ADVANCED HEALTH ASSESSMENTS EXAM 2 AND STUDY GUIDE, Exams of Health sciences

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ADVANCED HEALTH ASSESSMENTS EXAM 2 AND

STUDY GUIDE 2024 - 2025 WITH ACTUAL CORRECT

QUESTIONS AND VERIFIED DETAILED

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Which deep tendon reflex is being tested? triceps If the nurse tests the reflex located in the antecubital area, the nurse is testing the ______ reflex. biceps If the nurse taps here with the reflex hammer, the nurse is assessing the ______ reflex. achilles

The nurse is assessing the ______ reflex. patellar The nurse is assessing the ______ reflex. plantar How will the nurse document this reflex finding? Positive Babinski Reflex A patient draws a clock with all of the numbers on one side. This is consistent with: Cognitive Impairment A patient who can explain the deeper meaning of "A stitch in time saves 9" demonstrates: Abstract Reasoning Which of the following is hearing or seeing something that nobody else does? hallucination The nurse tells the student that a patient with dementia is agitated. This means that the patient: could strike out and injure himself or others A word to describe physical difficulty repeating a tongue twister (eg: Suzy sells seashells by the sea shore.) is: dysarthria This patient has an asymmetric smile r/t impaired function of cranial nerve:

7 Facial To assess for tactile agnosia (stereognosis), the nurse will ask the patient to identify ______ with the eyes closed. an object (coin) placed in the hand Which 3 cranial nerves control extraocular eye movements (EOMs)? 3 Oculomotor 4 Trochlear 6 Abducens Which of the following can be used to assess upper extremity coordination?

• Finger to Thumb in Rapid Succession
• Rapid Supination and Pronation of Hands
• Finger to Nose to Tongue Blade The muscle tone displayed by this infant will be documented as: hypotonia The nurse recognizes this sign of hypocalcemia after thyroid surgery in Video 1 as: The nurse recognizes this sign of hypocalcemia after thyroid surgery in Video 1 as: Chvostek's Sign The nurse will document this assessment finding as: nystagmus

This is what the nurse observes when the BP cuff is inflated. The nurse will document this as: Trousseau's Sign This patient's involuntary movements will be documented as: chorea This patient's involuntary movements will be documented as: athetosis This tremor will be documented as a _____ tremor. pill rolling These involuntary movements related to a seizure will be documented as: myoclonic

This patient's gait will be documented as a(n) ______ gait. ataxic This patient's gait will be documented as: hemiplegic This patient's gait will be documented as: shuffling This gait will be documented as a ______ gait. scissors This reflex will be graded ___ on a 0-4+ scale: 4+ with Clonus

The nurse is measuring joint range of motion (ROM) with a: goniometer What joint is the finger pointing to? Temporomandibular Joint Does asking the patient to tilt the head towards the shoulder test CN 11 Spinal Accessory Nerve? No Are this patient's FINGERS ABducted or ADDucted. ABducted Is this hand pronated or supinated? supinated Is the wrist flexed, extended, or hyperextended? hyperextended Look at the leg that is up in the air. Is this HIP extended or flexed? flexed

When a muscle has FULL strength against GRAVITY & RESISTANCE, it is graded ___ on a scale of 5. 5 This patient has: Dupuytren's Contracture This patient with osteoarthritis has: Bouchard's Nodes Look at the hand on your LEFT. What term will you use to document the appearance of the fingers? swan neck deformity Does this individual have bowed legs (genu varum) or knock knees (genu valgum)? Bowed legs (Genu Varum)

