questions on all systems for assessment Flashcards
Brudzinski sign aseessed how
Passively flex neck forward to chest
Brudzinski sign positive result +
+ response is flexion of 1 or both legs to pelvis arms may also flex
Kernig’s sign asessed
Pt in recumbent position, flex hip & flex @ knee, attempt to extend knee
Kernig’s sign positive result is
+ is resistance to extension & pain (spasm of hamstring) reliable sign of irritation(r/o HD)
CN1 testing is for
smell
anosmia with CN 1 testing is
inablity to smell
test Cerebellar Function
Romberg’s test:
Abnormal Romberg’s test:
sways, falls, must widen base of feet to stop fall indicates MS, ETOH, loss of proprioception & vestibular function
Test cellebellar function by observing
walking smooth
CNVIII is
Aucustic
Test CNVIII
test hearing acuity w/ Weber, Rinne
Meningeal Irritation have a positive
Kernig’s sign
Fluent aphasia
Wernicke’s
Wernicke’s aphasia people can
talk & read easily but words nonsensical, jumbled, meaningless
Nonfluent aphasia
Broca’s
Broca’s aphasia people can
struggle w/words, slow, monosyllabic
Broca’s aphasia is an injury
frontal lobe
Wernicke’s is an injury
temporal or parietal lobe
Vibration is abnormal if felt
in the knees
Vibration is abnormal with
peripheral neuropathy as w/DM, ETOH
Vestibular dysfunction with injury to CN
CNVIII
injury to the posterior colum in the brain decrease in
tactile Discrimination - Fine Touch
test the Posterior Column wit h
Stereogenisis
– Graphesthesia – Two-Point Discrimination
Abnormal sensory test of the posterior colum =
inability to perform indicates lesion of sensory cortex or posterior column
Test CN3, 4, 6 with
EOM and PERRLA
CN 9 and 10 test
Depress tongue w/blade note pharyngeal movement as Pt says “AHHH”, touch posterior pharyngeal wall for gag reflex, Note voice smooth or strained, swallowing
abnormal test of CN 9,10 =
absence or loss of symmetry, uvula does not rise or deviates, no gag, hoarseness, brassiness
Neuro test for reflexes you see a snout reflex you suspect
Amyotrophic lateral sclerosis(ALS)
snout reflex is
puckering of lips- abn after infancy
Cerebral Cortex has temporal werenike’s
associated with
auditory reception
damage = aphasia
Cerebral Cortex has Broca’s
frontal lobe mediates speech , damage =
aphasia
CN1 is
Olfactory
CN2 is
Optic
CN3 is
Oculomotor
CN4 is
Troclear
CN5 is
Trigeminal
CN6 is
Abducens
CN7 is
Facial
CN8 is
Acoustic
CN9 is
Glossopharyngeal
CN10 is
Vagus
CN11 is
Spinal
CN2 is
Hypoglossal
Dermatone C6
Thumb
Dermatone T4
Nipple line
Dermatone T10
Umbilicus
Dermatone L5
Top of foot
Dermatone S1
Bottom of foot
Dermatone S2-S4
perineum
Important components of the Neuro exam:
Mental status cranial nerves motor system sensory system cerebellum gait
GlasgowComaScale max score
15
GlasgowComaScale minimum
3
Fully awake
able to respond to various stimuli but maybe disoriented & forgetful
Alert:
fully awake & oriented to person,
place , and time. Able to respond and carry out commands
Lethargic
sleepy/drowsy but is arousable w/ gentle shaking, calling of name, falls back to sleep easily, maybe disoriented
Obtunded
sleeps most of the time, makes few spontaneous movements, vigorous shaking & name calling required - capable of verbal response but likely inappropriate
Stuporous
semi-comatose, unconscious most of time, strong painful stimuli required for w/ drawl response
Comatose
can not be aroused
Reflexes are
4+ very brisk hyperactive w/clonus = disease – 3+brisker than average, may indicate disease – 2+average, normal
– 1+ diminished, low normal
– 0 no response = SC damage
Pathological Reflexes:
Clonus:
• Upper motor neuron disease, preeclampsia
Babinski: norm in infancy until 15-18 months abnormal is
Abn: fan great toe w/toes abduct – lesions pyramidial tract- stroke/trauma
freckle,measles, nevus are skin lesion
macule
solar lentigos-sun induced well circumscribed is a skin lesion of
macule
macule is
flat, circumscribed, nonpalpable, small up to 1 cm a color change
mongolian spot, vitiligo, café au lait is skin lesion
Patch: macules > 1cm
Papule is
solid, elevated, circumscribed, < 1cm
papule looks like a
elevated nevus (mole), molluscum, wart (verruca)
Molluscum is a
solid skin colored Papules w/central umbilication
primary skin lesion of Plaque are
papules > 1cm plateau like, disc shaped confined to superficial dermis, may result from confluence of papules
Nodule is
