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Semester 2 > Clinical assessment quiz 2 > Flashcards

Clinical assessment quiz 2 Flashcards

1
Q

Why neurological testing?

A

test coordination of afferent/efferent impulses (to/away from CNS)

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2
Q

regions of body supplied by spinal nerves

A

8 cervical spinal nerves

12 thoracic spinal nerves

5 lumbar spinal nerves

5 sacral spinal nerves

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3
Q

myotomes and dermatomes

A

spinal nerves have

motor fibres
sensory fibres

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4
Q

motor fibres of spinal nerves

A

innervate certain muscles

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5
Q

sensory fibres of spinal nerves

A

innervate certain areas of skin

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6
Q

dermatome/myotome pattern – is it consistent between different people?

A

despite slight variations, pattern distribution is relatively consistent b/w people.

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7
Q

Dermatome =

A

skin area innervated by sensory fibres of a single nerve root

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8
Q

Dorsal vs Ventral roots of spinal nerves

A

Dorsal root = Afferent fibres enter CNS via “

Ventral root = Efferent fibres exit CNS via “

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9
Q

dermatome vs dorsal roots

A

bilateral area of skin associated with pair of Dorsal Roots from spine

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10
Q

why is dermatome region important?

A

pain following dermatome region may indicate spinal damage or neurological stenosis

E.g. Compressed spinal nerve may show as pain elsewhere (E.g. @ Dermatome region)

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11
Q

other clinical significances of DERMATOMES

A

finding site of damage to spine

E.g.
Viruses that affect spinal nerves – E.g. Herpes Zoster

“MIGRATES ALONG SPINAL NERVE TO AFFECT ONLY AREA OF SKIN SERVED BY THAT NERVE”

“Symptoms are usually unilateral but in the immune suppressed, they are more likely to become bilateral and symmetrical, meaning that the virus is present in both ganglia of a dorsal root ganglion pair.”

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12
Q

MYOTOMES

A

group of muscles innervated by the Motor fibres of a single nerve root (VIA VENTRAL ROOT OF SPINAL NERVE)

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13
Q

DEEP TENDON REFLEXES

A

assess the functioning of nerve or nerve roots supplying the reflex

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14
Q

how is DTR caused?

A

stretching of muscle spindle

” synapses via sensory neurons to spinal cord then back via motor neurons

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15
Q

What happens when DTR is absent?

A

spinal cord, nerve root, peripheral nerve or muscle has been damaged

when response is weak/abnormal – indicates disruption of sensory and/or motor neurons

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16
Q

CLONUS

A

“When reflexes are very brisk, clonus is sometimes seen. This is a repetitive vibratory contraction of the muscle that occurs in response to muscle and tendon stretch.”

clonus = “muscular spasm involving repeated, often rhythmic, contractions.”

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17
Q

DTR ratings/scale

A

0: absent reflex
1+: trace, or seen only with reinforcement
2+: normal
3+: brisk
4+: nonsustained clonus (i.e., repetitive vibratory movements)
5+: sustained clonus

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18
Q

normal vs. abnormal DTR reflex

A

Deep tendon reflexes are normal if they are 1+, 2+, or 3+

Reflexes rated as 0, 4+, or 5+ are usually considered abnormal.

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19
Q

clonus, hyperreflexia

A

In addition to clonus, other signs of hyperreflexia include spreading of reflexes to other muscles not directly being tested and crossed adduction of the opposite leg when the medial aspect of the knee is tapped.

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20
Q

hyperreflexia

A

Hyperreflexia happens when your muscles have an increased or overactive reflex response.

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21
Q

What is being tested during DTR test?

A

DTR reflex diminished during problems in
A) muscles
b) sensory neurons
c) lower motor neurons
d) NMJ
e) upper motor neurons (acute lesions)
f) joints (joint disease = mechanical factors)

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22
Q

abnormally increased reflexes =

A

upper motor neuron nerve lesions

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23
Q

DTR reflexes variables of influence

A

age

metabolism

thyroid dysfunction

electrolyte imbalances

mental state (e.g. anxiety)

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24
Q

why it is important to repeat the test multiple times (5-6 times)

A

to ensure consistent response

(inconsistent response can indicate pathology – E.g. fading response due to nerve root lesion)

25
Q

two point test (pin prick assessment)

A

ability to discern two distinct points touching skin

often as two sharp points touching a part of skin

E.g.
two points @ 2-4 mm apart should be felt on lips and finger pads

two points @ 8-15 mm on palms

two points @ 30-40mm on the shins or back

(points are at same dermatome)

26
Q

BP

A

force of blood pushing against walls of arteries

27
Q

units for BP

A

mm HG – mm of mercury

28
Q

why two readings?

