Exam 2 Flashcards
loss of vibratory perception…
pallenesthesia
Birbration is bet tested by using what kind of tuning fork?
128 or 256 HZ
the vibration test is an examination for what?
proprioceptionn
Where should the doctor hold the finger on the joint position test?
sides of the finger
what does a joint position exam test for?
proprioception
Where does the doctor perform the joint position test?
fingers and toes
if a patient gets a positive result with both the finger and toes during a joint position exam, what does that tell the doctor?
lesion above C5
What tract does the joint position test test?
cunatus and gracilus
What are the tests for deep pain?
pinching the Achilles’ tendon (Abadie’s sign)
pinching the testicles (Pitres sign)
Striking the ulnar nerve (Biernacki sign)
Pressure on the eyeball
What is a positive result for a deep pain test?
decreased pain sensation
indicative of dorsal column disease
tabesdorsalis as the classic example
What is a multimodal sensation?
multiple sensations interpreted by the brain (cortical sensations)
How would a doctor do a stereognosis test
placing a common object in the patients had and it is tested bilaterally
A Nervescope will swing to the hot or cold side?
hot
What occurs to blood vessels when the autonomic nervous system is cut?
this results in?
vasodilatation = increased heat
The loss of vibratory perception is known as…
pallenesthesia
If the nerve that is supplying the pancreas is subluxated what could the end result for the patient?
diabetes
what are the grades of reflex responses?
0 - areflexia 1 - sluggish or diminished 2 - normal 3 - slightly hyperactive 4 - hyperactive with transient clonus 4 - hyperactive with sustained clonus
What are the four muscle stretch reflexes and what is their segmental innervation; primary nerve root, and peripheral nerve?
biceps; C5-C6; p. C5; musculocutaneous
brachioradialis; C5-C6; prim C6; radial nerve
triceps; C6-T1; prim C7; radial nerve
finger flexors; C7-T1; prim C8; median/ulnar nerve
Where do you strike with the reflex hammer during a muscle reflex test?
tendon
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the supraspinatus?
C (4) 5 6; prim C5; Suprascapular N
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the deltoid?
C5-C6; p. C5; Axillary nerve
Superficial reflexes are a ___________ reflex
polysynaptic
Which reflexes have a grading scale?
a. superficial
b. deep
b
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the biceps?
C5-C6; prim. C5; musculocutaneous
The abdominal reflexes test what nerves?
T5-T12
What do you watch for when doing a abdominal reflex?
the movement of the umbilicus
The cremasteric reflex tests what nerve roots and nerve?
How is the procedure done?
L1-L2; Ilioinguinal Nerve and Genitofemoral Nerve
downward stroking on the inner thigh, cause ipsilateral testicle to rise
The gluteal reflex tests what nerve roots and name?
L4-S2; inferior gluteal nerve; stimulate skin over gluteal
The plantar reflex test what segmental innervation and peripheral nerve?
procedure?
What is an abnormal finding?
L4-S2; Tibial Nerve
stroke plantar surface of the toe to the metatarsals
No response (lower motor lesion)
Babinski response (upper motor lesion)
Hoffman’s sign is indicative of what?
lesion above C5 in Corticospinal tract
muscle twitching that can be seen by the eye is known as?
fasciculation
muscle twitching that cannot be seen by the naked eye is known as?
fibrillation
T/F When doing a muscle strength test the doctor only needs to test the side that is affected?
false, both side must be tested
how is power sometimes classified in a muscle strength test?
kinetic
the force exerted in resisting movement is known as?
static
What is the scale in a muscle strength test?
0/5 - complete paralysis
1/5 - a twitch of movement 0-10%
2/5 - moderate to severe paresis (active movement when gravity is eliminated) 11-25%
3/5 - moderate paresis 26-50%
4/5 - mild paresis (active against gravity and resistance) 51-75%
5/5 - normal 76-100%
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the brachioradialis?
C5-6; C5-6; Radial
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the wrist extensors?
C6-8; C6; Radial
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the triceps?
C6-T1; C7; Radial
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the wrist flexors?
C6-T1; C7; Median/Ulnar
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the finger extensors?
C6-C8; C7; Radial
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the finger flexors?
C7-T1; C8; Median/Ulnar
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the finger abductors?
C8-T1; T1; Ulnar
What is the segmental innervation, primary nerve root, and the peripheral nerve name for the finger adductors?
C8-T1;T1; Ulnar
What are the segmental innervation, peripheral nerve(s), procedure, and the normal response for a Gag Reflex Test?
