Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Patient Evaluation > DTRs > Flashcards

DTRs Flashcards

1
Q

Reflexes are an__________________ response ( predictable response is what we are looking for )

A

involuntary, stereotyped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Reflexes are a unit of ____________ and _____________ function.

A

sensory (afferent)

motor (efferent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Reflexes depend on ?

A

Intact sensory nerve fibers

Functional synapses in spinal cord

Intact motor nerve fibers

Functional neuromuscular junctions

Competent muscle fibers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DTRs helpful in ?

A

Can help to localize a lesion

Correlate with motor and sensory findings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

DTR: Ankle (Achilles) ?

A

S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

DTR: Knee (Patellar) ?

A

L 2, 3, 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

DTR: Supinator (Brachioradialis) ?

A

C 5, 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DTR: Biceps ?

A

C 5, 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

DTR: Triceps ?

A

C 6, 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cutaneous Reflexes: Abdominal – upper ?

A

T 8, 9, 10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cutaneous Reflexes: Abdominal – Lower ?

A

T 10, 11, 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cutaneous Reflexes: Plantar (Babinski) ?

A

L5, S1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cutaneous Reflexes: Anal ?

A

S 2, 3, 4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

DTR: To elicit a reflex ?

A

Patient must be relaxed!

Strike briskly with wrist movement

Patient can be supine or sitting for all

**the patient need to be completely relaxed

hit hard enough to get a response ( same strength on each side to elect a reflex)

pointed end for smaller areas and bigger end for bigger area **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DTR: Response is affected by your force ?

A

Use as little force as needed to elicit a response

Compare bilaterally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Rate DTR’s on ______ scale

A

0-4/4

**pulse 0-3
strength 0-5 ( 5/5 is NL)
reflex 0-4

some people just have really bad reflexes and it can be normal **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

DTR: 0/4 ?

A

absent, areflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

DTR: 1/4 ?

A

low normal, hyporeflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

DTR: 2/4 ?

A

average, NORMAL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

DTR: 3/4 ?

A

above average, +/- assoc. with disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

DTR: 4/4 ?

A

very brisk, hyperactive, with clonus

(rhythmic oscillations) hyperreflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

DTR: Use _________ for barely detectable response

A

reinforcement

**distracted to improve results **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

DTR: Isometric contraction of other muscles: UE ?

A

clench teeth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

DTR: Isometric contraction of other muscles: LE ?

A

lock fingers and pull hands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

DTR: Biceps and location ?

A

C5, C6

Partial elbow flexion, press on tendon, strike own finger, watch and feel for response

**thumb on tendon and then u hit yours thumb ( easier to find the tendon with you thumb) - looking for bicep to control = hand will move or the tendon will tighten up and it will push against your finger ( tighten is most common) **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

DTR: Triceps and location ?

A

C6, C7

OR – arm abducted, elbow flexed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

DTR: Brachioradialis and location ?

A

C5, C6

Use flat edge of hammer, 1-2” above wrist

Hand on lap, partially pronated – watch for forearm supination and flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

DTR: Patellar and location ?

A

L2, L3, L4

Flex knee, strike below patella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

DTR: Achilles and location ?

A

S1

Support foot in neutral position

**keep foot in little dorsiflexion

because reflex makes foot plantar flex and if it is already in flexion then it has not were to move **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

DTR: Clonus ?

A

hythmic oscillation response

Eg: Dorisflex and plantar flex foot a few times, then sharply dorsiflex foot, hold it there and feel for “beats”

**keep beating after the reflex should be over **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Clonus NL ?

A

A few beats of clonus can be normal if tense or after exercise

Sustained clonus can indicate CNS disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Cutaneous Stimulation Reflexes: Plantar (Babinski) and location ?

A

L5, S1

Use a key or wooden end of cotton applicator
Stroke foot, curving medially over ball of foot

Normal – plantar flexion
Abnormal - fanning of toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Plantar (Babinski) NL ?

A

plantar flexion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Plantar (Babinski) abnormal ?

A

fanning of toes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Cutaneous Stimulation Reflexes: Abdominal Reflexes ?

A

4 quadrants – upper and lower

Stroke toward umbilicus

Note umbilical deviation toward stimulus

Obesity can mask

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Cutaneous Stimulation Reflexes: Anal and location ?

A

S 2, 3, 4

Dull object (cotton swab)

Stroke outward from anus in 4 quadrants

Watch for reflex contraction of the anal musculature

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Recording DTR’s NL ?

A

All reflexes 2+/4 throughout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Recording DTR’s abnormal ?

A

All reflexes 2+/4 except_______

Or diagram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Special Maneuvers: Meningeal signs ?

A

if meningitis is suspected. Don’t do on trauma patients!

Neck mobility (nuchal rigidity) – supple flexion

Brudzinski’s sign

Kernig’s sign

  • *Inflammation in the subarachnoid space causes resistance to movement that stretches the spinal nerves (neck flexion), the femoral nerve(Brudzinski) or the sciatic nerve (Kernig).
  • *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Brudzinski’s sign positive ?