This contour of this patient's spine will be documented as: kyphosis What is the correct order for abdominal assessment? A. Inspection, palpation, auscultation, percussion B. Inspection, auscultation, percussion, palpation C. Auscultation, inspection, palpation, percussion D. Palpation, inspection, auscultation, percussion B. Inspection, auscultation, percussion, palpation How often should normal bowel sounds be heard in each quadrant of the abdomen? A. 5-35 times per minute B. Less than 5 times per minute C. 15-20 times per minute D. 20-40 times per minute a. 5-35 times per minute Which of the following is an important part of performing an abdominal assessment? A. Completing the assessment as quickly as possible B. Stopping the assessment if the patient has any tenderness C. Explaining each step of the assessment to the patient D. Having the patient breathe normally at all times C. Explaining each step of the assessment to the patient What should you do if a patient is ticklish when you are palpating the abdomen? A. Distract the patient by talking to him or her. B. Do not palpate the abdomen in the upper quadrants. C. Do only deep palpation of all four quadrants. D. Place your hand over the patient's hand during palpation. D. Place your hand over the patient’s hand during palpation. Moderate and deep palpation of the abdomen: A. May cause tenderness B. Should not detect masses C. May locate the margins of the liver D. All of the above D. All of the above

According to ConsultGeri, the Mini Nutritional Assessment is... "a screening tool used to identify older adults (>65 years) who are malnourished or at risk of malnutrition." If the patient's history includes Hepatitis, then identify the type (A,B,C,D,E) and the _______. Source (blood transfusion, food sanitation, IV drug use, unprotected sex) _________ _________ are a series of quantitative measurements of the muscle, bone, and adipose tissue used to assess the composition of the body. Anthropometric measurements Waist to hip ratio

• Can be calculated by dividing waist circumference by hip circumference Increased risk for cardiovascular disease:
• Male: greater than 1
• Female: greater than 0. Triceps Skinfold Thickness (TSF)
• This test reflects body fat stores
• not reliable in older adults due to sagging of the skin Mid-Upper Arm Circumference (MAC)
• reflects muscle mass and fat stores
• this test is not reliable in older adults due to sagging Mid-Upper Arm Muscle Circumference (MMC)
• reflects skeletal protein reserves Nine Abdominal Regions: Region 1: Right Hypochondriac Region (upper, right)Liver, Gallbladder, Right Kidney, Small Intestine Region 2: Epigastric Region (upper, middle):Stomach, Liver, Pancreas, Duodenum (first part of the small intestine), Spleen, Adrenal Glands Region 3: Left Hypochondriac Region (upper, left)Spleen, Colon, Left Kidney, Pancreas Region 4: Right Lumbar (or Right Flank) Region (middle, right)Gallbladder, Liver, Right Colon

Region 5: Umbilical Region (center)Umbilicus (navel), Jejunum (the part of the small intestine between the duodenum and ileum), Ileum (the third portion of the small intestine, between the jejunum and the cecum), Duodenum Region 6: Left Lumbar (or Left Flank) Region (middle, left)Descending Colon (the part of the large intestine that passes downward on the left side of the abdomen toward the rectum), Left Kidney Region 7: Right Iliac (lower, right)Appendix, Cecum (a pouch connected to the junction of the small and large intestines) Region 8: Hypogastric (more commonly called Suprapubic) Region (lower, middle)Urinary Bladder, Sigmoid Colon (the S-shaped last part of the large intestine, leading into the rectum), Female Reproductive Organs Region 9: Left Iliac (lower, left)Descending Colon, Sigmoid Colon Cachexia complex syndrome characterized by severe weight loss, muscle wasting, and a significant decline in overall body mass, often despite adequate caloric intake Flat abdominal contour Scaphoid abdominal contour

Rounded abdominal contour Protuberant abdominal contour During auscultation of the four quadrants, what sounds should you hear? Low-pitched gurgling sounds 4-12 times per minute Hyperactive bowel sounds

• More frequent, louder, and normal after eating
• Occur with diarrhea, GI bleeding, and early bowel obstruction (blockage) Hypoactive bowel sounds
• Less than four per minute
• Indicates a decrease in peristalsis Absent bowel sounds
• Absence of peristalsis greater than 5 minutes
• Normal after bowel surgery
• Occur with paralytic ileus (functional bowel obstruction r/t temporary loss of peristalsis), bowel obstruction (cancer) Tinkles bowel sounds High-pitched, quick, tinkling sounds related to early bowel obstruction succession splash (bowel sound)
• High-pitched, heard when abdomen is rocked in small bowel obstruction Abdominal bruits Caused turbulent blood flow in aorta, renal, iliac, or femoral arteries Enlarged spleen is known as splenomegaly (never palpate an enlarged spleen)

What should you palpate during pregnancy?

