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Neurology > Examination of Motor Function & Deep Tendon Reflexes > Flashcards

Examination of Motor Function & Deep Tendon Reflexes Flashcards

1
Q

What are checked during inspection of the motor funciton & DTRs?

A
  1. Observe general acitivity, posture, stands, sits, walks, gestures
  2. Observe body build, contours & proportions
  3. Inspect muscle size contous & involuntary movements (rostrocaudal sequece)
  4. Posture & gait
  5. neurocutanoeous lesions
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2
Q

What neurocutaneous lesions are inspected in px?

A

Cafe au lait spots = neurocutaneous stigmata

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3
Q

During range of motion, what is assessed in the px’s joint?

A

Spasticiity
Rigidity
Hypotonia
Range of movements

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4
Q

What are the 4 strength principles?

A

Matching principle
Length-strength principle
Antigravity muscle principle
Engagement principle

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5
Q

what strength test principle uses selective movements to match arm & hand strength to gauge the strength accurately?

A

Matching principle

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6
Q

What strength testing principle uses muscles when acting from their shortes postiion & have no strength when acting from their longest position?

A

length-strength principle

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7
Q

What strength principle has muscles working in opposing agonist-antagonist pairs?

A

Antigravity muscle principle

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8
Q

What strength test principle has most the examiner engaging the px’s competitive spirit to get maximum effort?

A

Engagement principle
“I’m trying to test how strong you are, don’t let me win”

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9
Q

what muscle of the neck is not included in assessment of the neck?

A

Trapezius muscle = already assessed in CN

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10
Q

what are the actions assessed in tesitng shoulder girdle strength?

A

Arm elevation
Arm adduction downward
Arm adduction across the chest (Pectoralis m)
Scapular adduction
Scapular winging

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11
Q

after testing the free movements of the shoulder girdle, what should then be assessed?

A

strength of these movements

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12
Q

what is done to test for weakness of the upper arm?

A
  • elbow flexion
  • elbow extension
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13
Q

What are done to the forearm to assess its presence or absence of weakness?

A

Wrist flexion
Wrist extension

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14
Q

what are tests done to assess presence/absence of weakness?

A

Finger extension
Finger flexion

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15
Q

What are also assesed in the finger muscles?

A
  • thenar & hypothenar eminences for size & asymmetry
  • atrohy of interosseous muscles
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16
Q

when assessing the abdominal muscles, what part of the body should be carefully observed?

A

contraction of the abdominal muscles in the umbilicus

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17
Q

What tests are done in assessing back muscles?

A

Prone position then palpate Paraspinal muscles

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18
Q

What tests are done in assessing the hip girdle?

A

Hip flexion & extension, Thigh abduction & adduction

Sitting position -> lift thigh then try to push the knee down with butt of palm

Hold legs abducted and counter it by placing ur hands at the L sides of the knees –> px squeezes legs as u place ur hands in the middle of the knees to pull the knees apart

Prone position –> lift thigh off the table & try to push it down at the popliteal space

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19
Q

What are tested in the lower extremities (thigh, ankle, & toes)?

A

Thigh muscles = Knee extensor muscles, Hamstrings/Flexor muscles

Ankle & Toes = Dorsiflex, evert and invert the feet

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20
Q

In grading muscle strength, what should also be done aside from scoring?

A

report pattern of weakness => where is it localized?

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21
Q

What is the grading of muscles?

A

5 = normal strength
4 = full range against resistance to greater gravity
3 = mores part full range against gravity but NOT against ANY RESISTANCE
2 = moves PART ONLY WHEN POSITIONED TO ELIMINATE GRAVITY
1 = Only. A FLICKER OF CONTRACTION of muscle but cannot move joint
0 = complete paralysis

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22
Q

what are the 3 things assessed during percussion of muscles?

A

check for irritability, Myoedema, Myotonia

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23
Q

what indicates percussion irritability

A

appearance of FAINT DIMPLE at the percussion site (using a hammer @ the biceps belly)

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24
Q

what is elicited in percussion myoedema?

A

non-propagating mound appears at the percussion site

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25
Q

In what conditions can you see Myoedema upon percussion?

A

Debilitation
Malnutrition
Dysmetabolic state (ie hyperthryoidism & Uremia)

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26
Q

What is assessed in percussion myotonia?

A

if there is a BRIEF RXN & RELAXATION that is NOT VISIBLE –> sign of neuromuscular disorder

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27
Q

How do you elicit perussion Myotonia?

A

tight fist => hold for 10secs => flip fingers open as quickly as possible => (+ MYotonia): cannot open fingers rapidly & wrist involuntary flexes

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28
Q

What are the diff DTRs?

A

Jaw jerk
Triceps reflex
Brachioradiaiis reflex
Finger flexion reflex
Knee reflex
Ankle reflex

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29
Q

what nerve roots mediate biceps reflex?

A

C5-C6

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30
Q

What nerve roots emdiate triceps reflex?

A

C7-C8

31
Q

What nerve roots mediate brachioradialis reflex?

A

C5-C6

32
Q

What are the 2 methods used to elicit finger flexion reflex?

A

Tromner method
Hoffman method

33
Q

What nerve roots mediate finger flexion reflex?

A

C7-T1

34
Q

what nerve roots mediate knee reflex?

A

L2-L4

35
Q

What nerve roots mediate ankle reflex?

A

L5-S2

36
Q

What is the NINDS scale for DTR grading?

A

0 = areflexia
1 = hyporeflexia
2 = NORMAL
3 = Hyperreflexia
4 = Clonus present

37
Q

What is mayo clinics reflex scale?

