Physical Examination for Medical Screening

Question 1

when is a physical examination for medical screening performed?

Answer 1

performed on initial examination

Question 2

when would you have to reperform a physical examination for medical screening?

Answer 2

if the patient has a health status change

Question 3

what does a physical examination for medical screening determine?

Answer 3

determines appropriateness for clinical services

Question 4

what are the three subdivisions of a physical examination for medical screening?

Answer 4

cervical stability
cervical positional tolerance
CNS integrity

Question 5

what is cervical stability?

Answer 5

if there is history of cervical trauma and suspicion of cervical instability, patient should be medically cleared by physician; alar ligament, lateral shear, and Sharp-Purser tests may be performed with caution at discretion of clinician

Question 6

What is the mVAT?

Answer 6

modified vertebral artery test

examines cervical spine position tolerance

Question 7

how do you perform an mVAT?

Answer 7

patient sits upright with hands on knees and guided forward into neck extension (10-30 seconds); add rotation and slight ipsilateral lateral flexion (10-30 seconds); return; then repeat to other side (10-30 seconds)

Question 8

What does an ocular alignment test examine?

Answer 8

examines otolithic tonic input to eye muscles

Question 9

How is the ocular alignment test performed?

Answer 9

patient sits upright with eyes open

Question 10

what does an spontaneous nystagmus test examine?

Answer 10

examines tonic vestibular input to eye muscles

Question 11

how is a spontaneous nystagmus test performed?

Answer 11

patient sits upright with eyes open

Question 12

What does the Gaze Evoked-Nystagmus Test(GEN) examine?

Answer 12

examines tonic vestibular input to eye muscles

Question 13

How is the GEN performed?

Answer 13

patient sits upright and moves eyes 30o left, center, 30o right (3 seconds each)

Question 14

What does the smooth pursuit test examine?

Answer 14

examines integrity of cranial nerves 3,4,6

Question 15

how is the smooth pursuit test performed?

Answer 15

patient sits upright with eyes open and follows pen tip with eyes

Question 16

What does the Saccadic Eye movement test examine?

Answer 16

examines saccade system; voluntary quick eye movements initiated by the pre-frontal cortex (frontal eye fields) and midbrain (superior colliculus)

Question 17

How is the Saccadic Eye Movement test performed?

Answer 17

patient sits upright and looks back and forth between stationary horizontal and vertical targets without moving their head

Question 18

What does the VOR Cancellation test (VORc) examine?

Answer 18

examines patients ability to cancel VOR via cerebellar input.

Question 19

How is the VOR cancellation Test (VORc) performed?

Answer 19

patient tracks moving target while moving their head and eyes in same direction

Question 20

What tests are performed is a CNS problem is suspected?

Answer 20

upper motor neuron and cerebellar tests are performed

Question 21

What are the upper motor neuron tests?

Answer 21

babinski, clonus, deep tendon reflexes

Question 22

what are the cerebellar tests?

Answer 22

finger-to-nose eyes open/closed and dysdiadochokinesia

Question 23

What is a positive VOR cancellation Test (VORc)?

Answer 23

positive test is inability to keep eyes on target and suggests possible CNS problem

Question 24

What is a positive Saccadic Eye movement test?

Answer 24

positive test is more than one saccade or overshoot

Question 25

what does a positive saccadic eye movement test suggest?

Answer 25

suggests possible CNS problem

Question 26

What is a positive smooth pursuit test?

Answer 26

positive test is non-smooth pursuit

Question 27

what does a positive smooth pursuit test suggest?

Answer 27

suggests possible CNS problem

Question 28

what is a positive GEN test?

Answer 28

positive test is nystagmus; greatest nystagmus when looking away from involved side and least nystagmus when looking toward involved side (Alexander’s Law); documented as 1st, 2nd, or 3rd degree GEN based on number of positions that provoke nystagmus; typically present in acute stages of UVH and resolves within 7 days;

Question 29

what does a positive GEN test suggest?

Answer 29

suggests possible CNS problem

Question 30

what is a positive spontaneous nystagmus test?

Answer 30

positive test is nystagmus; typically present in acute stages of UVH and resolves within 7 days;

Question 31

What does a spontaneous nystagmus test suggest?

Answer 31

suggests possible CNS problem

Question 32

what is a positive ocular alignment test?

Answer 32

positive test is skew deviation (diplopia); named by high eye although low eye side is involved; for example, patient with left UVH and low left eye is documented as right hypertropia; typically present in acute stages of UVH and resolves within 7 days;

Question 33

what does a positive ocular alignment test suggest?

Answer 33

suggests possible CNS problem

Question 34

What is a positive mVAT?

Answer 34

positive test includes symptoms suggestive of VBI including 5 D’s (dizziness, drop attacks, disequilibrium, diplopia, dysarthria), vertigo, headache, nausea, parasthesia and is considered a medical emergency