A

pressure changes when heart contracts/relaxes – therefore two readings

SYSTOLIC and DIASTOLIC

29
Q

systolic

A

heart contracts and forces blood into vessels

30
Q

diastolic

A

heart is relaxed

blood filling up inside heart

31
Q

BP varies – variables

A

lower when at rest

higher when active

lying down vs standing up

emotions

pregnancy

smoker or not

medication

environment

32
Q

acceptable BP?

A

less than 140 / 90

140 systolic

90 diastolic

120/80 = optimal

32
Q

BP chart

A

<130, <85 = Normal

130-140, 85-90 = high normal

140-160, 90-100 = stage 1 hypertension (mild)

160-180, 100-110 = stage 2 hypertension (moderate)

180-210, 110-120 = stage 3 hypertension (severe)

210 or more, 120 or more = stage 4 (very severe)

33
Q

how many BP reading per year?

A

once when healthy

> 1 if heart condition

34
Q

danger of high BP

A

too high = blood vessel can burst

burst in brain = stroke

burst in vessel leading to heart = heart attack

35
Q

other danger of high BP

A

damage BV wall

lead to fatty plaque build up (ATHEROSCLEROSIS)

36
Q

atherosclerosis and stroke/heart attack

A

piece of plaque breaks

blood clot forms

blocks blood flow to brain or heart

= stroke or heart attack

37
Q

BP for patients with diabetes or kidney disease

A

<130 mmHg systolic
<80 mmHg diastolic

38
Q

note about reliability of single BP reading

A

single high reading does not necessarily indicate high BP

should be tested at another time to confirm

high BP diagnosis not based on single reading

38
Q

BP assessment environment

A

create calm environment

keep patient relaxed

minimize disturbance

39
Q

pulse?

A

usually accurate measure of heart rate

40
Q

when is pulse not measuring heart rate correctly?

A

pathologies

some heart beats not strong enough to stretch aorta –> create palpable pressure wave

i.e.
Pulse is irregular and heart rate can be higher than pulse rate

E.g.
Some arrhythmias

41
Q

what to do if pulse is not a reliable measure of heart rate?

A

when pulse is not accurate, stethoscope should be used

“auscultation of heart apex”

42
Q

normal heart rate / pulse

A

60-100 BPM

43
Q

exception

A

“well-conditioned” athletes can have resting heart rate lower than 60BPM

44
Q

bradycardia

A

lower than 60BPM heartrate at rest

45
Q

tachycardia

A

greater than 100BPM heartrate at rest

46
Q

heart rate during sleep

A

as low as 40BPM

47
Q

heart rate during exercise

A

150-200BPM for intense physical activity

48
Q

heart rate / pulse in young children and infants

A

higher

49
Q

resting heart rate of infant

A

average 110BPM

close to adult’s pulse rate during exercise

50
Q

how to check pulse

A

count beats in period of time

E.g. 15 seconds

multiply by 4

51
Q

when faster when slower

A

slower at rest

E.g.
faster during stress, exercise, or fever

52
Q

which fingers to feel pulse

A

usually fingertip pads of 2nd and 3rd digits

53
Q

common pulses that can be felt

A

Temporal Artery

Facial Artery

Common Carotid Artery

Brachial Artery

Radial Artery

Ulnar Artery

Femoral Artery

Popliteal Artery

Posterior Tibial Artery

Dorsalis Pedis Artery

54
Q

the dermatomes

A

C1-8
T1-2

L1-5
S1-2

55
Q

the myotomes (lower extremity)

A

L1/L2 = hip flexion

L3 = knee extension
L4 = ankle dorsiflexion
L5 = big toe extension

S1 = plantar flexion
= hip extension
= ankle eversion

S2 = knee flexion

56
Q

the myotomes (upper extremity & head)

A

C1/C2 = neck flexion
C3 = neck side flexion
C4 = shoulder elevation
C5 = shoulder abduction

C6 = elbow flexion & wrist extension
C7 = elbow extension & wrist flexion

C8 = thumb extension, ulnar deviation

T1 = digit abduction/adduction

57
Q

the DTRs

A

C5/C6 = biceps
C6 = brachioradialis
C7 = triceps

L4 = patellar
L5 = medial hamstrings

S1 = achilles tendon (gastrocnemius/soleus?)

Semester 2 (14 decks)

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