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298 Cards in this Set
- Front
- Back
Active range of motion is when?
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The patient performs the motion
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Passive range of motion is when?
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The examiner performs the motion
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Strength against resistance is measured how?
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On a numerical, zero to five, scale
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What is the Lovett's descriptive scale?
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A scale that measures muscle strength as Zero, Trace, Poor, Fair, Good, "Normal"
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What are two things to inspect the fingers for in the musculoskeletal exam?
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Haberden's Nodes
Bouchard Nodes |
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Finkelstein's Test is used to diagnose what?
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DeQuervain's Syndrome - Tenosynovitis
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When this test is performed the knee is flexed at 15 degrees and externally rotated. The distal femur and proximal tibia are held, and the fingers are placed on the joint line simultaneously moving the tibia forward and the femur posteriorly.
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Lachman Test
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What in McMurray's Test is usually a sign of a torn meniscus?
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Locking of the knee
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This is when you instruct the patient to lie flat on the stomach and flex the knee to 90 degrees. Grasp the foot and apply downward pressure, internally and externally rotate foot, an audible click or pop is indicative of a loose body.
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Apley's Sign - Meniscus Problem
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This typically involves swelling and tenderness of the entire joint and limits both active and passive range of motion.
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Articular disease
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This typically involves selected regions of the joint and types of movement.
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Extra-articular disease.
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Approximately 85% of patients have _______________ without a precise underlying cause (this term is preferred to "sprain" or "strain").
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Idiopathic low back pain
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For this you need to assess for musculolgamentous injury, disc herniation, vertebral collapse, spinal cord metastases, or rarely epidural abscess.
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Midline back pain
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For pain __________, assess for sacroiliitis, trochanteric bursitis, sciatica, or hip arthritis.
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off the midline
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Radicular gluteal and posterior leg pain in the S1 distribution in ______ increases with cough or valsalva.
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Sciatica
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Leg pain that resolves with rest and/or lumbar forward flexion is seen in?
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Spinal stenosis
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Consider this from S2-4 midline disc or tumor if bowel or bladder dysfunction (usually urinary retention and overflow incontinence).
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Cauda equina syndrome
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If you see low back pain and a "red flag" - age older than 50 years, history of cancer, unexplained weight loss, pain lasting more than 1 month, or not responding to treatment, pain at night or increased by rest, history of IV drug use, or presence of infection - It could mean what?
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Serious Systemic Disease
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Radicular pain from ___________, most commonly C7 followed by C6.
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spinal nerve compression
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Usually from foraminal impingement from degenerative joint changes (70-75%) rather than disc herniation (20-25%)
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Low back pain
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Pain in _______ suggests trauma, monoarticular arthritis, possible tendinitis, or bursitis.
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Pain in one joint
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Lateral hip pain near the greater trochanter suggests?
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Trochanteric bursitis
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Extra articular pain in inflammation of the bursae.
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Bursitis
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Extra articular pain in inflammation of tendons and tendon sheaths.
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tendons - tendonitis
tendon sheaths - tenosynovitis |
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Severe pain of rapid onset in a red, swollen joint is seen in?
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Acute septic arthritis or gout
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If a child has severe pain of rapid onset in a red, swollen joint, what should be considered?
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Osteomyelitis
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Pain, swelling, loss of active and passive motion, "locking", deformity can occur in?
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articular joint pain
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Loss of active but not passive motion, tenderness outside the joint, absence of deformity often in?
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Nonarticular pain
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Stiffness and limited motion after inactivity, sometimes called gelling, in degenerative joint disease but usually lasts only a few minutes; stiffness lasting 30 minutes or more in ?
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rheumatoid arthritis and other inflammatory arthrides.
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Some joint problems have systemic features such as fever, chills, rash, anorexia, weight loss and weakness. What are they?
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Rheumatoid arthritis, systemic lupus erythematosus, PMR, and other inflammatory arthritides. High fever and chills suggest an infectious cause.
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A butterfly rash on the cheeks could be a sign of what?
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SLE
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The scaly rash and pitted nails of psoriasis could be a sign of ?
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Psoriatic arthritis
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A few papules, pustules, or vesicles on reddened bases, located on the distal extremities could be a sign of what?
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Gonococcal arthritis
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An expanding erythematous patch early in an illness could be a sign of what?
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Lyme disease
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Hives associated with joint problems could be?
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Serum sickness, drug reaction
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Erosions or scale on the penis and crusted, sclaing papules on the soles and palms along with joint pain could mean?
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Reiter's syndrome, which also includes arthritis, urethritis, and uveitis
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The maculopapular rash of rubella along with joint pain could mean?
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arthritis of rubella
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What dermatologic symptom is associated with Reiter's syndrome, Behcet's syndrome?
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Red, burning and itchy eyes (conjunctivitis)
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If you have joint pain that happens before a sore throat it could mean?
