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NMS Diagnosis (1.2) > Cranial Nerves 21% > Flashcards

Cranial Nerves 21% Flashcards

1
Q

Sensory:

- Smell (coffee, mint) is tested one nostril at a time with eyes closed

A

Olfactory (I)

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2
Q

Lost sense of smell (CN I)

A

Anosmia

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3
Q

Distorted sense of smell (CN I)

A

Parosmia

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4
Q

Sensory:

- Vision is tested with Snellen Chart for visual acuity, visual fields (peripheral vision)

A

Optic (II)

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5
Q

Direct Light Reflex CN

A

CN II Optic & III Oculomotor

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6
Q

Indirect (consensual) Light Reflex CN

A

CN II Optic & III Oculomotor

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7
Q

Eyes converge, pupils constrict & lens convexity (CN II)

A

Accommodation

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8
Q

What cranial nerves are tested together with the Six Cardinal Fields of Gaze?

A

CN III Oculomotor, IV Trohlear, VI Abducens

LR6, SO4, O3

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9
Q

Motor:

Levator Palpebrae, Inferior Oblique, Superior, Medial and Inferior Rectus

A

Oculomotor (III)

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10
Q 
Parasympathetic:
Ciliary muscles (lens shape) and constrictor papillae
A

Oculomotor (III)

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11
Q

Which CN:

  • Direct Light Reflex
  • Indirect Light Reflex
  • Accommodation
A

CN II Optic & III Oculomotor

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12
Q

Deviation of one or both eyes

A

Strabismus

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13
Q

Eyelids droop due to weakness or paralysis of levator palpebrae

A

Ptosis

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14
Q

Motor:
Superior Oblique muscle (down, in)
Ex: look at the tip of your nose

A

Trochlear (IV)

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15
Q

Sensory:
To Face (V1-3)
Touch forehead, cheekbone & chin with cotton wisp

A

Trigeminal (V)

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16
Q

Corneal Reflex
- What CN is for afferent & which is efferent?
Touch cornea with cotton wisp, both eyes blink or tear normally

TQ

A 
CN V (Trigeminal) is afferent (sensory)
CN VII (Facial) is efferent (motor)
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17
Q

Jaw Jerk Reflex CN?

The mandible is tapped with hammer and jaw draws upward

A

CN V Trigeminal

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18
Q

Oculocardiac Reflex CN for afferent & efferent?

Press on eye and heart rate decreases

A

CN V Trigeminal is afferent (sensory)

CN X Vagus is efferent (motor)

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19
Q

General sensation to the anterior 2/3 of the tongue (sensory)

TQ

A

CN V Trigeminal

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20
Q

Motor:
Muscles of Mastication

TQ

A

Trigeminal (V)

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21
Q

Extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. Lightening like, excruciating pain is repetitive, occurring several times per day. Pain is typically felt on one side of the jaw or cheek.

A

Tic Douloureaux aka Trigeminal Neuralgia

CN V Trigeminal

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22
Q

Motor:
to Lateral Rectus Muscle

TQ

A

Abducens (VI)

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23
Q

Sensory:
Taste - anterior 2/3 of tongue
(sweet, sour, salty)

A

Facial (VII)

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24
Q

Motor:

Muscles of facial expression

A

Facial (VII)

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25
Q

Unilateral facial paralysis caused by trauma, virus, or immune mediated response and is not permanent. Initial pain behind ipsilateral ear, twitching, weakness or paralysis, drooping eyelid, drooping corner of mouth, drooling, dry eye & impairment of taste.

TQ

A

Bell’s Palsy

Facial VII CN

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26
Q

What is the difference between Bell’s Palsy and Stroke?

