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Physical Dx > L12: Neuro & Sports Physical > Flashcards

L12: Neuro & Sports Physical Flashcards

1
Q

Gait: Inspection

What are you looking for?

What is an abnormal gait?

What does an abnormal gait indicate (generally?)

A
  • Observe posture and gait
    • Patient walks toward and away from you
    • Toe walk, heel walkTandem gait
  • Abnormal = gait that lacks coordination and stability
    • CNS or PNS abnormality
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2
Q

Steppage Gait

What is it?

Description of gait?

If unilateral?

If bilateral?

A
  • Steppage Gait AKA Neuropathic gait
  • Foot drop:
    • Patient drags foot/feet or lifts them high, then foot slaps floor
  • Unilateral → peroneal nerve injury, spinal nerve compression
  • Bilateral → amyotrophic lateral sclerosis (ALS), Charcot-Marie-Tooth disease and other peripheral neuropathies
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3
Q

Spastic Hemiparesis

What is it?

Description of gait?

Cause?

Example?

A

Spastic Hemiparesis

  • Drag toe, circle leg stiffly outward and forward (circumduction), or lean trunk to contralateral side to clear affected leg during walking.
  • Affected arm is flexed, immobile, and heldclose to the side, with elbow, wrists, and interphalangeal joints flexed.
  • Affected leg extensors are spastic; ankles are plantar-flexed and inverted.
  • Seen in corticospinal tract lesions
    • Stroke
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4
Q

Scissors Gait

What is it?

Description of gait?

Cause?

Example?

A

Scissors Gait

  • Patients advance each leg slowly and thighs tend to cross
  • Stiff gait and short steps
  • Seen in spasticity disorders
    • Cerebral palsy
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5
Q

Sensory Ataxia

What is it?

Description of gait?

Cause?

Example?

A

Sensory Gait

  • Unsteady gait and wide based stance
  • Throw feet forward and outward, first bring down heel then toes with double tap
  • Watch ground
  • Due to loss of proprioception
    • Peripheral neuropathy
    • Posterior column damage
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6
Q

Parkinsonian Gait

What is it?

Description of gait?

Cause?

Example?

A

Parkinsonian Gait

  • Stooped posture with head, arm, hip and knee flexion
  • Shuffling, short steps; slow to start
  • Decreased arm swing and stiff turns
  • Due to basal ganglia abnormalities
    • Parkinson disease
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7
Q

Trendelenburg Gait

What is it?

Description of gait?

Unilateral?

Bilateral?

A

Trendelenburg Gait AKA Myopathic gait

  • Pelvic drop leading to waddling gait
  • Due to hip abductor weakness
  • Unilateral → spinal nerve compression, superior gluteal nerve injury
  • Bilateral → muscular dystrophy
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8
Q

Coordionation

What does it require?

Ataxia: define

Dysmetria: define

A
  • Requires integration of the nervous system:
    • Motor
    • Cerebellar
    • Vestibular
    • Sensory
  • Neurologic Terms:
    • Ataxia: Impaired coordination of muscle (out of proportion to weakness)
    • Dysmetria: Improper measure of distance
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9
Q

Romberg Test

What does it test?

How to test?

Abnormal test? Indication?

A
  • Position sense
  • Ask patient to stand with feet together, watch for swaying, then ask patient to close eyes
  • Abnormal –> unable to maintain upright posture
    • Posterior column disease
    • Cerebellar abnormality
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10
Q

Pronator Drift

What does it test?

How to test?

Abnormal test? Indication?

A
  • Ask patient to elevate arms to shoulder level w/ palms up. Should hold position w/ eyes closed ~20 sec.
    • Variation – Firmly tap one arm; Patient should bring arm back up
  • Abnormal –> unable to keep arm at shoulder height and/or arm pronates/drifts downward
    • UMN lesion (stroke)
    • Oscillating – cerebellar
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11
Q

Heel to Shin Test

What does it test?

How to test?

Abnormal test? Indication?

A
  • Place heel at opposite knee, slide down leg then back up
  • Should be able to keep contact with opposite leg
  • Abnormal
    • Cerebellar disease: Heel overshoot’s the knee, foot oscillates side to side
    • Post. column damage: Heel lifts too high
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12
Q

Finger-to-Nose Test

What does it test?

How to test?

Abnormal test? Indication?