CN IX and X
CN IX and X
Touch posterior or back of throat
Gag and elevation of soft palate
What are the segmental innervation, peripheral nerve(s), procedure, and the normal response for a Corneal Blink test?
CN V and VII
CN V and VII
Touch cornea with wisp of cotton
Blinking of both eyes
What are the segmental innervation, peripheral nerve(s), procedure, and the normal response for the epigastric reflex?
T5-T7
Intercostal
Stimulate the sternum to the umbilicus
contraction of the upper abdominal ms
What are the segmental innervation, peripheral nerve(s), procedure, and the normal response for an upper abdominal reflex?
T7-T9
Intercostal
Stimulate the upper abs. Down and out, out to in
Contraction of the upper abs. moving umbilicus up and out
What are the segmental innervation, peripheral nerve(s), procedure, and the normal response for a lower abdominal reflex?
T11-T12
Intercostal, Iliohypogastric, Ilioinguinial
Stimulate the skin of the lower abs. from out to in
Contraction of the lower abs. moving umbilicus down and out
muscle twitching that can be seen by the eye is known as?
fasciculation
muscle twitching that cannot be seen by the naked eye is known as?
fibrillation
T/F When doing a muscle strength test the doctor only needs to test the side that is affected?
false, both side must be tested
how is power sometimes classified in a muscle strength test?
kinetic
the force exerted in resisting movement is known as?
static
What is the scale in a muscle strength test?
0/5 - complete paralysis
1/5 - a twitch of movement 0-10%
2/5 - moderate to severe paresis (active movement when gravity is eliminated) 11-25%
3/5 - moderate paresis 26-50%
4/5 - mild paresis (active against gravity and resistance) 51-75%
5/5 - normal 76-100%
What is the segmental innervation, peripheral nerve, procedure to perform test and the normal response when testing the cremasteric muscle?
L1-L2
Ilioinguinal, genitorgemoral
Stroke inner thigh from above down direction
Ipsilateral elevation of the testicle
What is the segmental innervation, peripheral nerve, procedure to perform test and the normal response when testing the gluteal superficial reflex?
L4-S2
Inferior gluteal
Stroke skin over gluteus max.
Contraction of gluteal ms.
What is the segmental innervation, peripheral nerve, procedure to perform test and the normal response when testing the plantar superficial reflex?
L4-S2
Tibial
Stroke plantar surface of the foot from heel to metatarsals to the big toe
plantar flexion of toes and foot
What is the segmental innervation, peripheral nerve, procedure to perform test and the normal response when testing the anal superficial reflex?
S2-S5
Inferior Hemorrhoidal Nerve
Stroke skin of perianal area
Contraction of external sphincter
What is the segmental innervation, procedure to perform test and the positive response when testing the pathological reflex Hoffmann sign?
Lesion above C5 in corticospinal tract
sharpp forcible flick of dr’s thumb against the patients middle finger
Flexsion of fingers and adduction of the thumb. UMNL
The pharyngeal gag reflex tests what CN?
IX and X
The Corneal Blink reflex tests what CNs?
V and VII
The uvular superficial reflex tests what CNs?
IX and X
what is the segmental innervation and peripheral nerve involved when testing the superficial abdominal reflexes?
T5-T12
Intercostal Nerve
what is the segmental innervation and peripheral nerve involved when testing the superficial cremasteric reflex?
L1-L2
Ilioinguinal and genitofemoral nerve
what is the segmental innervation and peripheral nerve involved when testing the superficial gluteal reflex?
L4-S2
Inferior gluteal nerve
what is the segmental innervation and peripheral nerve involved when testing the superficial plantar reflex?
L4-S2
Tibial Nerve
what is the segmental innervation and peripheral nerve involved when testing the superficial anal reflex
S2-S5
Inf. Hemorrhoidal Nerve
What are the two types of hypertonia?
Spasticity and Rigidity
muscle condition characterized by an high resistance of a joint initially follow by a decrease in resistance as the joint is opened, kind of like a clasped knife
Spasticity
Involuntary muscular resistance felt when moving a resting joint and persists as the joint is moved through its entire range of motion, commonly called “gooseneck”
Where is the lesion normally located??
Rigidity
extrapyramidal pathways UMNL
Hypotonia is usually indicative of neurological damage at the level of the _________
What may be a cause of diffuse hypotonia?
reflex arch LMNL
Cerebellar disease
A patient with a positive Tromner sign would have a problem at what segmental innervation, how would the procedure be done, and what would be the response?
lesion above C5 in Corticospinal Tract
Tap the volar surface of the middle finger
Flexion of fingers and adduction of the thumb
A patient with a positive Rossolimo sign of the foot sign would have a problem at what segmental innervation, how would the procedure be done, and what would be the response?