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acute rheumatic fever or gonococcal arthritis
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If a patient has joint pain with diarrhea, abdominal pain and cramping it could mean?
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Arthritis with ulcerative colitis, regional enteritis, or scleroderma
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If there are symptoms of urethritis and joint pain it could be what two things?
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Reiter's Syndrome or possibly gonococcal arthritis.
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If a patient has mental status change, facial or other weakness, a stiff neck along with joint pain it could be?
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Lyme disease with central nervous system involvement.
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Acute involvement of only one joint suggests?
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Trauma, septic arthritis or gout
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This typically involves several joints, and is symmetrically distributed.
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Rheumatoid arthritis
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What are three types of joint deformity/malalignment of bones?
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Dupuytren's Contracture, bowlegs or are knock kneed.
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Subcutaneous nodules maybe seen in?
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Rheumatoid arthritis or rheumatic fever
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Effusions are seen in what?
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Trauma
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Crepitus can be observed over?
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inflamed joints, in osteoarthritis, or inflamed tendon sheaths
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Muscle atrophy or weakness can be seen in what musculoskeletal problem?
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rheumatoid arthritis
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Palpable bogginess or doughiness of the synovial membrane indicates what?
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synovitis - which is often accompanied by effusion
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Tenderness over the tendon sheaths is?
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tendonitis
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In what conditions can the joints be warm?
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Arthritis, tendinitis, bursitis, osteomyelitis
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Tenderness and warmth over a thickened synovium suggest ?
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Arthritis or infection
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Redness over a tender joint suggests?
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Septic or gouty arthritis, or possibly rheumatoid arthritis.
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Typical features of this are unilateral chronic pain with chewing, jaw clenching, or teeth grinding, often associated with stress (may also present as headache).
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TMJ syndrome
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Pain with chewing can also be seen in what disorders, other than TMJ?
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Trigeminal neuralgia, temporal arteritis
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This may cause elevation of one shoulder.
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Scoliosis
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With this the rounded lateral aspect of the shoulder appears to be flattened.
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Anterior dislocation of the shoulder
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Atrophy of supraspinatus and infraspinatus over posterior scapula with increased prominence of scapular spine within 2-3 weeks of ?
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Rotator cuff tear
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A significant amount of synovial fluid is needed before the ?
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Joint capsule appears distended
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Swelling over the shoulder suggests a ?
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Bursal tear that communicates with the articular cavity.
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Tenderness over the SITS muscle insertions and inability to lift the arm above shoulder level are seen in sprains, tears and tendon rupture of the?
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rotator cuff
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What is the most commonly injured muscle in the rotator cuff?
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supraspinatus
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Age 60 years or older and a positive dropped arm test are the individual findings most likely to identify a ?
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rotator cuff tear
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Localized tenderness or pain with adduction of the shoulder suggests ?
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Inflammation or arthritis of the acromioclavicular joint.
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With this you seen swelling over the olecranon process.
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Olecranon bursitis
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If there is inflammation or synovial fluid at the olecranon it is a sign of?
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Arthritis
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Tenderness distal to the epicondyle near the olecranon is a sign of tennis elbow, what is this called?
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Lateral epicondylitis
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Pitcher's or golfer's elbow is known as?
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medial epicondylitis
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The olecranon is displaced posteriorly in posterior dislocation of the elbow and?
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supracondylar fracture
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Guarded movement suggests injury to the hand. Poor finger alignment is seen in?
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Flexor tendon damage
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Palmar and dorsal surfaces of the wrists:
1. Diffuse swelling is seen in ? 2. Local swelling is seen with? |
1. Arthritis or infection.
2. Cystic ganglion |
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Deformities of the hand, wrists or finger bones:
In osteoarthritis, what is seen at the 1. DIP joint? 2. PIP joint? 3. PIP, MCP and wrist joints with ulnar deviation? |
1. Heberden's nodes
2. Bouchard's nodes 3. Rheumatoid arthritis |
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Contours of the plam, thenar and hypothenar eminences:
1. Thenar atrophy is seen in? 2. Hypothenar atrophy is seen in? |
1. Median nerve compression from carpal tunnel syndrome
2. Ulnar nerve compression |
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Note any thickening of the flexor tendons or flexion contractures in fingers:
Flexion contractures in the ring, 5th, and 3rd fingers, or Dupuytren's contractures, arise from? |
Thickening of the palmar fascia
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Tenderness over the distal radius could be a sign of?
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Colles' fracture. Any tenderness or bony step-offs are suspicious for fracture.
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Swelling and or tenderness at the wrists suggests ________________ if bilateral and of several weeks' duration.
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rheumatoid arthritis
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Tenderness over the extensor and abductor tendons of the thumb at the radial styloid is seen in?
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de Quervain's tenosynovitis and gonococcal tenosynovitis.
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Tenderness over the "snuffbox" is seen in this, and it is the most common injury of the carpal bones.
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Scaphoid fracture
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What puts the scaphoid bone at high risk for avascular necrosis?