A

Positive = flexion of hips and knees in response to neck flexion

**flexion of neck stretches femoral nerve **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Kernig’s sign

Positive?

A

Positive = pain b/l behind knee when flexed knee is extended

**stretch on the sciatic nerve - sign of meningitis

pain behind the knee not just discomfort **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Asterixis: Helps identify metabolic _______________ when mental functions are impaired

A

encephalopathy

Liver disease, uremia, hypercapnia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Asterixis procedure ?

A

Ask patient to “stop traffic” – both arms extended, hands cocked up and fingers spread

Watch for 1-2 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Asterixis positive ?

A

Positive if sudden, brief nonrhythmic flexion of hands and fingers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Stuporous or Comatose Patient: facts ?

A

Typically evaluation sequence is H&P, Labs

These patients require a different sequence of evaluation

46
Q

Stuporous or Comatose Patient sequence of evaluation ?

A

ABC’s - first

Level of consciousness

Neuro exam

Info from relatives, friends, witnesses

47
Q

Stuporous or Comatose Patient sequence of evaluation: DO NOT DO THESE?

A

DO NOT

Dilate the pupils - can mask signs

Flex the neck - make C-spine trauma worse

48
Q

Comatose Patient: ABC’s ?

A

Skin color and breathing pattern

Check posterior pharynx, listen for stridor

Consider intubation

Pulse, BP and RECTAL temp ( more reflective or core temp.)

IV access/fluids

49
Q

Comatose Patient: level of consciousness ?

A

Alert

Lethargic – drowsy but arousable. Answers questions, then back to sleep

Obtunded – opens eyes, responds but slow and confused

Stuporous – require painful stimulus to arouse

Comatose - unarousable

50
Q

Comatose Patient : Posture and Tone- In response to painful stimulus NL ?

A

avoidant

51
Q

Comatose Patient : Posture and Tone- In response to painful stimulus - stereotypical ?

A

Decorticate - flexion abnormal

Decerebrate - extension abnormal

52
Q

Comatose Patient : Posture and Tone- In response to painful stimulus - flaccid ?

A

no response, no tone

Vertical forearm, wrist at 90

Raise arm 12” off bed and drop it

53
Q

Stereotypic response – painful stimulus evokes a postural response
: Decorticate rigidity ?

A

flexor response

54
Q

Stereotypic response – painful stimulus evokes a postural response: Decerebrate rigidity ?

A

extensor response

55
Q

Decerebrate rigidity lesion location ?

A

Lesion in diencephalon, midbrain or pons

56
Q

Decerebrate rigidity severe what can cause this ?

A

Or severe metabolic disorder – hypoxia, hypoglycemia

57
Q

Decorticate rigidity location of lesion ?

A

Lesion of corticospinal tracts in or near cerebral hemispheres

58
Q

Comatose Patient: 
Oculocephalic Reflex (Doll’s eyes) procedure ?

A

Hold eyelids open

Turn head side to side

59
Q

Oculocephalic Reflex (Doll’s eyes): If brainstem is intact ?

A

– eyes turn to keep looking at the same spot

** good - the eyes staying pointed forward **

60
Q

Oculocephalic Reflex (Doll’s eyes): If brainstem lesion ?

A

– eyes move with head

  • *if eyes go with head = bad!
  • *
61
Q

Oculovestibular reflex (caloric test)
 procedure ?

A

Head at 30°

Cold water into EAC

Eyes deviate toward water if brainstem is intact (initial nystagmus away)

62
Q

Comatose Patient: pupils inspection ?

A

size, equality, response to light

63
Q

Comatose Patient: pupils - structural cause of coma ?

A

no response

64
Q

Comatose Patient: pupils - Metabolic cause of coma ?

A

positive response

65
Q

Comatose Patient: ocular movements ?

A

eyes should be straight ahead at rest

66
Q

Comatose Patient – Signs of Poor Outcome or Death ?

A

Absent corneal reflex - wisp of cotton on cornea

Absent pupillary response

Absent withdrawal response from pain

No motor response

At 72 hours, no motor response

67
Q

Involuntary Movements types ?

A

Tremors

Orofacial dyskinesias

Tics

Chorea

Athetosis (athetoid movement)

68
Q

Tremors 3 types ?

A

Resting (Static)

Postural

Intention

69
Q

Tremor: Resting (Static) ?

A

↑ at rest, ↓ or gone with voluntary movement

ex: Parkinsonism

70
Q

Tremor: Postural ?

A

↑ with maintaining a posture

ex: anxiety, fatigue, hyperthyroidism

71
Q

Tremor: Intention ?

A

absent at rest, appears with activity, worse as closer to target

ex: MLS, cerebellar dz

72
Q

Orofacial dyskinesias ?

