Physical Examination for Medical Screening Flashcards
when is a physical examination for medical screening performed?
performed on initial examination
when would you have to reperform a physical examination for medical screening?
if the patient has a health status change
what does a physical examination for medical screening determine?
determines appropriateness for clinical services
what are the three subdivisions of a physical examination for medical screening?
cervical stability
cervical positional tolerance
CNS integrity
what is cervical stability?
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
What is the mVAT?
modified vertebral artery test
examines cervical spine position tolerance
how do you perform an mVAT?
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)
What does an ocular alignment test examine?
examines otolithic tonic input to eye muscles
How is the ocular alignment test performed?
patient sits upright with eyes open
what does an spontaneous nystagmus test examine?
examines tonic vestibular input to eye muscles
how is a spontaneous nystagmus test performed?
patient sits upright with eyes open
What does the Gaze Evoked-Nystagmus Test(GEN) examine?
examines tonic vestibular input to eye muscles
How is the GEN performed?
patient sits upright and moves eyes 30o left, center, 30o right (3 seconds each)
What does the smooth pursuit test examine?
examines integrity of cranial nerves 3,4,6
how is the smooth pursuit test performed?
patient sits upright with eyes open and follows pen tip with eyes
What does the Saccadic Eye movement test examine?
examines saccade system; voluntary quick eye movements initiated by the pre-frontal cortex (frontal eye fields) and midbrain (superior colliculus)
How is the Saccadic Eye Movement test performed?
patient sits upright and looks back and forth between stationary horizontal and vertical targets without moving their head
What does the VOR Cancellation test (VORc) examine?
examines patients ability to cancel VOR via cerebellar input.
How is the VOR cancellation Test (VORc) performed?
patient tracks moving target while moving their head and eyes in same direction
What tests are performed is a CNS problem is suspected?
upper motor neuron and cerebellar tests are performed
What are the upper motor neuron tests?
babinski, clonus, deep tendon reflexes
what are the cerebellar tests?
finger-to-nose eyes open/closed and dysdiadochokinesia
What is a positive VOR cancellation Test (VORc)?
positive test is inability to keep eyes on target and suggests possible CNS problem
What is a positive Saccadic Eye movement test?
positive test is more than one saccade or overshoot
what does a positive saccadic eye movement test suggest?
suggests possible CNS problem
What is a positive smooth pursuit test?
positive test is non-smooth pursuit
what does a positive smooth pursuit test suggest?
suggests possible CNS problem
what is a positive GEN test?
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;
what does a positive GEN test suggest?
suggests possible CNS problem
what is a positive spontaneous nystagmus test?
positive test is nystagmus; typically present in acute stages of UVH and resolves within 7 days;
What does a spontaneous nystagmus test suggest?
suggests possible CNS problem
what is a positive ocular alignment test?
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;
what does a positive ocular alignment test suggest?
suggests possible CNS problem
What is a positive mVAT?
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