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It has a poor blood supply
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The metacarpophilangeal joints are often boggy or tendor in?
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rheumatoid arthritis
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Bouchard's nodes are usually seen in what kind of arthritis?
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osteoarthritis
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Hard dorsolateral nodules on the DIP joints that are common in osteoarthritis.
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Heberden's nodes
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This is often related to repetitive motion with wrists flexed (as in keyboard use, mail sorting), pregnancy, rheumatoid arthritis, diabetes, or hypothyroidism.
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Carpal tunnel syndrome
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Lateral deviation and rotation of the head suggest this, from contraction of the sternocleidomatoid muscle.
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Torticollis
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Tenderness in the spine suggests this, if it is preceded by trauma, underlying infection or arthritis.
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fracture or dislocation
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Tenderness in the cervical vert., especially at the facet joints between C5 and C6 suggests?
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arthritis
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tenderness over the sacroiliac joint could be from?
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Sacroiliitis or ankylosing spondylitis
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Pain on percussion of the spine may arise from what three things?
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Osteoporosis, Infection or malignancy
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Increased ________ _________ occurs with aging. In children a correctable structural deformity should be pursued.
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thoracic kyphosis
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In this, there is a lateral and rotary curvature of the spine to bring the head back to midline. This often becomes evident during adolescence, before symptoms appear.
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Scoliosis
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Unequal shoulder heights may be seen in what?
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scoliosis, Sprengel's deformity of the scapula (from the attachment of an extra bone or band between the upper scapula and C7).
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Winging of the scapula is caused by?
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Loss of innervation of the serratus anterior muscle by the long thoracic nerve and in contralateral weakness of the trapezius.
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Unequal heights of the iliac crests, or pelvic tilt, suggest?
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unequal lengths of the legs and disappear when a block is placed under the short leg and foot.
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"listing" of the trunk to one side is seen with?
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a herniated lumbar disc
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Birthmarks, port wine stains, hairy patches, and lipomas often overlie bony defects such as?
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spina bifida
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Cafe-au-lait spots (discolored patches of skin), skin tags, and fibrous tumors are seen in?
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neurofibromatosis
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This suggests a herniated disc or mass lesion impinging on the contributing nerve roots.
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Sciatic nerve tenderness
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Herniated intervertebral discs are most common at?
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L5-S1, or L4-L5
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It is important to assess any complaints or findings of neck, shoulder, or arm pain or numbness for possible ?
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cervical cord or nerve root compression
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Tenderness at C1-C2 in rheumatoid arthritis suggests possible risk for?
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subluxation and high cervical cord compression.
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Deformity of the thorax on forward bending is?
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scoliosis
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Persistence of lumbar lordosis suggests what two things?
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muscle spasm or ankylosing spondylitis
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Most problems in the gait appear at what phase?
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In the weight bearing stance phase
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A wide base in the gait suggests?
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Cerebellar disease or foot problems
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Hip dislocation, arthritis, or abductor weakness can cause the pelvis to drop on the opposite side, producing a ?
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Waddling gait
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Loss of lordosis may reflect?
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Paravertebral spasm
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Excess lordosis suggests a what of the hip?
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flexor deformity
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Changes in leg length are seen in?
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adbuction or adduction deformities and scoliosis.
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Leg shortening and external rotation suggests?
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hip fracture
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In this, as the opposite hip is flexed (with the thigh against the chest), the affected hip does not allow full leg extension and the affected thigh appears flexed.
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In flexion deformity of the hip
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Flexion deformity may be masked by an increase, rather than flattening, in ?
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lumbar lordosis and an anterior pelvic tilt.
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Restrictions of internal and external rotation are sensitive indicators of hip disease such as?
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arthritis
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Stumbling or pushing the knee into extension with the hand during heel strike suggests?
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quadriceps weakness
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Bowlegs is also known as?
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(genu varum)
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knock knees are known as?
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(genu valgum)
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Swelling over the patella suggests?
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prepatellar bursitis
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Swelling over the tibial tubercle suggests 1.? or if more medial 2.?
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1. Infrapatellar bursitis
2. Anserine bursitis |
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If you have tender bony ridges along the joint margins, genu varum deformity, and stiffness 30 minutes or less, and crepitus may be present.
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Osteoarthritis of knee
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Tenderness over the tendon or inability to extend the leg suggests a partial or complete tear of the?
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patellar tendon
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Pain with compression and with patellar movement during quadriceps contraction suggests?
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Chondromalacia, or degenerative patella (the patellofemoral syndrome)
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This occurs from excessive kneeling?
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Pepattellar bursitis (housemaid's knee)
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This occurs from distention of the gastrocnemius semimembranosus bursa.
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A popliteal or "backer's cyst"
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Absence of plantar flexion is a positive test for this. Sudden severe pain "like a gunshot wound", an ecchymosis from the calf into the heel, and a flat footed gait with absence of "toe-off" may also be present with this.
