By Oliver Leach BSc Med. Sci (Hons) MBChB MRCP, Gijsbert Isaac van Boxel BMBCh PhD MRCS
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An immense amount of information can be gained by careful study of these aspects of gait (see Fig. 3). • Romberg’s test: this assesses posterior column function (proprioception). The joints A Supinator (C5, 6) Biceps (C5, 6) Left triceps (C7, 8) Right triceps (C7, 8) B 2 C Triceps (C7, 8) ‘Grip tightly as I tap the ankle/knee’ Biceps supinator (C5, 6) Knee (L3, 4) Ankle (L5, S1) For upper limbs, ask the patient to clench his or her teeth as you tap the reflex D E Fig. 30 Eliciting reflexes. (A) Upper limb tendon reflexes.
Then, starting distally, check vibration and joint position sense. Remember the different pathways these senses take (Fig. 32). The tests for the various sensory modalities are shown in Fig. 33. 28 Eversion (S1) Gait • Ask the patient to walk for 2–3 m, turn and walk back, then walk heel to toe (cerebellar ataxia) and finally stand on toes and on heels (any muscle weakness will now manifest itself). • Make sure you walk with the patient so you can catch them if they fall. • An immense amount of information can be gained by careful study of these aspects of gait (see Fig.
The anatomy and pathophysiology underlying physical signs and their interpretation. INTRODUCTION When it comes to examining patients, practice really does make perfect. Examiners will be able to tell whether you have examined many patients or not within the first 30 seconds of seeing you in action! Therefore, take every opportunity you have to rehearse your technique. Let others watch you examine and critique. These could be your teachers, fellow students, and even patients can give you valuable feedback.
Crash Course General Medicine by Oliver Leach BSc Med. Sci (Hons) MBChB MRCP, Gijsbert Isaac van Boxel BMBCh PhD MRCS