A
  • Hold your finger out in front of patient, then ask them to touch their nose then touch your finger with theirarmfullyextended. Moveyourfingerin different planes.
  • Patient should be steady and accurate
  • Abnormal = dysmetria (past pointing)
    • Cerebellar disease
    • Intention tremor – multiple sclerosis
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13
Q

Rapid Alternating Movements

What does it test?

How to test?

Abnormal test? Indication?

A
  • Patient places hands on thighs with palms down then palms up, perform as quickly as possible
  • Rapid finger tap – tap the distal joint of thumb with index finger
  • Abnormal = dysdiadokinesia (slow, clumsy, irregular movement)
    • Cerebellar disease
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14
Q

Aphasia

Define

Cause

A

Aphasia: inability to express or understand language

Often secondary lesion in dominant/left hemisphere

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15
Q

Dysarthria

Define

Cause

A
  • Dysarthria: abnormal pronunciation of speech
    • Many poss. causes.
    • Lesion involving muscles of articulation (CN V, VII, IX, X, XII) vs. central process
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16
Q

Neglect

Define

Cause

A
  • Neglect: abnormality in attention to one side
    • Most often secondary lesion in the nondominant/right hemisphere (seen on the left)
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17
Q

Mental Status

How to assess for:

Appropriate behavior

Orientation

Ability to concentrate & focus attention

A
  • Appropriate behavior:
    • Observation of speech, dress, hygiene, personal interaction, etc.
  • Orientation: A and O x 3 (or x 4)
    • Level of alertness/consciousness
    • Degree of orientation
      1. Person
      2. Place
      3. Time
      4. Situation
  • Ability to concentrate and focus attention:
    • Serial 7s, spell WORLD backwards, etc.
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18
Q

Mental Status: Memory

Define:

Immediate recall

Recent memory

Remote memory

A

Immediate recall: give patient 3 words to repeat

Recent memory: repeat the 3 words after 5 minutes

Remote memory: well known events/people, dates, or locations

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19
Q

Cranial Nerves

CN I

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN I: Olfactory (S)
  • Function:
    • Sense of smell
  • Test:
    • Could have patient smell familiar scent
  • Abnormal:
    • Anosmia
    • Head trauma, Parkinson disease
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20
Q

Cranial Nerves

CN II

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN II: Optic (S)
  • Function:
    • Vision
  • Test:
    • Visual fields
    • Acuity
    • Funduscopic
    • Pupillary light reflex
  • Abnormal:
    • Visual field defect 2° retinal emboli, optic neuritis, pituitary tumor, stroke
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21
Q

Cranial Nerves

CN III

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN III: Oculomotor (M)
  • Function:
    • Eye movement
    • Raises upper eyelid
  • Test:
    • EOMs
    • Pupillary light reflex
  • Abnormal:
    • Vertical and horizontal diplopia
    • Ptosis
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22
Q

Cranial Nerves

CN IV

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN IV: Trochlear (M)
  • Function:
    • Downward, internal rotation of the eye
  • Test:
    • EOMs
  • Abnormal:
    • Vertical diplopia
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23
Q

Cranial Nerves

CN V

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN V: Trigeminal (B)
  • Function:
    • Motor – temporal, masseter and lateral pterygoids
    • Sensory – 3 divisions
  • Test:
    • Clench jaw and lateral jaw movement
    • Check facial sensation
  • Abnormal:
    • Trigeminal neuralgia
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24
Q

Cranial Nerves

CN VI

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN VI: Abducens (M)
  • Function: Motor
    • Lateral deviation of the eye
  • Test:
    • EOMs
  • Abnormal:
    • Horizontal diplopia, esotropia
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25
Q

Cranial Nerves

CN VII

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN VII: Facial (B)
  • Function:
    • Motor – facial movements
    • Sensory – taste, ant. tongue
  • Test:
    • Raise eyebrows, smile, frown, puff out cheeks
  • Abnormal:
    • Central – Cerebral infarct (that spares the forehead)
    • Peripheral –Bell’s palsy (ipsilateral weakness of entire face)
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26
Q

Cranial Nerves

CN VIII

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN VIII: Acoustic (S)
  • Function:
    • Hearing and balance
  • Test:
    • Gross hearing, gait
  • Abnormal:
    • Unilateral hearing loss, disequilibrium, vertigo, nystagmus
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27
Q

Cranial Nerves

CN IX

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN IX: Glossopharyngeal (B)
  • Function:
    • Motor – pharynx
    • Sensory – posterior tongue
  • Test:
    • Palate elevation, gag reflex
  • Abnormal:
    • No gag reflex, loss of taste posterior 1/3 of tongue
28
Q