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Ruptured achilles tendon
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After trauma, inability to bear weight after 4 steps and tenderness over the posterior aspects of either the malleolus, especially the medial malleolus is suspicious for?
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Ankle fracture (known as the Ottawa ankle rule)
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Pain and tenderness over the metatarsals of the foot seen in trauma, arthritis and vascular compromise is called?
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metatasrsalgia
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Tenderness over the 3rd and fourth metatarsal heads on the plantar surface is seen in?
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Morton's neuroma
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Aching pain in the lumbosacral area, may radiate into lower leg, especially along L5 (lateral leg) or S1 (positive leg) dermatomes. Refers to anatomic or functional abnormality in absence of neoplastic, infectious or inflammatory disease. Commonly work related and occurring in patients 30-50 years old, risk factors include heavy lifting, poor conditioning, obesity.
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Mechanical low back pain
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Shooting pain below the knee, commonly into the lateral leg (L5) or posterior calf (S1), typically accompanies low back pain, patients report associated parasthesias and weakness, bending, sneezing, coughing, straining during bowel movements often worsens pain.
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Sciatica (radicular low back pain)
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"Pseudoclaudication" pain in the back or legs with walking that improves with rest, lumbar flexion (which decompresses the spinal cord), or both. Pain is vague but usually bilateral with parasthesias in one or both legs.
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Lumbar spinal stenosis
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Aching pain in the cervical paraspinal muscles and ligaments with associated muscle spasm, with associated stiffness and tightness in the upper back and shoulder, lasting up to six weeks. No associated radiation, paresthesias, or weakness. Headache may be present.
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Mechanical neck pain
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Mechanical neck pain with aching paracervical pain and stiffness, often beginning the day after injury. Occipital headache, dizziness, malaise, and fatigue may be present.
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Mechanical neck pain "whiplash"
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Sharp, burning or tingling pain in the neck and one arm, with associated parathesias and weakness. Sensory symptoms often in myotomal pattern, deep in muscle, rather than dermatomal pattern.
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Cervical radiculopathy - from nerve root compression
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Neck pain with bilateral weakness and parathesias in both upper and lower extremities, often with urinary frequency. Hand clumsiness, palmar parathesias, and gait changes may be subtle. Neck flexion often exacerbates symptoms.
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Cervical myelopathy-from cervical cord compression.
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Chronic inflammation of synovial membranes with secondary erosion of adjacent cartilage and bone, and damge to ligaments and tendons.
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Rheumatoid arthritis
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Degeneration and progressive loss of cartilage within the joints, damage to underlying bone, and formation of new bone at the margins of the cartilage.
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Osteoarthritis
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An inflammatory reaction to microcrystals of sodium urate.
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Gouty arthritis
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Multiple local accumulations of sodium urate in the joints and other tissues, with or without inflammation.
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Chronic Tophaceous Gout
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A disease of unclear etiology in people over age 509, especially women, may be associated with giant cell arteritis.
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Polymalgia rheumatica
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Widespread musculoskeletal pain and tender points. May accompany other diseases. Mechanisms unclear.
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Fibromyalgia syndrome
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Repeated shoulder motion as in throwing or swimming can cause edema and hemorrhage followed by inflammation, most commonly involving the supraspinatus tendon. Acute, recurrent or chronic pain may result, often aggrevated by activity.
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Rotator cuff tendonitis
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When the arm is raised in forward flexion, the rotator cuff may impinge against the undersurface of the acromion and the coracoacromial ligament. Injury from a fall or repeated impingement may weaken the rotator cuff, causing a partial or complete tear usually after age 40.
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Rotator cuff tears
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This is a degenerative process in the tendon associated with the deposition of calcium salts. Usually involves the supraspinatus tendon.
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Calcific tendinitis
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Inflammation of the long head of the biceps tendon and tendon sheath causes anterior shoulder pain resembling and often coexisting with rotator cuff tendinitis.
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Bicipital tendinitis
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This refers to fibrosis of the glenohumeral joint capsule, manifested by diffuse, dull, aching pain in the shoulder and progressive restriction of active and passive range of motion, but usually no localized tenderness. The condition is usually unilateral and occurs in people aged 50-70.
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Adhesive capsulitis (frozen shoulder)
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This is uncommon, usually arising from direct injury to the shoulder girdle with resulting degenerative changes. Tenderness is localized over the acromioclavicular joint.
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Acromioclavicular arthritis
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Shoulder instability from this usually results from a fall or forceful throwing motion, then becomes recurrent. The shoulder seems to "slip out of joint" when the arm is abducted and externally rotated, causing a positive apprehension sign.
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Anterior dislocation of the humerus
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Swelling and inflammation of the olecranon bursa.
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Olecranon bursitis
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Synovial inflammation or fluid is felt best in the grooves between the olecranon process and the epicondyles on either side.
