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Clinical Skills Anatmoy > CAS: Head, Neck and Spine (Missing stroke) > Flashcards

CAS: Head, Neck and Spine (Missing stroke) Flashcards

1
Q

A key part of every clinical examination includes the following steps

A

Ensuring you have the correct PPE

Washing your hands

Introducing yourself

Confirming the patient’s name and date of birth (biographical information)

Gaining consent from the patient

Ensuring there is adequate exposure and positioning of the patient

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2
Q

Define muscle tone

A

The amount of tension in a muscle.

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3
Q

Describe the tone of muscles at rest and explain why this occurs

A

Muscles have a constant tone at rest

This is due to the fact that muscles are in a constant state of partial contraction

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4
Q

How is muscle tone tested?

A

Passively moving the joints and comparing the resistance to the movements by the muscles on both sides of the body

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5
Q

A muscle without any tone indicates what?

A

Breach/disruption in the spinal segmental reflex arc and the simple spinal reflexes are not functioning

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6
Q

Hypotonia is indicative of what type of lesion?

A

Lower Motor Neuron (LMN) lesion

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7
Q

The lower motor neurons of the spinal segmental neurons are influenced by neurones from which 4 brain regions?

A

Cerebral cortex

Midbrain

Pons

Medulla

N.B. Collectively known as upper motor neurones

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8
Q

What effect does UMN have on LMN?

A

Inhibitory effect

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9
Q

What effect does an UMN lesion have on muscle tone?

A

Leads to hypertonia (exaggerated muscle tone/stiffness)

N.B. Sometimes may also have spasticity which is shown in image below.

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10
Q

What scale can be used to measure the power (strength) of muscles?

A

Medical Research Council (MRC) Muscle Power scale

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11
Q

According to the muscle power scale, what criteria must be met to give scores 0-5?

A
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12
Q

Define reflex

A

Involuntary resposne to stimuli

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13
Q

A reflex pathway consists of which 2 types of neurones?

A

Afferent (sensory) neurones conveying impulses from sensory receptors in the muscle spindle to the spinal cord (CNS)

Efferent (motor) neurones running from the anterior grey columns of the spinal cord (CNS) to the effector organ which is the limb muscle.

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14
Q

What are the 2 types of reflex arcs and which is most comon for myotatic reflex arcs?

A

The reflex arc may be monosynaptic or multi synaptic

Most of the myotatic reflex arcs are monosynaptic.

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15
Q

Testing for reflexes in a normal patient, you notice that you cannot elicit a reflex response. What is the next course of action?

A

May have to apply “reinforcement”

Ask the patient either clench the teeth or squeeze an object in the contralateral (other) hand while you directly test the reflex on the limb to be tested

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16
Q

Should a neurological deficit be concluded on the findings of abnormal absence/exageration of reflexes?

A

Must not jump into conclusion and instead findings should be used to support other clinical findings

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17
Q

Name the law which is used to explain how body posture works and antagonistic pairing between muscles

A

Law of reciprocal innervation

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18
Q

Explain the law of reciprocal innervation

A

In the same limb the flexor and extensor muscles cannot contract simultaneously.

The afferent nerves responsible for flexor reflex muscle action must have branches to synapse with the extensor motor neurons of the same limb to inhibit the extensor muscle contraction.

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19
Q

Abnormally exaggerated myotatic reflexes is indicative of which type of motor lesion?

A

Upper motor lesion

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20
Q

Complete absence (areflexia) of reflexes is indicative of which type of lesion?

A

Lower motor neurone lesion

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21
Q

Define dermatome

A

An area of skin supplied by a single spinal nerve root or spinal cord segment

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22
Q

Explain why loss of a single spinal nerve root may not produce any detectable sensory loss in that dermatome

A

On the skin, the adjacent dermatomes (for example C4, C5, C6) overlap considerably

23
Q

In order to detect a significant sensory loss at least how many adjacent dermatomes must be affected?

A

At least 3

24
Q

There is however no overlap of dermatomes in which regions of the body?

A

no overlap (for example C4 and T2 or C5 and T1) across the axial lines of the limb.

25
Q

Damage to which type of nerves may affect large areas of skin and muscle?

A

Peripheral nerves

26
Q

Damage to a peripheral nerve may result in?

A

Wide ranging effects on more than one dermatomal area or myotomes as peripheral nerves carry nerve components from several spinal segments (or roots) to muscles and skin areas.

27
Q

Memorise dermatome map

A
28
Q

C4 dermatome is located in which region?

A

Shoulder

29
Q

C5 dermatome is located in which region?

A

Lateral side of arm

30
Q

C6 dermatome is located in which region?

A

Lateral side of forearm and thumb

31
Q

C7 dermatome is located in which region?

A

Middle and ring finger

32
Q

C8 dermatome is located in which region?

A

Medial side of hand, little finger and forearm

33
Q

T1 dermatome is located in which region?

A

Medial side of forearm and arm

34
Q

T2 dermatome is located in which region?

A

Axilla

35
Q

What peripheral nerve is responsible for supplying the C5,C6 and C7 dermatome segments?

A

Musculocutaneous nerve

36
Q

What peripheral nerve is responsible for supplying the C6-C8 and T1 dermatome segments?

A

Median nerve

37
Q

What peripheral nerve is responsible for supplying the C5-C8 and T1 dermatome segments?

A

Radial nerve

38
Q

What peripheral nerve is responsible for supplying the C7, C8 and T1 dermatome segments?

A

Ulnar nerve

39
Q

Memorise dermatomal map of lower limb

A
40
Q

Where would you asses L1

A

Area over inguinal ligament

41
Q

Where would you assess L2 dermatome?

A

Lateral side of thigh

42
Q

Where would you assess L3 dermatome?

A

Medial side of thigh

43
Q

Where would you assess L4 dermatome?

A

Medial side of leg, medial side of foot and big toe

44
Q

Where would you assess L5 dermatome?

A

Lateral side of legt, mid dorsum of foot and middle three toes

45
Q

Where would you assess S1 dermatome?

A

Little toe

Lateral side of foot

Sole of foot

46
Q

Where would you assess S2 dermatome?

A

Back of upper leg and whole thigh

47
Q

Where would you assess S3 dermatome?

A

Area over gluteal fold

48
Q

The posterior rami (over the buttock region) supplies which dermatome segments?

A

L1-L3 and S1-S3

49
Q

The obturator nerve supplies which dermatome segments?

A

L2, L3, L4

50
Q

The femoral nerve supplies which dermatome segments?

A

L2, L3, L4 (Same as obturator)

51
Q

The common fibular nerve (part of sciatic nerve) supplies which dermatome segments?

A

L4-S2

52
Q

The tibial nerve (part of sciatic) supplies which dermatome segments?

A

L4-S3

53
Q
A

Clinical Skills Anatmoy (16 decks)

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