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3 - Clinical Skills > IDL Questions > Flashcards

IDL Questions Flashcards

1
Q

What is a presenting symptoms?

A

Why they have come to see the doctor

Includes anything else which comes up when screening for additional information at initiation of the session

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2
Q

What is an associated symptom?

A

Becomes apparent as we explore the presenting symptom.
Revealed independently or through questions.
Positive associated symptom: patient is experiencing the symptom
Negative associated symptom: patient is not experiencing the symptom

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3
Q

What is a red flag symptom?

A

Symptoms associated with a presenting complaint that may indicate a potentially serious or life threatening pathology.

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4
Q

What is important to note about headaches?

A

With a headache, the presence of any neurological symptom may indicate a potentially serious/life threatening condition.

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5
Q

What are red flag symptoms for headache?

A

Change in LOC and drowsiness = change in ICP
Fever, nausea, neck stiffness, photophobia = infection
Change in mood/personality = intracranial tumour
Weight loss = primary/metastatic tumours
Weight gain = tumour on pituitary gland
Issues with balance, coordination = tumour/stroke

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6
Q

What are the red flag features of a headache?

A
  • New headache in older person (over 50 years)
  • History of head trauma
  • Sudden onset especially with no history of headache
  • Severe + debilitating pain
  • Features of raised ICP - worse with coughing/sneezing/bending over, wakes them from sleep, worse when waking up
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7
Q

How do you assess orientation to person, place and time?

A

Can you tell me your full name?
Where are you right now?
Roughly what time of day is it/what is todays date/what day is it/what month is it/what year is it?

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8
Q

What is assessed in the Glasgow Coma Scale?

A

Best eye response
Best verbal response
Best motor response

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9
Q

Describe the best eye response scale.

A

Open spontaneously - 4
Open in response to sound/stimulus - 3
Open in response to physical stimulus/pressure - 2
Do not open - 1
Closed by local factor (e.g. swelling/trauma) - N/A

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10
Q

Describe the best verbal response.

A

Orientated, converses normally - 5
Confused, disorientated - 4
Utters inappropriate words in response - 3
Incomprehensible sounds - 2
No sounds - 1
Factors interfering with communication (dysphasia) - N/A

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11
Q

Describe the best motor response.

A

Obeys commands - 6
Localizes to physical stimulus - 5
Flexion/withdrawal from physical stimulus - 4
Abnormal flexion to physical stimulus - 3
Extension to physical stimulus - 2
No movements in response - 1
Paralyzed/limiting factor (trauma) - N/A

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12
Q

What is important to note about the GCS?

A

BEST response
If patient if resting or sleeping - should be given opportunity to wake first
Cannot measure GCS in post ictal phase

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13
Q

Describe the different stimuli used in the GCS.

A

Voice/Sound stimulus - speak to patient to ask them to open their eyes
Physical stimulus: central stimulus e.g. trapezius pinch or supraorbital ridge

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14
Q

Describe the abnormal flexion to stimulus. - DECORTICATE RESPONSE

A 
Slow stereotyped movement 
Forearms move across chest and are held close to body 
Hands pronate 
Elbows flex rigidly 
Thumb and fingers flex 
Legs extend
Feet plantarflex
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15
Q

What is the decorticate response?

A

Abnormal flexion in response to physical stimulus

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16
Q

What is the decerebrate response?

A

Abnormal extension to stimulus

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17
Q

Describe the abnormal extension (DECEREBRATE RESPONSE)

A 
Elbows extend 
Arms adduct and internally rotate at the shoulder
Wrists flex
Thumb and fingers flex
Legs extend
Feet plantarflex 
Less commonly the back arches
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18
Q

What is the lowest possible score for GCS?

A

3 = deep coma or death

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19
Q

What does a GCS score of 8 or less reflect?

A

Accepted definition of coma and suggests need for intubationn

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20
Q

What is the total GCS score used for and list the categories of severity.

A

Used prognistically
13-15 = mild head injury
9-12 = moderate head injury
3-8 = severe head injury (coma and intubation)

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21
Q

What factors may contribute/interfere with communication and ability to respond for GCS?

A

Deafness
Endotracheal tube
Physical injury to face
Neurological disability e.g. dysphasia

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22
Q

How do you apply supraorbital notch pressure?