A

Repetitive bizarre movements of face, mouth, jaw, tongue

73
Q

Orofacial dyskinesias are seen with ?

A

longstanding psychoses

elderly

edentulous

long term complication of certain psychotropic drugs (tardive dyskinesia)

**sometimes it is drug induced **

74
Q

Tics ?

A

brief, repetitive, coordinated movements at irregular intervals

75
Q

Tics examples ?

A

Wink

Grimace

Shoulder shrug

76
Q

Tics seen with ?

A

Seen with Tourette’s, certain meds, etc.

77
Q

Chorea – (choreiform movement) description ?

A

Unpredictable, non-repetitive

brief, rapid, jerky, irregular

78
Q

Chorea can involve what ?

A

can involve face, head, forearms, hands

79
Q

Chorea can occur at ?

A

can occur at rest or interrupt activity

80
Q

Chorea examples disease ?

A

Huntington’s disease

81
Q

Athetosis (athetoid movement) description ?

A

Slow, twisting, writhing movement of face or distal extremity

twisting movement of hand

82
Q

Athetosis associated with ?

A

Often associated with spasticity

83
Q

Athetosis example disorder ?

A

cerebral palsy

84
Q

Abnormalities of Gait and Posture types ?

A

Spastic Hemiparesis

Steppage Gait

Scissors Gait

Parkinsonian Gait

Cerebellar Ataxia

Sensory Ataxia

85
Q

Spastic Hemiparesis lesion ?

A

Corticospinal tract lesion from stroke

86
Q

Spastic Hemiparesis description ?

A

Poor control of flexor muscles during swing phase

87
Q

Spastic Hemiparesis affected arm is ?

A

flexed and immobile

88
Q

Spastic Hemiparesis affected ankle is ?

A

plantar-flexed and inverted

Toe drags, may circle leg stiffly outward or lean
leg is not bending

**“swing around cause flexors are not really good “ **

89
Q

Steppage Gait seen in ?

A

Seen in foot drop, secondary to peripheral motor unit disease

90
Q

Steppage Gait

patients either ?

A

Patients either drag their feet or lift them high with knees flexed and bring foot down with a slap

Unilateral or bilateral

91
Q

Steppage Gait cannot ?

A

heel walk

**foot drop so toes dont pick up unless they pick there knee up

no heel walking and it can be B/I **

92
Q

Scissors Gait seen in ?

A

Spinal cord disease

ex: CP

93
Q

Scissors Gait description ?

A

Bilateral lower extremity spasticity

Legs are advanced slowly and thighs tend to cross

94
Q

Scissors Gait: gait is ?

A

stiff

95
Q

Parkinsonian Gait seen in ?

A

Basal ganglia defects of Parkinson’s

96
Q

Parkinsonian Gait

has _________ posture ?

A

stooped

97
Q

Parkinsonian Gait: ______ of head, arms, hips and knees

A

Flexion

98
Q

Parkinsonian Gait

extra facts ?

A

Slow to start

Shuffling gait with short steps

Decreased arm swing

Patients turn slowly “all in one piece”

**once they get going they move faster but they have hard time stopping and run into stuff

difficulty initiated gait

masked facies **

99
Q

Cerebellar Ataxia

disease of ?

A

cerebellum

100
Q

Cerebellar Ataxia description ?

A

Staggering, wide base, unsteady

101
Q

Cerebellar Ataxia have exaggerated difficulty with ?

A

turns

102
Q

Cerebellar Ataxia: Can’t stand steadily with ?

A

feet together

103
Q

Sensory Ataxia description ?

A

Loss of position sense in the legs

Wide base, unsteady

104
Q

Sensory Ataxia patients throw ?

A

Pts throw feet forward, bring them down on heels with a double tap.

They watch the ground for guidance

Can’t stand steadily with feet together (+Romberg)

105
Q

Sensory Ataxia versus Cerebellar Ataxia ?

A

two types of ataxia but the gait is similar

wide gait cause they dont have balance

106
Q

Screening Neuro Exam -AAN: Mental status ?

A

Level of alertness,

appropriateness of responses,

orientation to date and place

107
Q

Screening Neuro Exam -AAN: Cranial nerves ?

A

Visual acuity, pupillary light reflex, EOM’s

Hearing

Facial strength – smile, eye closure

108
Q

Screening Neuro Exam -AAN: motor system ?

A

Strength – shoulder, elbow, wrist, finger, hip, knee, ankle

Gait – casual and tandem

Coordination – fine finger movements, finger-to-nose

109
Q

Screening Neuro Exam -AAN: sensory system ?

A

One modality at toes (light touch, pain/temp or proprioception)

110
Q

Screening Neuro Exam -AAN: reflexes ?

A

DTR’s – biceps, patellar, Achilles

Plantar response (Babinski)

If anything is suspicious, then more complete exam is required

111
Q

Neurologic Exam: last slide ?

A

Use your equipment for visual cues

Sample write up p.739 Bates

Patient Evaluation (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions