Exam Study Notes

Cranial Nerve Assessment

Facial Nerve (VII)

• Motor function: Controls facial muscles.

• Sensory function: Taste from the anterior two-thirds of the tongue.

• Functions assessed:

  • Closing eyes tightly.

  • Smiling and showing teeth.

  • Puffing out cheeks.

Vestibulocochlear Nerve (VIII)

• Function: Hearing and balance.

• Components:

  • Cochlear nerve: Transmits auditory information.

  • Vestibular nerve: Transmits information about balance to the brain.

• Assessment:

  • Air conduction vs. bone conduction.

  • Types of hearing loss:

    • Conductive: Issues in the outer or middle ear.

    • Sensorineural: Issues in the inner ear or auditory nerve.

Hearing Tests

• Rinne Test:

  • Procedure: Compares air conduction to bone conduction using a tuning fork.

  • Interpretation:

    • Normal: Air conduction > bone conduction (positive Rinne).

    • Conductive hearing loss: Bone conduction > air conduction (negative Rinne).

• Weber Test:

  • Procedure: Tuning fork placed on the forehead to assess lateralization.

  • Interpretation:

    • Normal: Sound heard equally in both ears.

    • Conductive hearing loss: Sound louder in affected ear.

    • Sensorineural hearing loss: Sound louder in unaffected ear.

Vestibular Assessment

• Hallpike Test:

  • Purpose: To assess for vertigo.

  • Procedure: Patient quickly moved from sitting to supine with head turned 45 degrees; observe for nystagmus.

Glossopharyngeal (IX) and Vagus (X) Nerves

• Glossopharyngeal: Sensory (taste) and motor (swallowing).

• Vagus: Motor control of palate, pharynx, larynx; sensory from the same areas.

Accessory (Spinal) Nerve (XI)

• Function: Controls sternocleidomastoid and trapezius muscles.

• Assessment:

  • Sternocleidomastoid: Turn head against resistance.

  • Trapezius: Shoulder elevation against resistance.

Hypoglossal Nerve (XII)

• Function: Motor control of the tongue.

• Assessment: Observe tongue movement for any deviation or fasciculations.

Sensory Assessment

Superficial Sensation

• Pain: Assessed using a pin or sharp object.

• Light Touch: Assessed using a cotton swab.

• Temperature: Assessed using tubes filled with hot (40-45°C) and cold (5-10°C) water.

Deep Sensation

• Pressure: Assessed using thumb and finger pressure.

• Vibration: Assessed using a tuning fork.

• Joint Position Sense (Static): Assesses awareness of joint position while stationary.

• Joint Kinesthetic Sense (Dynamic): Assesses awareness of joint movement (ROM).

Combined Cortical Sensation

These assess higher-level sensory processing.

• Stereognosis: Identifying objects by touch.

• Tactile Localization: Identifying where on the body you are being touched.

• Two-Point Discrimination: Minimum distance to perceive two points as separate.

• Graphesthesia: Recognizing letters or numbers drawn on the skin.

Reflex Assessment

Purpose

• To help identify the level of a lesion.

• To assess the relationship between sensory and motor functions.

• To differentiate between Upper Motor Neuron (UMN) and Lower Motor Neuron (LMN) lesions.

Superficial Reflexes

• Pupillary Reflex: Pupillary constriction in response to light.

• Corneal Reflex: Eye closure in response to corneal touch.

• Plantar Reflex:

  • Normal: Plantar flexion of toes.

  • Abnormal (Babinski sign): Dorsiflexion of the big toe and fanning of other toes.

• Abdominal Reflex: Contraction of abdominal muscles when the skin is stroked.

Deep Tendon Reflexes

• Biceps: C5-C6 nerve roots.

• Triceps: C6-C7 nerve roots.

• Brachioradialis: C5-C6 nerve roots.

• Knee (Patellar): L3-L4 nerve roots.

• Ankle (Achilles): S1-S2 nerve roots.

Grading

• 0: No response.

• 1+: Diminished response.

• 2+: Normal response.

• 3+: Hyperactive response.

• 4+: Clonus (rhythmic oscillating movements).

Interpretation

Special Cases

• Spinal Shock: Immediately after spinal cord injury, reflexes below the lesion may be hypoactive or absent.

Bowel and Bladder Assessment

Neurogenic Bladder

• UMN (Spastic) Bladder:

  • Lesion above S2-S4.

