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PCM II Final Exam > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

lesion to CN 4 causes:

A
  1. Extorsion: eye moves laterally
  2. Weakness looking down
  3. Verrtical diplopia that increases in you look down
  4. Head will tilt towards opposite die of lesion
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2
Q

CN4 lesion can be misdiagnosed as what?

A

Idiopathic torticollis

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3
Q

CN 4 is vulnerable to what?

A

DAMAGE D/T HEAD TRAUMA bc it wraps around the B.S

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4
Q

_________ is the most Common isolated CN palsy due to its long peripheral course.

Seen often in patients with:
1, subarachnoid hemorrhage,
2. late syphilis
3. trauma.

A

CN 6 (abducens)

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5
Q

CN 6 lesions result in:

A
  1. Esotropia/medial strabismus: the patient cannot look abduct the eye
  2. Horizontal diplopia
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6
Q

laterality of nystagmus is based on what?

A

fast beating part of the nystagmus.

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7
Q

when do we see a nystagmus?

What kind are there?

A

when a person has an extreme deviation of gaze.

Hortizontal, vertical and rotary

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8
Q

What causes nystagmus?

A
  1. due to impairment of vision at an early age
  2. labyrinth and cerebellar systems disorders
  3. drugs
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9
Q

Trigmeninal nerve does what?

A
  1. Sensory of face: use pinprick. if abnormal, conduct a temperature test with hot or cold stimuli
  2. Motor for mastication muscles (temporal ,masseter, pterygoids). move jaw side to side (lateral pterygoids) and clench (temporal and masseter)
  3. Corneal reflex: tests 5 and 7: feel cotton on eye, 7 will close it via the orbicularis oculi
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10
Q

CNS patterns of stroke –

  1. L cortical or thalamic lesion = _____
  2. L brain stem lesion =______
A
  1. L cortical or thalamic lesion=> R body and facial sensory loss
  2. L brainstem lesion=> L facial and and R body sensory loss
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11
Q

in trigeminal lesion, what way will the jaw deviate?

A

to the weak side because of the unopposed action of the opposite lateral pterygoid

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12
Q

Corneal blink reflex tests the ____ component of CN 5 and _____ component of CN 7

A

afferent of CN 5

efferent of CN 6

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13
Q

loss of corneal blink reflex can be seen in

A

acoustic neuromas, brainstem (pontine)

lesions etc

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14
Q

Blinking is absent in both eyes in CN ____ lesions

Blinking is absent on the side of weakness for CN ___ lesions

A

5

7

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15
Q

facial N does what?

A
  1. Motor for facial muscles, closes eyes and mouth
  2. taste for anterior 2/3 of tongue
  3. PArasympathetic secretion of saliva and tears
  4. Sensation of external ear
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16
Q

Inspect face during rest & conversation to note any asymmetry & observe any ticks or
other abnormalities

is testing what CN?

A

7

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17
Q

Bell’s Palsy (peripheral facial paralysis)

A

CN 7 lesion caused by unkown reasons in most cases.

affects BOTH upper & lower face causing widened palpebral fissure and increased nasolabial fold.

loss of taste,

hyperacusis (increases sensitivity to sound),

↑ or ↓ tearing

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18
Q

(supranuclear) central lesion

A

CN 7 lesion that affects mainly lower face muscles and is usually assx with hemiplegia (weakness on one side of the body).
This isimportant in determining if the weakness is central or peripheral in nature.

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19
Q

how to test CN 8

A

Cochlear: whisper test (if +, do webers and rhinne test)

vestibular: usually isnt done isolated. Usually tested with cerebellum

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20
Q

CN 8 (vestibular) lesions usually result in

A
  1. dysequillibrium

2. nystagmus

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21
Q

CN 8 (cochlear) lesions can result in

  • Destructive lesions=>
  • Irritative lesions =>
A

• Destructive lesions => sensorineural hearing loss. Ex. acoustic neuroma

• Irritative lesions => tinnitus (ringing in ears). Ex. Medications (aspirin, some
antibiotics etc)

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22
Q

CN 9 does what

A
  1. Motor – innervates the stylopharyngeus
    muscle => elevates and widens the
    pharynx when swallowing and phonation
  2. Sensory – taste to the posterior 1/3 of
    the tongue, sensation to the palate and
    pharynx, skin of the external ear.

