Important things that you should know Flashcards
Define tone
tone is the state of contraction in the muscles at rest
- so normal muscles are floppy at rest
what kind of lesion is increased muscle tone
UMN lesion
what kind of lesion is decreased muscle tone
LMS lesion
what is clonus
- it is associated with UMN lesions involving descending motor pathways
- it is a series of involuntary rhythmic muscular contractions and relaxation
what is fascinations
this is a brief spontaneous contraction affecting a small number of muscle fibres, this often causes a flicker of movement under the skin
describe Lower motor neurone lesions
- loss of alpha motor neurone or peripheral nerve
- decreased tone
- decreased reflexes
- leads to muscle wasting
- fasciculation - the spontaneous contraction of denervated muscle
describe upper motor neurone weakness
- loss of descending control
- increased tone and clonus
- increased reflexes
- abnormal reflexes
what is the cause of clubbing and what diseases does it occur in
- 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
what are the common symptoms of clubbing
- 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
why do you check the lymph nodes in a respiratory examination
cervical lymph nodes for evidence of metastatic disease
why do you check the apex beat in a respiratory examination
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
what does chest expansion check for
lung collapse or pneumonia
what is muscle wasting a sign of
nerve damage
what can cause the temperature change in an joint examination
cellulitis
inflammatory arthritis
why do you hold the joint as they are moving it
crepitus - creaking at the joint
where do flexors and extensors attach in the elbow
flexors - these attach medially
extensors - these attach laterally
what tests examination for effusion in the knee
- patellar tap
- bulge test - this is to detect smaller effusions
where does the ACL attach
anterior of the tibia to the posterior of the femur
- stops tibia moving forwards on the femur
where does the PCL attach
- posterior of the tibia to anterior of the femur
- stops the tibia moving back of the femur
how do you test visual acuity
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.
what is the test called in which you test for visual fields
confrontation
how do you check colour vision
- you check colour vision with islihara plates
what does damage to the occumotor nerve do
Damage to the oculomotor nerve leads to unopposed actions of trochlear and abducens nerves, leading to a ‘down and out’
appearance.
what does the oculomotor nerve innervate
medial rectus, inferior rectus, superior rectus, inferior oblique.
where does the trochlear nerve originate form
Only cranial nerve to emerge from the posterior aspect of the brainstem.
what does the trochlear nerve innervate
Innervates superior oblique, which is responsible for depressing eyeball.
what does the abducens nerve innervate
- innervates the lateral rectus this is responsible for abducting the eyeball
when you do the H sign what are you assessing
- you are assign the extra ocular muscles and there innervation
when you are assessing the pupillary light reflex what are you assessing
- you are assessing direct and consensual pupillary responses
what do you inspect for when you look at hands
- splinter haemorrhages of infective endocarditis
- tobacco staining and ishcemic heart disease
what can not be tested at radial
character
what is character
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
what does a delay in between radial pulses mean
- it suggests aortic coarctation
what is narrow blood pressure (pulse pressure) associated with
aortic stenosis
what is a wide pulse pressure associated with
aortic regurgitation
when you check the carotid arteries what are you checking for
- character and volume
- checking if there is stenosis in one
how do you check for pitting oedema
- push down over a bony area for 5 seconds and it should return in 2 seconds
what does the patient need to have for consent
◦ 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.