  • Overactive detrusor muscle.

  • Incomplete bladder emptying.

• LMN (Flaccid) Bladder:

  • Lesion below S2-S4.

  • Detrusor muscle areflexia.

  • Urinary retention.

Assessment

• History: Medical, surgical, and medication history.

• Questions:

  • Duration of symptoms.

  • Aggravating factors.

  • Frequency of urination.

  • Urgency.

  • Incontinence (cough, laugh, sneeze).

  • Continuous or intermittent stream.

  • Feeling of complete bladder emptying.

  • History of urinary tract infections.

Balance and Coordination Assessment

Balance

• Romberg Test:

  • Procedure: Patient stands with feet together, eyes open and then closed; observe for increased sway.

  • Positive Romberg: Increased sway with eyes closed, indicating proprioceptive deficit.

• Single Leg Stance:

  • Static: Standing on one leg.

  • Dynamic: Alternating single leg stance.

• Wobble Board Test

Coordination

• Finger-Nose Test:

• Finger-to-Examiner Test:

• Heel-Shin Test:

  • Procedure: Patient slides heel down the opposite shin.

• Circle Drawing Test:

• Tandem Walking:

• Object Avoidance Walk:

• Alternating Box Walking Test

• Figure Eight Walking Test

Musculoskeletal System Assessment

Subjective Assessment

• Patient information (age, name, gender, etc.).

• Chief complaint.

• History:

  • Past.

  • Present (onset, aggravating/relieving factors, duration, characteristics, radiation, severity, associated symptoms).

  • Family.

  • Personal.

Objective Assessment

• Observation:

  • Posture.

  • Gait.

  • Swelling, redness.

  • External appliances.

• Palpation:

  • Skin temperature.

  • Tenderness.

  • Muscle tone.

  • Edema (pitting/non-pitting).

• Measurements:

  • Muscle power.

  • Range of motion (ROM).

• Movement: AROM, PROM, and ADL assessment.

• Special Tests

• Vital Signs: HR, BP, RR

Motor Assessment

Muscle Tone Assessment

• Spasticity: Velocity-dependent increase in muscle tone (clasp-knife phenomenon).

• Rigidity:

  • Cogwheel: Resistance with catches throughout the range of motion.

  • Lead-pipe: Uniform resistance throughout the range of motion.

Note: Rigidity is more resistance than velocity, often sign of Parkinson's disease.

• Hypotonia (Decreased Muscle Tone):

• Floppy Baby Test

• Kinetics

Tone Assessment Tests

Assessment of Specific Movements

• Upper Extremity:

• Sholder: adduction, internal rotation, elbow flexion, wrist/finger flexion.

• Lower Extremity:

• Hip: extension, adduction, internal rotation, knee extension, plantar flexion, inversion.

• Clonus Test: Plantar flexion, oscillation.

