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PDX 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the various forms of augmentation for enhancing DTR responses?

A

“counter-pressure” and Jendrassik maneuver (clasped hands pulling apart)

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2
Q

What kind of motor neuron lesions can be found by testing sensory, DTR and motor changes?

A

LMNLs

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3
Q

What kind of motor neuron lesions can be found by testing DTR and motor changes?

A

UMNLs

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4
Q

Five things to keep in mind when performing a neuro exam?

A
  1. “overlap” in distribution 2. pt’s history and natural hx of dz 3. overlap of sensory fibers of adjacent peripheral nn. 4. dermatomes aren’t clear-cut 5. “pure patches”
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5
Q

What is the dermatome map called?

A

Hoppenfeld-dominant dermatomes

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6
Q

What can cause “foot drop”?

A

nerve root lesions (L5) OR common peroneal nerve lesions

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7
Q

What are the findings for foot drop d/t L5 NR lesion?

A

dermatomal sensory changes and possible back pain/signs of disc herniation

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8
Q

What are the findings for foot drop d/t common peroneal nerve lesion?

A

non-dermatomal sensory changes, poss. Injury around head of fibula, Hx of degenerative knee changes

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9
Q

What NR controls triceps DTR and wrist flexion?

A

C7

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10
Q

What NR controls finger flexion?

A

C8

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11
Q

What NR controls interossei mm?

A

T1

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12
Q

What NR controls biceps DTR and lateral deltoid shoulder abduction?

A

C5

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13
Q

What NR controls brachioradialis DTR and wrist extension?

A

C6

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14
Q

What peripheral nerve controls sensation over deltoid tubercle and shoulder abduction?

A

Axillary n

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15
Q

What peripheral nerve controls sensation to lateral tip of index finger and flexion of thumb and first finger?

A

Median n.

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16
Q

What peripheral nerve controls opposition of thumb and little finger?

A

Median n.

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17
Q

What peripheral nerve controls sensation of dorsal thumb web and finger extension (and wrist extension)?

A

Radial n.

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18
Q

What peripheral nerve controls sensation of medial tip of little finger and interossei mm?

A

Ulnar n.

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19
Q

Are complaints of numbness and/or paresthesia objective or subjective?

A

Subjective

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20
Q

What tract is pain sensation associated with?

A

Lateral spinothalamic tract (LST)

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21
Q

What does the sharp-dull test assess?

A

pain perception (LST)

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22
Q

What is -algesa?

A

pain perception

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23
Q

What is -esthesia?

A

touch perception

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24
Q

What is dysesthesia?

A

distortion of any sense, especially touch. Unpleasant abnormal sensation produced by normal stimuli

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25
Q

What part of SC is vibration/pallesthesia classically associated with?

A

dorsal columns

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26
Q

What tuning fork is used to test vibration?

A

128 cps

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27
Q

When should you test vibration?

A

suspected peripheral neuropathy (diabetes, alcoholism) OR suspected cord compression (esp. cervical cord)

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28
Q

What is L’Hermitte’s sign associated with?

A

cervical flexion

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29
Q

What is the “barber chair” sign associated with?

A

cervical extension

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30
Q

How do L’Hermitte’s sign and “barber chair” sign present?

A

electrical shock sensation down the arms OR down the arms and legs (“tingling”)

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31
Q

What is palsy?

A

“an enfeebled condition”

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32
Q

What is paresis?

A

weakness of voluntary movement (partial paralysis)

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33
Q

What is paralysis?

A

loss of muscle function (total)

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34
Q

What are fasciculations?

A

“muscle twitches” arising from skeletal muscle fibers in a single motor unit

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35
Q

T/F: fasciculations in an otherwise strong muscle are usually benign.

A

TRUE

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36
Q

What do fasciculations in weak muscles indicate?

A

LMNLs of slow onset or dz of anterior horn cells (ALS)

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37
Q

When should you consider repetitive or sustained muscle testing?

A

if there is weakness or fatigue, abnormalities on sensory exam, or abnormalities of DTRs

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38
Q

What are the findings for classic myopathy?