• The upper border of the uterus (fundus) Abdominal reflexes: The umbilical ________ when the abdomen is stroked. The umbilicus "winks" when the abdomen is stroked. When palpating the abdomen of a 20-year-old patient, the nurse notices the presence of tenderness in the right lower quadrant with deep palpation. Which of these structures is most likely to be involved? Appendix Hernias can be located in these three areas:
• Umbilical
• Inguinal
• Femoral Which type of hernias are more common in infants and children? Umbilical These type of hernias are the most common type of hernia in males and may descend into the scrotum. Inguinal These hernias are lower and more lateral than inguinal hernias. Femoral The inflammation/infection of the peritoneal membrane that occurs when an abdominal organ perforates. For example, this may occur when an appendix bursts.
• Peritonitis
• Rebound tenderness, or localization of pain when a palpating hand is quickly lifted, is indicative of peritonitis. - Pain may also increase when bouncing, hopping, or during a bumpy car ride. Common assessment findings in liver disease:
• Red, spider-like vessels on the abdomen, chest, neck, and face
• Ascites, or fluid in the abdomen.
• Shifting dullness to percussion occurs when ascites is present because fluid goes where gravity takes it. When the patient is lying on the back, there is bilateral dullness in the lumbar regions. When the patient turns to the side, the dullness shifts to the side of the abdomen closest to the bed.
• Fluid Wave occurs when a tap sends fluid towards the hand on the other side of the abdomen. An assistant places the side of the hand on the abdomen in a vertical position, as demonstrated in the video.
• Hepatomegaly, enlargement of the liver. Liver enlargement can be detected using palpation and percussion.

Urinary history assessment

• The pattern of voiding (urination), day and night
• Odor (aromatic, acetone, ammonia, antibiotic, foul, fecal)
• Self-care activities such as adequate fluid intake, regular emptying, limiting caffeine
• Female self-care activities
• Avoid pantyhose, void after sex, hygiene
• Kegel exercises Burning during urination Dysuria Swelling caused by excess fluid in the body's tissues Edema: Urinating often (such as hourly) Frequency Blood in the urine, from pink-tinged to gross hematuria Hematuria Difficulty starting urination Hesitancy Getting up at night to urinate Nocturia Inability to fully empty the bladder Retention Needing to urinate immediately or there might be an accident Decreased force of stream (a weak stream or dribbling) Urgency Ask if the patient has experienced ant of the following complications when urinating: Dysuria: Edema: Frequency: Hematuria: Hesitancy: Nocturia:

Retention: Urgency: Needing to urinate immediately or there might be an accident Decreased force of stream (a weak stream or dribbling)

• Nausea
• History of urinary tract infection
• History of renal calculi (kidney stones)
• Prior renal or bladder surgery
• Flank pain
• Incontinence Both ______ and ______ can indicate health concerns. Both color and clarity can indicate health concerns. Healthy urine may be _______ or _______ in color. Healthy urine may be straw or yellow in color. Amber urine usually indicates... dehydration Urine orange, blue, or green can be due to... Medications Pink, red, or brown urine is indicative of _______. blood Liver disease causes ____-colored urine. Tea Purple urine in a urinary drainage bag is associated with... UTI Bladder Scan
• Use a bladder scan for distended bladders or residual urine.
• Before performing a bladder scan, indicate the gender of the patient. (Select male for women after a hysterectomy.)
• Apply lubricant on the abdomen just above the symphysis pubis, aim the probe towards the bladder, and push the scan button.
• Rescan if the bladder is not centered in the crosshairs on the screen or the volume will be inaccurate.
• Record the volume.

