Neurologic and Musculoskeletal Physical Exam

Question 1

health promotion and counseling

Answer 1

preventing stroke or TIA
reducing risk of peripheral neuropathy
detecting delirium, dementia, depression

Question 2

3 important questions as you examine the patient for neurologic system

Answer 2

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?

Question 3

5 categories for assessment

Answer 3

mental status
speech
language
cranial nerves
motor system
sensory sytems
reflexes

Question 4

common or concerning sysmtpoms of the nervous system

Answer 4

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

Question 5

Olfactory nerve summary

Answer 5

I, sensory, smell

Question 6

optic nerve summary

Answer 6

II, sensory, vision

Question 7

oculomotor nerve summary

Answer 7

III, motor, movement of eye ball

Question 8

Trochlear nerve summary

Answer 8

IV, motor, movement of eye ball

Question 9

Trigeminal nerve summary

Answer 9

V, mixed nature, eye movement

Question 10

Adbucent nerve summary

Answer 10

VI, motor, eye movement

Question 11

Facial nerve summary

Answer 11

VII, mixed nature, taste, salivation, tear secretion

Question 12

auditory nerve summary

Answer 12

VIII, sensory, hearing

Question 13

glossopharyngeal nerve summary

Answer 13

IX, mixed nature, taste, salivation, swallowing

Question 14

vagus nerve summary

Answer 14

X, mixed nature, gastric and pancreatic secretion, GI movement, cardiac reflex, visceral reflex, respiratory reflex

Question 15

spinal accessory nerve summary

Answer 15

XI, motor nature, muscles movement and visceral reflex

Question 16

hypoglossal nerve summary

Answer 16

XII, motor, tongue movement

Question 17

cranial nerve I exam (olfactory)

Answer 17

occlude each nostril and test different smells

Question 18

cranial nerve II exam (optic)

Answer 18

test visual acuity with snellen eye chart or hand-held card; inspect fundi; screen visual fields by confrontation

Question 19

cranial nerve II-III exam (optic, oculomotor)

Answer 19

inspect size and shape of pupils; test reactions to light and near response

Question 20

cranial nerve III, IV, VI exam (oculomotor, trochlear, abducens)

Answer 20

test extraocular movements in 6 cardinal directions of gaze, lid elevation, check convergence

Question 21

cranial nerve V exam (trigeminal)

Answer 21

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

Question 22

cranial nerve VII exam (facial)

Answer 22

assess face for asymmetry, tics, abnormal movements. Ask patient to raise eyebrows, frown, close eyes tightly, show teeth (grimace), smile, puff both cheeks

Question 23

cranial nerve VIII exam (acoustic)

Answer 23

test hearing, lateralization, and air and bone conduction

Question 24

cranial nerve IX and X exam (glossopharyngeal, vagus)

Answer 24

assess if voice is hoarse, assess swallowing. inspect movement of palate as patient says “ah.” test gag reflex, warning patient first

Question 25

cranial nerve XI exam (spinal accessory)

Answer 25

assess strength as patient shrugs shoulders up against your hands. note contraction of opposite sternocleidomastoid, and force as patient turns head against your hands

Question 26

cranial nerve XII exam (hypoglossal)

Answer 26

ask patient to protrude tongue and move it side to side. assess for symmetry, atrophy

Question 27

romberg test

Answer 27

stand with feet together/close eyes for up to 30 seconds, loss of balance is a positive test

Question 28

how do you test the bicep reflex?

Answer 28

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

Question 29

how do you test the triceps reflex?

Answer 29

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.

Question 30

how do you test the brachioradialis reflex|

Answer 30

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.

Question 31

how do you test the pateller (quad) / knee reflex?

Answer 31

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

Question 32

how do you test the achilles reflex?

Answer 32

if sitting, dorsiflex the foot at the ankle. strike the achilles tendon, watch for plantar flexion at the ankle and note speed of relaxation

Question 33

how do you test the abdominal reflex?

Answer 33

lightly but briskly stroke each side of abdomen from above and below the umbilicus. there should be contraction of abdominal muscles

Question 34

how do you test the plantar reflex?

Answer 34

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

Question 35

how do you grade reflexes?

Answer 35

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

Question 36

common or concerning symptoms for musculoskeletal system

Answer 36

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

Question 37

tips for assessing joint pain

Answer 37

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,

Question 38

technique of examination of major joints

Answer 38

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

Question 39

Hawkins impingement sign

Answer 39

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

Question 40

Neer impingement sign

Answer 40

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

Question 41

Drop- arm test

Answer 41

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

Question 42

McMurray Test

Answer 42

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

Question 43

Lachman Test

Answer 43

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

Question 44

Medial Meniscus tear

Answer 44

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