Lumbar Spine Special Tests

Pelvis Special Tests

Term 1: Facial Nerve (VII) - Motor function
Definition 1: Controls facial muscles.
Term 2: Facial Nerve (VII) - Sensory function
Definition 2: Taste from the anterior two-thirds of the tongue.
Term 3: Vestibulocochlear Nerve (VIII) - Function
Definition 3: Hearing and balance.
Term 4: Vestibulocochlear Nerve (VIII) - Components: Cochlear nerve
Definition 4: Transmits auditory information.
Term 5: Vestibulocochlear Nerve (VIII) - Components: Vestibular nerve
Definition 5: Transmits information about balance to the brain.
Term 6: Conductive Hearing Loss
Definition 6: Issues in the outer or middle ear.
Term 7: Sensorineural Hearing Loss
Definition 7: Issues in the inner ear or auditory nerve.
Term 8: Rinne Test - Procedure
Definition 8: Compares air conduction to bone conduction using a tuning fork.
Term 9: Rinne Test - Normal Interpretation
Definition 9: Air conduction > bone conduction (positive Rinne).
Term 10: Rinne Test - Conductive hearing loss Interpretation
Definition 10: Bone conduction > air conduction (negative Rinne).
Term 11: Weber Test - Procedure
Definition 11: Tuning fork placed on the forehead to assess lateralization.
Term 12: Weber Test - Normal Interpretation
Definition 12: Sound heard equally in both ears.
Term 13: Weber Test - Conductive hearing loss Interpretation
Definition 13: Sound louder in affected ear.
Term 14: Weber Test - Sensorineural hearing loss Interpretation
Definition 14: Sound louder in unaffected ear.
Term 15: Hallpike Test - Purpose
Definition 15: To assess for vertigo.
Term 16: Hallpike Test - Procedure
Definition 16: Patient quickly moved from sitting to supine with head turned 45 degrees; observe for nystagmus.
Term 17: Glossopharyngeal Nerve (IX)
Definition 17: Sensory (taste) and motor (swallowing).
Term 18: Vagus Nerve (X)
Definition 18: Motor control of palate, pharynx, larynx; sensory from the same areas.
Term 19: Accessory (Spinal) Nerve (XI) - Function
Definition 19: Controls sternocleidomastoid and trapezius muscles.
Term 20: Hypoglossal Nerve (XII) - Function
Definition 20: Motor control of the tongue.
Term 21: Superficial Sensation - Pain
Definition 21: Assessed using a pin or sharp object.
Term 22: Superficial Sensation - Light Touch
Definition 22: Assessed using a cotton swab.
Term 23: Superficial Sensation - Temperature
Definition 23: Assessed using tubes filled with hot (40-45°C) and cold (5-10°C) water.
Term 24: Deep Sensation - Pressure
Definition 24: Assessed using thumb and finger pressure.
Term 25: Deep Sensation - Vibration
Definition 25: Assessed using a tuning fork.
Term 26: Deep Sensation - Joint Position Sense (Static)
Definition 26: Assesses awareness of joint position while stationary.
Term 27: Deep Sensation - Joint Kinesthetic Sense (Dynamic)
Definition 27: Assesses awareness of joint movement (ROM).
Term 28: Combined Cortical Sensation
Definition 28: Assess higher-level sensory processing.
Term 29: Stereognosis
Definition 29: Identifying objects by touch.
Term 30: Tactile Localization
Definition 30: Identifying where on the body you are being touched.
Term 31: Two-Point Discrimination
Definition 31: Minimum distance to perceive two points as separate.
Term 32: Graphesthesia
Definition 32: Recognizing letters or numbers drawn on the skin.
Term 33: Reflex Assessment - Purpose
Definition 33: To help identify the level of a lesion, assess sensory/motor functions, and differentiate between UMN and LMN lesions.
Term 34: Superficial Reflexes - Pupillary Reflex
Definition 34: Pupillary constriction in response to light.
Term 35: Superficial Reflexes - Corneal Reflex
Definition 35: Eye closure in response to corneal touch.
Term 36: Superficial Reflexes - Plantar Reflex - Normal
Definition 36: Plantar flexion of toes.
Term 37: Abnormal Plantar Reflex (Babinski Sign)
Definition 37: Dorsiflexion of the big toe and fanning of other toes.
Term 38: Superficial Reflexes - Abdominal Reflex
Definition 38: Contraction of abdominal muscles when the skin is stroked.
Term 39: Deep Tendon Reflexes - Grading: 0
Definition 39: No response.
Term 40: Deep Tendon Reflexes - Grading: 1+
Definition 40: Diminished response.
Term 41: Deep Tendon Reflexes - Grading: 2+
Definition 41: Normal response.
Term 42: Deep Tendon Reflexes - Grading: 3+