Decorticate arms flexed and legs extended Decerebrate limbs extended Flaccid

• these responses are inappropriate
• means there is an absence of muscle tone or movement, resulting in limp and unresponsive limbs Glasgow Coma Scale evaluates eye-opening, verbal, and motor responses. FOUR score coma scale evaluates eye and motor responses, brainstem, and respiratory scores Orientation Record whether the patient is able to state the day, month, and year as well as location and name. Abstract reasoning
• asking patients to explain the deeper meaning of saying such as "A stitch in time saves nine" or "People who live in glass houses shouldn't throw stones." - Please note that such sayings are not familiar to young people or those with English as a second language.
• For such patients, the completion of analogies may be more appropriate. For example, you might ask a patient to complete the analogy "A dog is to a puppy as a cat is to a ________." Judgment may be assessed by asking a patient what the individual would do in a realistic situation. Dementia

• is a chronic, progressive loss of cognitive function.
• One way to assess for dementia is to aks the patient to repeat four unrelated words immediately, 5, and 30 minutes later.
• Normal adults less than 60 years of age can recall between three and four words. A patient with dementia may recall 0 or 1 word.
• Alternatively, you may pose food, animals, colors, and towns as four categories to the patient (FACT Test). Then ask the patient to name as many objects in each category within one minute. Delirium Delirium is an acute change in mental status related to infection, illness, medications, and/or hospitalization. It is reversible. Aphasia Aphasia is the inability to communicate and/or understand. Auditory, Wernicke’s or Receptive Aphasia Assess ability to carry out commands (single and multiple) Expressive, Broca’s or Speaking Aphasia Assess for difficulty with word selection, hesitation, use of inappropriate words, or inability to speak Visual Receptive Aphasia Assess the ability to read and interpret Expressive Writing Aphasia Assess the ability to write Dysarthria
• the loss of control of the muscles used for speech
• Use tongue twisters such as the following to assess. "Massachusetts artillery." "Suzy sells seashells by the seashore." "Peter Piper picked a peck of pickled peppers. If Peter Piper picked a peck of pickled peppers, how many peppers did Peter Piper pick?" Olfactory Nerve
• 1
• Smell is often decreased in the elderly. Test sense of smell with vanilla, cloves, or coffee. Use a disposable medication cup with coffee grounds. Optic nerve
• 2
• Visual acuity with glassesMinimize contact by testing near vision with letters on a disposable piece of

paper Visual fields by confrontation method (See demonstration in Evolve video.) Ophthalmoscopic exam Oculomotor 3 Torchlear 4 Abducens 6 Oculomotor (3), Trochlear (4), and Abducens (6) Nerves

• Inspect the lid position, pupil size, and pupillary reactions to light (CN3 Oculomotor only).
• Also, inspect extraocular eye movements (EOMs).
• Smooth and symmetric in all fields of gaze
• Minimize contact by not holding the patient's chin to keep the patient from moving the head Nystagmus rhythmic jerking of eyes. Anisocoria unequal pupil size Trigeminal Nerve
• 5
• Check the motor division, sensory division, and corneal reflex. Palpate the jaw while the patient clenches the teeth to check the motor division. You can assess a child by having the child chew a cracker.
• sensory division, test the patient’s ability to feel light touch on the forehead, cheek, and chin with the eyes closed. Minimize contact by using a cotton tipped applicator.
• The corneal reflex is not routinely tested (cotton in eyeball) Facial Nerve
• 7
• The facial nerve controls facial expressions. Ask the patient to raise and wrinkle the eyebrows, close the eyes tightly, smile, show the teeth, frown, puff out the cheeks, and whistle. You can make this into a game for children.
• Sensory Division

You can test sweet and salty sensation on the anterior two-thirds of the tongue, but this is not routinely tested. Auditory Nerve (Acoustic Nerve or Vestibulocochlear nerve)

