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spinal surgery 1 > Hands Off Exam > Flashcards

Hands Off Exam Flashcards

1
Q

Neurological patient - why should a full CE be performed?

A

Rule out systemic dx which can cause neuro signs

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2
Q

Neuro exam - must differentiate between what 3 postures?

A

Schiff-Sherrington syndrome
decerebrate rigidity
decerebellate rigidity.

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3
Q

Define ataxia

A

Lack of co-ordination

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4
Q

Define paresis

A

weakness or inability to generate movement voluntarily.

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5
Q

The aim of the neurological examination is firstly to establish the nature of the condition (neurological vs non-neurological) and then to establish the .

A

Neuro anatomical location

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6
Q

What questions might you want to ask when taking a history for a patient with a suspected spinal problem? (9)

A
  • Previous health
  • Vacc
  • Worm
  • Toxin
  • Trauma
  • Wellbeing
  • Onset
  • Progression
  • Tx and response?
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7
Q

What are the 6 sections of a neuro clinical exam?

A

1 Mentation
2 Posture and Gait evaluation
3 Proprioceptive testing
4 Segmental spinal reflexes
5 Sensorium
6 Cranial nerve examination

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8
Q

Which aspects of the neuro exam are hands off?

A

Mentation

Posture and Gait evaluation

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9
Q

How can mentation be classified (5)

A

Normal
Obtunded
Disorientated
Stuporous
Comatose

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10
Q

It is important to differentiate three different postures, name them

A

1 Schiff-Sherrington syndrome
2 Decerebrate rigidity
3 Decerebellate rigidity

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11
Q

What does the patient look like with Schiff Sherrington syndrome and decerebrate rigidity and decerebellate rigidity?

A

recumbent with hyperextension of the thoracic limbs due to lack of inhibition of the thoracic limbs’ extensor tone.

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12
Q

With Schiff Serrington:
A) This is due to an interruption of the inhibitory pathway of what cells?
B) What spinal segment is this present in?
C) Where + what normally happens here?

A

A) Border cells
B) L1-L4
C) thoracolumbal intumescence where they normally inhibit the thoracic limb extensor tone

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13
Q

T or F
The Schiff-Sherrington posture is not a prognosis indicator for recovery.

A

True

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14
Q

What does Schiff Sherrington syndrome relate to?

A

An acute or peracute thoracolumbar spinal cord injury

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15
Q

What do decerebrate rigidity and decerebellate rigidity relate to?

A

Intracranial pathology

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16
Q

With Schiff-Sherrington syndrome, the patient is usually recumbent with hyperextension of the thoracic limbs due to lack of inhibition

A

Thoracic limb extensor tone

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17
Q

Decerebrate rigidity and decerebellate rigidity; what other sings do they often have?

A

opisthotonos
altered mentation

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18
Q

Define opisthotonos

A

Spasm of the muscles causing backward arching of the head, neck, and spine.

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19
Q

Decerebrate rigidity;
A) Mentation?
B) Pelvic limb position?

A

A) Stuporous or comatose
B) Hyperextension

20
Q

Does decerebrate rigidity or decerebellate rigidity have better prognosis?

A

decerebellate rigitity

21
Q

What are the 4 causes of ataxia?

A

afferent peripheral nerve
spinal cord lesion
, a vestibular disorder (vestibular ataxia)
cerebellar disorder (cerebellar ataxia)

22
Q

How does vestibular ataxia present?

A

loss of balance reflected in a head tilt, and a tendency to lean, drift, fall or roll to one side.

23
Q

General proprioceptive ataxia and upper motor neuron paresis are often associated in cases of a A) disorder that affects B) pathways.

A

A) a spinal cord disorder
B) Both

24
Q

Cerebellar ataxia reflects the inability to modulate what and where resulting in abnormal and uncontrolled limb movements.

A

gait generating systems in the brain stem

25
Q

What are excessive limb movements known as?

A

Hypermetria

26
Q

What are the 3 types of ataxia?

A

Sensory
Vestibular
Cerebellar

27
Q

What is sensory ataxia?
What is seen if brainstem/spine involved

A

Abnormal proprioception

paresis if brainstem or spinal.

28
Q

Vestibular ataxia:
A) What proprioception?

A

Normal or abnormal

29
Q

Cerebellar - proprioception?

A

Normal conscious proprioeption

30
Q

What is difference between paresis vs plegia?

A

Paresis implies some voluntary movement, whereas plegia refers to complete loss of voluntary movement.

31
Q

2 types of paresis?

A

upper motor neuron (UMN) and lower motor neuron (LMN)

32
Q

LMN Paresis:
A) Posture
B) Gait
C) Motor function?

A

A) Difficultly supporting weight
B) Short strides/tendency
C) Flaccid

33
Q

LMN paresis:
A) Segmental reflexes
B) Resting muscle tone
C) Muscle atrophy

A

A) Decreased - absent
B) Decreased - absent
C) Early and severe

34
Q

UMN paresis:
A) Segmental reflexes
B) Resting muscle tone
C) Muscle atrophy

A

A) Normal to increased
B) Normal to increased
C) Late and disuse

35
Q

UMN Paresis:
A) Posture
B) Gait/proprioception
C) Motor function?

A

A) Usually normal / abnormal limb position
B) Stiff and ataxic/delayed proprioception
C) Spastic

36
Q

Where are UMN tracts? (2)

A

Spinal cord
Brainstem

37
Q

Where do UMN tracts run?

A

Next to general proprioceptive tracts

38
Q

UMN - knuckling or scuffing seen?

A

Varies - but can be

39
Q

UMN paresis;
What is the gait like?

A

Long-strided gait with a delay in the swing phase and stiffness.

40
Q

LMN gait

A

short-strided gait with inability to support weight in many cases,

41
Q

Which nerves are commonly affected with LMN paresis causing inability to support weight?

A

Radial and femoral

42
Q

The LNMs that innervate the muscles of the limbs are located in the spinal intumescences;
Where for FL?

A

C6-T2

43
Q

The LNMs that innervate the muscles of the limbs are located in the spinal intumescences;
Where for HL?

A

L4-S1

44
Q

The cell bodies of the lower motor neurons lie within the ? of the spinal intumescences,

A

ventral horn

45
Q

Cell bodies of LMN connect what?

A

Effect organ (muscle with limbs) to SC

46
Q

What muscle atrophy do LMN cause?

A

Neurogenic

spinal surgery 1 (10 decks)

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