A

Bells: Ipsilateral Motor loss of entire face & forehead does NOT wrinkle
Stroke: contralateral motor loss below eye & forehead does wrinkle

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27
Q

Sensory:

Balance, Mittelemeyer, Barany Caloric Test, Rombergs

A

VIII. Vestibulocochlear - Vestibular part

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28
Q

Sensory:
Hearing, Weber, Rinne, Whisper, Auditory Acuity/Watch

TQ

A

VIII. Vestibulocochlear - Cochlear part

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29
Q

Cause is unknown, but probably results from an abnormality in the fluids of the inner ear. Symptoms are episodic rotational vertigo, hearing loss, & tinnitus.

A

Meniere’s Disease
aka Endolymphatic Hydrops
VIII. Vestibulocochlear CN

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30
Q

Sensory (Afferent):

  • Gag (Pharyngeal) Reflex
  • Uvula Reflex
  • Carotid Reflex: massage carotids and heart rate drops
  • Taste to posterior 1/3 of tongue (bitter)

TQ

A

IX. Glossopharyngeal

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31
Q

Motor:

Stylopharyngeus muscle elevates pharynx & larynx; dilates pharynx to permit swallowing

A

IX. Glossopharyngeal

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32
Q

Sensory:

Epiglottis & laryngeal muscles of swallowing (palate, pharynx, contracting muscles)

A

X. Vagus

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33
Q

Motor (efferent):

  • Gag Reflex
  • Uvular Reflex
  • Carotid Reflex

TQ

A

X. Vagus

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34
Q

Uvular Reflex: palate and uvula deviate to the _____ side of lesion when patient says “AHHHH”

TQ

A

Opposite side of lesion (Vagus)

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35
Q

Motor:
Trapezius & SCM muscles
- Shoulder shrug against resistance

TQ

A

XI. Spinal Accessory

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36
Q

Spasm of SCM muscle?

A

Torticollis aka Wry Neck

XI. Spinal Accessory CN

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37
Q

Motor:
Tongue muscles
- Stick tongue out; tongue will deviate _____ side of lesion
- Look for atrophy & fasciculations

TQ

A

XII. Hypoglossal

Toward side of lesion

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38
Q

Involuntary motor responses to potentially harmful stimuli?

A

Reflexes

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39
Q

T/F - All reflex tests are done bilaterally with the normal side tested first.

A

True

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40
Q

Absence of any DTR, especially patellar (LMNL)

A

Westphal’s Sign

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41
Q

Brings out reflexes by cortical distraction?

A

Jendrassik’s Maneuver

aka Reinforcement Test

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42
Q 
Deep Tendon Reflexes: Wexler Scale
0+
1+
2+
3+
4+
5+
A 
0+  Absent with reinforcement
1+   Hypoactive with no reinforcement
2+  Normal
3+  Hyperactive
4+  Hyperactive with transient clonus ~~ TQ
5+  Hyperactive with sustained clonus
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43
Q

DTR: Jaw Jerk

A

Trigeminal V

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44
Q

DTR: Biceps

A

Musculocutaneous (C5)

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45
Q

DTR: Brachioradialis

TQ

A

Radial (C6)

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46
Q

DTR: Triceps

TQ

A

Radial (C7)

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47
Q

DTR: Patella aka Knee Jerk

A

Femoral (L4)

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48
Q

DTR: Medial Hamstring

A

Sciatic (L5)

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49
Q

DTR: Achilles aka Ankle Jerk

A

Tibial (S1)

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50
Q

Superficial Reflexes:

Corneal - touch with cotton wisp produces blinking or tearing

A

V. Trigeminal (afferent)

VII. Facial (efferent)

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51
Q

Superficial Reflexes:

Gag/Pharyngeal - touch back of tongue with tongue blade to produce gagging

A

IX. Glossopharyngeal (afferent)

X. Vagus (efferent)

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52
Q

Superficial Reflexes:

Stroke inner thigh of male; ipsilateral rise in testes

A 
Cremasteric (L1)
Femoral Nerve (afferent)
Genitofemoral Nerve (efferent)
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53
Q

Superficial Reflexes:

Stroke inner thigh of female; poupart’s ligament contracts

A 
Geigel's (L1)
Femoral Nerve (afferent)
Genitofemoral Nerve (efferent)
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54
Q