• 8
• Assess the ability to hear your voice and/or whispered voice. Have the patient plug the ear not being tested. Perform the Weber and Rinne tests. (These are covered in the module that covers the ear and hearing.) Glossopharyngeal
• 9 Vagus
• 10 Glossopharyngeal (9) and Vagus (10) Nerves
• Innervates the pharynx and larynx
• Assess the symmetry of the soft palate, and uvula at rest and when saying "ah"
• Assess the gag reflex by touching the posterior pharyngeal wall with a tongue blade. The gag reflex will not be tested due to COVID and increased risk of contact with secretions.
• Assess swallowing
• Assess for hoarseness Spinal Accessory Nerve
• 11
• This nerve innervates the trapezius and sternomastoid (also called sternocleidomastoid) muscles.
• Have the patient shrug the shoulders against resistance. Also, have the patient turn the head to the side against resistance. Hypoglossal Nerve
• 12
• The hypoglossal nerve innervates the tongue. Inspect the tongue for atrophy, involuntary movement, and fasciculations (uncontrolled twitching). - Have the patient stick out the tongue and observe for deviation.
• Have the patient keep the mouth closed and palpate the cheek while the patient pushes the tongue against the cheeks and closed lips. "Oh, Oh, Oh, To Touch And Feel A Girl's Velvet, Soft Hands." Oh - Olfactory (1) Oh - Optic (2) Oh - Oculomotor (3) To - Trochlear (4)

Touch - Trigeminal (5) And - Abducens (6) Feel - Facial (7) A - Auditory (Acoustic or Vestibulocochlear) (8) Girl's - Glossopharyngeal (9) Velvet - Vagus (10) Soft - Spinal Accessory (11) Hands - Hypoglossal (12) Pain Sensation Use the sharp and dull side of a broken tongue blade. Ask the patient to say "sharp" or "dull" when randomly touched while the patient's eyes are closed. Use both halves of the broken tongue blade without touching the part that touches the patient Superficial Tactile Sensation Tell the patient to say yes each time you touch the skin lightly with a cotton ball while the patient's eyes are closed. Do not use long strokes. Minimize touch by using a cotton tipped applicator. Monofilament Testing This is used to detect neuropathy in patients with diabetes. The monofilament bends with a certain amount of pressure. The patient should feel the pressure of the monofilament on the bottom of the feet. Vibration Sensitivity Place a vibrating tuning fork (128 cps) on the patient's wrist and the joint behind the big toe when the patient's eyes are closed. Ask what the patient feels. Then, tell the patient to tell you when the vibrations stop. Wait a few seconds and stop the vibration by grasping the top of the tuning fork. Vibration sensitivity is lost in peripheral neuropathy. Disinfect the tuning fork before and after use. Position Sense Grasp the toes and fingers from the sides and move them up and down, and from side to side while the patient's eyes are closed. Ask the patient to say "up" or "down" each time a digit is moved randomly. Sanitize your hands after touching the feet. Tactile Interpretation

Have the patient identify a common object (key or coin) by touch with the eyes closed. Tactile agnosia is the inability to identify an object by touch. Graphesthesia (Parietal Lobe) Have the patient identify numbers written on the hand with the eyes closed. Write the numbers with a disposable cotton-tipped applicator. The numbers should face the patient not the examiner. Point Localization Have the patient point to each area touched with the eyes closed. Visual Interpretation Have the patient identify common objects by sight. Ask what the object is used for. Visual agnosia is the inability to identify an object by sight. Auditory Interpretation Have the patient identify sounds with the eyes closed. Auditory agnosia is the inability to identify sounds with the eyes closed. Pronator Test (or Arm Drift Test) detects upper extremity weakness. Have the patient hold the arms out with palms up and eyes closed. The patient should be able to hold the arms up at the same level. If there is slight weakness, the weaker arm may shift to a position lower than the other, and the hand may not remain in a palm-up position, as shown in the image below. Hand grasps and blood pressure cuff Hand grasps can be used to test the strength of both hands simultaneously. Cross your arms at the wrists. Next, ask the patient to grasp the index and middle fingers of your hands. Then try to break the individual’s grip by pulling your hands towards you. Hand strength can also be tested using a blood pressure cuff. Roll up the BP cuff and inflate it to 20 mmHg. Have the patient squeeze the cuff with one hand. Normal adults can typically achieve 150 mmHg. Rapid Alternating Movement The ability to perform rapid alternating movements is a normal finding that indicates coordination is intact. This can be tested with rapid bilateral hand patting or supination/pronation. Finger to Nose To assess coordination of the upper extremities, have the patient touch the tip of the nose with the index finger. The finger-to-nose to examiner's finger test involves asking the patient to rapidly alternate between touching the finger to the nose and the examiner's finger. To decrease the risk of contact with

