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Physical Exam > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

Components of mental status

A
  1. Attention
  2. Memory
  3. Orientation
  4. Perceptions
  5. Thought process/content
  6. Insight
  7. Judgement
  8. Affect
  9. Mood
  10. Language
  11. Higher cognitive functions
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2
Q

What triggers a MSE?

A
  1. Medically unexplained physical Sx
  2. High Sx count
  3. High severity of the complaint when organic causes are ruled out
  4. Chronic pain
  5. Recent stressor
  6. Difficult encounters
  7. Low self rating of health
  8. Frequent use of healthcare servicces
  9. Substance abuse
  10. Cognitive complaints of any sort
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3
Q

Illusions & when are they seen?

A

Mis-interpretation of real stimuli

  1. Grief
  2. PTSD
  3. Schizophrenia
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4
Q

MMSE components

A
  1. Date orientation - 5 pts
  2. Place orientation - 5
  3. Register - 3 (Name objects & repeat)
  4. Serial 7’s - 5 (Count back from 7, WORLD)
  5. Recall - 3 (3 objects from register)
  6. Naming - 2
  7. Repeating phrase - 1
  8. Verbal commands - 3
  9. Written commands - 1
  10. Writing - 1
  11. Drawing - 1
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5
Q

What is a normal MMSE score?

A

24 or higher

Depends on age & education

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6
Q

What does a neuro exam test?

A
  1. MSE
  2. CN
  3. Sensory
  4. DTR/Plantar response
  5. Cerebellar function
  6. Muscle strength
  7. Motor screening
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7
Q

CN I

A

Olfactory

Sensory

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8
Q

CN II

A

Optic

Sensory - visual acuity & visual fields

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9
Q

CN III

A

Oculomotor

Motor - raise eyelids, most EOM
Parasympathetic - pupil constriction, lens shape

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10
Q

CN IV

A

Trochlear

Motor - downward, inward eye mvmt (SO)

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11
Q

CN V

A

Trigeminal

Motor - jaw opening & clenching, mastication
Sensory - 3 branches

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12
Q

CN VI

A

Abducens

Motor - lateral eye mvmt (LR)

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13
Q

CN VII

A

Facial

Motor - facial expression muscles (except jaw), eye closure, mouth closure
Sensory - taste (ant. 2/3 tongue)
Parasympathetic - Secretion of saliva & tears

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14
Q

CN VIII

A

Acoustic

Sensory - hearing & equilibrium

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15
Q

CN IX

A

Glossopharyngeal

Motor - voluntary muscles for swallowing & pronation
Sensory - nasopharynx, gag reflex, taste (post. 2/3 tongue)
Parasympathetic - secretion of saliva, carotid reflex

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16
Q

CN X

A

Vagus

Motor - Voluntary muscles of phonation & swallow
Sensory - behind ear, part of external canal
Parasympathetic - secretion of digestive enzymes, peristalsis, carotid reflex, heart, lungs, digestive tract

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17
Q

CN XI

A

Spinal Accessory

Motor - turn head, shoulder shrug, some phonation

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18
Q

CN XII

A

Hypoglossal

Motor - tongue mvmt for speech, sound articulation, swallowing

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19
Q

Spinal nerve C3

A

Front & back of neck

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20
Q

Spinal nerve C6

A

thumb/C8

5th finger

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21
Q

Spinal nerve T4

A

nipple line

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22
Q

Spinal nerve T10

A

umbilicus

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23
Q

Spinal nerve L1

A

inguinal

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24
Q

Spinal nerve S2/3

A

Anogenital

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25
Q

Spinal nerve L4

A

Knee

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26
Q

Lesions above & below corticospinal tract

A

Motor Tract
A - contralateral Sx

B - ipsilateral Sx

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27
Q

UMN lesions Sx & when are they seen

A
    • babinski
  2. Inc. DTRs
  3. Muscular spasticity
  4. MS
  5. ALS
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28
Q

LMN lesions Sx & when are they seen

A
  1. Dec. DTRs
  2. Ipsilateral weakness
  3. Dec. or absent muscle tone
  4. Nerve transection
  5. Guillan-Barre
  6. Polio
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29
Q

What are the sensory pathways?

A

Participate in reflex activity, regulation of position & autonomic function

  1. Spinothalamic
  2. Posterior Column
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30
Q

Spinothalamic tract

A 
Sensory pathway
Crosses in cord
1. Pain
2. Temp
3. Crude touch
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31
Q

Posterior Column tract

A 
Sensory pathway
Crosses in the medulla
1. Position
2. Vibration
3. Fine touch

All affected by diabetic neuropathy

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32
Q

What do differences in reflexes indicate?

A
  1. Level of spinal lesion
  2. Electrolyte disturbances
  3. Endocrine disturbances
  4. UMN vs LMN disease
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33
Q

What kind of reflex does hypermagnesemia cause?

A

Delayed DTR

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34
Q

DTR & Spinal nerves

A

Biceps & Brachioradialis - C5&6
Triceps - C6&7
Patellar - L2,3&4
Achilles - S1

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35
Q

Grading DTRs

A 
0 - absent
1+ - Hypoactive
2+ - Normal
3+ - Hyperactive
4+ - Hyperactive w/ clonus
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36
Q

What are cerebellar disease signs?

