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what is aphonia?

loss of voice that accompanies disease of the larynx or its nerve supply.

What can cause dysphonia?

laryngitis, laryngeal tumors, unilateral vocal cord paralysis (CNX)

Aphasia usually occurs on which side of the brain?

left

What is dysarthria?

defect in control of muscles that produce speech (lips, tongue, palate, pharynx);
can be caused by lesions, parkinsonism, and cerebellar disease

What does downward drift of the pronator drift test indicate?

CST injury

What does overshooting displacement during the pronator drift test indicate?

cerebellar incoordination

If a patient has a positive test for babinskis, toes up, what do you suspect?

UMN lesion

If a patient is positive for the straight leg test (back pain or leg pain), what do you suspect?

impingement of the L5or S1 nerve

Cervical radiculopathy, DeQuervain's tenosynovitis, carpal tunnel, and arthritis/epicondylitis might present with what abnormal PE finding?

weak grip

How do you test for dequervain's tenosynovitis?

finklsteins test - grab thumb, deviate ulna

Which muscle is assessed by the drop arm test?

supraspinatus

Damage to which nerve will cause a medial scapular winging during the scaupular winging test?

long thoracic nerve (C7)

How do you perform the PE test for tennis elbow?

extend wrist against resistance while palpating lateral epicondyle joint (extensor origin)

What does the subscapularis do?

internal rotation of the arm

What does teres minor and infraspinatus do?

external rotation of the arm

When testing for FDP isolation, which joint do you hold as you watch the DIP?

You hold the PIP while you watch the DIP flex

Which joints are responsible for internal and external rotation of the forearm?

DRUJ, PRUJ

How would you assess a patient who comes in with shoulder pain, and you suspect they might have subacromial bursitis?

Neers impingement- abduct shoulder and rotate internally

What are two ways to check for ACL stability?

1) anterior drawer
2) lachmans test

If you wanted to assess the GH joint integrity, which test would you use?

Sulcus' sign - pull down arm while palpating GH joint

What can cause calf muscle wasting, weak dorsiflexion, and a positive straight leg test, and is also the most common cause of sciatica?

herniated disc

You have a patient who complains about having swelling in their joints, especially those in her hands and feet. She also complains of stiffness, weakness, and wt loss. After examination, she appears to have a gradually increasing swelling of the synovial membranes that is bilateral. What do you suspect?

Rheumatoid arthritis

A patient comes in complaining of joint pain in her hands, and back. After examination you notice her joints are swollen and bony. The patient complains of stiffness, but it doesn't last that long when it presents. What do you suspect?

osteoarthritis.

What is the most common cause of cervical radiculopathy?

encroachment on the nerve in the foramina, commonly at C7

Which muscle insertion is most commonly responsible for RC tendonitis?

supraspinatus

What else might cause referred pain to the back?

1) peptic ulcer
2) pancreatitis
3) prostatitis
4) aortic aneurysm
5) endometriosis

Where does gout often present?

it's usually red, hot and tender
1) big toe
2) feet/ankles
3) knees
4) elbows

A patient comes in and complains of pain in his shoulder. He is an athlete and says his pain becomes worse after swimming. Where do you expect him to have the most tenderness?

just below the tip of the acromion

What clinical exam findings would you expect if a patient comes in with a RC tear?

1) difficulty with abduction and forward flexion
2) shrugging of the shoulder
3) positive drop arm test

A patient presents to the ER following a bar fight, his arm seems to have slipped out of the joint. What test would you perform on him to see if he has dislocated his joint?

apprehension sign

What is the cause of tenosynovitis?

infection of the flexor tendon sheaths (NOT in the joint itself)

A stroke in the ACA might present as what?

leg weakness

A patient comes in with stroke symptoms, the most alarming of which is a field cut in their vision. Her eyes are PERRLA. Where do you suspect her infarct to be?

PCA, posterior circulation

A patient comes in with stroke Sx, including motor and sensory deficits. Most of his cortical signs seem to be intact. Where do you suspect his stroke to have occurred?

MCA, subcortical circulation

A patient presents with face, arm, and leg weakness from a sudden onset. She is experiencing paresthesia in her left arm and is exhibiting signs of expressive aphasia (Wernicke's). Where do you suspect her stroke to be?

MCA, anterior circulation

A patient presents with stroke symptoms. After testing her EOMs, you find that she cannot move her eyes laterally. Where do you suspect her infarct to be?

Basilar artery, posterior circulation

A patient is brought in by her granddaughter because she was having difficulty eating her food and speaking. When testing her CNXII, you notice she has impaired movement of her tongue, as it deviates to the right. Where do you suspect her stroke to have occurred?

brainstem, vertebral, or basilar arteries, posterior circulation

What is the name of the cells that surround the central core of low perfusion in a stroke?

The ischemic penumbra. These cells are still salvagable if treatment is given and blood flow is restored.

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