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Arthritis of the elbow
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Subcutaneous nodules may develop at pressure points along the extensor surface of the ulna in patients with rheumatoid arthritis or acute rheumatic fever.
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Rheumatoid nodules
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This follows repetitive extension of the wrist of pronation-supination of the forearm. Pain and tenderness develop 1cm distal to the lateral epicondyle and possibly in the extensor muscle close to it.
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Epicondylitis - Lateral Epicondylitis
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The first sign of this is a thickened plaque overlying the flexor tendon of the ring finger and possibly the little finger at the level of the distal palmar crease. Subsequently the skin in this area puckers and a thickened fibrotic cord develops between the palm and finger.
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Dupuytren's Contracture
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Caused by a painless nodule in a flexor tendon in the palm, near the metacarpal head. The nodule is too big to enter easily into the tendon sheath during extension of the fingers from a flexed position.
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Trigger finger
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This suggests a median never disorder such as carpal tunnel syndrome.
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Thenar Atrophy
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Cystic, round usually nontender swellings along tendon sheaths or joint capsules, frequently at the dorsum of the wrist.
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Ganglion
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Infection of the flexor tendon sheaths, may follow local injyry, even when trivial in nature. Unlike arthritis, tenderness and swelling develop not in the joint but along the course of the tendon sheath, from the distal phalanx to the level of the MCP joint.
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Acute tenosynovitis
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If the infection progresses it may extend from the tendon sheath into the adjacent fascial spaces within the palm. Early diagnosis and TX are important.
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Acute tenosynovitis and Thenar space involvement.
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Injury to the fingertip may result in infection in the enclosed fascial spaces of the finger pad.
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Felon
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The great toe is abnormally abducted in relationship to the first metatarsal.
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Hallux Valgus
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Tenderness over the plantar surface, third and fourth metatarsal heads, from probable entrapment of the medial and lateral plantar nerves.
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Morton's neuroma
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Most commonly involving the second toe, this is characterized by a hyperextension at the MCP joint with flexion at the proximal interphalangeal joint. A corn frequently develops at the pressure point over the proximal interphalangeal joint.
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Hammer Toe
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This is a painful conical thickening of skin that results from recurrent pressure on normally thin skin. The apex of the cone points inward and causes pain.
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Corn
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Like a corn, this is an area of greatly thickened skin that develops in a region of recurrent pressure. Unlike a corn, this involves skin that is normally thick.
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Callus
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This is a common wart, verruca vulgaris, located in the thickened skin of the sole It may look like a callus or even be covered by one.
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Plantar Wart
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When pain sensation is diminished or absent, as in diabetic neuropathy, these may develop at pressure points on the feet.
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Neuropathic ulcer
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This may present as "the worst headache of my life".
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Subarachnoid hemorrhage
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If there is a dull headache, and it is affected by coughing, sneezing or sudden movement of the head, especially in the same location it could be what?
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A mass lesion or an abscess
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Light headedness can be experienced with?
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Palpitations
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Vasovagal stimulation, low blood pressure, febrile illness etc. can cause?
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Near Syncope
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What symptom can inner ear conditions and brainstem tumors cause?
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vertigo
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Diplopia, dysarthria, ataxia can be seen in?
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in vertebrobasilar transient ischemic attack (TIA) or stroke
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Transient ischemic attack can result in ?
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weakness or paralysis
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This may arise from ischemic, vascular, or mass lesions in the central nervous system; also from peripheral nervous system disorders, neuromuscular disorders, or disease in the muscles themselves.
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Focal weakness
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This may happen in myopathy.
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Bilateral proximal weakness
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This may happen in polyneuropathy?
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Bilateral, predominately distal weakness
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Weakness made worse with repeated effort and improved with rest suggests?
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Myasthenia gravis
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These are a loss of sensation in central lesions in the brain and spinal cord, as well as disorders of peripheral sensory roots and nerves.
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parasthesias and dysthesias
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These occur in the hands and round the mouth in hyperventilation.
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parasthesias
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Burning pain occurs with?
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painful sensory neuropathy
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Young people with emotional stress and warning symptoms of flushing, warmth, or nausea may have?
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Vasodepressor (or vasovagal) syncope of slow onset, slow offset.
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This occurs from arrhythmias, more common in older patients, often with sudden onset, sudden offset.
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Cardiac syncope
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Tonic-clonic motor activity, bladder or bowel incontinence, and postictal state suggest a ?
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generalized seizure - Unlike syncope, injury such as tongue biting or bruising of the limbs may occur.
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Parkinson's disease presents with?
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Tremor, rigidity and bradykinesia
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True or False, Restless leg syndrome is a common but overlooked benign syndrome.
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True
|
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This can occur when there is a loss of smell, head trauma, smoking, aging, and the use of cocaine, as well as Parkinson disease.
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Loss of smell
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1. Disc pallor occurs in?
