Neurologic and Musculoskeletal Physical Exam Flashcards
health promotion and counseling
preventing stroke or TIA
reducing risk of peripheral neuropathy
detecting delirium, dementia, depression
3 important questions as you examine the patient for neurologic system
is mental status intact
are right and left sided findings the same|
if findings are asymmetric or abnormal, do the causative lesions lie in the CNS or the PNS?
5 categories for assessment
mental status
speech
language
cranial nerves
motor system
sensory sytems
reflexes
common or concerning sysmtpoms of the nervous system
headache
dizziness or vertigo
generalized, proximal, or distal weakness
numbness
abnormal or loss of sensations
LOC, syncope, or near syncope
seizures
tremors or involuntary movements
Olfactory nerve summary
I, sensory, smell
optic nerve summary
II, sensory, vision
oculomotor nerve summary
III, motor, movement of eye ball
Trochlear nerve summary
IV, motor, movement of eye ball
Trigeminal nerve summary
V, mixed nature, eye movement
Adbucent nerve summary
VI, motor, eye movement
Facial nerve summary
VII, mixed nature, taste, salivation, tear secretion
auditory nerve summary
VIII, sensory, hearing
glossopharyngeal nerve summary
IX, mixed nature, taste, salivation, swallowing
vagus nerve summary
X, mixed nature, gastric and pancreatic secretion, GI movement, cardiac reflex, visceral reflex, respiratory reflex
spinal accessory nerve summary
XI, motor nature, muscles movement and visceral reflex
hypoglossal nerve summary
XII, motor, tongue movement
cranial nerve I exam (olfactory)
occlude each nostril and test different smells
cranial nerve II exam (optic)
test visual acuity with snellen eye chart or hand-held card; inspect fundi; screen visual fields by confrontation
cranial nerve II-III exam (optic, oculomotor)
inspect size and shape of pupils; test reactions to light and near response
cranial nerve III, IV, VI exam (oculomotor, trochlear, abducens)
test extraocular movements in 6 cardinal directions of gaze, lid elevation, check convergence
cranial nerve V exam (trigeminal)
palpate temporal and masseter muscles while patient clenches teeth’ test forehead, each cheek, and jaw on each side for sharp or dull sensation, test corneal reflex
cranial nerve VII exam (facial)
assess face for asymmetry, tics, abnormal movements. Ask patient to raise eyebrows, frown, close eyes tightly, show teeth (grimace), smile, puff both cheeks
cranial nerve VIII exam (acoustic)
test hearing, lateralization, and air and bone conduction
cranial nerve IX and X exam (glossopharyngeal, vagus)
assess if voice is hoarse, assess swallowing. inspect movement of palate as patient says “ah.” test gag reflex, warning patient first
cranial nerve XI exam (spinal accessory)
assess strength as patient shrugs shoulders up against your hands. note contraction of opposite sternocleidomastoid, and force as patient turns head against your hands
cranial nerve XII exam (hypoglossal)
ask patient to protrude tongue and move it side to side. assess for symmetry, atrophy
romberg test
stand with feet together/close eyes for up to 30 seconds, loss of balance is a positive test
how do you test the bicep reflex?
patient arm must be relaxed, partially flexed at the elbow, and positioned with palm down. depress biceps tendon with thumb or finger, strike thumb or finger briskly with reflex hammer, you should see biceps muscle contract and see flexion of the forearm
how do you test the triceps reflex?
flex the patients arm at the elbow, with palm toward the body. pull arm slightly across the chest, strike triceps muscle and extension at the elbow.
how do you test the brachioradialis reflex|
patient forearm should rest on the abdomen with forearm partly pronated. strike radius 1-2 inches above the wrist. observe for flexion and supination of forearm.
how do you test the pateller (quad) / knee reflex?
locate pateller tendon with patients knee flexed. briskly tap the tendon just below the patella. note contraction of the quadriceps and look for quick extension of the knee
how do you test the achilles reflex?
if sitting, dorsiflex the foot at the ankle. strike the achilles tendon, watch for plantar flexion at the ankle and note speed of relaxation
how do you test the abdominal reflex?
lightly but briskly stroke each side of abdomen from above and below the umbilicus. there should be contraction of abdominal muscles
how do you test the plantar reflex?
use wood end, stroke lateral aspect of the sole of the foot from the heel to the ball curving medially across the ball (may be uncomfortable), downgoing of big toe should occur
how do you grade reflexes?
0- no response
1- somewhat diminished, low normal
2- average, normal
3- brisker than average, possibility but not neccesarily indiciative of disease
4- very brisk, hyperactice, typically with clonus
common or concerning symptoms for musculoskeletal system
low back pain
neck pain
monoarticular or polyarticular joint pain
inflammatory or infectious joint pain
join pain with fever, chills, rash, anorexia, weight loss, weakness
joint pain with symptoms from other organ systems
tips for assessing joint pain
ask patient to “point to the pain”
clarify and record the mechanism of injury
determine if pain is localized or diffuse, acute or chronic, inflammatory or non-inflammatory,
technique of examination of major joints
inspect for symmetry, alignment, or bony deformities
inspect and palpate surrounding tissues for any changes, nodules, atrophy, or crepitus
assess any degenerative or inflammatory changes, (swelling, warmth, tenderness, redness)
perform ROM
Hawkins impingement sign
Flex the patient’s shoulder and elbow to 90 degrees with palm facing down. then with one hand on the forearm and one on the arm, rotate the arm internally. this compresses the greater tuberosity against the supraspinatus tendon and coracoacromial ligament
Neer impingement sign
press on the scapula to prevent scapular motion with one hand and raise the patient’s arm with the other. this compresses the greater tuberosity of the humerus against the acromion
Drop- arm test
ask patient o fully abduct the arm to shoulder level, up to 90 degrees, and lower it slowly. note that abduction above shoulder leel from 90-120 degrees, reflects action of the deltoid muscle
McMurray Test
with patient supine, grasp the heel and flex the knee. cup your other hand over the knee joint with fingers and thumb along the medial joint line. from the heel, externally rotate the lower leg, then push on the lateral side to apply a valgus stress on the medial side of the joint. at the same time, slowly extend the lower leg in external rotation
Lachman Test
place the knee in 15 degrees of flexion and mild external rotation. grasp distal femur on lateral side with one hand and proximal tibia on medial side with other. with thumb on the tibial hand on the joint line, forcefully and simultaneously pull tibia forward and femur back. estimate the degree of forward excursion. there should be a firm endpoint to any forward movement. lack of firm endpoint with excessive movement may indicate no longer intact ACL
Medial Meniscus tear
same maneuver with internal rotation of foot stresses the lateral meniscus, if click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assess the meniscus for a tear
Which cranial nerves are sensory only?
Cranial nerve 1,2 and 8
Which cranial nerves are motor only?
3;4;6;11;12
Which cranial nerves are both sensory and motor?
5,7,9,10
