Physical Exam Flashcards by Bradley Martin

How can you tell the difference be veg and encrphalopatic

Sleep wake cycle

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Right eye gaze

Right frontal eye field

Bs.

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What anatomical landmark differentiates decorticating and decerebrate.

Red nucleus

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When you pinch arm what do you look for?

See if feet extend. Diff withdraw and decerebrate.

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DTR jaw jerk

Five buckles hit you in jaw.

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Scale value for clonus/hyperactive

4/4

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Scale value for brisk reflexes

3/4

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Inability to recognize objects/ keys

Stereo gnosis

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Clock drawing tests

Neglect parietal.

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In ability to recognize numbers when drawn on hand

Graphesthesia.

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Steppage gait looks like

Caused by.

High knees
High knees over l5 and s1
Can’t lift off floor so you compensate by high stepping
Fall risk

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Gait where you swing legs out and return in a circular fashion
-Caused by

Hemiparesis

Circumduction gait

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Describe Parkinsonian gate

Turn en block

Fes tin stination

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Trouble initiating steps

Nph

Frontal dysfx

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Associated with cn. 3

Lesion of cn 3

Eyelid retraction.
Pupillary constriction
Can’t Ad duction
Can’t elevate

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Cn3 lesion 3

Down and out
Fixed dilated pupil
Ptosis

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What two exams indicate non organic paralysis.

Hovers and aBduction sign

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Test for milingering involves cuppin heals.

Hoover test. If you don’t feel them push down. Nonorganic.

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Test for malingering, have the pt Stand on good. Raise bad leg.

Mcnride test.

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Malingering Sensory test that shoes a sharp midline split

Cutaneous nerves cross and overlap so a mid line split isn’t consistent.
Fp- 8%
Fn- 80 % failed to detect

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What do you call the motor malingering test that has pt drop hands on face.

Arm drop test

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Back pain malingering test that has 8 signs in 5 categories

Gordon Waddell

3 out 8

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WadDELL 8 signs

Pinch
Deep pain everywhere
Axial load
Abductor test
Straight leg test pos but can flex hip 90 degree to do babinski

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Cranial 3 vs 7 blink

3 is tone 7 is blink

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Special about sternoclido

Bilaterally innervated | Opposite of everything else

Sensations of pseudo seizure

Nonphysioolgical or nonorganic

Split midline sensory modality specific for.

Pin prick. Vibratory affects the whole bone.

What is difference between vibratory and pin prick.

Pin prick more local vibratory affect the whole bone.

Describe aura?

``` 4 to 60 Typically 15 to 60 Atypical if over 1 hr Should slowly build up Not sudden ```

Migraine with aura over time. What happens when you get old.

Headache goes away but aura stays.

Herpes encephalopathy EEG signs

Pled.

Tx of serious vertigo

Mescolin | Valium tid

Why is it important for Neuro exam on comatose (4)

Diagnose Prognosis Establish baseline Figure level Pb ld

What happens to cerebral auto regulation with stroke

Auto regulation resets and shifts to the right.

Off all the people who die how many are d t stroke

1 in. 17

Differential for stroke

``` Seizure w Todd's paralysis - stroke can cause seizure Meds Li and Dilantin -get level Glucose -accu ``` Bell's palsy 7 flat forehead, can't close -eye ball rolls up when closing Bell phenomenon Conversion

Bells phenomenon

Eye rolls up Cranial 7 Can close eye

Question to assess stoke onset

When was the last time you didn't have symptoms

Increase risk for Cva with afib

Five fold

Valvular probl associated with high risk of stroke

Mitral stenosis

Flick toe is

Ganda

Risk increase for stroke w rheumatoid is....

Disorient ion pattern

1. Situation 2. Time 3. Place 4. Name

Aphasia means

Abnormal language ( express or comprehension)

Tadle for table, 1 phonemic for another

Phonemic paraphasias

Door for window

Semantic errors

Repetition intact plus deficient fluency

Trams cortical aphasia

Wernickes located

Posterior superior temporal

Broca locate

Dorsolateral dominant frontal lobe

Test for hemineglect

Bisect a line

Can't pantomime the mo bent

Idiomotpt

Frontal release signs

Myersoms

Only responds to pain

Stuporous

Blood in team panic membrains | Or blood under skin of mastoid

Battle signs

Neck stiffness suggests

Meningeal irritation | SAH or meningitis

Petechia in coma pt suggests

Intra vascular coagulation

Term for nail above eye

Supra orbital ridge stimuli

Abreviations for coma score

GCS

Pe finding that suggests coma

Non lateralizing | Non specific responses to pain

Formula for cerebellar perfusion

Systolic minus intracranial pressure

What does it mean that the brains auto regulator fx is down

It no longer controls pressure. It just does what ever the wants to. If bp goes up than cerebral perfusion increases

How is Hoffman different from babinski

Hoffman is deep tendon reflex Babinski is not a deep tendon reflex Rexed lamina 9

When is Hoffman bad sign

MRI w and wo Wo if arthritic

Pin point pupil differential

Pin point HOP Horners Opiates, opthalmic Pontine