2. Disc bulging occurs in? |
1. Optic atrophy
2. Papilledema |
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These visual field defects are seen in glaucoma, retinal emboli, optic neuritis.
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Prechiasmal or anterior defects
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This occurs with defects at the optic chiasm, usually from pituitary tumor.
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Bitemporal hemianopsias
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These defects may occur in postchiasmal lesions, usually in the parietal lobe, with associated findings of stroke.
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Homonymous hemianopsias or quadrantanopsia
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Minimal constriction in the larger pupil if abnormality of the pupillary constrictor muscle from what two things?
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Iris disorder
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With this you can see parasympathetic denervation, ptosis, and ophthalmoplegia (eyes not aligned).
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CN III palsy
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Pupils constrict to light, but due to sympathetic degeneration the affected pupil remains (miosis) due to abnormal pupillary dilator muscle. What causes this?
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Horner's Syndrome
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This can occur when there are problems with glasses or contact lenses, cataracts; astigmatism, ptosis.
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Disconjugate gaze, momocular diplopia
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This can occur when there is CN III, IV, VI neuropathy, eye muscled disease from myasthenia gravis, trauma, thyroid ophthalmopathy, internuclear ophthalmoplegia.
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Binocular diplopia
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This is seen in cerebellar disease, especially with gait ataxia and dysarthria (increases with retinal fixation) and vstibular disorders (decreases with retinal fixation. This is also seen in internuclear ophthalmoplegia.
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Nystagmus
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Ptosis (drooping of the upper eyelid) can be seen in?
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3rd nerve palsy (CN III)
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Ptosis, meiosis, anhidrosis, and myathenia gravis can be seen with?
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Horner's Syndrome
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Difficulty in clenching the jaw or moving it to the opposite side in?
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Masseter and lateral pterygoid weakness, respectively
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Isolated facial sensory loss in peripheral nerve disorders like?
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trigeminal neuralgia
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Absent blinking occurs when?
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There is a lesion in CN V or VII
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Absent blinking and sensorineural hearing loss occurs in?
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acoustic neuroma
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Flattening of the nasolabial fold and drooping of the lower eyelid suggest?
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facial weakness.
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A peripheral injury to this, as in Bell's palsy, affects both the upper and lower face, a central lesion affects mainly the lower face. Loss of taste, hypercusis, increased or decreased tearing also in bell's palsy.
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Injury to CN VII
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The mouth droops on the paralyzed side when the patient smiles or grimaces.
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In unilateral facial paralysis
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This is a loss of muscle bulk, or wasting. It results from diseases of the peripheral nervous system such as diabetic neuropathy, as well as diseases of the muscles themselves.
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Muscular atrophy
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Fasciculations with atrophy and muscle weakness suggest disease of the?
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peripheral motor unit
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This is increased resistance that worsens at the extremes of range.
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Spasticity
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This is increased resistance throughout the range of movement and in both directions.
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Rigidity
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Weakness of extension in the arm is seen in peripheral nerve disease such as?
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radial nerve damage and in central nervous system disease producing hemiplegia, as in stroke or multiple sclerosis
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This symptom can be seen with cervical radiculopathy, de Quervain's tenosynovitis, carpal tunnel syndrome, arthritis, epicondylitis.
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A weak grip
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Weak finger abduction occurs in?
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ulnar nerve disorders
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Weak opposition of the thumb occurs in?
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Median nerve disorders such as carpal tunnel syndrome
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This should be suspected if nystagmus, dysarthria, hypotonia, and ataxia are seen.
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Cerebellar disease
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With this, one movement cannot be followed quickly by its opposit and movements are slow, irregular, and clumsy. This abnormality is called dysdiadochokinesis. Upper motor neuron weakness and basal ganglia disease may also impair rapid alternating movements, but not in the same manner.
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Cerebellar disease
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Abnormalities of gait increase?
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The risk of falls
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A gait that lacks coordination, with reeling and instability is called?
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Ataxic
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Ataxia may be due to?
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cerebellar disease, loss of position sense, or intoxication
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Inability to heel walk is a sensitive test for?
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corticospinal tract damage
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Walking on toes and heels may reveal?
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distal muscular weakness in the legs
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This is a test that is sensitive and specific for a corticospinal tract lesion originating in the contralateral hemisphere.
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Pronator drift
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if you have a glove and stocking sensory loss of a polyneuropathy this is seen in what two things?
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Alcoholism and Diabetes
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This refers to the inability to recognize objects placed in the hand.
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Astereognosis
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The inability to recognize numbers, like astereognosis, suggests?
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A lesion in the sensory cortex
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There is an increase in the distance between two recognizable points with?
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A lesion in the sensory cortex
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This can be seen in CNS lesions along the descending corticospinal tract. Look for associated upper motor neuron findings of weakness, spasticity, or a positive babinski sign.
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Hyperactive reflexes
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This is seen in diseases of the spinal nerve roots, spinal nerves, plexuses, or peripheral nerves. Look for associated findings of lower motor unit disease, namely weakness, atrophy and fasciculations.