A

Proximal bilateral weakness WITHOUT sensory loss. Weakness does NOT get better with rest

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39
Q

In classic myopathy, do you see atrophy or fasciculations?

A

No

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40
Q

What results in waddling/dystrophic gate?

A

late-stage myopathy pt

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41
Q

What is the first symptom of Duchenne’s muscular dystrophy?

A

Waddling gait (lumbar lordosis and protruding abdomen are common)

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42
Q

What leads to msl weakness that increases after periods of activity and improves after periods of rest?

A

myasthenia gravis

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43
Q

What is the first stage of myasthenia gravis?

A

ocular MG with fluctuating double vision and ptosis (dz remains solely ocular in only 16% of pts)

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44
Q

What is the most commonly affected msl of ocular MG?

A

superior rectus

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45
Q

What is the second stage of MG?

A

MG involving facial and bulbar msls

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46
Q

What is the older imprecise term that refers to medulla oblongata?

A

bulbar (the way Jim Carollo learned it)

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47
Q

What is the third stage of MG?

A

“generalized” MG involving muscle girdles. Might exhibit waddling gait

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48
Q

When grading DTRs, what is normal?

A

2+

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49
Q

When grading DTRs, what is clonus?

A

4+

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50
Q

What is the only reflex that is always abnormal?

A

clonus

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51
Q

What is clonus?

A

hit once => more than one response

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52
Q

What peripheral nerve is assoc. with C5?

A

musculocutaneous n

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53
Q

What peripheral nerve is assoc with C6?

A

radial n.

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54
Q

What peripheral nerve is assoc with C7?

A

radial n.

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55
Q

What peripheral nerve is assoc with L4?

A

femoral n.

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56
Q

What peripheral nerve is assoc with L5?

A

sciatic n.

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57
Q

What peripheral nerve is assoc with S1?

A

tibial n.

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58
Q

What NR is assoc with patellar tendon DTR?

A

L4

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59
Q

What NR is assoc with medial hamstring DTR?

A

L5-S1

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60
Q

What NR is assoc with achilles tendon DTR?

A

S1

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61
Q

What does a pure LMNL present with?

A

motor deficits only

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62
Q

What is presentation for LMNL with peripheral n lesion (or NR lesion)?

A

combined motor and sensory deficits

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63
Q

What are the 5 classic signs of LMNLs?

A
  1. hyporeflexia 2. flaccid paralysis 3. marked atrophy 4. fasciculations 5. possible nerve irritability
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64
Q

What does SLR test for?

A

nerve irritability

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65
Q

What is a common cause of hyporeflexia?

A

technique errors

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66
Q

Classic signs of UMNLs?

A
  1. hyperactive DTRs 2. clonus 3. spastic paresis/paralysis (clasp knife phenomenon) 4. presence of pathologic reflexes (Babinski, etc)
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67
Q

T/F: All abnormal reflexes are “pathologic”.

A

TRUE

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68
Q

How many types of peripheral neuropathies have been ID’ed?

A

More than 100

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69
Q

What are the 2 common sub-sets of peripheral neuropathy?

A
  1. symmetric/bilateral 2. asymmetric/unilateral
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70
Q

What are symmetric polyneuropathies most often due to?

A

diabetes and/or alcoholism

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71
Q

What are asymmetric polyneuropathies due to?

A

peripheral nerve entrapment/impingement/injury

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72
Q

Which type of polyneuropathy will we see more often in practice?

A

Asymmetric

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73
Q

T/F: Almost all peripheral neuropathies begin proximally.

A

False - begin distally

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74
Q

What is the first sign of peripheral neuropathy?

A

Paresethesia or pain

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75
Q

What is the second sign of peripheral neuropathy?

A

sensory deficits

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76
Q

What is the third sign of peripheral neuropathy?

A

possible focal ANS dysfunction

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77
Q

With a peripheral neuropathy, will you see sensory or motor changes first?

A

sensory

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78
Q

What is the most common cause of peripheral neuropathy in the US?

A

diabetes and alcoholism

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79
Q

What is the most common presentation of peripheral neuropathy?

A

distal symmetric/bilateral sensori-motor dysfunction

80
Q

What is the distribution pattern of metabolic neuropathy?

