Physical and Neurological Assessment

• These flashcards cover various topics related to physical and neurological assessments, including reflexes, cranial nerves, musculoskeletal conditions, abdominal and mental status examinations, and gait abnormalities.

Reflex Testing

• Hold the hammer lightly with your thumb and index finger when testing reflexes.
• If a patellar reflex is difficult to elicit, have the patient clench their hands together and pull apart for reinforcement.
• Reflex grading:
  • 0: Absent despite reinforcement.
  • 1: Present only with reinforcement.
  • 2: Normal.
  • 3: Increased but still normal.
  • 4: Markedly hyperactive with clonus.

Cranial Nerves

• CN1: Olfactory nerve, responsible for the sense of smell.
• CN V (5): Trigeminal nerve, tested by assessing the temporal and masseter muscles (TMJ) by having the patient clench their jaw.
• CN 11: Spinal accessory nerve, tested by having the patient shrug their shoulders against resistance.
• CN 3: Oculomotor nerve.

Cerebellar Function

• Cerebellar injury affects coordination and balance.
• Cerebellar ataxia is characterized by a wide-based, staggering, unsteady gait and a positive Romberg test result.

Musculoskeletal Assessment

• Bulge Test: Checks for swelling in the suprapatellar pouch (under the knee); a bulge indicates small amounts of fluid. Normal results show no bulge.
• Carpal Tunnel Syndrome: Assessed using Tinel's and Phalen's tests.
  • Tinel's Test: Tapping over the volar aspect of the transverse carpal ligament. A positive test causes tingling or paresthesia in the thumb, index, middle, or lateral half of the ring finger.
  • Phalen's Test: Assesses median nerve compression.
• Range of Motion:
  • Flexion: Bending a joint.
  • Extension: Straightening a body part.
  • Pronation: Turning the palm downward.
  • Supination: Turning the palm upward.
• Arthritis:
  • Gout: A metabolic disease caused by uric acid crystal accumulation, often affecting the great toe unilaterally.
  • Rheumatoid Arthritis: A chronic autoimmune disorder causing inflammation and thickening of synovial membranes and other tissues.
  • Osteoarthritis: Inflammation of the bones and joints, starting at an isolated joint when cartilage wears out.
• Osteoporosis: A condition where bones become weak and easily break, often due to vitamin D and calcium deficiency.
• Shoulder Rotation:
  • External Rotation: Involves the infraspinatus, teres minor, and posterior deltoid muscles; turning the joint outward.
  • Internal Rotation: Involves the subscapularis, pect major, teres major, and lat dorsi muscles; turning the joint inward.

Neurological Conditions

• Meningitis: Symptoms include headache, fever, and stiff neck.
• Stroke: If the uvula deviates to the right, it may indicate a stroke.

Abdominal Assessment

• Tympany: Typically heard over the stomach and intestines.
• Dullness: Typically heard over the liver and solid organs.
• Flat Sounds: Heard over solid areas such as bones.
• Tenderness: Indicates an abnormality.
• Bowel Sounds:
  • Hypoactive: Less than 5 per minute.
  • Normoactive: 5-35 per minute.
  • Hyperactive: More than 30 per minute or continuous, potentially indicating diarrhea.
• Absent Bowel Sounds: If no bowel sounds are heard, listen for a full 5 minutes in each quadrant.
• Abdominal Distention: Possible causes include flatus (gas), fetus (pregnancy), feces (trapped stool), fluid, and fat.
• Rovsing's Sign: Palpation of the left lower quadrant causing pain in the right lower quadrant, suggesting appendicitis.
• Rebound Tenderness (Blumberg Sign): After deep palpation, rapid release causes pain, indicating peritoneal inflammation.
• Blumberg's Sign: Rebound tenderness is associated with appendicitis.
• Murphy's Sign: Pain with palpation of the right upper quadrant during inspiration, indicative of cholecystitis (gallbladder inflammation).
• McBurney's Point: Pain in the right lower quadrant, indicative of appendicitis, along with rebound tenderness.
• Referred Pain: Pain felt in a location different from its origin.
• Abdominal Visualization: Assess for veins, distension, peristaltic waves, ascites, and unusual shapes.
• Abdominal Contour: Can be flat, scaphoid, rounded, or protuberant.
• Peristaltic Waves: Rhythmic contractions of smooth muscles to move material forward.
• Ascites: Abnormal fluid accumulation in the abdomen.

Mental Status Examination

• A set of interview questions and observations designed to reveal the degree and nature of a client's abnormal functioning
• Mental health assessment should be performed before the initial assessment to understand the patient's mental state and cooperativeness and to validate data.