Cranial Nerves

CN X

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN X: Vagus (B)
  • Function:
    • Motor - Palate, pharynx, larynx
    • Sensory – Pharynx, larynx
    • Cardiac, thorax and abdomen
  • Test:
    • Palate elevation, quality of “ah” and uvula midline
  • Abnormal:
    • Hoarseness, dyspnea, dysarthria, loss of gag reflex
29
Q

Cranial Nerves

CN XI

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN XI: Spinal Accessory (M)
  • Function:
    • Sternocleidomastoid and upper trapezius motor function
  • Test:
    • Shoulder shrug and head rotation
  • Abnormal:
    • Trapezius weakness, atrophy and fasciculation’s = scapular winging
30
Q

Cranial Nerves

CN XII

Name

Sensory/Motor/Both

Function

Test

Abnormal

A
  • CN XII: Hypoglossal (M)
  • Function:
    • Tongue movement
  • Test:
    • Wag tongue, push tongue into cheek
  • Abnormal:
    • Central lesion = contra. weakness/tongue deviates away
    • Peripheral lesion = ips. weakness/tongue deviates to weak side
31
Q

Name that CN

  • What are 3 CN’s involved in articulation?
  • An abnormality in what CN would cause shoulder to droop?
  • Damage to which CN results in anosmia?
  • Patient w/ vertigo and nystagmus could be due to damage to which CN?
  • In patient with asymmetric smile and loss of nasolabial fold, what CN is affected?
A
  • What are 3 CN’s involved in articulation?
    • CN V, VII, IX, X, XII
  • An abnormality in what CN would cause shoulder to droop?
    • CN IX (Glossopharyngeal)
  • Damage to which CN results in anosmia?
    • CN I (Olfactory)
  • Patient w/ vertigo and nystagmus could be due to damage to which CN?
    • CN VIII (Acoustic)
  • In patient with asymmetric smile and loss of nasolabial fold, what CN is affected?
    • CN VII (Facial)
32
Q

Sensory Terms: Touch

Define:

Anesthesia

Hypoesthesia

Hyperesthesia

A

Anesthesia: absence of touch sensation

Hypoesthesia: decreased sensation to touch

Hyperesthesia: increased sensitivity to touch

33
Q

Sensory Terms: Pain

Define:

Analgesia

Hypoalgesia

Hyperalgesia

Allodynia

A

Analgesia: absence of pain sensation

Hypoalgesia: decrease in pain awareness

Hyperalgesia: increased sensitivity to pain

Allodynia: pain elicited from non-painful stimulus

34
Q

Sensory Exam Components

How to test for:

Light touch

Pain

Temperature

Position

Vibration

A
  • Compare bilaterally, evaluate distal to proximal
  • Light touch:
    • Cotton swab/ball, pad of finger
    • Don’t apply too much pressure
  • Pain:
    • Sharp end of cotton swab, do not pierce skin
  • Temperature:
    • Compare hot/cold (if unable to feel pain sensation)
  • Position:
    • Hold sides of digit, demonstrate position
  • Vibration:
    • Place vibrating tuning fork on DIP joint, ask what patient feels
35
Q

Dermatomes: Upper Extremity

What are the dermatome levels for:

  • Lateral upper arms
  • Radial forearm and thumb
  • Middle finger
  • Ring and little finger
  • Ulnar Forearm
A

Dermatomes are helpful when patient has complaint of sensory loss in a specific distribution

  • Lateral upper arms (C5)
  • Radial forearm and thumb (C6)
  • Middle finger (C7)
  • Ring and little finger (C8)
  • Ulnar Forearm (T1)
36
Q

Dermatomes: Landmarks

What are the dermatome levels for:

  • Nipple line
  • Umbilicus
  • Inguinal region
A

Dermatomes are helpful when patient has complaint of sensory loss in a specific distribution

  • Nipple line (T4)
  • Umbilicus (T10)
  • Inguinal region (L1)
37
Q

Dermatomes: Lower Extremities

What are the dermatome levels for:

  • Anterior/proximal thigh
  • Knee/medial shin
  • Lateral shin, dorsal foot to great toe
  • Lateral and plantar foot
A

Dermatomes are helpful when patient has complaint of sensory loss in a specific distribution

  • Anterior/proximal thigh (L3)
  • Knee/medial shin (L4)
  • Lateral shin, dorsal foot to great toe (L5)
  • Lateral and plantar foot (S1)
38
Q

Specialized: Discriminative Sensations

  • What are these/how to test for?
    • Stereognosis
    • Graphesthesia
    • Two-point discrimination
      • What is normal?
    • Extinction
  • Indication if abnormal?
A
  • Will depend on touch and position sense
  • Stereognosis – ask patient to recognize familiar objects
  • Graphesthesia – number identification
  • Two-point discrimination – alternate double and single stimulus.
    • Normal <5mm on finger pads
  • Extinction – touch patient in same place on both sides of body
    • Test for neglect
  • Abnormal – sensory cortex pathology
39
Q

Motor Exam Componnets

What are you evaluating for?

