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18 Cards in this Set
- Front
- Back
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Grading reflexes
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4+ very brisk, hyperactive with clonus. 3+ Brisker than average but not indicative of dz. 2+ normal. 1+ Low normal, dimished. 0 No response
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Reinforcement
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If patient's reflexes are symmetrically diminished or absent. Isometric contraction of other muscles for up to 10 seconds may increase the reflex activity. Clench teeth or squeeze one thigh with the opposite hand or lock fingers and pull one against the other
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Biceps reflex (C5-C6)
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pt's arm-partially flexed at elbow with palm down. Place you finger firmly on the biceps tendon, strike hammer so the blow is aimed directly through your digit toward the biceps tendon. Observe flexion at the elbow, and watch and feel for the contraction.
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Triceps reflex (C6, C7)
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Flex the patients arm at the elbow with the palm toward the body. Strike the triceps tendon above the elbow. Use a direct blow. Watch for contraction of the triceps muscles and extension at the elbow. If you have difficulty getting the patient to relax try supporting the upper arm and ask the patient to go limp as if "hung to dry" Then strike the tendon.
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The supinator of brachioradialis (C5, C6)
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The patent's hand should rest of the abdomen or lap, with the forearm pronated. Strike the radius with the point or flat edge of the reflex hammer about 1-2 inches above the wrist. Watch for flexion and supination of the forearm.
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Knee reflex (L2,3,4)
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Briskly tap the patellar tendon just below the patella. Note the contraction of the quadriceps with the knee extension. A hand on the patient's anterior thigh lets you feel this reflex.
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Ankle relax (S1)
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If the patient is sitting, dorsiflex the foot at the ankle. Persuade the pt to relax. Strike the achilles tendon. Watch and feel for plantar flexion at the ankle. If the patient is lying down, flex one leg at both hips and knee and orate it externally so that the lower leg rests across the opposite shin. Then strike. Note also the speed of relaxation after muscular contraction. The slowed relaxation phase of reflexes in hypothyroidism is often seen and felt in the ankle reflex.
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Clonus
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If reflexes seem hyperactive, test for ankle clonus. Support the knee in a partly flexed position. With your other hand, dorsiflex and plantar flex the foot a few times while encouraging the patient to relax and then sharply dorsiflex the foot and maintain it in dorsiflexion. Look at feel for rhythmic oscillations between dorsiflexion and plantar flexion. In most normal people, the ankle does not react. However a few clonic beats may be seen if the pt is tense or just exercised. Sustained clonus indicates central nervous system diease. The ankle plantar flexes and dorsiflexes repetitively and rhymically.
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Ischemic Stroke risk factors
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HTN'; Smoking; dyslipidemia; diabetes; weight; exercise; ETOH use; DZ-a.fib & CAD; *TIA's are a major risk factor for subsequent stroke.
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Early predication of stroke/TIA-ABCD2
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Age->60; BP>140/90; Clinical features-focal weakness or impaired speech without focal weakness. Duration up to or more than 60 minutes; Diabetes
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Ischemic stroke
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Thrombus or embolus. Infarction of the central nervous system. Central core of very low perfusion/cell death. There may be disturbed cells that are potentially vibe depending on flow and duration of the ischemia. Most irreversible damage occurs within 3-6 hours after onset of symptoms, therapies targeted to the 3 hour window achieve the best outcomes.
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Hemorrhagic
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Intracerebral or subarchnoid
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Most common ischemic stroke
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occlusion of the middle cerebral artery (MCA); causes visual field cuts and contralateral hemiparesis and sensory deficits.
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Left middle artery occlusion produces (MCA)
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aphasia
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Right middle artery occlusion produces (MCA)
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neglect or inattention to the opposite side of the body; hemorrhagic Stroke prevention (ruptured circle of willis)
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Risk factors: Stroke
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optimal blood pressure is essential; smoking; ETOH; fam hx with 1st degree relative.
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TIA and stroke - secondary prevention
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focus on identifying risk factors
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Assessing Gait
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Look at posture, how are they moving their elbows, wrists, knees; look for weakness, poor stature, decreased fluidity of movement.
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