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Hypoactive or absent reflexes.
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The slowed relaxation phase of reflexes in this is often easily seen and felt in the ankle reflexes.
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Hypothyroidism
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This indicates central nervous system disease. The ankle plantar flexes and dorsiflexes repetitively and rhythmically.
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Sustained clonus
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Abdominal reflexes may be absent in both?
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central and peripheral nerve disorders.
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This can occur from a central nervous system lesion in the corticospinal tract; also seen in unconscious states from drug or alcohol intoxication or the postictal period following a seizure.
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Babinski response/reflex
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A marked babinski response is occasionally accompanied by ?
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reflex flexion at hip and knee
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Loss of this suggests a lesion in the S2, 3, 4 reflex arc, as in cauda equina lesion.
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Loss of the anal reflex
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Neck stiffness and resistance to flexion in 90% of patients occurs with?
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bacterial meningitis, and in 20%-85% of patients with subarachnoid hemorrhage.
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What do you never do when assessing a comatose patient?
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Don't dilate the pupils
Don't flex the neck if there is any chance of trauma there. |
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Five clinical signs strongly predicting death or poor outcome with comatose patient.
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At 24 hours - absent corneal response, absent pupillary response, absent withdrawal response to pain, no motor response
At 72 hours - no motor response |
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This patient appears drowsy but opens the eyes and looks at you, responds to questions and then falls asleep.
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Lethargic patient
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This patient opens the eyes and looks at you, but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.
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Obtunded patient
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This patient arouses from sleep only after painful stimuli, verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimulus ceases. There is minimal awareness of self or the environment.
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Stuporous patient
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This patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli.
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Comatose patient
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No response to stimulus suggests?
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Brainstem injury
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Two sterotypic responses predominate with comatose patients what are they?
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decorticate and decerebrate rigidity
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If there is no response on side of a comatose patient that suggests a?
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corticospinal tract lesion
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These are tremors most prominent at rest, and may decrease or disappear with voluntary movement.
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resting static tremors
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These tremors appear when the affected part is actively maintaining a posture. Examples include the fine rapid tremor of hypterthyroidism, the tremors of anxiety or fatigue, and benign essential tremor. Tremor may worsen somewhat with intention.
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Postural action tremors
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These are absent at rest, appear with activity and often get worse as the target is nered. Causes include disorders of cerebellar pathways, as in MS.
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Intention tremors
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These affect the face, and are rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue, grimacing pursing of the lips, protrusion of the tongue, opening and closing of the mouth, and deviations of the jaw.
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Oral-facial dyskinesias
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Brief, repetitive stereotyped coordinated movements occuring at irregular intervals.
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Tics
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Movements are similar to athetoid movements, but often involve larger portions of the body, including the trunk. Grotesque, twisted postures may result.
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Dystonia
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These movements are slower and more twisting and writhing that choreiform movements, and have a larger amplitude, they are seen most commonly in the face and distal extremities.
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Athetosis
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These movements are brief, rapid, jerky, irregular, and unpredictable. They occur at rest or interrupt normal coordinated movements.
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Chorea
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This is a speech disorder that results in speech that is fluent, often rapid, voluble, and effortless. Inflection and articulation are good, but sentences lack meaning and words are malformed (paraphasias) or invented (neologisms). Speech may be totally incomprehensible.
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Wernicke's Aphasia
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This speech disorder is nonfluent, slow, with few words and laborious effort, inflection and articulation are impaired but words are meaningful, with nouns transitive verbs and important adjectives, small grammatical words are often dropped.
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Broca's Aphasia
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Eyes do not close, but eyeballs roll up, flat nasolabial fold, forehead is not wrinkled, eyebrows are not raised, paralysis of lower face is witnessed.
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CN VII peripheral lesion
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Eye closes, perhaps with slight weakness, flat nasolabial fold, Forehead wrinkled, eyebrow raising, paralysis of lower face is witnessed.
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CN VII central lesion
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This can be seen in the elderly with depression, Parkinsons disease, or Alzheimers.
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Flag or impoverished affect
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Undernutrition, slowed motor performance, loss of muscle mass, or weakness suggests?
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Frailty
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Kyphosis or abnormal gait can impair balance and increase?
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The risk of falls
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This is SBP >140 occuring after age 50 which triples the risk for coronary heart disease in men and increases the risk of stroke.
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Isolated systolic hypertension
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Caution is advised when doing this in the oldest old - people over 80 years old because it can be a risk factor for cardiovascular, renal disease and stroke.
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Lowering blood pressure
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This occurs in 10%-20% of older adults and in up to 30% of frail nursing home residents, especially when they first arise in the morning.
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Orthostatic hypotension
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A respiratory rate in the elderly over 25 breaths per minute indicate?
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Lower respiratory infection, also CHF and COPD exacerbation
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This is more common in elderly patients in regards to temperature.
