Questions and Answers
What should you do if you are unfamiliar with a medical term during the exam?
Which vital signs should be recorded by the rehab during the patient's exam?
What should you do once you took a picture of both eyes for the PLR?
What order do we do BP in?
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During the Reflex app process, how should the patient's eyes be managed?
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What is necessary to present after the physical exam is completed?
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What should you do if you got an E for one or both of the eyes during PLR?
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Where should the patients arms be during BP?
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What is the maximum score a patient can achieve on the digit span test when reciting numbers?
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What does a capillary refill time of 2 seconds indicate?
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What should a patient be able to do during the visualization testing concerning convergence?
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What is the normal data of the Fundoscopic exam in terms of A/V ratio?
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If a patient spells 'WORLD' correctly forwards but not backwards, what should you do?
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What does the patient do during "Gait" testing portion of bedside?
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What section is the Hand Supination/Pronation in?
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What does a normal response in the Fitz-Ritzen Testing indicate?
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What is the significance of finding hypometric saccades during testing?
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If the doctor said "Reduced arm swing with dual tasking" you can assume they are at what part of the bedside?
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What does the patient do during HEVM testing?
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What test involves the patient repeating three hand motions that the doctor makes?
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What does a normal pinwheel test suggest regarding sensory function?
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What does the Antisaccades test evaluate?
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Which finding would indicate normal functioning of deep tendon reflexes?
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What does a finding of 2/5 muscle strength in the lower extremities signify?
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Which result does not suggest a problem with auditory function during cranial nerve testing?
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What does an abnormal finger to nose test indicate?
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What indicates the presence of facial paresis in a cranial nerve assessment?
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Where should you put "C2" in the spine section?
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Can we shorten Grade 1 to G1?
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What would indicate a normal result during the saccades test?
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Which test might the doctor need the rehabs assistance during?
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Which test is the doctor saying 7 numbers in monotone straight forward style?
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How is a normal result determined in the Antisaccades test?
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Which outcome indicates a potential issue during the Gait assessment?
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What finding in the muscle testing indicates potential weakness?
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What is not something you will note for resting head position?
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At what point in testing are the doctors likely to report a terminal/intention tremor?
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What finding in the deep tendon reflexes suggests hyperactivity?
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Which response indicates normal muscle tone?
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Which test involves the patient watching a target with their eyes but not moving their head
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What finding in cranial nerve testing is for olfactory function?
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What does it mean if a patient shows improvement in sway with visual stimuli?
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What does the patient look at during optokinetic reflex testing?
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Which test assesses a patient's ability to count backward from 100 by 7?
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What finding would indicate normal gaze stability during testing?
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A patient's capillary refill time of 2 seconds is considered?
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Where would you record patients interpretation of if they are feeling like they are moving in any direction?
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If a patient demonstrates normal convergence, what does it suggest about their visual function?
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Which cognitive ability is evaluated by spelling the word 'WORLD' forwards and backwards?
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When the doctor makes a note during a section you should?
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Study Notes
Bedside Exam
- During exams, doctors communicate findings for documentation.
- If unfamiliar with medical terminology, approximate the spelling and inquire later for clarification.
- Avoid contradictory statements in documentation; for instance, remove "WNL" if a test grade is recorded as "G3".
- Scribing may be challenging initially but improves with practice and familiarity with terminology.
Vital Signs
- Essential vital signs include blood pressure, heart rate, and oxygen saturation, measured in various positions (sitting, supine, standing) on both sides.
- Record patient height and weight; leave weight blank if unknown temporarily.
Reflex App
- Use the Reflex app on an iPad mini for patient evaluations.
- Create a new patient profile before starting the exam.
- Instruct the patient to focus on a distant point while testing each eye separately; cover one eye at a time to avoid blocking vision.
- Capture data for both eyes, ensuring optimal lighting conditions.
- Present captured data to the doctor during the examination.
Post-Exam
- After completing the physical exam, patients schedule a "Report of Findings" meeting.