Superficial Reflexes:

Stroke up sole of foot; see curling of toes & pulling away of foot

A 
Plantar (L4-S2)
Tibial Nerve (afferent & efferent)
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55
Q

Superficial Reflexes:
Abdominal - stroke in all 4 abdominal quadrants away from umbilicus.
Normal = umbilicus moves toward side stroked

A

Afferent & Efferent:

Upper T7-T9 & Lower T10-T12

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56
Q

Superficial Reflexes:
While observing the umbilicus, the pt does a partial sit up.
Normal = umbilicus stays midline

TQ

A

Beevor’s
Afferent & Efferent:
Upper T7-T9 & Lower T10-T12

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57
Q

Lesion of the brain and spinal cord not including the anterior horn cells

A

UMNL

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58
Q

Lesion of the anterior horn cells out to the myoneural junction

A

LMNL

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59
Q

Paralysis: UMNL? LMNL?

A

UMNL: Spastic
LMNL: Flaccid

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60
Q

Deep Tendon Reflexes: UMNL? LMNL?

A

UMNL: Hyperactive
LMNL: Hypoactive/Absent

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61
Q

Pathological Reflex: UMNL? LMNL?

A

UMNL: Present
LMNL: Absent

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62
Q

Clonus: UMNL? LMNL?

A

UMNL: Present
LMNL: Absent

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63
Q

Tone: UMNL? LMNL?

A

UMNL: Hypertonic
LMNL: Hypotonic

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64
Q

Reaction of Degeneration: UMNL? LMNL?

A

UMNL: Absent
LMNL: Present

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65
Q

Atrophy: UMNL? LMNL?

A

UMNL: Absent
LMNL: Present

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66
Q

Fasiculation: UMNL? LMNL?

A

UMNL: Absent
LMNL: Present

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67
Q

Superficial Reflexes: UMNL? LMNL?

A

UMNL: Absent
LMNL: Absent

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68
Q

Visceral Organic Reflexes:
Absent in UMNL & LMNL
Pinch neck while noting dilation of the eyes

A

Ciliospinal - Sensory from neck

Cervical sympathetics

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69
Q

Visceral Organic Reflexes:
Absent in UMNL & LMNL
Press on eye while noting the slowing of the heart by 10 bpm

A

Oculocardiac
V. Trigeminal
X. Vagus

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70
Q

Visceral Organic Reflexes:
Absent in UMNL & LMNL
Press on carotid sinus while noting the slowing of the heart & decreased pressure

A

Carotidcardio reflex
IX. Glossopharyngeal
X. Vagus

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71
Q

Which CN are sensory only?

A

I. Olfactory
II. Optic
VIII. Vestibulocochlear

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72
Q

Which CN are motor only?

A 
III. Oculomotor
IV. Trochlear
VI. Abducens
XI. Spinal Accessory
XII. Hypoglossal
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73
Q

Which CN are both sensory & motor?

A

V. Trigeminal
VII. Facial
IX. Glossopharyngeal
X. Vagus

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74
Q

Pathological Reflex indicates UMNL:

Stroke up lateral aspect of foot to great toe

A

Babinski:

Dorsiflexion of great toe with splaying of other toes (+)

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75
Q

Pathological Reflex indicates UMNL:

Stroke lateral malleolus to fifth toe

A

Chaddock:

Babinski-like response (+)

76
Q

Pathological Reflex indicates UMNL:

Stroke down tibial crest to the ankle

A

Oppenheim:

Babinski-like response (+)

77
Q

Pathological Reflex indicates UMNL:
Squeeze the calf below the knee

TQ

A

Gordon’s Calf:

Babinski-like response (+)

78
Q

Pathological Reflex indicates UMNL:

Squeeze Achilles tendon

A

Schaefer:

Babinski-like response (+)

79
Q

Pathological Reflex indicates UMNL:

Tap the ball of the foot

A

Rossolimo:

Plantar flexion of great toe with curling of other toes (+)

80
Q

Pathological Reflex indicates UMNL:

Examiner extends middle phalanx & flicks distal phalanx inferior

A

Hoffman:

Flexion & adduction of thumb and flexion of fingers (+)

81
Q

Pathological Reflex indicates UMNL:

Examiner sharply taps the tips of the middle 3 fingers

A

Tromner:

Flexion & adduction of thumb and flexion of the fingers (+)

82
Q

Pathological Reflex indicates UMNL:

Examiner strokes the pisiform of the pt

A

Gordon’s finger:

Flexion of wrist & fingers, or thumb & index finger (+)

83
Q

Pathological Reflex indicates UMNL:

Examiner strokes the distal ulnar side of the forearm near the wrist

A

Chaddock’s Wrist:

Flexion of wrist with extension & fanning of fingers (+)

84
Q

Muscle Grading:
5, 4, 3, 2, 1, 0

TQ

A

5 - Normal: complete ROM, against gravity, full resistance
4- Good: complete ROM, against gravity, some resistance
3 - Fair: complete ROM, against gravity
2 - Poor: complete ROM, no gravity
1 - Trace: evidence of slight contractility w/ no joint motion
0 - Zero: no evidence of contractility

85
Q

C5 nerve root: Motor function?

A

Arm Abduction / Forearm Flexion

86
Q

C5 nerve root: Muscle?

A

Middle Deltoid / Biceps Brachii

87
Q

C5 nerve root: Sensory?

A

Lateral Arm

88
Q

C5 disorder

A

Erb’s Palsy
Paralysis of the arm primarily from dystocia; LMN syndrome; MC affected nerves are Suprascapular N, Musculocutaneous N, and Axillary N.

89
Q

C6 nerve root: Motor function?

A

Wrist Extension

90
Q

C6 nerve root: Muscle?

A

Extensor Carpi Ulnaris/Radialis & Brachialis

91
Q

C6 nerve root: Sensory?

A

Lateral Forearm & Digits 1-2

92
Q

C6 disorder

A

*** Erb’s Palsy

93
Q

C7 nerve root Motor Function?

A

Wrist Flexion & Finger extension

94
Q

C7 nerve root muscles

A

Flexor Carpi Ulnaris/Radialis & Triceps

95
Q

C7 nerve root sensory?

96
Q

C7 nerve root disorder

A

Wrist Drop

97
Q

C8 motor function

A

Finger Flexion

98
Q

C8 muscles

A

Flexor Digitorum Superficialis/Profundus & Lumbricals

99
Q

C8 sensory

A

Medial Forearm & Digits 4-5

100
Q

C8 nerve root disorder

A

*** Klumpke’s Paralysis (C8-T1)

Paralysis involving the intrinsic muscles of the forearm & hand; “Claw Hand”; lower brachial plexus injury

101
Q

T1 nerve root motor function

A

Finger abduction & adduction

102
Q

T1 nerve root muscle

A

Dorsal Interossei & Palmer Interossei

103
Q

T1 nerve root sensory

A

Medial Elbow

104
Q

T5-T12 nerve root motor function

A

Trunk Flexion

105
Q

T5-T12 nerve root muscle

A

Rectus Abdominus

106
Q

T5-T12 nerve root sensory

A

T5-T12 follow vertebral levels

107
Q

L1-L3 nerve root motor funtion

A

Hip Flexion

108
Q

L1-L3 nerve root muscle

109
Q

L1-L3 nerve root sensory

A

Inguinal Ligament (L1), Oblique (L2), Oblique across Knee (L3)

110
Q

L1-L3 nerve root disorder

A

*** Meralgia Paresthetica
Numbness/pain in outer thigh caused by injury to the nerve from thigh to spinal column.
Lateral Cutaneous Nerve of the thigh