solid, elevated, hard or soft, > 1cm may extend deeper into the dermis than a papule, can be a xanthoma, fibroma, carcinoma,
Tumor is
same but > 2cm can be aipoma, hemangioma - benign or malignant
Wheal: superficial, raised, transient,
erythematous, irregular seen with
insect bite, allergic reaction
Urticaia: wheals coalesce to form extensive reaction very pruritic
severe allergic reaction
herpes simplex, varicella, herpes zoster, are skin lesions classified as
Vesicle: elevated cavity w/ free fluid up to 1 cm, clear serum flows if opened
friction blister, 2nd burn, contact dermatitis are known as
Bulla: as above but > 1cm thin walled, ruptures
easily
acne, impetigo, folliculitus are known as a
Pustule:circumscribed, elevated & filled w/pus in the cavity
skin lesion is angular it is
ring shaped
skin lesion is Linear
in a line
skin lesion is Reticular
net like
skin lesion is Gyrate
serpentine
skin lesion is Clustered
close proximity
skin lesion is Confluent
multiple blended together
skin lesion is Dermatonal
along dermatome
nail is spoon look for
anemia
nail is dirty nails
poor self care
nail is bitten nails
anxiety
nail is clubbing
angle is 180` w/spongy base, O2 insufficiency
nail is paronychia
red swollen nail folds acute is bacterial, chronic is fungal
nail is Onycholysis
separation of nail plate from nail bed
Yellow nails associated with
Lung disorders
White nail syndrome associated
Arsenic, heart disease, CRF
Koilonchyia spooning (dented nails) associated with
FE deficiency -spooning
stasis, pressure, chancre are classified as
Ulcer: deep depression, extends into dermis & beyond, irregular shape, may bleed, leaves scar
Scar is
connective tissue (collagen) that replaces healed damaged normal tissue – eg: after surgery, acne, injury
ntense itching thickens
skin produces increased visibility of skin furrows is known as
Lichenification
hypertrophic scar, elevated, invasive is known as
Keloid
skin lesion >1cm with clear serious fluis is considered a
Bulla
Dermatophyte known as ring worm is called
tinea corpis
(athletes foot) is known as
tinea pedis
Positive Fitzpatricks sign is
is the dimpling and retraction of the lesion beneath the skin with lateral compression seen with Dermatofibromas:
Increase your chance of melonoma with what type of sun exposure
Intense, intermittent
• H/O 2 or more blistering sunburns before 20
Malignant Melonoma has ? signs
7
what are the 7 letters for assesment of Melanoma
ABCDEEF
Assessment Melanoma whar does ABCDEEF mean
Asymmetry in shape - 1/2 unlike other
• Border irregular - scalloped
• Color is mottled - many shades
• Diameter is large > 6 mm (size of pencil eraser)
• Elevation is usual - tangential lighting
• Enlargement- h/o increased size, most important
• Feeling- presence of sensation itching, tenderness, or pain
Sharply demarcated erythematous papules & plaques of varying size & shape w/white overlying scales Removal of scale =dot of blood – Auspitz sign seen in
Psoriasis
ring worm is
tinea corporis
tinea corporis is a
(ringworm) a dermatophyte infection of the trunk, legs, arms
Stage one ulcer is
nonblanchable erythema of intact skin, epidermal redness, swelling, heat or pain
Stage 2 ulcer is
par0al thickness skin loss involving epidermis, dermis or both. Blister or superficial break in the epidermis w/dis0nct edges &
surrounded by an area of redness
stage 3 ulcer is
full thickness skin loss involving damage of subcutaneous 0ssue, may or may not be infected, could be covered w/eschar
stage 4 ulcer is
full thickness skin loss w/extensive destruc0on. Extends to muscle &/or bone, may or may not be infected
w/ intraabdominal bleed see
Cullen sign
Cullen sign looks like
bluish periumbilical color occurs w/ intraabdominal bleed -
Rebound Tenderness - McBurney’s Point is associated with
w/appendicitis
Rovsing’s Sign
Press deeply for 5 secs in LLQ
• Pain felt in RLQ = + Rovsing’s assoc w/appendicitis
Murphy’s Sign
Seen w/cholecystitis (sonographic Murphy’s) • Palpate at inspiration at liver margin
Place hand right thigh & push down as pt raises leg is known as
Iliopsoas Muscle test
Iliopsoas Muscle test indicative of
Pain in RLQ = +iliopsoas assoc w/ inflamed appendix
Flex r leg at hip & knee, rotate leg internally & externally is known as
Obturator test
Obturator test is indicative of
Pain in hypogastric area = + Obturator sign assoc w/ ruptured appendix or pelvic abscess