A
  1. Dysmetria
  2. Nystagmus
  3. Intention tremor
  4. Ataxia
37
Q

Grading Muscle Strength

A

0/5 - No muscle mvmt
1/5 - Visible contraction but no joint mvmt
2/5 - Mvmt at joint, but not against gravity
3/5 - Mvmt against gravity, but not against resistance
4/5 - Mvmt against resistance but less than normal
5/5 - Normal strength

38
Q

Primitive reflexes

A

Rooting - 4 mo
Palmar grasp - 6 mo
Moro - 2 mo
Plantar - 1 yr

Frontal Release signs

39
Q

What is the Glabellar reflex?

A

Tap on Parkinson’s Pts head & they don’t stop blinking

40
Q

What is Kernig’s sign?

A

Pain when extending knee w/ leg in air

Sign of meningeal irritation

41
Q

What is Brudzinski’s sign?

A

Move hips when flex head while laying down

Sign of meningeal irritation

42
Q

Signs of Parkinson’s

A
  1. Rigidity
  2. Bradykinesia
  3. Resting tremor
  4. Slow, shuffling gait w/ loss of arm swing
  5. Flexed body posture
  6. Excessive salvation
  7. Masked facies
43
Q

UMN signs

A
  1. Spastic weakness
  2. Hyperactive reflexes
    • Babinski
  4. Pronator drift
44
Q

LMN signs

A
  1. Flaccid weakness
  2. Hypoactive reflexes
  3. Muscle atrophy
  4. Fasciculations
45
Q

Extrapyrimidal signs

A
  1. Resting tremor, rigidity
  2. Postural deformity & instability
  3. Slow RAM
46
Q

Cerebellar signs (B1 deficiency)

A
  1. Intention tremor
  2. Ataxia
  3. Impaired RAM
47
Q

What muscle is paralyzed with a winged scapula?

A

Serratus anterior

From long thoracic nerve

May be caused by C7 entrapment from mastectomy Pts

48
Q

Causes of torticollis

A

SCM contraction

  1. Hematoma
  2. Tear
  3. Phenothiazines
49
Q

Which vertebrae are most susceptible to compression Fx?

A

T10-T12

50
Q

Which rotator cuff muscle is most likely to be injured?

A

Supraspinatous

51
Q

How do you test for AC separation?

A

Cross over test

52
Q

How do you test for biceps tendonitis?

A

Yergason test

53
Q

What muscles are involved in supination of forearm?

A

Biceps & supinator

54
Q

What muscles are involved in pronation of forearm?

A

Pronator teres

55
Q

What is the Trendelenburg test?

A

Pt stands on one leg & opposite hip should point down

56
Q

Normal knee deviation ages

A

0-3 Genu varum

3-8 Genu valgus

57
Q

How do you test for ACL tear

A

Lachman test
Flex knee 20-30 degreses
DIsplace tibia anteriorly

58
Q

+ anterior drawer test?

A

ACL injury

59
Q

+ posterior drawer test?

A

PCL injury

60
Q

+ McMurray test?

A

Meniscal injury

61
Q

Valgus vs. varus stress tests

A

Valgus - MCL

Varus - LCL

62
Q

Test for patellofemoral syndrome?

A

Pain w/ patellar grind test

63
Q

Inversion of ankle causes which sprain?

A

Anterior tibiofibular ligament

64
Q

When do you get an ankle Xray?

A

Ottawa Ankle rules

  1. Malleoli point tenderness
  2. Unable to WB
65
Q

What is the Thompson test?

A

Grab gastrocnemius & soleus

Foot should plantar flex if achilles intact

66
Q

Who gets alopecia areata?

A

Kids - autoimmune & hereditary

Patchy hair loss w/o scarring

67
Q

What is the MCC of hair loss in women?

A

Telogen effluvium

68
Q

What causes koilonychia?

A

iron deficiency anemia?

Spoon shaped nails

69
Q

What causes leukonychia?

A

White lines on nails

After serious systemic illness

70
Q

What causes pitted nails?

A

Psoriasis & atopic dermatitis

71
Q

What is onycholysis?

A

Separation of nail plate from nail bed

72
Q

What is onychomycosis?

A

Fungal infection of nail

Tineal ungium

73
Q

What is paronychia?

A

Infection of nail

Staph most common

74
Q

What is melanonychia?

A

Single band along fingernail = cancer

75
Q

When should you start doing routine digital rectal exams?

A

40

76
Q

What is the most common male cancer?

A

Prostate

Staged via Gleeson score
Prevalence assoc. w/ age
assoc. w/ BRCA2 gene

Biopsy cut point >4

Start at age 50

77
Q

Acute prostatitis

A

< 35 GC/chlymidia
>40 GRE - enterobacteraciae

Dysuria, pelvic & rectal pain, fever

78
Q

When do you do mammograms?

A

40 & yearly

79
Q

When do you do clinical breast exams?

A

20 then q3y

40 every year

80
Q

Which nerve does finger spread test?

A

Ulnar

81
Q

Which nerve does the corneal reflex test?

A

CN V

82
Q

Which nerves does the gag reflex test?

A

CN IX & X

83
Q

Sensory ONLY Cranial nerves?

A

I
II
VIII

84
Q

Motor, Sensory & Parasympathetic Cranial nerves?

A

VII
IX
X

85
Q

Motor ONLY Cranial nerves?

A

IV
VI
XI
XII

86
Q

Cranial nerves involved in swallowing?

A

IX
X
XII

87
Q

Nerves involved in abdominal reflex?

A

T8-12

88
Q

Which surfaces does psoriasis usually appear on?

A

Extensor

89
Q

Which surfaces does atopic dermatitis usually appear on?

A

Flexor

Physical Exam (6 decks)

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