Mental Status Assessments

• AUDIT (Alcohol Use Disorders Identification Test): Assesses alcoholic beverage usage; a score of 7-10 or more suggests harmful alcohol use and alcohol dependence.
• Quick Inventory of Depressive Symptomatology (Self-Report):
  • 0-5: No risk of depression
  • 6-10: Mild depression
  • 11-15: Moderate depression
  • 16-20: Severe depression
  • 21-27: Very severe depression
• SAD PERSONS Scale: Assesses suicide risk factors.
  • SAD PERSONS: Sex (Male), Age (Teenager or Elderly), Depression, Previous Attempt, Ethanol or Drug Use, Rational thinking loss, Sickness (medical illness), Organized plan, No spouse, Social support lacking. Men succeed more often at suicide while women attempt it more.
• Glasgow Coma Scale: Used for early assessment of level of consciousness after brain injury.
  • Eye Opening: 4 (spontaneous), 3 (to speech), 2 (to pain), 1 (no response)
  • Verbal Response: 5 (alert and oriented), 4 (disoriented conversation), 3 (inappropriate words), 2 (nonsensical sounds), 1 (no response)
  • Motor Response: 6 (obeys commands), 5 (localizes pain), 4 (withdraws to pain), 3 (decorticate posturing), 2 (decerebrate posturing), 1 (no movement)
• Initial Brain Injury Assessment: First, ask the patient to verbalize something or shake the patient for a response.
• Older Patients: Instead of assuming brain injury or mental disorder, test for dementia or fall risk as a priority.
• Cognitive Assessment: Measures thoughts, beliefs, and attitudes related to emotional problems.
• SLUMS Examination: Assesses cognitive function through questions about objects and memory recall, with scoring adjusted for education level.
• Pupil Reactivity Score: Both pupils react (2), one pupil reacts (1), neither pupil reacts (0).
• Mini-Cog Test: Assesses dementia by testing the patient's ability to remember and repeat three common objects and draw a clock face indicating a specific time.
• Clinical Institute Withdrawal Assessment (CIWA): Measures withdrawal symptoms using 10 criteria, including vital signs, clinical signs, and symptoms; requires the patient to be alert.
• Abstract Thinking Questions: Assesses the use of metaphors, reasoning, relationships, and the ability to manipulate objects.

Language and Speech

• Wernicke's Area: Controls language reception and comprehension, typically located in the left temporal lobe; damage results in Wernicke's aphasia (inability to comprehend speech).
• Broca's Area: Controls language expression, typically located in the left frontal lobe; damage results in Broca's aphasia (difficulty speaking fluently).

Levels of Consciousness

• Deep Coma: Patient is unresponsive to all stimuli.
• Coma Scale: Refers to the Glasgow Coma Scale to determine level of consciousness.
• Coma Stages:
  • 1: Unresponsiveness.
  • 2: Early responsiveness.
  • 3: Agitation and confusion.
  • 4: High level of responsiveness.

Memory Assessment

• Remote Memory: Assess long-term memory with questions about birth dates and anniversaries.
• Recent Memory: Assess short-term memory with questions like "What is my name?" and "Where are you?".

Posturing

• Decorticate Posturing: Upper extremities flexed at the elbows and held closely to the body; lower extremities externally rotated and extended; indicates brainstem is not inhibited by the cerebral cortex.
• Decerebrate Posturing: Neck extended with jaw clenched; arms pronated, extended, and close to the sides; legs extended straight out; indicates severe brain stem damage and is more ominous.

Constructional Ability

• Assessed by having the patient draw a clock.

Gait Abnormalities

• Cerebellar Ataxia: Staggering, wide-based gait with difficulty turning and uncoordinated movement; Romberg sign is positive.
• Parkinsonian Gait: Increased forward flexion of trunk and knees; shuffling with quick, small steps; festinating may occur.
• Scissors Gait: Stiff, short gait with thighs overlapping each other; seen with partial paralysis of the legs.
• Spastic Hemiparesis: Flexed arm held close to the body while the patient drags the toe of the leg or circles it stiffly outward and forward; seen with lesions of upper motor neurons.
• Footdrop Gait: Patient lifts the knee high and slaps the foot to the ground on the affected side only.

Romberg Test

• Patient stands with feet together, arms at sides, and eyes closed.
• Normal result: able to stand with minimal swaying for at least 5 seconds.

Stroke

• Modifiable Risk Factors: Hypertension, hypercholesterolemia, atherosclerosis, atrial fibrillation, obesity, drugs and alcohol, diabetes, sickle cell anemia, TIAs.
• Nonmodifiable Risk Factors: Age, gender, race, heredity/family history.

Lobe Functions

• Temporal Lobe: Hearing and smell.
• Parietal Lobe: Somatic sensory processing, auditory and memory processing.
• Frontal Lobe: Motor function, problem solving, memory, judgment, impulse control, cognitive functions.
• Occipital Lobe: Visual processing.
• Broca's Area: Located in the left frontal lobe.

General Movement

• Adduction: Movement toward the midline of the body.
• Abduction: Movement away from the midline of the body.