separately or in combination, produced forcibly extending or flexing the neck.

This is most often due to direct or indirect irritation of the spinal cord.

Question 8

What is Menigissmus?

Answer 8

Meningissmus is a reflex resistance to passive neck flexion (usually accompanied by pain from meningial irritation).

Question 9

What is the Brudzinski sign?

Answer 9

Brudzinski sign is a clinical sign in which forced flexion of the neck elicits a reflex flexion of the hips.

Question 10

What does the Brudzinski sign indicate?

Answer 10

Brudzinski sign is due to irritation of the meninges.

It is found in patients with meningitis, subarachnoid haemorrhage and possibly encephalitis.

Question 11

What is the Kernig sign?

Answer 11

Kernig sign is positive when thre is reflex flexion of the knees when the straight lower limb is passively flexed.

Question 12

What does the Kernig sign indicate?

Answer 12

The Kernig sign is due to meningeal or nerve root irritation and may indicate subarachnoid hemorrhage or meningitis

Question 13

What is the Patrick test?

Answer 13

A positive Patrick test occurs when pain is reproduced (or motion is limited) when the flexed hip is rotated.

Question 14

What does a positive Patrick Test indicate?

Answer 14

A positive Patrick Test indicates pathology of the hip joint or the sacroiliac joint

Question 15

What happens to blood pressure and pulse with increased intracranial pressure?

Answer 15

Increased intracranial pressure usually increases blood pressure, with decreased pulse (Cushing sign).

Question 16

What part of the brain contains the primary respiratory centers?

Answer 16

The medulla contains centers that are involved in generating respiration.

The medullary centers are under control from higher centers. Abnormal patterns of respiration are seen with lesions at these higher centers (esp more caudal levels).

Question 17

What is the most common finding that differentiates orthostatic hypotension due to hypovolemia from that due to sympathetic failure?

Answer 17

With hypovolemia the pulse will increase in response to lowering blood pressure.

Most causes of autonomic failure will also damage autonomic nerves to the heart, preventing the compensatory acceleration of heart rate.

Question 18

Can the brain cause EKG changes that appear as ischemia?

Answer 18

Subarachnoid hemorrhage can cause EKG changes commonly found in cardiac ischemia, including elevation of ST segments and cardiac arrhythmia.

Question 19

What is the most reliable finding of increased intracranial pressure in an infant?

Answer 19

A tense or bulging fontanelle in the seated or upright position is the most reliable sign of increased intracranial pressure in an infant.

Question 20

Why is it important to measure cranial circumference in young children?

Answer 20

Large head => sign of increase intracranial pressure

• Hydrocephaly
• Masses
• Subdural fluid accumulations
• Metabolic disorders

Small head => may indicate failure of normal development.

Question 21

What are some causes of cranial bruits?

Answer 21

Cranial bruits arise from turbulent blood flow.

They may come from vascular malformations or, in young children, from conditions that increase cranial blood flow (ie severe anemia or meningitis).

Question 22

What are the major causes of increased intracranial pressure?

Answer 22

• Cerebral edema
• Acute hydrocephalus
• Mass lesions (e.g., neoplasm, abscess, hemorrhage)
• Venous occlusion (e.g., sagittal or transverse sinus thrombosis).

Question 23

What is the most sensitive finding in increased intracranial pressure?

Answer 23

The first finding with increased intracranial pressure is loss of spontaneous venous pulsations seen in the region of the optic disc.

Papilledema => late finding, consisting of swollen, blurred and elevated disk edges, engorged and pulseless veins, and increased vascularity of the disk margins.

Question 24

What is the difference in appearance between papillitis (inflammation of the optic nerve head at the optic disc) and papilledema?

Answer 24

Papillitis => severe vision loss and unilateral

Papilledema => mild enlargement of the physiologic blind spot and bilateral.

Question 25

What is the difference between Lhermitte symptom produced by intramedullary disease as opposed to that caused by extramedullary compression?

Answer 25

Intramedullary lesions => Lhermitte symptom with neck flexion

Extramedullary lesions => Lhermitte symptom upon neck extension.

Question 26

What is Spurling maneuver and what does it show?

Answer 26

The Spurling maneuver involves extending the neck, rotating the head towards the affected side while the examiner pushes down gently on top of the head.

This is positive when it reproduces arm symptoms due to compression of affected nerve roots at the intervertebral foramen.

Question 27

What is the function of the straight leg-raising test?

Answer 27

This test stretches the lumbosacral nerve roots that contribute to the sciatic nerve and may reproduce lower extremity symptoms due to sciatic radiculitis.