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Hypothermia
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This is a key indicator of poor nutrition.
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Low weight
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This is seen with depression, alcoholism, cognitive impairment, malignancy, chronic organ failure, medication use, social isolation, and poverty.
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Undernutrition
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These may develop from obliteration of arteriolar and capillary blood flow to the skin or from shear forces during movement across sheets or when lifted upright incorrectly.
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Pressure sores
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This is the world's leading cause of blindness. Risk factors include cigarette smoking, exposure to UV-B light, high alcohol intake, diabetes, medications (including steroids), and trauma.
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Cataracts
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This suggests open angle glaucoma, caused by irreversible optic neuropathy and leading to loss of peripheral and central vision and blindness.
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An increased cup to disc ratio
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This causes poor central vision and blindness. Types include dry atrophic (more common but less severe) and wet exudative, or neovascular.
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Macular degeneration
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This may occur with poor oral hygiene or periodontitis, caries.
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Malodor
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Increased anteroposterior diameter, purse-lipped breathing, and dyspnea with talking or minimal exertion suggest?
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Chronic obstructive pulmonary disease
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|
Isolated systolic hyptertension and a widened pulse pressure are cardiac risk factors, prompting a search for ?
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Left ventricular hypertrophy
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This can raise pressure in the left jugular veins by impairing drainage into the right atrium. It may also cause kinking of the carotid artery low in the neck on the right, chiefly in women with hypertension, which can be mistaken for a carotid aneurysm.
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A tortuous atherosclerotic aorta
|
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These in the elderly warrent further investigation for possible carotid stenosis due to risk for ipsilateral stroke.
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Carotid Bruit
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When do you see sustained PMI?
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Left ventricular hypertrophy
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Diffuse PMI occurs in?
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congestive heart failure
|
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In older adults an S3 suggests?
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Dilation of the left ventricle from congestive heart failure or cardiomyopathy.
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|
An S4 in the elderly usually accompanies?
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Hypertension
|
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A systolic crescendo decrescendo murmur in the second right intercostal space suggests ?
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Aortic sclerosis or aortic stenosis
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|
Delay during simultaneous palpation but not compression of the brachial and radial pulses denotes ?
|
Aortic stenosis
|
|
A harsh holosystolic murmur at the apex suggests?
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Mitral regurgitation
|
|
Lumps or masses in older women, and rarely in older men, mandate?
|
further investigation for possible malignancy
|
|
Widened aorta and pulsatile mass are seen in?
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Abdominal aortic aneurysm
|
|
Erythema with satellite lesions results from infection with?
|
Candida
|
|
Erythema with ulceration or necrotic center is associated with?
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Carcinoma
|
|
Multifocal reddened lesions with white scaling plaques are consistent with?
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Paget's disease
|
|
Clitoral enlargement may accompany?
|
Androgen producing tumors or use of androgen creams.
|
|
Estrogen stimulated cervical mucus with ferning is seen with use of?
|
Hormone replacement therapy, endometrial hyperplasia and estrogen producing tumors.
|
|
A uterus that is enlarged, fixed, or irregular may indicate?
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Adhesions, or possible malignancy
|
|
Rectal masses are found in?
|
Colon cancer
|
|
What are three things that can be seen with the geriatric male genitalia?
|
Smegma, penile cancer, scrotal hydroceles
|
|
These symptoms are seen with?
Tremor, rigidity, bradykinesia, micrographia, shuffling gait, and difficulty turning in bed, opening jars, and rising from chair. |
Parkinson's Disease
|
|
What are five things noticed in the skin with aging?
|
Wrinkles and becomes lax and loses turgor*
Decreased Vascularity of the dermis Actinic Purpura* Effects of Sun Exposure become evident* Dryness (asteatosis) - Atrophy of sweat glands |
|
What are three benign lesions associated with aging skin?
|
actinic keratoses
actinic lentigines - liver spots seborrheic keratosis |
|
What are five things associated with the aging eye?
|
Periorbital fat atrophies - Wrinkles around the eyes
Eyeball recedes into the orbit Fewer lacrimal secretions - Dry Eyes Senile ptosis Entropium/ectropium |
|
What are four changes in the ear with aging?
|
1. Degenerative changes of ossicles
2. Increased obstruction of the eustachian tubes 3. Atrophy of cochlear hair cells 4. Loss of auditory neurons |
|
What are six endocrine changes seen in the elderly?
|
Decreased triiodothyronine (T3)
Decreased free (unbound) testosterone Increased insulin Increased norepinephrine Increased parathormone Increased vasopressin |
|
Your role as a Clinician with the elderly is to?
|
enhance your patients coping mechanisms by identifying and treating their
remediable problems properly, facilitating their environment and obtaining needed services to maximize their function and quality of life. |
|
What are three important immunizations for the elderly patient?
|
Influenza
Pneumococcal Tetanus |