General physical examination Flashcards
What is Battle sign?
Battle sign is suboccipital bruising that may be seen with basilar skull fractures.
What are Racoon Eyes?
“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.
What is papilledema?
Papilledema is swelling of the optic nerve head due to obstruction of venous outflow from the eyes
*Usually due to increased intracranial pressure.
Define Myelopathy.
Myelopathy is damage to the spinal cord for any reason.
Define radiculopathy.
Radiculopathy is damage to one or more nerve roots for any reason.
What is radiculitis?
Radiculitis is irritation or inflammation of one or more nerve roots.
What is Lhermitte’s symptom?
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.
What is Menigissmus?
Meningissmus is a reflex resistance to passive neck flexion (usually accompanied by pain from meningial irritation).
What is the Brudzinski sign?
Brudzinski sign is a clinical sign in which forced flexion of the neck elicits a reflex flexion of the hips.
What does the Brudzinski sign indicate?
Brudzinski sign is due to irritation of the meninges.
It is found in patients with meningitis, subarachnoid haemorrhage and possibly encephalitis.
What is the Kernig sign?
Kernig sign is positive when thre is reflex flexion of the knees when the straight lower limb is passively flexed.
What does the Kernig sign indicate?
The Kernig sign is due to meningeal or nerve root irritation and may indicate subarachnoid hemorrhage or meningitis
What is the Patrick test?
A positive Patrick test occurs when pain is reproduced (or motion is limited) when the flexed hip is rotated.
What does a positive Patrick Test indicate?
A positive Patrick Test indicates pathology of the hip joint or the sacroiliac joint
What happens to blood pressure and pulse with increased intracranial pressure?
Increased intracranial pressure usually increases blood pressure, with decreased pulse (Cushing sign).
What part of the brain contains the primary respiratory centers?
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).
What is the most common finding that differentiates orthostatic hypotension due to hypovolemia from that due to sympathetic failure?
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.
Can the brain cause EKG changes that appear as ischemia?
Subarachnoid hemorrhage can cause EKG changes commonly found in cardiac ischemia, including elevation of ST segments and cardiac arrhythmia.
What is the most reliable finding of increased intracranial pressure in an infant?
A tense or bulging fontanelle in the seated or upright position is the most reliable sign of increased intracranial pressure in an infant.
Why is it important to measure cranial circumference in young children?
Large head => sign of increase intracranial pressure
- Hydrocephaly
- Masses
- Subdural fluid accumulations
- Metabolic disorders
Small head => may indicate failure of normal development.
What are some causes of cranial bruits?
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).
What are the major causes of increased intracranial pressure?
- Cerebral edema
- Acute hydrocephalus
- Mass lesions (e.g., neoplasm, abscess, hemorrhage)
- Venous occlusion (e.g., sagittal or transverse sinus thrombosis).
What is the most sensitive finding in increased intracranial pressure?
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.
What is the difference in appearance between papillitis (inflammation of the optic nerve head at the optic disc) and papilledema?
Papillitis => severe vision loss and unilateral
Papilledema => mild enlargement of the physiologic blind spot and bilateral.