A
  1. Body Position
  2. Involuntary Movements
  3. Muscle Bulk
  4. Muscle Tone
  5. Muscle Strength
40
Q

Involuntary Movements: Tremors

Define & eaxmples:

Static

Postural

Intention

A
  • Static tremor: seen at rest
    • Parkinson disease (pill-rolling tremor)
  • Postural tremor: seen when affected area maintains posture
    • Hyperthyroid, anxiety, fatigue, essential tremor
  • Intention tremor: absent at rest, appear with movement
    • Multiple sclerosis
41
Q

Involuntary Movements: Tics

Define

Eaxample

A
  • Tics: brief, habitual motion of particular muscles
    • Tourette syndrome, medications
42
Q

Involuntary Movements: Dystonia

Define

Example

A
  • Dystonia: twisted posture of large body parts
    • Medications, spasmodic torticollis
43
Q

Involuntary Movements: Dyskinesias

Define

Example

A
  • Dyskinesias: bizarre, rhythmic, repetitive movements
    • Parkinson disease, psychoses, medications
44
Q

Involuntary Movements: Akathisia

Define

Example

A
  • Akathisia: inability to sit still
    • Medications (antipsychotics, Compazine)
45
Q

Involuntary Movements: Chorea

Define

Example

A
  • Chorea: brief, jerky, rapid unpredictable movements
    • Huntington disease, rheumatic fever
46
Q

Involuntary Movements: Athetosis

Define

Example

A
  • Athetosis: slow, twisting, writhing movements
    • Cerebral palsy
47
Q

Muscle Bulk

A
48
Q

Muscle Tone

Define:

Hypertonia vs hypotonia

Spasticity

Rigidity

A
  • Hypertonia vs. hypotonia?
    • Central vs. peripheral causes
  • Spasticity: increased muscle tone, velocity dependent
    • UMN pathology
  • Rigidity: increased resistance throughout range of motion
    • Basal ganglia lesion
    • Cog-wheel rigidity –> Parkinsonism
49
Q

Muscle Strength

What are the grades of muscle function?

A
50
Q

UE: what are the nerve root & peripheral nerve for:

Shoulder abduction

Wrist Extension

Finger abduction

Thumb opposition

A
  • Shoulder Abduction
    • C5, C6
    • Axillary n.
  • Wrist Extension
    • C6, C7
    • Radial n.
  • Finger Abduction
    • C8, T1
    • Ulnar n.
  • Thumb opposition
    • C8, T1
    • Median n.
51
Q

LE: What are the nerve root(s) for:

Hip Flexion

Hip Adduction

Knee Extension

Hip Abduction

Knee Flexion

Ankle Dorsiflexion

Ankle Plantarflexion

A
  • Hip Flexion, Hip Adduction, Knee Extension
    • L2, L3, L4
  • Hip Abduction
    • L4, L5, S1
  • Knee Flexion
    • L5, S1
  • Ankle Dorsiflexion
    • L4, L5
  • Ankle Plantarflexion
    • S1
52
Q

Deep Tendon Reflexes (DTRs)

How to rate response?

A
  • How to rate response:
    • 0 = No response
    • 1+ = Diminished/Hypoactive
    • 2+ = Normal
    • 3+ = Increased/Hyperactive
    • 4+ = Hyperactive, associated with clonus
53
Q

DTRs: Hypoactive vs. Hyperactive

Define

Cause

Additional findings in LMN/UMN disease

A
  • Hypoactive
    • Diminished or absent
    • Diseases of spinal nerve roots or peripheral nerves
    • Additional findings in LMN disease:
      • Weakness
      • Atrophy
      • Fasciculations
  • Hyperactive
    • Brisk and can be associated with clonus
    • CNS lesions along descending corticospinal tract
    • Additional findings in UMN disease:
      • Weakness
      • Spasticity
      • Positive Babinski
54
Q

DTRs: What is the nerve root for:

  • UE
    • Biceps
    • Brachioradialis
    • Triceps
  • LE
    • Patella
    • Achilles
A
  • UE
    • Biceps: C5, C6
    • Brachioradialis: C5, C6
    • Triceps: C6, C7
  • LE
    • Patella: L4
    • Achilles: S1
55
Q

Clonus

What does it test?