Cotricospinal tract
Tap the ball of the foot or tap the tips of the toes
Plantar flexion of the toes UMNL
A patient with a positive Babinski sign would have a problem at what segmental innervation, how would the procedure be done, and what would be the positive response?
Corticospinal tract
Stroke the plantar foot from heel to metatarsals to big toe
Dorsiflexioin of the great toe and flaring of the others
A patient with a positive Chaddock sign would have a problem at what segmental innervation, how would the procedure be done, and what would be the positive response?
Corticospinal tract
Stroke lateral malleolus from heel to toe
dorsiflexon of great toe nd flaring of the other toes. UMNL
A patient with a positive Oppenheim sign would have a problem at what segmental innervation, how would the procedure be done, and what would be the positive response?
Corticospinal tract
Stroke anterior tibial surface from superior to inferior
dorsiflexion of great toe and flaring of the other toes UMNL
A patient with a positive Gordon sign would have a problem at what segmental innervation, how would the procedure be done, and what would be the positive response?
Corticospinal tract
Squeeze the calf
Dorsiflexion of great toe and flaring of the other toes
A patient with a positive Schaefer sign would have a problem at what segmental innervation, how would the procedure be done, and what would be the positive response?
Corticospinal tract
squeeze the achilles
Dorsiflexion of great toe and flaring of the other toes
what does the presence of dejerine sig indicate?
a space occupying mass at the C level
a Dejerine sign is present when one of the following exists
herniated or protruding intervertebral disc
spinal cord tumor
spinal compression fracture
What is the purpose of testing the valsalva’s maneuver??
test for the presence of a space occupying lesion
What does a sharp accentuation of pain at the lever of the lesion usually indicate?
space occupying lesion
what test is done when the patient is seated and then instructed to swallow?
swallowing test
what does the presence of pain or difficulty swallowing indicate, and what is the test?
swallowing test
What does a positive swallowing test indicate?
dysphagia
What test does the doctor stand behind a seated patient and occludes the external jugular veins at the level of the clavicles for 10-15 sec
naffziger’s test
a barr’elie’ou test is considered positive with the presence of what symptoms?
vertigo, dizziness, visual disturbances, nausea, syncope, and nystagmus
While doing a vertebrobasilar artery function test compression of the subclavian and carotid on the right side indicate vertebrobasilar insufficiency on what side?
right side
While doing a DeKleyn’s test the patient experience positive sign on the right side, this suggests varterobasilar insufficiency on what side?
right side
What does a decrease in pain indicate while doing a distraction test?
An increase in pain?
intervertebral foraminal encroachment or facet capsulitis
muscle spasms
how long does the doctor do the Distraction test??
30-60 sec
During a foraminal compressioin test what does localized pain indicate?
redicular pain?
foraminal encroachment
indicates pressure on the nerve root
What test is performed with downward compression and then the patient laterally bends the head?
jackson compression tetst
What does pain on the side of rotation suggest while doing a Jackson Compression Test?
Opposite side?
facet or nerve root involvement
muscular strain
What test do you instruct the patient to rotate his/her head to the side and then laterally bend and extend the head?
Maximum Cervical Compression Test
What does pain on the concave side indicate during a Maximum Cervical Compression Test?
Convex side
nerve root or facet involvement
Muscular straini
During a Maximum Cervical Compression Test what does pain on the side being tested indicate?
opposite side?
facet capsulitis
muscle stretch of strain
What test does the doctor deliver a vertical blow to the uppermost portion of the cranium?
Spurling’s Test
What test does the doctor passively flex the patients head?
Lhermitte’s test
An electric shock like sensation radiating down the neck and spine is a sign of what?
It is also a classic sign of what disease?
posterior column disease
Mul
What maneuver is used to actively move the cervical spine through range of motion, through passive range of motion, and through resisted range of motion?
O’Donoghue Maneuver
The O’Donoghue maneuver is consider positive when?
there is muscular strain in the cervcal spine
What does in pain during resisted range of motion or isometric contraction signify?
muscle strain
What does pain during passive range of motion while doing the O’Donoghue maneuver indicate?
ligamentous sprain
What is a Brudzinki sign?
What other condition is often present?
flexion of both knees when the doctor passively flexes the patients head in the supine position
Meningitis
What is a positive Kernig sign?
What other condition is usually present with a positive sign?
doctor attempts to completely extend the leg while the patient is supine. The sign is often accompanied by involuntary flexion of the opposite knee and hip
meningitis
A soto-hall test pulls on what ligament?
Ligamentum Nuchae