- Doctors will discuss diagnostic results and propose a treatment plan.
- If patients agree with the plan, enrollment in the NeuroRestoration program will commence.
Vitals Assessment
- Capillary refill time: 2 seconds for both left and right fingers indicates good perfusion.
- Red desaturation test revealed no asymmetry, indicating normal color perception in both eyes.
Cognitive Testing
- Patient is oriented to self, time, and place, suggesting intact cognitive function.
- Well-nourished appearance and grooming noted.
- Attention and concentration are intact.
- Digit span test results: 7/7 with linear presentation, varying scores with prosodic variations indicate varying memory retention.
- Serial 7s task intact, demonstrating proper numerical cognition.
- Successful phrase recall after 30 seconds and 5 minutes indicates short-term memory function.
- Accurate spelling of "WORLD" forwards and backwards suggests good verbal processing.
Visual Testing
- Normal resting head position, indicating no immediate visual-motor issues.
- Fundoscopic exam shows an artery-to-vein (A/V) ratio of 1:1.5, with other findings normal.
- Park's 3 Step Test shows no muscle paresis.
- Normal convergence reflects appropriate eye coordination.
- Stable gaze in all cardinal fields confirms good ocular stability.
- Smooth pursuits exhibit minimal saccades, maintaining eye tracking ability.
- Head-eye vestibular movement shows normal gain bilaterally.
- Saccades and antisaccades exhibit fast and accurate movements.
- Optokinetic reflexes normal in all directions indicate healthy visual tracking.
Vestibular Testing
- Normal gait with symmetrical arm swing indicates stable lower body control.
- Dual tasking performance normal, no issues noted while walking and talking.
- Perceived sway and initial sway tests reveal normal balance without significant sway perception.
- Balance improved with optokinetic tracking in the lower left quadrant.
Motor Sensory Testing
- Touch localization test normal bilaterally shows intact sensory perception.
- Finger-to-nose test normal bilaterally, ensuring good coordination.
- Heel-to-shin coordination normal bilaterally indicates good motor function.
- Normal finger tap and alternating finger tap results show adequate hand dexterity.
- Normal hand supination/pronation and Luria sequencing tests confirm bilateral motor coordination.
- Pinwheel testing reveals normal sensation in upper and lower extremities.
- Applause sign test normal, reflecting appropriate motor response.
Muscle Testing
- Muscle strength graded 5/5 bilaterally in both upper and lower extremities.
- No signs of flaccidity, spasticity, or cogwheel rigidity observed.
- No evident atrophy noted bilaterally.
Deep Tendon Reflexes
- Reflexes assessed showed 2+ responses in biceps, triceps, brachioradialis, patellar, and Achilles bilaterally.
- Negative for pathological reflexes and percussive myotonia absent bilaterally.
Cranial Nerves Assessment
- CN1: Nasal passages clear; smell intact with lavender recognition.
- CN5: Normal jaw function; deviation noted upon examination.
- CN5, CN7: Normal corneal blink reflex bilaterally.
- CN7: Absence of facial paresis and symmetrical facial movements observed.
- CN8: Finger rub test normal, with no lateralization in Weber's test; AC>BC noted in Rinne test.
- CN9, CN10: Palatal elevation and gag reflex normal; swallowing function intact.
- CN12: Tongue protrusion midline; strength 5/5 bilaterally.
Spine/Pain Assessment
- Segmental/somatic dysfunction noted from C1-S2.
- Taut and tender muscle fibers observed in the upper trapezius and bilaterally in suboccipitals.
Vitals
- Capillary refill time: 2 seconds on both left and right fingers, indicating adequate perfusion.
- No asymmetry in red desaturation; patient perceives colors consistently with both eyes.
Cognitive Testing
- Patient oriented to self, time, and place.
- Appears well-nourished and groomed.
- Attention and concentration intact.
- Digit span: 7/7 with linear and prosodic variation, indicating good short-term memory.
- Serial 7s intact, showing ability to count backward from 100 by sevens.
