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Showing posts with label Abnormal Reflex. Show all posts
Showing posts with label Abnormal Reflex. Show all posts

Thursday, August 24, 2017

Instruments and Objects Required for complete CNS examination

One of the major preparation before any medical examination is that you have all the necessary instruments ready to perform the clinical examination. It takes a lot of effort, time and money to gather all the necessary instruments. But it is not feasible that we have all the necessary instruments to perform complete examination. 

The following table includes all the instruments needed to perform complete CNS examination. They are classified as MUST HAVE, SHOULD HAVE and GOOD TO HAVE based upon their need, availabililty and cost needed to buy them. 

 No medical student both undergraduate and post graduate should take all the MUST HAVE items in their examination along with other basic examination tools such as Stethescope, BP cuff, Measauring Scale, Notebook, Pen, Pencil and Cardboard. No CNS examination can be completed without major instruments like Pen Torch, Reflex Hammer, Tuning Fork and measuring tape which  have to be bought. Other object like cotton, pin, pen, paper, spatula, disposable gloves, thumb pins, and Key can be obtained from our own household object and stationary items.

Know about plantar reflex and its variants before you go for exams.

Certain things like solution containing various solutions used for tasting, smelling has to be prepared and labelled so that it can be identified by examiner but not by the one taking  physical examination.

The objects like Snellens chart, Jaegers chart, Ischihara chart, Ophthalmoscope can not be assesscible to all and may cost more than regular instruments to buy. If we can manage from some source that is acceptable otherwise alternative methods of gross examination can be used to perform those test. Similarly MMSE chart can be printed however that may not be acceptable to some examiner to have such material in exam hall.

So, make a set of instruments that contains all the items in MUST HAVE section. TRY to make sure you have all the objects in SHOULD HAVE. But GOOD TO  HAVE are really good to have items. If some one gives you, take it with a big smile but dont worry if you dont have it .


Cranial nerve examination techniques: Step by Step and with video


SN
Instrument
Purpose
MUST HAVE
1
Pen
HMF, CN II, III, IV, VI,
2
Pen Torch (White light)
CN II
3
Cotton
Fine touch sensory, corneal, Conjuctival reflexes
4
Pin / Tooth pick
CN V, Sensory examination, Two point discrimation  
5
Reflex hammer
CN V jaw jerk,
6
Measuring tape
Muscle Bulk, BMI
7
Spatula
Gag reflex
8
Tuning Fork
CN VIII, Vibration sensation
9
Paper/Note book
HMF, To note the findings
10
Key
Babinski Sign , HMF , stereognosis




SHOULD HAVE
1
4 vessels with Tasting material (Sugar/ Salt/ Vinegar/ Metronidazole) in solution form
CN  VII Taste sensation
2
Cards with various tastes (Sweet/ Salty/ Sour/Bitter )
CN VII taste Sensation
3
Soap/ clove/ coffee powder in various sachets
CN I Smell sensation
4
Thumb Pins with various color heads
Color vision and Confrontation test
5
Pair of Gloves
To Hold tongue
6
Guaze piece
To hold tongue
7
Two test tubes with warm and cold water
Temperature sensation
8
Ear Buds
Sensory fine touch, Application of solution in tongue
9
Objects of various shapes (Ring, cup, cables)
HMF, Stereognosis




NICE TO HAVE
1
Snellens Chart
Visual Acquity
2
Ischihara Chart
Color vision
3
Drinking Water
To rinse mouth in between various taste sensation
4
Blunted Divider
Two point discrimination
5
Mini Mental Score Chart
HMF

Monday, February 29, 2016

Plantar Reflexes and its equivalents with youtube video

The Normal Plantar Reflex

Nocireceptive relfex
Root value : S1

Stroking the lateral aspect of the sole with a sharp object produces (In increasing order of stimulus)

  1. Flexion of all five toes 
  2. Dorsiflexion and inversion of foot (with stronger stimuli)
  3. Contraction of adductors of thigh, sartorius and tensor fascia lata.

Different resposnses

Normal: Flexor/Downgoing plantar reflex  (as mentioned above)

Babinski Sign (Extensor/ upgoing plantar reflex)

Components of extensor reflex are 

  1. Dorsiflexion of great toe (precedes all other movements)
  2. Fanning (outspreading) and extension of remaining four toes 
  3. Dorsiflesion of ankle. flexion of knee and hip joint 
  4. Contraction of fascia tensor lata 

Equivocal/incomplete/variable response

No Response 


Withdrawal reflex


Plantar Equivalents 

Oppenhiems sign 

Heavy pressure applied by thumb and index finger over the medial aspect of tibial (shin) from above down ward

Gordon Reflex

Squeezing or applying pressure over the calf muscle 

?Shefer sign/?Schaefer Sign 

Squeezing the Achilles tendon 

Chaddock Sign 

Striking the skin just below lateral malleolus and moving anterior /in circular fashion 

Bing sign 

Prinking the dorsum of foot or great toe by a pin

Moniz sign 

Forceful passive flexion of ankle 

Gonda sign 

Forceful stretching or snapping of distal phalanges of euther the 2nd or the 4th toe 

Brissauds reflex

Contraction of tensor fascia lata in amputated/absent great toe patients or complete paralysis of extensors of toe

Rossimillo Sign 

Tap the ball of the foot or flick the distal phalages of toe into extension nad allow them to fall back to their normal position produces  PLANTIFLEXION of ALL phalanges. (Only sign with Plantiflexion of great toe)
Equivalent of Hoffmann's Sign 


Hoffmann sign 

Flex the distal interpalangeal joint of the middle finger and now flick it down suddenly, response is brisk flexion and abduction of thumb as well as flexion of the other fingers.

Videos

All reflexes in one video




Sources
http://www.ncbi.nlm.nih.gov/books/NBK397/
www.youtube.com
Harrisons Text Book Of Medicine
Bedside Clinics In Medicine 6e (Arup Kumar Kundu)