111
Q

L2-L4 nerve root motor function

A

Hip flexion & adduction

Knee extension

112
Q

L2-L4 nerve root muscle

A

Quadriceps & Adductors

113
Q

L4 nerve root motor function

A

Inversion & Dorsiflexion

114
Q

L4 nerve root muscle

A

Tibialis Anterior

115
Q

L4 nerve root sensory

A

Medial aspect of leg & foot

116
Q

L4 nerve root disorder

A

Foot Drop

Gait abnormality; Common Fibular Nerve; unable to extend toe or dorsiflex ankle; common with ALS, MS, Cerebral Palsy

117
Q

L5 nerve root motor function

A

Toe extension, Heel walk, Hip abduction

118
Q

L5 nerve root muscle

A

Extensor digitorum
Extensor Hallucis Longus
Gluteus Medius & Minimus

119
Q

L5 nerve root sensory

A

Lateral aspect of the leg across dorsum of foot to big toe

120
Q

L5 disorder

A

Foot Drop

Gait abnormality; Common Fibular Nerve; unable to extend toe or dorsiflex ankle; common with ALS, MS, Cerebral Palsy

121
Q

S1 nerve root motor function

A

Eversion
Plantar Flexion
Hip Extension

122
Q

S1 nerve root muscle

A

Peroneus longus/brevis

Gluteus Maximus

123
Q

S1 nerve root sensory

A

Lateral aspect of foot & plantar surface of foot

124
Q

S2-S4 nerve root motor function

125
Q

S2-S4 nerve root muscle

A

Levator Ani & Coccygeus

126
Q

S2-S4 nerve root sensory

127
Q

S2-S4 nerve root disorder

A

Cauda Equina

128
Q

Axillary Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Arm Abduction
Deltoid & Teres Minor
Lateral Arm
Glenohumeral Dislocation

129
Q

Radial Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Wrist/Finger Extension & Thumb Abduction
Wrist/Finger Extensors & Triceps
Dorsal web between thumb and index
Wrist Drop, Crutch Palsy, Erb’s Palsy

130
Q

Musculocutaneous Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Elbow Flexion
Biceps, Brachialis, Coracobrachialis
Lateral Forearm
Impingement

131
Q

Median Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Thumb pinch, Opposition of thumb
Wrist & thumb flexors, Thumb abductors, Thenar
Distal Radial hand, 2nd digit
Carpal Tunnel, Pronator Teres, Ape Hand

132
Q

Ulnar Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Abduction of 5th digit & Adduction of Thumb
Finger abductors/adductors & Thumb adductors
Distal Ulnar Hand, 5th digit
Claw Hand

133
Q

Dorsal Scapular Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Elevation & Retraction of Scapula
Rhomboids & Levator Scapula
NO sensory
Flaring of Scapula

134
Q

Long Thoracic Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Protraction of Scapula
Serratus Anterior
NO sensory
Winged Scapula

135
Q

Lateral Femoral Cutaneous Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

No Motor function
No Muscle innervation
Lateral Thigh
Meralgia Paresthetica

136
Q

Saphenous Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

No motor function
No muscle
Anteromedial Knee & Medial Leg
No disorder

137
Q

Obturator Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Hip Adduction
Hip Adductor muscles
Medial Thigh
Impingement

138
Q

Femoral Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Hip Flexion, Knee Extension
Iliopsoas, Quadriceps
Anteromedial Thigh & Leg
Impingement

139
Q

Sciatic Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Flexion of the Knee
Hamstrings
Ant/Post Leg & Sole/Dorsum of Foot
Piriformis Syndrome (15%)

140
Q

Peroneal Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Foot Dorsiflexion, Inversion & Eversion
Tib Anterior, Toe Extensors, Peroneals
Anterior leg & Dorsum of foot
Fibular Head fracture

141
Q

Medial Plantar Nerve:

  • Motor function
  • Muscle
  • Sensory
  • Disorder
A

Toe Flexion
Toe Flexor muscles
NO sensory
Tarsal Tunnel Syndrome

142
Q

List the 10 Peripheral Nerve Entrapments

A 
"DR CUMA"
D - Drop Wrist
R - Radial Nerve
C - Claw Hand
U - Ulnar Nerve
M - Median Nerve
A - Ape Hand
143
Q