- Can repeat “BLUE, FISH, HOUSE” after 30 seconds and 5 minutes, indicating memory retention.
- Spells “WORLD” accurately both forwards and backwards, demonstrating cognitive function.
Visual Testing
- Resting head position normal; movement is fluid without tilt or restriction.
- Fundoscopic exam reveals an A/V ratio of 1:1.5, indicating a normal finding in one eye that is elevated in the other.
- Park's 3 Step Test reveals no muscle paresis, indicating normal motor control.
- Convergence testing normal, with appropriate eye crossing behavior.
- Stable gaze maintained in all cardinal fields, indicating no gaze abnormalities.
- Smooth pursuits demonstrate minimal saccades and no head movement, indicating efficient tracking.
- Head-eye vestibular movement shows normal gain bilaterally, indicating intact vestibular function.
- Saccades appear fast, accurate, and symmetrical in horizontal and vertical planes, confirming coordination.
- Antisaccades also fast and accurate, demonstrating appropriate inhibitory control.
- Optokinetic reflexes normal in all directions, indicating healthy visual-vestibular integration.
Vestibular Testing
- Gait is normal with symmetrical arm swing; dual-tasking shows no impairments during cognitive interference.
- Fitz-Ritzen test negative for dizziness; patient remains balanced during movements.
- Perceived sway and initial sway are both normal; patient feels stable when standing or sitting.
- Sway improves with visual stimulus in the lower left quadrant, indicating a reliance on visual input for balance.
Motor Sensory Testing
- Touch localization normal bilaterally; accurate identification of touch location.
- Finger-to-nose coordination normal in both sitting and supine positions.
- Heel-to-shin coordination is normal bilaterally, indicating lower limb motor control.
- Finger tap test normal bilaterally; no motor deficits noted.
- Alternating finger tap test is also normal bilaterally, confirming dexterity.
- Hand supination/pronation normal; fluid movement is maintained.
- Luria sequencing shows coordinated movements bilaterally, reflecting appropriate motor sequencing skills.
- Pinwheel test normal across all extremities, no deficits in sensory perception.
- Applause sign is normal, indicating rhythmic motor control.
Muscle Testing
- Muscle strength in upper extremities graded 5/5 bilaterally; no weakness in arms.
- Muscle strength in lower extremities also graded 5/5 bilaterally; no weakness in legs.
- No evident flaccidity, spasticity, or cogwheel rigidity detected during examination.
- No atrophy observed in any muscle groups.
Deep Tendon Reflexes
- Biceps, triceps, and brachioradialis reflexes graded 2+ bilaterally, indicating normal reflex activity.
- Patellar and Achilles reflexes also 2+ bilaterally, consistent with healthy lower limb function.
- No pathological reflexes noted, and percussive myotonia absent bilaterally.
Cranial Nerves
- Cranial nerve 1: Nasal passages patent; smell intact with recognition of lavender.
- Cranial nerve 5: Jaw opening and closing normal; TMJ assessment noted.
- Cranial nerves 5 and 7: Corneal blink reflex normal bilaterally; facial muscle tone symmetrical.
- Cranial nerve 8: Finger rub test shows equal distance on both sides; normal hearing thresholds verified by Rinne test.
- Cranial nerves 9 and 10: Palatal elevation and gag reflex present bilaterally; normal swallowing noted.
- Cranial nerve 12: Tongue protrudes midline with no deviations or abnormal movements; strength measured at 5/5 bilaterally.
Spine/Pain
- Segmental/somatic dysfunction noted from C1 to S2 in cervical spinal region.
- Taut and tender muscle fibers observed in upper trapezius and bilateral suboccipital regions, indicating potential muscle strain or discomfort.
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Description
Test your knowledge on bedside examination techniques, vital signs measurement, and patient evaluation strategies using the Reflex app. This quiz covers essential medical terminology and documentation practices that improve as one gains experience. Enhance your clinical skills and ensure accurate record-keeping.