Definition 42: Hyperactive response.
Term 43: Deep Tendon Reflexes - Grading: 4+
Definition 43: Clonus (rhythmic oscillating movements).
Term 44: LMN Lesion - Response
Definition 44: Absent or decreased
Term 45: UMN Lesion - Response
Definition 45: Increased
Term 46: LMN Lesion - Superficial Reflexes
Definition 46: Depressed
Term 47: UMN Lesion - Superficial Reflexes
Definition 47: Normal or hyperactive
Term 48: LMN Lesion - Reflexes at Lesion Level
Definition 48: Absent or depressed
Term 49: UMN Lesion - Reflexes at Lesion Level
Definition 49: Normal or increased initially
Term 50: LMN Lesion - Reflexes Below Lesion Level
Definition 50: Normal or decreased
Term 51: UMN Lesion - Reflexes Below Lesion Level
Definition 51: Hyperactive
Term 52: LMN Lesion - Muscle Tone
Definition 52: Decreased
Term 53: UMN Lesion - Muscle Tone
Definition 53: Increased (spasticity)
Term 54: LMN Lesion - Clonus
Definition 54: Absent
Term 55: UMN Lesion - Clonus
Definition 55: Present
Term 56: Neurogenic Bladder - UMN (Spastic) Bladder - Lesion
Definition 56: Above S2-S4.
Term 57: Neurogenic Bladder - UMN (Spastic) Bladder
Definition 57: Overactive detrusor muscle, incomplete bladder emptying.
Term 58: Neurogenic Bladder - LMN (Flaccid) Bladder - Lesion
Definition 58: Below S2-S4.
Term 59: Neurogenic Bladder - LMN (Flaccid) Bladder
Definition 59: Detrusor muscle areflexia, urinary retention.
Term 60: Balance - Romberg Test - Procedure
Definition 60: Patient stands with feet together, eyes open and then closed; observe for increased sway.
Term 61: Romberg Test - Positive
Definition 61: Increased sway with eyes closed, indicating proprioceptive deficit.
Term 62: Muscle Tone Assessment - Spasticity
Definition 62: Velocity-dependent increase in muscle tone (clasp-knife phenomenon).
Term 63: Muscle Tone Assessment - Rigidity - Cogwheel
Definition 63: Resistance with catches throughout the range of motion.
Term 64: Muscle Tone Assessment - Rigidity - Lead-pipe
Definition 64: Uniform resistance throughout the range of motion.
Term 65: Lumbar Spine Special Tests - Slump Test - Patient Position
Definition 65: Sitting
Term 66: Lumbar Spine Special Tests - Slump Test - Therapist Position
Definition 66: Standing
Term 67: Lumbar Spine Special Tests - Slump Test - Technique
Definition 67: Patient flexes neck, extends knee, and dorsiflexes foot while therapist applies pressure
Term 68: Lumbar Spine Special Tests - Slump Test - Observation
Definition 68: Pain, stretch in meninges
Term 69: Lumbar Spine Special Tests - Slump Test - Remark
Definition 69: Disc herniation, nerve root compression
Term 70: Lumbar Spine Special Tests - Straight Leg Raise (SLR) - Patient Position
Definition 70: Supine
Term 71: Lumbar Spine Special Tests - Straight Leg Raise (SLR) - Therapist Position
Definition 71: Standing
Term 72: Lumbar Spine Special Tests - Straight Leg Raise (SLR) - Technique
Definition 72: Raise leg with knee extended until pain, then lower slightly and dorsiflex foot
Term 73: Lumbar Spine Special Tests - Straight Leg Raise (SLR) - Observation
Definition 73: Excruciating pain at 70°
Term 74: Lumbar Spine Special Tests - Straight Leg Raise (SLR) - Remark
Definition 74: Disc herniation
Term 75: Lumbar Spine Special Tests - Brudzinski's Sign - Patient Position
Definition 75: Supine
Term 76: Lumbar Spine Special Tests - Brudzinski's Sign - Therapist Position
Definition 76: Standing
Term 77: Lumbar Spine Special Tests - Brudzinski's Sign - Technique
Definition 77: Same as SLR, but neck is passively flexed
Term 78: Lumbar Spine Special Tests - Brudzinski's Sign - Observation
Definition 78: Pain, hamstring tightness
Term 79: Lumbar Spine Special Tests - Brudzinski's Sign - Remark
Definition 79: Meningeal irritation, nerve root compression
Term 80: Lumbar Spine Special Tests - Modified SLR - Patient Position
Definition 80: Side Lying
Term 81: Lumbar Spine Special Tests - Modified SLR - Therapist Position
Definition 81: Standing
Term 82: Lumbar Spine Special Tests - Modified SLR - Technique
Definition 82: Support pelvis, extend knee of upper leg
Term 83: Lumbar Spine Special Tests - Modified SLR - Observation
Definition 83: Pain in lower back
Term 84: Lumbar Spine Special Tests - Modified SLR - Remark
Definition 84: Disc herniation
