Physical Dx Exam 3
Terms
undefined, object
copy deck
- # of PNs
- 31
- anterior (ventral) PN responsible for?
- motor
- posterior (dorsal) PN responsible for?
- sensory
-
segmental level of DTR:
ankle - S1
-
segmental level of DTR:
knee - L2-4
-
segmental level of DTR:
supinator - C5-6
-
segmental level of DTR:
biceps - C5-6
-
segmental level of DTR:
triceps - C6-7
- diplopia, dysarthria, and ataxia
- postior circulation stroke
- bilateral proximal weakness
- myopathy
- bilateral distal weakness
- polyneuropathy
- awareness of personal identity, place, and time
- orientation
- sensory awareness of objects in env. and their interrelationship
- perceptions
- awareness that sx or behaviors are NL or abNL
- insight
- comparing and evaluating alternatives when deciding on a course of action
- judgement
- 5 things to test for aphasia
-
word comprehension
repetition
naming
reading comprehension
writing
* if can write correct sentence then NOT aphasia - speech characterized by delay in reaching pt. b/c of unnecessary detail
- circumstantiality
- person shifts from one subject to another that are unrelated
- derailment
- continuous flow of speech where person changes abruptly from one topic to the next
- flight of ideas
- invented or distorted words
- neologisms
- speech that is incomprehensible
- incoherence
- sudden interuption of speech in midsentence
- blocking
- fabrication of ffacts in response to questions
- confabulation (seen in amnesia)
- persistent repitition of words/ideas
- perseveration
- repitition of words/phrases of others
- echolalia
- person chooses a word based on sound rather than meaning
- clanging
- repetitive behaviors that a person feels driven to perform to produce or prevent future state of affairs
- compulsion
- recurrent uncontrollable thoughts, images, impulses that another considers unacceptable
- obsessions
- misinterpretations of real external stimuli
- illusions
- subjective sensory perceptions in absence of relevant external stimuli
- hallucinations
-
What do these measure?
digit span
serial 7s
spelling backwards - attention
-
What does this measure?
proverbs
similarities - abstract thinking
- CN I
- olfactory
- CN II
- optic
- CN III
- Oculomotor
- poor sense of smell
- olfactory (CN I)
-
abNL
visual acuity
optic fundi
visual fields - Optic (CN II)
- abNL size and shape of pupils and papillary rxns to light
- Optic and Oculomotor (CN II and CN III)
- CN IV
- Trochlear
- CN VI
- abducens
-
abNL
extraocular movements
convergence of eyes
nystagmus
ptosis - oculomotor, trochlear, abducens (III, IV, VI)
-
abNL
masseter muscle
pain sensation of forehead, cheeks, and jaw
corneal reflex - trigeminal (V)
- CN V
- trigeminal
-
AbNL
raise eyebrows
frown
close eyes
show teeth
smile
puff out cheeks - facial (VII)
- CN VII
- facial
- CN VIII
- acoustic
- hearing loss
- CN VIII (acoustic)
- CN IX
- Glossopharyngeal
- CN X
- vagus
-
abNL
hoarseness of voice
swallowing
movement of soft palate and pharynx
gag reflex - CN IX and X (glossopharyngeal and vagus)
- tongue abNL
- hypoglossal
- CN XII
- hypoglossal
- repetitive and consistent deviation to 1 side
- past pointing (w/ cerebellar disease)
- inability to heel walk
- corticospinal tract weakness
- stand w/ feet together and eyes open and then closed, w/o support- note ability to maintain upright posture
- Romberg Test
- pt stands w/ both arms straight forward, palms up, eyes closed - note ability to hold position
- test for pronator drift
- 1st sensation lost in peripheral neuropathy
-
vibration
(caused by DM, alcoholism, posterior column disease, tertiary syphilis, or Vit B12 deficiency) - inability to ID an object by feeling it
- asterognosis
- stimulus on side opposite damaged cortex is extinguished
- sensory cortex lesion
- rating of DTR: very brisk, hyperactive w/ clonus
- 4+
- NL DTR
- 2+
- absent DTR
- 0
- slow relaxation phase of ankle reflex
- hypothyroidism
- sudden, brief, nonrhythmic flexion of hands and fingers
- asterixis (helps to ID metabolic encephalopathy)
- what muscle weakness causes winging of the scapula
- serratus anterior
- flex neck, watch hips and knees for rxn
- Brudzinki's sx
- flex pt legs at both hip and knee, then straighten knee and determine presence of pain
- Kernig's sx
- to determine whether brainstem is intact check these reflexes
-
oculocephalic reflex (Doll's eyes)
oculovestibular reflex w/ caloric stimulation (if intact, eyes drift toward irrigated ear) - dpressed mood and sx for most of day, for more days than not, over at least 2 yrs (no more than 2mo of relief from symtoms)
- dysthymic disorder
- numerous periods of hypomanic and depressive sxs that last for at least 2 yrs
- cyclothymic disorder
- inflection and articulation good, but sentences lack meaning; word comprehension, repetition, naming, reading and writing are all impaired; lesion in temporal lobe
- Wernicke's Aphasia
- inflections and articulation are impaired but words are meaningful; word and reading comprehension are fair; repetition, naming and writing are impaired; lesion in frontal lobe
- Broca's Aphasia
- Delusions, hallucinations, disorganized speech, catatonic bx, and negative sx present for > 6mo
-
Schizophrenia
(if < 6mo- schizophreniform disorder) - nonbizarre delusions that involve real-life situations that last for a mo
- delusional disorder
- may be associated w/ uremia or acute hepatic failure
- delerium
- may be associated w/ thyroid disorders, alzheimers or vascular cause
- demetia
- paralysis of entire side of face including forehead, eye doesn't close
- CN 7 lesion
- paralysis of opposite lower side of face, can close eyes and wrinkle forehead
- UMN lesion
- spasticity
- caused by UMN lesion
- flaccidity
- cuased by lesion of LMN
- associated w/ corticospinal tract lesion; one arm held close to side, extended leg, dragging foot
- spastic hemiparesis
- associated w/ bilateral spastic paresis of legs
- scissor gait
- associated w/ foot drop due to LMN disease
- steppage gait
- upper arms tight to chest; legs extended and internally rotated
-
decorticate rigidity
(lesion of corticospinal tract) - jaw clenched, adducted arms, wrist flexed
- decerebrate rigidity