nasal secretions, have the patient touch a tongue blade instead of your finger. Be sure to perform these tests on both upper extremities. Posture Posture is characterized as being either erect or stooped. Which of the following tests coordination? a. Finger to thumb in rapid succession b. Standing with the feet together and eyes closed c. Identifying an object by touch d. Hand grasps test a Gait Normal gait is characterized by arms and legs that alternate smoothly and symmetrically. Older adults with Parkinson's Disease may have short, shuffling steps. Watch for tremors or involuntary movements to determine whether the patient needs a cane, crutches, walker, or wheelchair. Assess the patient's ability to walk on the heels and toes if it is safe to do so. Tandem Gait Tandem gait tests balance. It is also used by law enforcement as a field sobriety test. Ask the patient to walk heel-to-toe in a straight line. Demonstrate what you want the patient to do. When performing this test on a child, ask the child to pretend to walk on a tightrope. There are five primary deep tendon reflexes: biceps, brachioradialis, triceps, patellar, and ankle Each reflex corresponds to a particular root and muscle and will evaluate the integrity of the root and associated nerve." Biceps: Root C5–C6, biceps muscle Brachioradialis: Root C6, brachioradialis muscle Triceps: Roots C7, C8, triceps muscle Patellar: Roots L2–L4, the quadriceps muscle Ankle (Achilles): Roots S1–S2, gastrocnemius muscle

• Testing deep tendon reflexes requires an intact afferent (sensory) nerve, spinal cord, and efferent (motor) nerve. Biceps Reflex (C5 and C6)

When testing the biceps deep tendon reflex, have the patient bend the elbow with the palm down. Support the weight of the arm with your arm. To find the tendon, palpate the antecubital area while the arm is being flexed. Strike your thumb on the biceps tendon in the antecubital area. The forearm should flex. Minimize touch by placing the arm on a table instead of holding the arm in yours. Brachioradialis Reflex (C5 and C6) To find the tendon, palpate on the thumb side of the wrist while the hand is opening and closing. Tap on your thumb on the radial side of the wrist. The forearm will turn and the elbow will flex. Triceps Reflex (C6, C7, and C8) Have the patient flex the arm and position it across the chest. Another method is to hang the arm from your hand and support the weight of the arm. Tap on the hollow area just above the elbow. The forearm should extend. Patellar Reflex (L2, L3, and L4) Have the patient sit with the legs hanging freely. Tap the hollow area just below the patella. The leg will swing forward. If supine, have the patient cross the leg at the ankle or place your hand under the knee. Achilles Reflex (S1 and S2) Have the patient kneel on a chair with the foot hanging freely. Or, have the patient sit with the leg hanging free. (Do not have the patient kneel or sit on the floor). Hold the foot in dorsiflexion. Tap the back of the ankle. The foot will plantarflex. If supine, have the patient cross the leg at the ankle. Abdominal Reflex (T7, T8, T9, T11, and T12) The following video demonstrates the abdominal reflexes. The umbilicus will "wink" when the abdomen is stroked. Plantar and Babinski Reflexes (S1 and S2)

• Stroke the lateral sole on the bottom of the foot. Use a disposable tongue blade instead of the end of the reflex hammer. [Normally, the big toe will point down, and the toes will curl. Record this normal reflex using a downward pointing arrow.
• If the big toe points up and the rest of toes fan outward, then document the reflex as "+ Babinski." The Babinski reflex is normal until a child is 18 months old. Test for Clonus Dorsiflex the foot rapidly and hold it. Multiple contractions indicate clonus. Carpal Tunnel Syndrome

