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CLET > Hand Tingling Wk 7 > Flashcards

Hand Tingling Wk 7 Flashcards

1
Q

Biceps Reflex

A
  • Elbow Flexion
  • Musculocutaneous N
  • C5
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2
Q

Brachioradialis Reflex

A
  • Slight forearm flexion
  • Radial N
  • C6
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3
Q

Triceps Reflex

A
  • Elbow extension
  • Radial N
  • C7
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4
Q

Patellar Reflex

A
  • Knee extension
  • femoral N
  • L2,3,4
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5
Q

Achilles Reflex

A
  • Foot Plantar Flexion
  • Tibial N
  • S1,2 Spinal Cord
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6
Q

Westphal Sign

A

-absence of any DTR, especially patellar

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7
Q

Jendrassik maneuver aka

A

aka reinforcement test

-pt hooks hands or feet together and pulls on the clenched hands or feet at the moment the reflex is performed

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8
Q

Oxford/ Van Allens Scale

A 
1- evidence of contraction
2- motion gravity neutral, ev of contr
3- motion against gravity, 2,1
4- resistance, 3,2,1
5- joint lock, 4,3,2,1
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9
Q

Wexler Reflex Chart

A

0-no response
1- slightly diminished, hypoactive
2- normal
3- slightly increased, possible pathology
4- highly increased response, hyperactive
5- high respose, sustained clonus

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10
Q

decreased reflex indicates?

increased reflex indicates?

A
  • lower motor neuron lesion

- upper motor lesion

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11
Q

Direct Light Reflex

A
  • ipsilateral pupillary constiction
  • afferent: optic nerve
  • integrating center: midbrain
  • efferent: oculomotor
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12
Q

Indirect Light Reflex

A
  • contralateral pupillary constriction
  • afferent: optic
  • integrating: midbrain
  • efferent: oculomotor
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13
Q

Accommodation Reflex

A
  • bring object close to eyes then away
  • convergence of the eyes with pupillary constriction
  • afferent: optic N
  • integrating center: occipital cortex
  • efferent: oculomotor N
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14
Q

Carotid Sinus Reflex

A
  • reduction in the HR when dr presses carotid sinus
  • afferent: glossopharyngeal
  • integrating center: medulla
  • efferent: vagus
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15
Q

Occulocardiac Reflex

A
  • no lenses
  • reduction in HR when pressing the eye
  • afferent: trigeminal N
  • integrating center: medulla
  • efferent: vagus
  • 2-3 beats slower per 15 secs
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16
Q

Ciliospinal Reflex

A
  • pupillary dilation when pinching the base of neck at cervical sympathetic chain
  • afferent: cervical sympathetic chain
  • integrating center: T1-2 spinal cord
  • efferent: cervical sympathetic chain
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17
Q

Visceral Reflexes List

A
  • direct light
  • indirect light
  • accommodation
  • carotid sinus
  • occulocardiac
  • ciliospinal
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18
Q

Superficial Reflex List

A
  • Corneal
  • Gag/Pharyngeal
  • Uvular/Palateal
  • Interscapular
  • abdominal
  • plantar
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19
Q

Corneal Reflex

A
  • blinking and tearing of the eye upon touching the cornea with cotton wisp
  • afferent: trigeminal
  • integrating: pons
  • efferent: facial
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20
Q

Gag/Pharyngeal Reflex

A
  • gagging upon touching the back of the throat with a tongue depressor
  • afferent: glossopharyngeal N
  • integrating: medulla
  • efferent: vagus
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21
Q

Uvular/Palateal Reflex

A
  • raising of the uvula upon phonation or touching
  • afferent: glossopharyngeal
  • integrating: medulla
  • efferent: vagus
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22
Q

Interscapular Reflex

A
  • drawing inward of scapular when skin or interscapular space is irritated
  • afferent: T2-T7 spinal nerves
  • integrating: T2-T7 spinal nerves
  • efferent: dorsal scapular n
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23
Q

Abdominal Reflex

A
  • umbilicus deviation to the stroked side. absence is normal only if bilateral
  • afferent: upper T7-10, lower T11-12
  • integrating: spinal cord T7-12
  • efferent: Upper T7-10, lower T11-12
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24
Q

Plantar Reflex

A
  • plantar flexion (curling) of toes upon stroking side of foot
  • afferent: tibial N
  • integrating: spinal cord S1-2
  • efferent: tibial N
25
Q

Pathological Reflexes

A
  • glabella aka mccarthy
  • hoffman
  • tromner
  • ankle clonus
  • babinski
26
Q

Glabella aka?

A
  • mccarthy
  • contraction of orbicularis occuli muscle upon percussion of supraorbital ridge
  • upper motor neuron lesion
  • abnormal response is clonus
27
Q

Hoffman

A

clawing of the fingers and thumb (flexion and adduction of thumb with flexion of the fingers) upon flicking tip of index finger into extension

  • abnormal is clonus
  • upper motor neuron lesion
28
Q

Tromner

A

flexion of the fingers and thumb upon tapping palmar surface or tips of middle three fingers, positive is clonus
-upper motor neuron

29
Q

Ankle Clonus

A

continued involuntary contraction (sustained plantar flexion) of foot upon quick forcible dorsiflexion of the foot, clonus of gastroc
-upper motor neuron lesion

30
Q

Babinski

A
  • dorsiflexion of the big toe and fanning or splaying of other toes upon stimulation of the plantar surface of the foot
  • upper motor neuron lesion
31
Q

Oppenheim sign

A
  • application of pressure to anterior tibia stroking downward
  • alt to babinski
32
Q