A

symmetric “stocking and glove”

81
Q

Two common asymmetric mononeuropathies?

A
  1. common peroneal nerve palsy 2. carpal tunnel syndrome
82
Q

What is “steppage gait” (foot drop) CLASSICALY assoc with?

A

L4-L5 NR LMNLs

83
Q

What is “steppage gait” (foot drop) COMMONLY assoc with?

A

compression of common peroneal n. at fibular head

84
Q

What is radiculopathy?

A

peripheral neuropathy d/t nerve root dz

85
Q

What are the 3 “classic” symptoms of radiculopathy?

A
  1. asymmetric pain 2. flaccid weakness 3. sensory deficits
86
Q

Do all radiculopathies manifest in pain?

A

No

87
Q

What is the quality of pain in a radiculopathy?

A

“sharp”, “stabbing”, “hot”, or “shooting”

88
Q

What denervation changes occur in the area served by the NR in a radiculopathy?

A

atrophy and fasciculations

89
Q

Which type of atrophy occurs quicker - denervation or disuse?

A

Denervation

90
Q

What happens to DTRs with a radiculopathy?

A

diminished or absent

91
Q

Do sensory abnormalities accompany radiculopathies?

A

Yes

92
Q

Do sensory or motor changes occur first in radiculopathies?

A

Sensory

93
Q

Which sensory modalities are affected in radiculopathy?

A

All 4

94
Q

Are most radiculopathies symmetric?

A

No - usually asymmetric

95
Q

What is the Heel Walk?

A

Pt walks 10 steps on heels

96
Q

What does the heel walk screen for?

A

L4-L5 NRs, peroneal fibers of sciatic n, and common & deep peroneal nn

97
Q

Two abnormal findings of the heel walk?

A

foot drop or steppage gait

98
Q

What is the Toe Walk?

A

Pt walks 10 steps on toes

99
Q

What does the toe walk screen?

A

L5-S2 NRs

100
Q

Abnormal finding of the toe walk?

A

heel drop

101
Q

What is a common cause of cervical NR impingement?

A

cervical spondylosis

102
Q

What findings would compression of the WHITE matter in the SC cause?

A

UMNL findings

103
Q

What findings would compression of the gray matter in the SC cause?

A

LMNL findings

104
Q

How do “incomplete” cord lesions present?

A

“mixed” LMNL/UMNL presentation

105
Q

How does “central cord syndrome” present?

A

LMNL findings in upper extremity and UMNL findings in lower extremity

106
Q

What is central cord syndrome usually assoc with?

A

combination of trauma/whiplash and cervical spondylosis

107
Q

What does SLOW onset of mixed upper and lower motor neuron lesions classicaly signify?

A

ALS (Lou Gehrig’s)

108
Q

What are slurring of words and/or choking during a meal the first clinical indications of?

A

UMNL of slow onset

109
Q

What are a common symptom of corticospinal tract lesions?

A

muscle cramps

110
Q

What are wide-spread fasciculations an early sign of?

A

LMNLs of slow onset

111
Q

What causes wide-spread fasciculations in LMNLs?

A

irregular firing at anterior horn cells

112
Q

What are the three categories of CN lesions?

A
  1. supranuclear 2. nuclear 3. infranuclear
113
Q

What are supranuclear lesions?

A

“central lesions” - involve CORTEX

114
Q

What are nuclear lesions?

A

“peripheral lesions” - involve CN nucleus

115
Q

What are infranuclear lesions?

A

“peripheral lesions” - involve nerve fibers

116
Q

What causes a large portion of olfactory defects?

A

obstruction of nasopharynx (polyps, mucus accumulation, etc)

117
Q

Why should you not use noxious substances when testing sense of smell?

A

Could stimulate CN V instead of CN I

118
Q

What do most olfactory problems originate from?

A

disorders of nasopharynx and/or paranasal sinuses

119
Q

What can swelling of the mucosa and submucosa lead to that can last for months or years?

A

olfactory deficits

120
Q

What is seen in 33% of rhinitis cases?

A

Hyposmia/anosmia

121
Q

What is -osmia?

A

olfaction

122
Q

What is dysosmia/parosmia?