• Carpal tunnel syndrome is due to compression of the median nerve in the wrist because of repetitive wrist flexion. Carpal tunnel syndrome causes pain, numbness, and loss of strength from the thumb to the middle finger. Thenar atrophy is possible. Phalen’s Test
• Phalen's test is a test for carpal tunnel syndrome. The patient flexes the wrists 90 degrees for 1 minute.
• According to Physiopedia, a positive test occurs “when the patient’s symptoms are reproduced, namely paresthesia (burning, tingling, numbness) in the distribution of the median nerve.” A negative test is when the patient “feels no pain or any other symptom, even if the motion is maintained for three minutes or longer.” Tinel’s Sign Tinel's sign, produced by the tapping on the wrist, may also be used to detect carpal tunnel syndrome. Hypocalcemia Hypocalcemia occurs when calcium levels are decreased. Paresthesias (numb, tingly sensations) and muscle spasms are common assessment findings. These muscle spasms feel similar to a Charley horse, a spasm in the calf that occasionally occurs at night. The worst-case scenario is tetany. When tetany occurs, muscles throughout the body spasm. Imagine what it would feel like to have a Charley horse in all of your muscles at the same time! Chvostek’s Sign Chvostek's Sign is grimacing when the facial nerve is tapped, is a diagnostic test used for hypocalcemia. Trousseau’s Sign

Trousseau's sign is a hand spasm that occurs when a blood pressure cuff is inflated. It is also used to detect hypocalcemia. Tic A tic is a repetitive contraction of muscles (grimacing). There are two categories of tics, motor and verbal. Motor tics are involuntary movements of the muscles. Verbal tics result in involuntary bursts of noise. Tremor A tremor is rhythmic twitching at rest, with specific postures, or with active movement (intention tremor). The following videos demonstrate essential, pill-rolling, Parkinson’s, and intention tremors.

• Pill Rolling Tremor in Parkinson’s (5 seconds)
• Intention Tremor Fasciculation Fasciculation is a visible twitching of muscle bundles, often around the eyes, calf, or tongue. Chorea Chorea consists of rapid, jerky, and irregular movements.
• Chorea from Huntington’s Disease Athetosis Athetosis consists of slow twisting and writhing movements. Myoclonus Myoclonus is a sudden, rapid jerking of muscles. Myoclonic movements occur during certain types of seizures. Dystonia Dystonia refers to twisting movements and postures.
• Dystonia Treated With an Implanted Pacemaker Ataxic Gait An ataxic gait is broad based and characterized by staggering, swaying, and being off balance. Shuffling Gait A shuffling gait is characterized by short, shuffling steps. There is minimal arm and leg swing. Patients with Parkinson’s typically have a shuffling gait.
• Parkinson’s Shuffling Gait

Hemiplegic Gait After a stroke, the patient may have weakness on the left or right side of the body. During a hemiplegic gait, the affected extremity is dragged forward in a semicircle. The upper extremity is flexed and does not swing. Waddling Gait A waddling gait often occurs during pregnancy. Scissoring (Spastic) Gait Patients with cerebral palsy may have a scissoring (spastic) gait. It is not uncommon for the legs to cross in front of each other when walking. Broad-Based Gait A broad-based gait is common when an individual has balance problems. Such a gait is normal until three years of age. Musculoskeletal History Ask about pain and the effects of activity on pain. Determine if there is any tenderness to touch or muscle cramping. Ask if the patient takes any musculoskeletal medications (analgesics or muscle relaxants) for pain. Rate stiffness on a 0–10 scale Ask the patient when stiffness occurs, effects of activity on their stiffness, and medications or treatments used. Ask whether the patient's joints lock up or give away deformities of bones or joints, limited range of motion (ROM), edema, redness or warmth, crepitations (cracking sounds), atrophy (loss of muscle mass), arthritis, limping, or fatigue. Have patients rate weakness on a 0-10 scale. Ask about the patient's involvement in exercise, running, or sports activities. Determine whether the patient uses protective equipment and/or other injury prevention measures when partaking in these activities. Document injuries (such as sprains, fractures, or dislocations) related to falls, sports, or accidents. Determine if there is a history of surgery involving bones, joints, or muscles (including arthroscopy, internal fixation, or joint replacement) and the outcome of the surgery. Identify whether there is a history of osteoporosis or bone density screening test if so, determine preventive measures taken and if the patient is taking supplemental calcium, vitamin D, or other medication.