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36 Cards in this Set
- Front
- Back
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How do you evaluate upper extremity motor testing
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pt. sitting down, ask to flex the arm
- push forearm down against my resistance - try to pull forearm up against my resistance |
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Lower extremity motor testing
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pt. sitting down
- holding anterior bw ankle and calf ask pt to push against resistance - holding posterior bw ankle and calf ask pt to pull against my resistance |
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triceps tendon reflex
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flex pt arm to the side
tap the tendon of the triceps musc. with the pointy end of reflex hammer - repeat on opposite elbow |
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Cranial nerve I examination
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sense of smell
- cover one nostril identify a scent - repeat w other nostril |
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Cranial nerve II
- visual fields by confrontation |
- Visual fields by confrontation
inspect upper, middle, lower visual fields. - stand in front of pt -make eye contact, ask pt to keep looking at you -place fingers at side of pt head (outside of peripheral vision) -bring moving fingers anteriorly and ask pt to tell you when he can see your fingers. |
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Cranial nerve II
- test for visual acuity |
Rosenbaum card 14in from pt.
Snellen 20in form pt - ask pt to cover one eye - ask pt to read the lines - determine the smallest print the pt can read more than half of the letters - ask pt to cover the other eye and repeat the exam |
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cranial nerve II and III
- direct and consensual reaction |
- ask pt to look into distance
- shine light obliquely into each pupil - DO IT TWICE - once for direct reaction - second time for consensual rx - test at room light one eye at a time |
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Cranial nerves II and III
- Near reaction and Near response |
-hold a pen 10cm in front of pt
-ask pt to look alternately to pen and to the wall - note pupillary CONStricion w NEAR focus |
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Cranial nerve III
- assessing convergence |
- ask pt to follow finger as i move it towards the bridge of the nose to about 5 cm
- normal will follow eye to about 5-8cm of the nose |
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Cranial n. III, IV, and VI
- assessing extraocular eye movements |
assess eye movement of the patient in 6 positions
- gaze tracing - trace an H pattern with my hand - ask pt to follow my hands with his eyes - Pt should NOT move his head |
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Cranial nerve V trigeminal
- sensory examination |
with a piece of cotton I will run the cotton on pt face evaluating:
- Ophtalmic branch - Maxillary branch - Mandibular branch Assess bilaterally |
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Cranial nerve V trigeminal
- motor assessment |
- palpate masseter musc bilaterall and ask pt to clinch teeth lightly.
- or ask pt to move jaw from side to side |
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Cranial n. VII facial
- facial motor testing |
ask pt to
- raise eyebrows - open eyes vs. resistance - frown - smile - puff cheeks - show teeth |
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Cranial n. VIII vestibulocochlear
- Weber test |
for lateralization
- use tuning fork - tap fork on hand - place base of fork on top of pt head - - ask. pt Where does the sound appear to be coming from? (nl is midline) |
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Cranial n. VIII vestibulocochlear
- Rinne test |
compare air vs. bone conduction
- tap tuning fork -place in pt mastoid process -ask pt to tell you when he can no longer hear the sound - then move the fork near the same ear, and ask if he can hear the vibration - repeat process in other ear NOTE AC>BC |
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Cranial n. VIII vestibulocochlear
- gross auditory acuity |
Ask pt to cover one ear
- rub fingers next to non occluded ear - ask pt if sound is heard Repeat on opposite ear |
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Cranial N. X and XII
- motor testing - sensory componet |
- ask pt to swallow
- ask pt to say AHH and observe uvula - sensory test for GAG reflex |
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Cranial n. XI, Accessory N.
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- ask pt to shrug shoulder vs. resistance
Note strength and contraction of trap - ask pt to turn head vs. resistance Note: strength of SCM musc. Assess bilaterally |
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Cranial n. XII Hypoglossal n.
- motor testing |
- Inspect pt. tongue lying in floor of mouth
- note asymmetry, atrophy, fasciculations. - ask pt to protrude tongue - finally ask pt to move tongue from side to side |
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Lower extremity motor testing
- HIP |
- pt supine
- test bilaterally --flexion of hip: by placing hand on pt thigh and ask pt to raise leg vs. resistance - hip extension: ask pt to push posterior thigh vs my hand |
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Lower extremity motor testing
- thigh |
Patient sitting up:
ADDuction of hip: place my hand bw pt legs ask pt to try to bring legs together ABDuction: ask pt to spread legs vs my resistance |
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Upper extremity motor testing
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ask pt to flex arm vs. resistance
- ask pt to extend vs. resistance - done bilaterally |
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Lowe extremity motor testing
- legs |
ask pt to flex leg vs. resistance
- ask pt to extend vs. resistance --done bilaterally |
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lower extremity motor testing
- feet |
ask pt to dorsiflex vs. resistance
- ask pt to plantarflex vs. resistance -- done bilaterally |
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Biceps reflex evaluation
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- flex pt arm partially
- strike tendon to elicit a reflex - or place thumb firmly over biceps and strike thumb to elicit a biceps reflex |
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Triceps reflex evaluation
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-flex pt arm at elbow
- tap triceps tendon with hammer - assess bilaterally |
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brachioradialis reflex
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- pt hand resting in a relaxed position in his lap.
- strike the radius 1-2inches above the wrist - assess bilaterally |
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patellar tendon reflex
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- pt sitting up w feet dangling from exam table
- strike patellar tendon *optional to place hand on quadriceps |
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achilles reflex
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- all socks need to be removed
- dorsiflex pt foot at ankle - strike achilles tendon - assess bilaterally |
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plantar or babinski reflex
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- pt supine
- strike from sole to ball of foot curving medially (w end of reflex hammer) - assess bilaterally (normal toes curl down) |
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Assess rapid alternating movements
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1- pronate and supinate rapidly
2- touch thumb to each finger 3- slap wrist agains thigh - done bilaterally |
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finger to nose movements
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ask pt to touch my finger and then his nose, while i move finger randomly in multiple movements
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assessing GAIT
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ask pt to walk, turn and comeback
- heel to toe (tandem walk) |
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Romberg test
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ask pt to stand with feet together
- ask pt to close eyes for 20sec --I stand behind patient to provide support for imbalance - |
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Pronator drift test
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ask pt to stand with eyes closed
- ask pt to extend arms with palms up for 20secs --I stand behind pt |
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Sensory testing
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demostrate to pt the difference bw dull vs. sharp
- ask pt to keep eyes closed - test both arms and legs - bilateral on both upper and lower extremities |
