Important things that you should know

Question 1

Define tone

Answer 1

tone is the state of contraction in the muscles at rest

- so normal muscles are floppy at rest

Question 2

what kind of lesion is increased muscle tone

Answer 2

UMN lesion

Question 3

what kind of lesion is decreased muscle tone

Answer 3

LMS lesion

Question 4

what is clonus

Answer 4

• it is associated with UMN lesions involving descending motor pathways
• it is a series of involuntary rhythmic muscular contractions and relaxation

Question 5

what is fascinations

Answer 5

this is a brief spontaneous contraction affecting a small number of muscle fibres, this often causes a flicker of movement under the skin

Question 6

describe Lower motor neurone lesions

Answer 6

• loss of alpha motor neurone or peripheral nerve
• decreased tone
• decreased reflexes
• leads to muscle wasting
• fasciculation - the spontaneous contraction of denervated muscle

Question 7

describe upper motor neurone weakness

Answer 7

• loss of descending control
• increased tone and clonus
• increased reflexes
• abnormal reflexes

Question 8

what is the cause of clubbing and what diseases does it occur in

Answer 8

• the amount of soft tissue beneath the nail bed increases
• it occurs in disorders such as lung cancer, lung abscess, pulmonary fibrosis and some ongeitnal heart disorders and liver disorders

Question 9

what are the common symptoms of clubbing

Answer 9

• nail beds soften - nails seem to float instead of being firmly attached
• nails form a sharper angle with the cuticle
• last part of the finger may appear larger or bulging and it may also be warm and red
• nail curves downwards so it looks like the round part of an upside down spoon

Question 10

why do you check the lymph nodes in a respiratory examination

Answer 10

cervical lymph nodes for evidence of metastatic disease

Question 11

why do you check the apex beat in a respiratory examination

Answer 11

cor pulmonale - this is abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

Question 12

what does chest expansion check for

Answer 12

lung collapse or pneumonia

Question 13

what is muscle wasting a sign of

Answer 13

nerve damage

Question 14

what can cause the temperature change in an joint examination

Answer 14

cellulitis

inflammatory arthritis

Question 15

why do you hold the joint as they are moving it

Answer 15

crepitus - creaking at the joint

Question 16

where do flexors and extensors attach in the elbow

Answer 16

flexors - these attach medially

extensors - these attach laterally

Question 17

what tests examination for effusion in the knee

Answer 17

• patellar tap

- bulge test - this is to detect smaller effusions

Question 18

where does the ACL attach

Answer 18

anterior of the tibia to the posterior of the femur

- stops tibia moving forwards on the femur

Question 19

where does the PCL attach

Answer 19

• posterior of the tibia to anterior of the femur

- stops the tibia moving back of the femur

Question 20

how do you test visual acuity

Answer 20

Broadly check acuity by asking patient to cover one eye and read a
line off a sheet of paper/ID card, and repeat with the other one.

Mention you would assess this properly with a Snellen chart.

Question 21

what is the test called in which you test for visual fields

Answer 21

confrontation

Question 22

how do you check colour vision

Answer 22

• you check colour vision with islihara plates

Question 23

what does damage to the occumotor nerve do

Answer 23

Damage to the oculomotor nerve leads to unopposed actions of trochlear and abducens nerves, leading to a ‘down and out’
appearance.

Question 24

what does the oculomotor nerve innervate

Answer 24

medial rectus, inferior rectus, superior rectus, inferior oblique.

Question 25

where does the trochlear nerve originate form

Answer 25

Only cranial nerve to emerge from the posterior aspect of the brainstem.

Question 26

what does the trochlear nerve innervate

Answer 26

Innervates superior oblique, which is responsible for depressing eyeball.

Question 27

what does the abducens nerve innervate

Answer 27

• innervates the lateral rectus this is responsible for abducting the eyeball

Question 28

when you do the H sign what are you assessing

Answer 28

• you are assign the extra ocular muscles and there innervation

Question 29

when you are assessing the pupillary light reflex what are you assessing

Answer 29

• you are assessing direct and consensual pupillary responses

Question 30

what do you inspect for when you look at hands

Answer 30

• splinter haemorrhages of infective endocarditis

- tobacco staining and ishcemic heart disease

Question 31

what can not be tested at radial

Answer 31

character

Question 32

what is character

Answer 32

A ‘slow-rising’ pulse has a delayed up-stroke and occurs in aortic stenosis.
A pulse is described as ‘bounding’ if it has an increased up-stroke and down-stroke. This may be a sign of CO2 retention.
A ‘jerky’ pulse is characteristic of hypertrophic cardiomyopathy, but this is unlikely to be detected peripherally

Question 33

what does a delay in between radial pulses mean

Answer 33

• it suggests aortic coarctation

Question 34

what is narrow blood pressure (pulse pressure) associated with

Answer 34

aortic stenosis

Question 35

what is a wide pulse pressure associated with

Answer 35

aortic regurgitation

Question 36

when you check the carotid arteries what are you checking for

Answer 36

• character and volume

- checking if there is stenosis in one

Question 37

how do you check for pitting oedema

Answer 37

• push down over a bony area for 5 seconds and it should return in 2 seconds

Question 38

what does the patient need to have for consent

Answer 38

◦ have capacity (Adults are presumed to have capacity unless evidence to the contrary)
◦ be offered sufficient information to make an informed decision
◦ be acting voluntarily and free from undue pressure
◦ be aware that he or she can refuse.