Term 85: Lumbar Spine Special Tests - Lhermitt's Sign - Patient Position
Definition 85: Supine/Cross-over
Term 86: Lumbar Spine Special Tests - Lhermitt's Sign - Therapist Position
Definition 86: Standing
Term 87: Lumbar Spine Special Tests - Lhermitt's Sign - Technique
Definition 87: lift leg of unaffected/Cross-over side gradually
Term 88: Lumbar Spine Special Tests - Lhermitt's Sign - Observation
Definition 88: Pain in opposite leg
Term 89: Lumbar Spine Special Tests - Lhermitt's Sign - Remark
Definition 89: Disc herniation
Term 90: Lumbar Spine Special Tests - Prone Knee Bending Test - Patient Position
Definition 90: Prone
Term 91: Lumbar Spine Special Tests - Prone Knee Bending Test - Therapist Position
Definition 91: Standing
Term 92: Lumbar Spine Special Tests - Prone Knee Bending Test - Technique
Definition 92: Flex knee to maximum without hip rotation
Term 93: Lumbar Spine Special Tests - Prone Knee Bending Test - Observation
Definition 93: Pain in lumbar region, buttock, or posterior thigh
Term 94: Lumbar Spine Special Tests - Prone Knee Bending Test - Remark
Definition 94: L2-L3 nerve root lesion
Term 95: Lumbar Spine Special Tests - Bowstring Test - Patient Position
Definition 95: Supine
Term 96: Lumbar Spine Special Tests - Bowstring Test - Therapist Position
Definition 96: Standing
Term 97: Lumbar Spine Special Tests - Bowstring Test - Technique
Definition 97: Place affected leg on shoulder with extended knee, apply pressure on the popliteal fossa
Term 98: Lumbar Spine Special Tests - Bowstring Test - Observation
Definition 98: Pain radiating in lumbar area
Term 99: Lumbar Spine Special Tests - Bowstring Test - Remark
Definition 99: Sciatic nerve compression
Term 100: Lumbar Spine Special Tests - One Leg Standing Test - Patient Position
Definition 100: Standing
Term 101: Lumbar Spine Special Tests - One Leg Standing Test - Therapist Position
Definition 101: Standing
Term 102: Lumbar Spine Special Tests - One Leg Standing Test - Technique
Definition 102: Patient stands on one leg and extends back
Term 103: Lumbar Spine Special Tests - One Leg Standing Test - Observation
Definition 103: Pain in back
Term 104: Lumbar Spine Special Tests - One Leg Standing Test - Remark
Definition 104: Stress fracture of pars interarticularis (spondylolisthesis)
Term 105: Lumbar Spine Special Tests - Stoop's Test - Patient Position
Definition 105: Standing/Walking
Term 106: Lumbar Spine Special Tests - Stoop's Test - Therapist Position
Definition 106: N/A
Term 107: Lumbar Spine Special Tests - Stoop's Test - Technique
Definition 107: Patient performs brisk walk for 50 m
Term 108: Lumbar Spine Special Tests - Stoop's Test - Observation
Definition 108: Pain in gluteal region and lower limbs
Term 109: Lumbar Spine Special Tests - Stoop's Test - Remark
Definition 109: Intermittent claudication
Term 110: Pelvis Special Tests - Gapping Test - Patient Position
Definition 110: Supine
Term 111: Pelvis Special Tests - Gapping Test - Therapist Position
Definition 111: Standing
Term 112: Pelvis Special Tests - Gapping Test - Technique
Definition 112: Apply pressure over ASIS in downward and outward direction
Term 113: Pelvis Special Tests - Gapping Test - Observation
Definition 113: Pain in one side, buttocks, or posterior leg
Term 114: Pelvis Special Tests - Gapping Test - Remark
Definition 114: Sprain in SI ligament
Term 115: Pelvis Special Tests - Approximation Test - Patient Position
Definition 115: Side lying
Term 116: Pelvis Special Tests - Approximation Test - Therapist Position
Definition 116: Standing
Term 117: Pelvis Special Tests - Approximation Test - Technique
Definition 117: Apply pressure over the upper part of the iliac crest in a downward direction
Term 118: Pelvis Special Tests - Approximation Test - Observation
Definition 118: Pain in the SI joint
Term 119: Pelvis Special Tests - Approximation Test - Remark
Definition 119: SI joint lesion
Term 120: Pelvis Special Tests - Sacral Apex Pressure - Patient Position
Definition 120: Prone
Term 121: Pelvis Special Tests - Sacral Apex Pressure - Therapist Position
Definition 121: Standing
Term 122: Pelvis Special Tests - Sacral Apex Pressure - Technique
Definition 122: Apply pressure over the apex of the sacrum
Term 123: Pelvis Special Tests - Sacral Apex Pressure - Observation
Definition 123: Pain in the SI joint