A

Notify patient what youre doing
Thumb to apply pressure to one supraorbital notch
Initiate: mild pressure and increase pressure as needed
Apply pressure with increasing intensity for up to 10 seconds

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23
Q

Trapezius squeeze

A

Mild pressure, increase pressure with increasing intensity for 10 seconds

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24
Q

What do you look for when inspecting during motor exam?

A 
Symmetry - compare both sides
Use of limbs - function 
Posture of limb and trunk
Gait 
Fasciculation 
Tremor 
Wasting or hypertrophy
Scars 
Rash
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25
Q

What is tone

A

Resistance felt by the examiner when moving a joint passively through its ROM

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26
Q

Hypotonia and causes

A

Reduced tone

Lower motor neuron lesion e.g. trauma to peripheral nerve

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27
Q

Describe the different types of hypertonia.

A

Spasticity - dynamic response: greater at beginning of movement if movement is fast e.g. spastic catch (clonus is associated with spasticity)

Rigidity - increased tone with uniform resistance to movement (lead pipe or cogwheel). Leadpipe present throughout movement, cogwheel occurs if tremor is superimposed on increased tone (

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28
Q

What are the special tests examined as component of motor system?

A

Coordination

Deep tendon reflexes

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29
Q

What is hyperreflexia a sign of?

A

UMN lesion

Hyperthyroidism

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30
Q

What is hyporeflexia a sign of?

A

LMN lesion

Hypothyroidism

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31
Q

If a patient has normal tone, what would you expect to see as the knee is rapidly flexed?

A

Hell of the foot on that side should stay on the couch and drag up towards the buttocks

32
Q

What would you find on examination of the motor system of the lower limbs if the person had a left upper motor neuron lesion?

A

Symptoms would affect the right leg:

  • minimal muscle atrophy
  • hypertonia
  • hyperreflexia
  • weakness
  • may have associated sensory disturbance
33
Q

What is clonus?

A

Series of rhythmic contractions in the muscle when the muscle and the tendon are suddenly stretched

34
Q

What is the significance of clonus?

A

If it is not sustained (<6 beats) it may be physiological but if it is sustained it suggests UMN damage

35
Q

What sensory modalities are tested in routine sensory examination?

A

Light touch: of least discriminatory value - as some fibres travel in the posterior columns, and some travel in the spinothalamic tract
Pain (and temperature) - fibres enter spinal cord and cross a few segments higher to ascend in the opposite ST
Vibration and joint sense - fibres enter spinal cord, ascend in posterior (dorsal) columns and cross in medulla

36
Q

What is the difference between the sensory distribution of a nerve root and a peripheral nerve?

A

A dermatome = area of skin supplied by a sensory nerve root.
The sensory distribution of a peripheral sensory nerve crosses over different dermatomes.
Individual peripheral nerves are composed of multiple nerve roots

37
Q

Why do we need to know the difference between the sensory distribution of a nerve root and a peripheral nerve?

A

We use the knowledge of dermatomal distribution (single nerve root) and the peripheral nerve distribution (from multiple nerve roots) to map sensory deficits and localize the lesion.
Sensory distribution of a nerve root is dermatomal.
Sensory distribution of a peripheral nerve will be made up of dermatomes of nerve roots that contribute to that peripheral nerve.

38
Q

Name the 4 main patterns of sensory loss.

A

Global sensory loss: entire limb is affected e.g. stroke
Peripheral neuropathy: glove and stocking distribution e.g. diabetes
Dermatomal sensory loss e.g. compression of a single nerve root as it exits the spinal cord

39
Q

What is dissociated sensory loss?

A

Loss of certain sensory modalities, but preservation of others e.g. loss of temperature and pain, but light touch is still intact

40
Q

What is right monocular blindness and where is the lesion?

A

Right eye is blind
Left eye is normal

Right optic nerve

41
Q

What is bitemporal hemianopia and where is the lesion?

A

Loss of temporal vision in both eyes

Lesion in optic chiasm

42
Q

What is left homonymous hemianopia and where is the lesion?

A

Left side of both eyes affected

Lesion in the right optic tract

43
Q

What is left upper quadrantanopia and where is the lesion?

A

Left upper quadrant in both eyes is affected

Lesion in lower fibres of the right optic radiation in the temporal lobe

44
Q

What is the examination of the olfactory nerve?