A

can notice presence of odor but have trouble identifying it (distorted/altered)

123
Q

What is phantosmia?

A

reporting an odor when no odor is present

124
Q

What causes dysosmia?

A

damage to receptors and neuroepithelium (infranuclear)

125
Q

What causes phantosmia?

A

supranuclear lesion - damage to olfactory cortex

126
Q

T/F: CN V sensory innervation includes the angle of the jaw.

A

False

127
Q

What are the afferent and efferent nerves for the corneal reflex?

A

Afferent = CN V Efferent = CN VII

128
Q

What is the normal result of the corneal reflex?

A

both eyes blink

129
Q

What are the results of a neuro exam for pts with idiopathic trigeminal neuralgia?

A

Neuro exam is NORMAL

130
Q

What is the typical age of onset for idiopathic TN?

A

60-70 yrs (assoc w/ shingles in younger)

131
Q

How does TN present?

A

severe stabbing, paroxysmal, and unilateral facial pain that is triggered by chewing or similar activities or by touching the affected facial areas

132
Q

When assessing mm of facial expression (CN VII LMNL), which msl should you pay special attention to?

A

Frontalis m

133
Q

What could result from ipsilateral orbicularis oris dysfunction?

A

Possible dysarthria with lip sounds “B” “P” and “M”

134
Q

How does a LMNL of CN VII present?

A

Ipsilateral flaccid paresis/paralysis

135
Q

How does a UMNL of CN VII present?

A

Contralateral spastic paresis/paralysis

136
Q

During what action is an UMNL of CN VII most obvious?

A

lip retraction

137
Q

What does the term “Bell’s palsy” refer to?

A

idiopathic facial paralysis

138
Q

What does assessment of CN VIII consist of?

A

hearing exam (vestibular function not tested in routine exam)

139
Q

How do you separate the testable functions of CN IX and X?

A

You can’t - Usually tested together

140
Q

What is the best screening exam for CN IX, X, and XII?

A

listen to the pt’s speech. If they speak clearly, everything else will be redundant

141
Q

Signs of abnormal oropharynx?

A

Decreased or absent pharyngeal sensation, decreased gag reflex, decreased upward movement of post. Aspect of soft palate when “aaahhhh”

142
Q

What does a “peripheral” nuclear/infranuclear lesion of CN IX/X imply?

A

ipsilateral lesion involving medulla or CNs

143
Q

What does a “central” supranuclear lesion of CN IX/X imply?

A

bilateral lesion involving cerebral hemispheres

144
Q

What conditions can LMNL of CN XI lead to?

A

“shoulder droop”, “winged scapula” (unilateral weakness and atrophy)

145
Q

What sounds are difficult with CN XII lesions?

A

“L”, “D”, “T”, and “N”

146
Q

What msls are used to pull the tongue toward your chin (stick out your tongue)?

A

Inferior fibers of genioglossus m

147
Q

What do LMNLs of CN XII affect?

A

ipsilateral tongue

148
Q

In a pt with a left CN XII LMNL, the tongue deviates toward which side?

A

To the left

149
Q

What is Romberg’s test?

A

Pt stands erect with feet together and arms at their sides. 20-30 sec with eyes open and 20-30 sec with eyes closed

150
Q

What are the signs of an abnormal (positive) Romberg’s test?

A

Takes a step, pt falls, or truncal ataxia, takes a step, and body wobbles

151
Q

What is ataxia?

A

“a lack of order”

152
Q

What are the findings for bilateral peripheral neuropathy with the Romberg’s test?

A

50% take a step or fall within 10 seconds after closing their eyes

153
Q

What are the findings for cerebellar dz with romberg’s test?

A

50% take a step or fall within 60 seconds

154
Q

What are the findings for vestibular dz with Romberg’s test?

A

Not as clear-cut, pts sway more after closing their eyes

155
Q

How does the sensory exam and speech present with cerebellar ataxia?

A

sensory = normal speech = slurred

156
Q

What does the finger-to-target/finger-to-nose test for?

A

upper extremity cerebellar limb ataxia

157
Q

What does heel-to-shin test for?