Pain along the sensory distribution of a nerve root

A

Dermatogenous

144
Q

Pain that originates within a muscle

A

Myotogenous

145
Q

Pain that arises from structures derived from embryological sclerotomes (joint pain)

A

Scleratogenous

146
Q

Pain along the course of a dermatome due to irritation of a nerve root

147
Q

Pain along scleroderm of origination involving more than one kind of tissue (shared pathway)

148
Q

Muscle - type of pain

A

Cramping, spasm, aching, dull

149
Q

Nerve - type of pain

A

Shooting, radiating, burning

150
Q

Circulation - type of pain

A

Throbbing, pulsating

151
Q

Bone Cancer - type of pain

A

Constant, deep, boring, nocturnal, progressive, unremitting

152
Q

Scleratogenous - type of pain

A

Poorly localized, dull, ache

153
Q

Myofascial - type of pain

A

Trigger Points

154
Q

Gallbladder referred pain sites

A

Right Shoulder, Inferior Scapula

155
Q

Pancreas referred pain sites

A

Spine & T10 level (epigastric)

156
Q

Heart referred pain sites

A

Left Shoulder & Medial Left arm

157
Q

Intestines referred pain sites

A

Periumbilical

158
Q

Appendix referred pain sites

A

Epigastric (early) or RLQ (late)

159
Q

Kidney referred pain sites

A

Flank pain

160
Q

Ureter referred pain sites

161
Q

Bladder referred pain sites

A

Suprapubic area

162
Q

Normal findings include ability for patient to distinguish between sharp and dull sensations with their eyes closed.

A

Dermatomes

163
Q

Abnormalities for Dermatomes

A

Anesthesia - no feeling
Hypoesthesia - minimal sense of feeling
Hyperesthesia - increased sense of feeling

164
Q

C4 dermatome

A

Neck (C7 location)

165
Q

C5 dermatome

A

Lateral arm shoulder to elbow

166
Q

C6 dermatome

A

Lateral forearm & 1st two digits

167
Q

C7 dermatome

A

Middle finger (3rd digit)

168
Q

C8 dermatome

A

Medial forearm & 4th and 5th digits

169
Q

T1 dermatome

A

Medial Elbow

170
Q

T2 dermatome

A

Medial upper arm into axilla

171
Q

T10 dermatome

A

Waist at bellybutton level

172
Q

T11 dermatome

A

Waist just below bellybutton

173
Q

T12 dermatome

A

Above hip down to groin area

174
Q

L1 dermatome

A

Upper 1/3 of thigh

175
Q

L2 dermatome

A

Middle 1/3 of thigh

176
Q

L3 dermatome

A

Lower 1/3 of thigh just above knee

177
Q

L4 dermatome

A

Medial calf to bottom of foot

178
Q

L5 dermatome

A

Lateral calf to top of toes

179
Q

S1 dermatome

A

Lateral foot

180
Q

Ménière’s disease is associated with what CN?

A

VIII. Vestibulocochlear

181
Q

Torticollis aka Wry Neck is associated with which CN?

A

XI. Spinal Accessory Nerve

182
Q

Paralysis of the arm from dystopia;
LMN Syndrome;
MC affected nerves are Suprascapular, Musculocutaneous, and Axillary

A

Erb’s Palsy

183
Q

Paralysis involving intrinsic muscles of forearm and hand from lower brachial plexus injury.

A

Klumpke’s paralysis

184
Q

Numbness/Pain in outer thigh caused by injury to nerve from thigh to spinal column.
Lateral cutaneous nerve of the thigh

A

Meralgia Paresthetica

185
Q

Gait abnormality; Common Fibular Nerve; associated with ALS, MS, and Cerebral Palsy.
Nerve roots affected are L4-5

NMS Diagnosis (1.2) (20 decks)

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