Upper Practical 2
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Palpations for skull and face
- skull: rotary all around temporal area ear occiput and battle sign
- face: forehead rotary eye socket all around zygo arch nose and septum
what sinuses are palpated? mandible is palpated and trachea
frontal and maxillary sinuses trachea area have them swallow
eye exam for eye motion? periph vision? C nerves for motion?
- H test and when u see it test
- nerves 2346
Pupils should be pearl... direct light reflex and consensual light reflex? accommodation conversion reflex... symmetry of gaze
- pupils equal and reactive to light
- other pupil should react to light as well
- look at far then look at close object
- check where the glare is on eye, compare
Nose (septum) and teeth exam...
- push on septum and make sure can breath on other side
- teeth observe and make sure ok..
Ear exam whispered voice, ticking watch, weber..
- plug oppo side be foot away and whisper word, compare
- start ticking watch 6" away then bring till hear
- hit fork put mid forehead
Tests for expanding intracranial lesions
-neurological control test upper limb, lower?
-walking and stand tandem
- eyes closed zombie arms for 30.. same but legs out
- stand for 20
- walking with one foot in front of other and stand
-finger to nose
-past point: also proprioception
-heel to knee
finger to nose is that then eyes closed then faster
reflex and cutaneous distribution test..
-consensual light reflex.. CN?
-jaw reflex.. CN?
- light to eye and both react.. CN 3
- .. CN 5
Palpation for posterior aspect
ext occipital protuberance
lateral aspect palpations
parotid glands (salivary)
mandible even with C2
- salivary is more under ear
- TMJ by ear too
first cricoid ring
then thyroid glands (all while swallowing)
fossa is above clavicle
Cervical Exam... AROM
nodd flex extend side flex rotate
extend neck later flex and ipsi rotate
you know it ha
Functional assessment ndl
- look up look to shoes
- chin out and chin in
- breathing and swallowing
peripheral joint scanning
motions for each
-spurlings test -valsava
-distraction - scalene cramp test
-shoulder depression -tinels sign
-jacksons test - brachial plex comp
- spur is compression on head then lat flex
- distract is pull head off (hands under chin/occi)
- put press on shoulder then lat flex away
- jacksons is compression with rotate
- vals is bear down/scalene is chin to clav and rotate
- tinel is lat flex with tap to brachial plex/comp is easy
Upper motor neuron lesions...
romberg again and it also tests
- eyes closed and stand for 30
- sit legs out... PROM hip and neck flex
- passive ext lat flex and rotate
- do eyes closed zombie for 30 then cerv quad too
vertigo and dizzyness
-trans lig test
- neck rotate to extremes then hold for 20
- trans lig: anteriorly lift head
tests for first rib mobility
Reflexes and CN with them
jaw bis brachio tri
- rub above clavi for first rib and have them breathe
- prone push on traps behind ribs for each side
- jaws is CN V bis are C5 and C6
- brachio is C5 and C6
- tris are C7 and C8
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