A

-2 = low response
-1 = moderately low
0 = normal
+1 = brisk
+2 = very brisk

38
Q

what are the causes of hyperreflexia?

A

interruption of UMN pathway (betw the cerebrum & LMN)

39
Q

when do we see sustained and abortive clonus?

A

Sustained clonus = newborns & infants
Abortive clonus = adults
Sustained clonus in adults = ABNORMAL

40
Q

how do you know is it is sustained clonus?

A

foot oscillates betw flexion and extension for as long as you maintain pressure

41
Q

What are signs of Hypertonia & Hypotonia?

A

Hypertonia = Spasticity, rigidity, paratonia/Gegenhalten

Hypotonia = flaccidity

42
Q

what causes rigidity?

A

extrapyramidal lesion in the basal motor circuit

43
Q

What is a phenomenon that occurs with the rigidity of Parkinsons disease?

A

Cogwheel phenomenon

44
Q

What is the resistance that equals in degree & range every attempt of exminaer to move a part in any directoin?

A

Paratonia/Gegenhalten

45
Q

what are the clinical differences of spasticity & rigidity?

A

Spasticity
- Clasp-knife phenomenon
- Quick jerk of the resting extermity
- extensor toe sign
- predominate in one set of muscles
- EMG inactive

Rigidity
- lead pipe phenomenon w/ cogwheel and tremor at rest
- slow movement of the px’s resting extremity

46
Q

what are clinical signs of hypotonia?

A

DEC resistance
INC range of joint movements

47
Q

what are the nerve roots of upper & lower quadrants of abdominal skin & muscle reflex?

A

Upper = T8-T9
Lower = T11-T12

48
Q

What sign is checked for px suspecting of having thoracic spinal cord lesions?

A

Beevor sign

49
Q

what nerve roots are affected in cremasteric reflex?

A

Afferent L1
Efferent L2

50
Q

what is the normal response of cremasteric reflex?

A

Elevation of ipsilateral testicle

51
Q

what is the normal response of Anal pucker reflex and nerve roots responsible for it?

A

Response: Pricking or scratching the perianal skin
S4-S5

52
Q

why is anal pucker & Bulbocavernosus-anal reflex done?

A

to see if there is incontinence/impotence in sacral or cauda equinal lesions, lumbosacral plexus

53
Q

What is the normal response & nerve root of Bulbocavernosus/Clitoral-Anal reflex?

A

Response: pricking the glans penis
S3-S4

54
Q

what are the nerve roots assoc with Babinski reflex?

A

Afferent: S1
Efferent: L5-S1

55
Q

what are the diff methods for eliciting the extensor toe sign?

A

Babinski
Chaddock
Schaeffer
Oppenheim
Gordon
Bing
Gonda, Stansky

56
Q

for whom should we do the nerve root stretching test?

A

px with low back or leg pain

57
Q

what are the 2 signs observed in nerve root stretching test?

A

Lasegue Sign: Straight-knee-leg raising test
Kernig sign: Bent-knee leg raising test

58
Q

In px suspecting of meningeal irritation, we also test for what?

A

Local rigidity and concomitant leg flexion

59
Q

What are the diff involuntary movements?

A

Physiologic synkinesia
Myoclonic jerks
Physiologic tremor
Emotional tremor

60
Q

what is the bell phenomenon?

A

automatic rolling up of eyeballs when you close your eyes

61
Q

what are the 2 classifications of tremors?

A

rest tremor
action tremor

62
Q

what are the 2 types of action tremor?

A

postural tremor - voluntary maintained posture
kinetic tremor - voluntary movement, visually/non-visually guided

63
Q

what are the 4 types of kinetic tremor?

A

simple kinetic tremor = voluntary movements not target directed just to and for wrist movements

intentional tremor = target-directed movements that increases in amp as that part approaches the target

task specific kinetic tremor = exacerbated by specific task

isometric tremor = muscular contraction against a stationary object

64
Q

what are the diff non-tremor hyperkinesia movement disorders?

A

Chorea
Athetosis
Dystonia
Hemiballismus
Tics
Multiple tic syndrome of Gilles de la Tourette

65
Q

what type of movement disorder is the fasts wherein with each movement, it is measure to be less than a sec?

A

chorea

66
Q

what type of movement disorder has slow, writhing movements most severe in the appendicular muscles?

A

Athetosis

67
Q

What type of movement disorder has long, sustained twisting movements most sever ein axial muscles?

A

Dystonia

68
Q

What type of movement disorder is due to hemorrhagic lesion of the CL subthalmic nucleus in HTN px?

A

Hemiballismus

69
Q

What are the 3 major features of Multiple tic syndrome?

A

change from time to time
involuntary respiratory actions & vocalization
personality traits differ

70
Q

What are general/simple tests for motor dysfunction?

A

Writing
Finger-tapping speed
Tasks for daily living
Archimedes spiral

71
Q

Px with what motor dysfunction can have a hard time writing?

A

Ataxia dysgraphia-cerebellar disease
Micrographia or rigidity pD
Tremulous dysgraphia-essential tremor

72
Q

In finger-tapping speed, what is the normal speed?

A

50 taps/10 secs

Children & elderly
- taps at slower rates

73
Q

In Archimedes spiral , what are the indications of diff spirals drawn by px?

A

Spiral narrows, lines regular = RIGIDITY
Lines irregularly weave in and out = ATAXIA
Continuous wavering of lines = ESSENTIAL TREMOR

Neurology (8 decks)

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