How to test?

Abnormal test? Indication?

A
  • Alternate dorsi- and plantar flexing patient’s ankle, then brisklydorsi-flexankle. Evaluateforrhythmicoscillations.
  • Compare bilaterally, can be normal
  • If abnormal, check at wrist
  • Abnormal:
    • UMN pathology
56
Q

Babinski

What does it test?

How to test?

Abnormal test? Indication?

A
  • L5, S1
  • Stroke lateral aspect of plantar foot from heel to ball
  • Normal for toes to flex
  • Abnormal:
    • Great toe extends and other toes fan out
    • UMN pathology
57
Q

Superficial Abdominal Reflex

What does it test?

How to test?

Abnormal test? Indication?

A
  • Stroke abdomen toward umbilicus
  • Muscle contracts toward stimulus
  • Rated as present or absent
    • Should get a muscle contraction
  • Abnormal: no muscle contraction
    • Central (UMN) and peripheral (LMN) pathologies
58
Q

Cremateric Reflex

What does it test?

How to test?

Abnormal test? Indication?

A
  • Stroke proximal medial thigh
  • Normal for ipsilateral testicle to rise
  • Rated as present or absent
  • Abnormal:
    • UMN, LMN
    • L1, L2 nerve injury
    • Ilioinguinal injury s/p hernia repair
59
Q

Brudzinski Sign

What does it test?

How to test?

Abnormal test? Indication?

A
  • Minengeal Signs
  • Patient is supine, then flex patient’s neck
    • Normal→patient remains relaxed
    • Abnormal→hip and knee flexion; meningeal inflammation
60
Q

Nuchal Rigidity

What does it test?

How to test?

Abnormal test? Indication?

A
  • Meningeal Signs
  • Place hands behind patient’s head and flex head toward chest
  • Normal→easy motion
  • Abnormal → pain and resistance indicating potential meningeal inflammation
61
Q

Kernig Sign

What does it test?

How to test?

Abnormal test? Indication?

A
  • Meningeal Signs
  • Flex patient’s hip and knee, then straighten knee
  • Normal→may have tightness in hamstring
  • Abnormal→neck pain and resistance indicating meningeal irritation
62
Q

Name that test:

Abnormal gait due to loss in proprioception?

How to test?
Abnormal test? Indication?

A

Sensory ataxia

  • Unsteady gait and wide based stance
  • Throw feet forward and outward, first bring down heel then toes with double tap
  • Watch ground
  • Due to loss of proprioception
    • Peripheral neuropathy
    • Posterior column damage
63
Q

Name that test:

What test(s) do you perform to evaluate a patients position sense?

How to test?
Abnormal test? Indication?

A
  • Romberg
    • Position sense
    • Ask patient to stand with feet together, watch for swaying, then ask patient to close eyes
    • Abnormal –> unable to maintain upright posture
      • Posterior column disease
      • Cerebellar abnormality
  • Joint position
64
Q

Name that test:

What test is performed by placing a familiar object in patient’s hand?

How to test?
Abnormal test? Indication?

A

Stereognosis: ask patient to recognize familiar objects

65
Q

Name that test:

What test(s) help evaluate cerebellar function?

How to test?
Abnormal test? Indication?

A
  • Heel to shin
    • Place heel at opposite knee, slide down leg then back up
    • Should be able to keep contact with opposite leg
    • Abnormal
      • Cerebellar disease: Heel overshoot’s the knee, foot oscillates side to side
      • Post. column damage: Heel lifts too high
  • Fnger-to-nose
    • Hold your finger out in front of patient, then ask them to touch their nose then touch your finger with theirarmfullyextended. Moveyourfingerin different planes.
    • Patient should be steady and accurate
    • Abnormal = dysmetria (past pointing)
      • Cerebellar disease
      • Intention tremor – multiple sclerosis
  • and/or RAMs
    • Patient places hands on thighs with palms down then palms up, perform as quickly as possible
    • Rapid finger tap – tap the distal joint of thumb with index finger
    • Abnormal = dysdiadokinesia (slow, clumsy, irregular movement)
      • Cerebellar disease
66
Q
A

Physical Dx (11 decks)

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