Comprehensive Study of Neurological Abnormalities and Movement Disorders

pregnancy

normal finding for someone with a distended abdomen

fat

obesity counts for most protuberant abdomens.

feces

hard stool in intestines are a cause for localized distention

fibriods

benign tumors in the uterus; also called leiomyoma

can cause distention of lower abdomen

flatus

gas expelled through the anus

ascitic fluid

A watery fluid containing albumin, glucose, and electrolytes that accumulates in the peritoneal cavity in association with certain disease conditions (such as liver disease).

umbilical hernia

protrusion of the intestine through a weakness in the abdominal wall around the umbilicus (navel)

epigastric hernia

Protrusion of abdominal structures presents as a small, fatty nodule at epigastrium in midline, through the linea alba.

Usually one can feel it rather than observe it. May be palpable only when standing.

diastasis recti

midline longitudinal ridge in the abdomen, a separation of abdominal rectus muscles

Incisional hernia

A type of hernia caused by an incompletely-healed surgical wound

enlarged liver

a span greater then 12 cm at midclavicular line and greater then 8cm at midsternal line

Cirrhosis

chronic degenerative disease of the liver

enlarged and nontender

congestive heart failure, acute hepatitis, and abscesses can suggest

an enlarged tender liver

enlarged nodular liver

Enlarged firm, hard, nodular liver suggests cancer. Other causes may be late cirrhosis or syphilis.

Liver higher than normal

may be caused by an abdominal mass, ascites, or a paralyzed diaphragm

liver lower then normal

may be caused by emphysema because the diaphragm is so low

enlarged spleen

defined by an area of dullness exceeding 7 cm. When enlarged, the spleen progresses downward and toward the midline.

Aortic aneurysm, abdominal

a prominent, laterally pulsating mass above umbilicus suggesting an aortic aneurysm.

accompanied with a bruit and wide bounding pulse

enlarged kidney

Enlarged with hydronephrosis, cyst, or neoplasm.

May be difficult to distinguish an enlarged kidney from an enlarged spleen because they have a similar shape. Both extend forward and down. However, the spleen may have a sharp edge, whereas the kidney never does. The spleen retains the splenic notch, whereas the kidney has no palpable notch. Percussion over the spleen is dull, whereas over the kidney it is tympanitic because of the overriding bowel.

enlarged gall bladder

extremely tender

suggests cholecystitis

positive finding is murphys sign

thoracic kyphosis

humpback, increased thoracic curvature, loss of height over time, dowager hump

lordosis

thoracic spine is too straight, loss of natural curve

Scoliosis

abnormal lateral curvature of the spine

s curve

flattening of the lumbar curvature

may be seen with a herniated lumbar disc or ankylosing spondylitis

lumbar hyperlordosis

Hip flexion contracture and hip extensor weakness drive the lumbar spine into increasing lordosis to balance head over pelvis.

Note the use of the hands for stability.

kyphosis

hunchback

ankylosing spondylitis

a form of rheumatoid arthritis that primarily causes inflammation of the joints between the vertebrae

rheumatoid arthritis

A chronic systemic disease characterized by inflammation of the joints, stiffness, pain, and swelling that results in crippling deformities

Boutonniere deformity

flexion of PIP and hyperextension of DIP

Swan neck deformity

hyperextension of PIP joint and flexion of DIP joint

ganglion cyst

a harmless fluid-filled swelling that occurs most commonly on the outer surface of the wrist

Osteoarthritis

inflammation of the bone and joint

Heberden and Bouchard nodes

Heberden: DIP

Bouchard: PIP (less common)

DIP joint

distal interphalangeal joint. the joint between the middle and closest phalange of a given finger

PIP joint

proximal interphalangeal joint. the joint between the middle and closest phalange of a given finger

tenosynovitis

Inflammation of the tendon sheath where muscle connects to bone.

Thenar atrophy

Thenar atrophy suggests a median nerve disorder such as carpal tunnel syndrome. Hypothenar atrophy suggests an ulnar nerve disorder.

gouty arthritis

inflammation and painful swelling of joints caused by excessive uric acid in the body

found in great toe

painful red hot and swollen

Flat feet (pes planus)

has no arch and may cause pain and swelling of the foot surface

callus

area of thick hard skin at pressure points

Halluz Valgus (bunion)

great toe is deviated laterally and may overlap the second toe

enlarged, painful, inflamed bursa/bunion may form on medial side

Corns

Keratinized conical masses on the toes,

thickening of soft tissue

develop on the dorsum over bony prominence from prolonged pressure from shoes

Plantar warts (verruca vulgaris)

warts that develop on the soles of the foot, grow inward, and can become painful

often found under a callus

dark tiny spots

painful warts

Brown-Sequard Syndrome

Hemi-section of the cord

ipsilateral (same side) spastic paralysis and loss of position sense

contralateral (opposite side) loss of pain and thermal sense

Central Cord Syndrome

Injury results in sacral sparing and preferentially upper- more than lower-extremity weakness.

Anterior cord syndrome

Injury results in variable loss of motor function as well as pain and temperature. Proprioception is preserved.

Posterior Cord Syndrome

Injury results in loss of proprioception and variable preservation of motor function and pain and temperature sensation.

Eye tic

Tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Causes include Tourette's syndrome and drugs such as phenothiazines and

amphetamines.

choreiform movements of the hand

are brief, rapid, jerky, irregular, and unpredictable. They occur at rest or interrupt normal coordinated movements. Unlike tics, they seldom repeat themselves. The face, head, lower arms, and hands are often involved. Causes include Sydenham chorea (with rheumatic fever) and Huntington disease.

resting tremor

a tremor that is apparent when the client is at rest and diminishes with activity

Postural tremor

A tremor that occurs as the person holds a body part still.

Athetosis

Type of involuntary movement of the body, face, and extremities

slower, twisting movements

intention tremor

involuntary trembling when an individual attempts a voluntary movement

absent at rest

gets worse when target is near

cerebellar ataxia

staggering, wide-based gait; difficulty with turns; uncoordinated movement with positive Romberg sign

Parkinson's gait

Shuffling gait

stiff manner

stooped over

scissors gait

Stiff, short gait; thighs overlap each other with each step.

Seen with partial paralysis of the legs.

spastic hemiparesis gait

arm is held close to body while patient drags foot

seen with lesions of upper motor neurons

footdrop

The foot falls down at the ankle; permanent plantar flexion

the patient lifts foot then slaps it on the groud

lower motor neuron disease

Decorticate posturing

arms flexed inward and bent in toward the body and the legs are extended

Decerebrate posturing

position of an unconscious person where the upper extremities and lower extremities are extended and the wrists are flexed

lethargy

lack of energy; sluggishness

Obtunded

Less than full alertness (altered level of consciousness), typically as a result of a medical condition or trauma.

stupor

a state of near-unconsciousness or insensibility

coma

state of profound unconsciousness

dysphonia

difficulty producing speech sounds, usually due to hoarseness

Cerebellar dysarthria

irregular, uncoordinated speech caused by multiple sclerosis

aphasia

impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).

Wernicke's aphasia

condition resulting from damage to Wernicke's area, causing the affected person to be unable to understand or produce meaningful language

broca aphasia (expressive)

nonfluent, good comprehension, poor repetition