A

CN1

Smell - test each nostril separately for smell

45
Q

Optic nerve (II)

A

Visual acuity - Snellen’s Chart or near vision chart
Visual fields - confrontation with fingers
Fundoscopy

46
Q

Oculomotor, trochlear, abducens

A

Observe: pupils, ptosis, strabismus
Eye movements: H and + sign with pen
Pupillary reflexes (light and accommodation)

47
Q

Trigeminal nerve

A

Sensation - all 3 divisions with light touch, superficial pain
Corneal reflex
Motor - jaw opening
Jaw reflex

48
Q

Facial Nerve

A

Facial movements - eyes tight, smile, puff cheeks

49
Q

Vestibulocochlear (VIII)

A

Whisper test to screen hearing

Rinne and Webers tests

50
Q

Glossopharyngeal, Vagus and Hypoglossal

A

Speech/articulation: 10, 12
Cough - 10
Movement of uvular: 10
Gag reflex (if problems with swallowing/regurgitation) 9 and 10
Appearance of tongue including abnormal movements 12
Power of tongue movements 12

51
Q

Accessory VI

A

Trapezius and sternocleidomastoid muscle power

52
Q

What is conductive deafness?

A

Abnormal conduction of sound anywhere from external auditory meatus to the stapes
Causes = otitis media, wax

53
Q

What is sensorineural deafness?

A

Abnormal conduction of acoustic vibration and neural impulses by the cochlear and vestibulocochlear nerve respectively to the brain
Bilateral sensorineural deafness = exposure to noise and toxins e.g. gentamicin antibiotic
A cause of sudden unilateral sensorineural deafness = viral infection

54
Q

Conductive hearing loss affecting left ear: what will I find in the Rinnes test and why?

A

Patient cannot hear L tuning fork when placed next to the L ear canal
Can hear tuning fork alongside R ear canal

Air conduction should be better than bone conduction, but air conduction through the external auditory meatus or middle ear (left) is impeded so conduction through the bone is better

Negative Rinne Test in Left Ear
Positive Rinne Test in Right Ear

55
Q

Conductive hearing loss in L ear: Weber test findings and explanation.

A

Sound will be hear loudest in the affected ear (left)

Masking - if there is a problem conducting sound, there will be no masking of sound transmitted via bone/by environmental noise transmitted via external and middle ear
Occlusion - if sound cannot dissipate out of the auditory canal due to a conductive defect, this will cause increased cochlear stimulation and the sound will be louder on the affected side

56
Q

Sensorineural deafness affecting left ear: Rinnes Test findings and why?

A

Provided hearing is good enough to hear the tuning fork - when the tuning fork is moved from the R mastoid process to outside R ear canal, it can be heard. Same thing for right ear.

Both air conduction and bone conduction will be reduced equally if there is a problem with the cochlear or 8th cranial nerve.
Positive Rinne’s test for both ears.

57
Q

Sensorineural deafness in left ear: Weber test findings and why?

A

Sound will be referred to/heard loudest in normal ear.

Because sound cannot be transmitted as well by left cochlear/vestibulocochlear nerve.

58
Q

Facial symmetry

A

Oculomotor, trigeminal, facial nerve (3,5, 7)

59
Q

Ability to wrinkle forehead

A

Facial (7)

60
Q

Ability to shut eyes tightly

A

Facial (VII)

61
Q

Ability to puff out cheeks

A

Facial

Vagus - allows you to hold the air in your mouth and prevent air escaping through the nose

62
Q

Cough

A

Vagus 10

63
Q

Articulation

A

Facial
Vagus
Hypoglossal
7, 10, 12

64
Q

Soft palate/uvular movement

A

Vagus

65
Q

Gag reflex

A

Glossopharyngeal
Vagus
9,10

66
Q

Tongue appearance and movement

A

Hypoglossal

12

67
Q

Ability to shrug shoulders

A

Accessory = 11

68
Q

Mouth drooping on one side

A

Facial nerve

69
Q

Symmetry of forehead wrinkling

A

Facial

70
Q

Cheek muscle wasting

A

Facial

71
Q

Evidence of dribbling

A

Facial

72
Q

Ptosis

A

Oculomotor

73
Q

Unequal pupils

A

Oculomotor

74
Q

Squint/strabismus

A

Oculomotor

75
Q

Abnormal movement of eyes

A

Oculomotor
Trochlear
Abducens

76
Q

Quality of speech

A

Facial, vagus, hypoglossal

77
Q

Articulation

A

Facial, Vagus, hypoglossal

3 - Clinical Skills (9 decks)

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