Chaddock sign

A
  • stroking down the lateral leg around the lateral malleolus
  • alt to babinski
33
Q

Gordon Sign

A
  • squeezing the calf

- alt to babinski

34
Q

Schaefer sign

A
  • squeezing the achilles tendon

- alternative to babinski

35
Q

clinical signs of upper motor neuron lesion

A
  • spasticity of muscles with possible contractures
  • decreased muscle strength
  • presence of pathological reflexes
  • hyperactive DTRs
  • no fasciculations (twitches)
36
Q

Clinical signs of lower motor neuron

A
  • flaccidity of muscles
  • loss of muscle strength and tone
  • noticable muscle atrophy
  • absence of pathological reflexes
  • decreased DTR
  • altered superficial reflexes
  • fasciculations (twitches)
37
Q

Olfactory nerve exam

A
  • ask about taste and smell
  • inspect nostrils with light
  • eyes closed and 1 nostril occulded have them smell
  • do you smell anything?
  • can you identify it?
38
Q

Optic Nerve exam

A
  • inspect external eye
  • inspect optic fundi with ophthalmascope
  • test visual acuity
  • confrontation test
  • direct light reflex
  • indirect light reflex
  • accommodation reflex
39
Q

visual acuity

A
  • read printed text

- identify shapes and colors

40
Q

Confrontation test

A
  • finger wiggling
  • have pt cover one eye
  • bring object into view from 8 different directions per eye
41
Q

oculomotor, trochlear, abducens nerve exam

A 
oculomotor--
   -direct light reflex
   -indirect light reflex
   -accommodation reflex
   -check for ptosis (eyelid drooping)
Combined--
   -extraocular movements ( H in air)
            -trochlear-down and in
            -abducens- lateral
            -oculomotor all other fields 
        -abnormal is nystagmus
42
Q

Trigeminal N exam

A
  • clench teeth and palpate masseter and temporalis
  • pain discrimination (sharp vs dull) all 3 divisions
  • light touch of face all 3 divisions
  • corneal reflex
  • light touch to anterior 2/3 tongue (inside cheeks and hard palate with toothpick)
  • Oculocardiac reflex
43
Q

Facial Nerve

A
  • inspect face for asymmetry (at rest and during motion)
  • ask pt to
    • raise eyebrows
    • close eyes tight
    • show teeth
    • puff cheeks
    • smile
    • frown
  • ask about changes in taste for sweet salty and sour on anterior 2/3 tongue
44
Q

Vestibulo-Cochlear Nerve

A
  • finger rub test
  • whisper test
  • weber test
  • rinne test
  • fukuda step test
  • hallpike dix maneuver
  • barany whirling chair test
  • vestibulo-ocluar reflex
45
Q

Whisper test

A

-have them close eyes and cover one ear

46
Q

Weber Test

A

place handle of vibrating 512Hz fork on midline of skull and ask to compare intensity in both ears

  • sound lateralizes to bad ear- conductive deafness
  • sound lateralizes to good ear- sensorineural deafness
47
Q

Rinne Test

A

hand of 512Hz fork against the mastoid bone. have them say when no longer heard. then hold near ear until they no longer hear

  • normal: air conduction persists twice as long as bone conduction
  • air conduction is absent, equal,or less than bone is conduction deafness
  • air and bone conduction are decreased or absent is sensorineural deafness
48
Q

Fukuda Step test aka?

A
  • aka Mittlemeyer test
  • pt marches in place, eyes closed
  • a turning to one side indicates side of vestibular lesion
49
Q

Hallpike Dix maneuver

A
  • pt seated with head turned 45d. dr brings pt to supine with head extended off table. note any nystagmus, then repeat other side
  • nystagmus starting 2-5 secs after movement and stopping within 30 secs indicates benign positional vertigo
50
Q

Barany Whirling Chair test

A
  • seated pt is spun in chair

- fast component of nystagmus will be in the direction of the spin

51
Q

Vestibulo-ocular reflex

A

dr holds pt head and instructs pt to fix vision on the drs face. observe and note spontaneous nystagmus. then turns pts head into rotation, lateral flexion, and flexion, extension.

normal pt should maintain eye contact, eyes moving at the same speed in the opposite directino of head movement.

-inability to maintain fixation or spontaneous nystagmus indicates a vestibular lesion

52
Q

Glossopharyngeal and Vagus

A
  • ask about hoarseness in voice
  • uvula reflex
    • watch for symmetrical rise of soft palate
  • gag reflex
  • swallow while feeling thyroid cartilage
  • carotid sinus reflex
  • ask about change in bitter taste on posterior 1/3 of tongue
53
Q

Spinal Accessory Nerve

A
  • trapezius muscle
    - inspect, palpate, muscle test (shrug shoulders and add resistance)
  • SCM
    • inspect, palpate, muscle test (pt rotates head to one side and holds, then dr attemps to return head to neutral using knife edge of hand)
54
Q

Hypoglossal Nerve

A
  • inspect tongue
    • atrophy
    • fasiculations
    • deviation
  • have pt stick out tongue and test bilateral with tongue depressor or use tongue in cheek method
55
Q

Cerebellar Tests

A
  • diadochokinesia (2)
  • dysmetria (2)
  • Gait (2)
56
Q

Spinothalamic tests

A
  • crude touch

- pinprick

57
Q

Dorsal Column Tests

A
  • Pallestheisa
  • light touch
  • joint position sense
  • Romberg
58
Q

Somatosensory Cortex tests

A
  • topognosis (point localization)
  • sharp vs dull
  • stereognosis
  • graphesthesia
  • barognosis
  • two point discrimination
  • double simultaneous stimulation

CLET (9 decks)

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