Lab FInal: Test B

Question 1

Mental Status: Calculations test

Answer 1

i.e. 5 + 5 - 3 = 7

Question 2

Mental Status: Apraxia test

Answer 2

“Pretend to brush your teeth”

Testing complex motor functions.

Question 3

Sensory Exam: Vibration test

AKA?

Answer 3

AKA Pallesthesia
Place handle of 128 Hz tuning fork on 5 bony prominences per extremity (test all 4).
“Say ‘NOW’ when you feel something.”
“Say ‘NOW’ when you feel it stop.

Question 4

Sensory Exam: Light Touch Test

Answer 4

Stroke patient w/ sterile cotton swab; have them say “NOW” when they feel something.

Question 5

Motor Exam: Passive Wrist Motion

Answer 5

Dr. moves wrist through: Flexion, Extension, Ulnar/Radial Deviation, Pronation & Supination

Question 6

Motor Exam: Muscle Test Quadriceps

Answer 6

Patient prone, bring straight leg up, Dr. pushes down patient resists.

Question 7

Coordination & Gait: Heel Shin Test

AKA?

Answer 7

AKA- dysmetria

Patient seated and runs their heel from their knee to foot.

Question 8

Coordination &; Gait: Finger Nose Test

Answer 8

AKA-dysmetria

Patient touches their nose then Dr.’s finger in all 4 quadrants.

Question 9

Superficial Reflex: Abdominal Test

Answer 9

Stroke abdomen with brush starting at umbilicus and going out diagonally into all 4 quadrants w/ smooth edge of hammer.

response: Umbilicus should deviate to stroked side, absence is normal only if bilateral
afferent: upper T7-10 lower T11-12
integrating: spinal cord T7-T12
efferent: upper T7-10 lower T11-12

Question 10

Visceral Reflex: Accommodation Test

Answer 10

Move an object towards/away from patient while they focus on it. Eyes should converge with pupillary constriction.

response: convergence of eyes with pupillary constriction
afferent: optic nerve
integrating: occipital cortex
efferent: oculomotor

Question 11

Deep Tendon Reflex: Biceps

Answer 11

response: elbow flexion
innervation: musculocutaneous
integrating: C5 spinal cord

Question 12

Pathological: Hoffman Test

Answer 12

Support back of their hand while flicking their index finger into full extension then releasing quickly.

Question 13

C.N. Exam: A patient complains of dizziness and loss of balance when turning and looking over left shoulder. Additionally, the patient complains of difficulty hearing with the left ear when on the phone.
-STATE THE APPROPRIATE C.N.’S TO BE TESTED AND STATE THE SENSORY, MOTOR & INTEGRATION CENTERS FOR REFLEXES IF APPLICABLE

Answer 13

cochlear—

      - Finger Rub
      - Whisper Test
      - Weber Test
      - Rinne

Vestibular Portion

      - Fukuda Step Test (Mittlemeyer) 
      - Hallpike Dix Maneuver 
      - Barnary Whirling Chair -  
      - Vestibulo-Ocular Reflex -

Question 14

Nerve Root Eval: A patient complains of tingling sensations running down the inside of his right leg and foot, with weakness of knee extension and ankle that rolls outward.

• State the appropriate nerve root
• State the appropriate disc level
• Perform the related muscle tests (stating muscles and peripheral nerve
  innervations) , deep tendon reflex and sensory exam

Answer 14

Nerve root: L4
Disc lvl: L3
Muscle test: Foot inversion w/ slight dorsiflexion = Tibialis anterior (Deep fibular nerve)
Reflex: Patellar Tendon
Sensory: Medial aspect of leg (L3), Medial Foot (L4), Medial big toe (L5)

Question 15

Ortho Exam: A patient complains of a weakness of thumb opposition with tingling in the first 3 fingers.
-STATE & PERFORM AN APPROPRIATE ORTHO TEST TO EVALUATE THIS PATIENT.

Answer 15

Phalens
Reproduction of pain and/or parasthesia in the median nerve distribution area. (1,2,3 and lateral 1/2 of 4th digits)
Median neuritis, possible carpal tunnel syndrome

Question 16

Ortho Exam: A patient complains of radiating pain into his left arm when he turns to look to the right.
-STATE & PERFORM AN APPROPRIATE ORTHO TEST TO EVALUATE THIS PATIENT.

Answer 16

Roo’s test
hands like allens open/closing
positive: ischemic pain, heaviness of arms, numbness/tingling of hand
indicates: TOS on side involved

Question 17

Ortho Exam: A patient complains of lateral chest pain when laterally flexing
-STATE & PERFORM AN APPROPRIATE ORTHO TEST TO EVALUATE THIS PATIENT.

Answer 17

Schepelman’s sign
hands up, laterally flex bot sides
Pain on concave side = intercostal neuritis
Pain on convex side = fibrous inflammation of pleura

Question 18

weber test

Answer 18

-place handle of 512 vibrating tuning fork on midline of skull and ask pt to compare sound of both ears
-negative=normal
-positive- conductive deafness, sound lateralizes to bad ear
OR sensorineural deafness, sound lateralizes to good ear

Question 19

rinne test

Answer 19

hand of 512 vibrating fork against mastoid and time. ask when no longer heard. then move to ear and time. ask them to stop you

• normal response: air conduction twice as long as ear conduction
• abnormal: conduction deafness, air conduction is absent, equal to, less than bone
• abnormal: sensorineural deafness, air and bone conduction both decreased or absent

Question 20

fukuda step test

aka?

Answer 20

AKA- mittlemeyer test
pt marches in place, eyes closed 50 steps
positive: turning to one side
indicates: side of vestibular lesion

Question 21

hallpike dix maneuver

Answer 21

pt seated with head turned 45 to R or L. dr brings pt into supine position with head extended off table

positive: nystagmus starting 2-5 secs after mov’t and stopping within 30 secs
indicates: benign positional vertigo

Question 22

barany whirling chair test

Answer 22

normal- fast component of nystagmus will be in the direction of the spin

Question 23

vestibulo-ocular reflex

Answer 23

dr holds pts head and instructs pt to fix vision on drs face. observe nystagmus. dr then turns pts head into rotation, lateral flexion, flexion, and extension
indicates: normal pt should maintain eye contact, inability to maintain fixation or spontaneous nystagmus indicates vestibular lesion