A

lower extremity cerebellar limb ataxia

158
Q

What are 4 other forms of neurologic gait abnormalities?

A
  1. cerebral palsy 2. spastic hemiplegia/”circumduction” gait 3. “scissors gait”/spastic diplegia 4. parkinsonism
159
Q

What presents with a resting tremor in ONE upper extremity that is usually maintained, but can progress?

A

Parkinsonism

160
Q

What type of stimulus should you use to test a superficial reflex?

A

Noxious stimulus

161
Q

What does “pathologic reflex” indicate?

A

abnormal response to superficial reflex, indicative of UMNL

162
Q

What is an abnormal Babinski response?

A

extensor response/big toe up

163
Q

What is the finger flexor reflex classically assoc with?

A

hyperreflexia (UMNL)

164
Q

Why do signs of brainstem stroke sometimes overlap?

A

shared blood supply

165
Q

What is Wallenberg syndrome aka and how does it present?

A

aka lateral medullary artery infarct/PICA. Gait ataxia/staggering in 88% of pts

166
Q

Does PICA present contralaterally or ipsilaterally?

A

Contralateral body (loss of pain/temp) and ipsilateral face (numbness/paresthesias)

167
Q

What is the diameter of the fovea centralis and what does it contain?

A

1.5 mm cones only

168
Q

What happens with progressive decrease in acuity outside the fovea?

A

peripheral vision is not as sharp as central vision

169
Q

What are the three requirements for development of binocular vision?

A
  1. conjugate eye movements 2. yoked vergence movements 3. lens accommodation for near vision
170
Q

What is hyperopia?

A

far-sighted

171
Q

What do the ciliary msls do to accommodate for far vision?

A

ciliary msls relax

172
Q

What do the ciliary msls do to accommodate for near vision?

A

ciliary msls contract

173
Q

What is the concurrent requirement for the development of binocular vision?

A

cortical mapping (“wire together fire together”)

174
Q

Where do the optic n fibers terminate?

A

lateral geniculate nuclei (processing center for visual info)

175
Q

how is the balancing of ocular dominance columns accomplished?

A

learned, activity-driven sorting process

176
Q

Where should the corneal light reflections land?

A

same clock position in each eye

177
Q

What is the accommodative “triad”?

A
  1. convergence 2. pupillary constriction 3. lens accommodation for near vision
178
Q

What happens in a “convergence break”?

A

One eye deviates back to original starting position as pencil approaches nose

179
Q

What is an abnormal result for the convergence insufficiency self-test?

A

double image of the line is seen as the paper nears the eye (implies ciliary msl fatigue)

180
Q

What is strabismus?

A

an eye is obviously deviated when both eyes are open (“a squint”) (old term)

181
Q

What is tropia?

A

an eye is obviously deviated when both eyes are open (“a turning”)

182
Q

What is phoria?

A

an eye that deviates only when it is covered and its visual stimulus is taken away (“a bearing”)

183
Q

What test do you use for evidence of a phoria?

A

cover-uncover test

184
Q

What do the cardinal fields of gaze evaluate?

A

fixation and pursuit movements

185
Q

What does an “undershoot” or “overshoot” during cardinal fields of gaze indicate?

A

possible cerebellar dz or acute alcohol intoxication

186
Q

What do “jittery eye movements” during a cardinal field of gaze indicate?

A

early indication of MS

187
Q

What can an eyestrain headache be due to?

A

convergence insufficiency

188
Q

What is the most common cause of eye strain headache?

A

extended use of a computer or digital electronic device

189
Q

What are the complaints of eye strain?

A

blurred vision, double vision, difficulty focusing, and moving print

190
Q

What are the serious/long-term consequences of eye strain?

A

There are none

191
Q

What is amblyopia?

A

lazy eye

192
Q

Is amblyopia usually unilateral or bilateral?

A

unilateral

193
Q

What is the leading cause of monocular vision loss in those age 20-70?

A

amblyopia

194
Q

What is anisometropia?

A

unequal refractive power, one eye is more far-sighted or near-sighted than the other

195
Q

What are constant tropias aka?

A

concomitant strabismus

PDX 2 (2 decks)

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