3 Afferent limb of the gag reflex

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23
Q

test CN 9

A
  1. Motor function & gag reflex of CN IX tested w/ CN 10 (gag reflex rarely tested in
    primary care office setting – reserved for high index of suspicion)
  2. Tasting – CN IX tested w/ CN VII (rarely tested in primary care office setting)
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24
Q

Afferent (sensory) part of gag reflex is CN ___.

efferent (motor) part is CN ____

A

9

10

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25
Q

Loss of the gag reflex is generally an indicator of lesion to _____
(and perhaps CN __)

A

ipsilateral CN 9

maybe 10

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26
Q

CN 10 (vagus) actions

A
  1. Motor – voluntary m for swallowing & phonation (pharynx and larynx ms except stylo)
  2. Sensory – sensation behind ear & part of external ear canal
  3. Parasympathetic – VISCERAL AFFERENT FIBERS to mucosa of eso => mid transverse colon AND to SMOOTH Ms => secretion of digestive enzymes, peristalsis, carotid reflex,
    involuntary action of heart, lungs & digestive tract
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27
Q

test CN 10 (4 ways)

A

Testing:
1. listen to voice for hoarseness
(vocal cord), nasal tone (palatal
weakness)

  1. Check gag reflex
  2. Check for difficulty swallowing
    (indicating either pharyngeal or
    palatal weakness)
  3. Inspect soft palate & uvula for symmetry. b/l lesion: fails to rise, u/l lesion: goes to normal side
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28
Q

Unilateral loss of soft palate and uvula symprret indicates an _____
CN X lesion.

A

ipsilateral

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29
Q

Pt has

Loss of gag reflex
• Loss of sensation in pharynx &
posterior 1/3 of tongue
• Slight dysphagia

where is the lesion

A

CN 9

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30
Q

Pt has

  • Dysphonia
  • Dysphagia
  • Dyspnea
  • Loss of gag or cough reflex

where is the lesion

A

CN 10

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31
Q

test CN 11

A
  1. look for fascilations of shoulders from behind
  2. Trapezius m: shrug shoulders against resistance. Weakness => ipsilateral shoulder droop.
  3. SCM: turn face against resitance. Lesion => problem turning head to opposite side
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32
Q

Trap weakness w/ atrophy & fasciculations =

A

peripheral N disorder

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33
Q

CN 12 actions

A

Motor –innerv all intrinsic and extrinsic tongue ms (except palatoglossus=> cn 10)

34
Q

test CN12

A

protrude tongue and push into OPPOSITE cheek

35
Q

CN 12 lesions cause

A

tongue will deviate to WEAK side and can t push tongue to opposite cheek

36
Q

when inspecting motor system; what do we look at

A
  1. Body position & gait
  2. Involuntary movement – tremors, tics or fasciculations
  3. Muscle bulk – is the muscle wasting, atrophy
  4. Muscle tone – feeling the muscle resistance to passive stretch
  5. Muscle power: rate 0-5
37
Q

muscle strength scale

A
  • 0 = no muscle contraction
  • 1 = barely detectable flicker or trace of contraction
  • 2 = active movement W/O gravity
  • 3 = active movement against gravity
  • 4 = active movement against gravity & some resistance
  • 5 = active movement against full resistance w/o fatigue
38
Q

Neck and Upper extremity testing:

A

patient activates each muscle action against resistance

-Shrug shoulder– trapezius (CNXI)
• F (C5,6) & E (C6,7,8) elbow
• F & E  wrist (C6,7)
• Hand grip (C7,8,T1)
• Abduct finger (C8,T1)
• Opposition of thumb (C8,T1)
39
Q

Low back and LE testing

A

Hip

  1. Flexion (L2,3,4 – psoas and iliacus),
  2. extension (S1 – glut max), adduction (L2,3,4)
  3. abduction (L4,5,S1)

Knee –

  1. Flexion (L4,5,S1,2 –hamstrings)
  2. extension (L2,3,4 –quads)

Ankle

  1. Plantar (S1 – gastrocnemius )
  2. dorsiflexion (L4,5 – tibialis anterior)
40
Q

what dertmatomes should we test motor functions

A
  1. Biceps (C5-6)
  2. Triceps (C6-8)
  3. Quads (L2-4)
  4. Gastroc (L5-S2)
41
Q

Upper Motor Neuron (UMN) will see a _____ pattern of weakness

A

Pyramidal: weak extensors in arms (EA), weak flexors in legs (FL)

FLEA= UMN lesion

42
Q

pronartor drift tests what?

how to conduct?

A

UMN lesion (lesion to CST)

  1. Place arms out with palms up.
  2. If UMN lesion, forearm will move inward and down.
  3. Tapping on the arm should cause it retrun back to normal with the help of muscle stretnth, coordination and good position
43
Q

Lower Motor Neuron (LMN) will see a _____ pattern of weakness

A

peripheral

weak flexors in arms (FA)
weak extensors in legs (EL)

44
Q

____ MN lesion can cause muscle disease,where the muscle wastes, decreased tone and reflexes

A

LOWER

45
Q

Coordination of muscle movement requires input from 4

systems:

A
  1. motor
  2. sensory
  3. vestibular
  4. cerebellar= rhythmic movement and steady posture
46
Q

Cerebellar function

  • Rapid alternating movements;
  • Finger-to-nose
  • Finger-to-finger
  • Heel-to-shin
A
  1. rapidly pronate and supinate hand
  2. looks at dysmetria/dysataxia of voluntary movements
  3. position sense and function of both labyrinth and cerebellum

4.- tap heel on opposite patella and glideheel slowly along the
shin, look for accuracy and smoothness. repeat with eye closed

47
Q

how to perform finger to finger

A
  1. have doc move finger in secveral places
  2. Then have doc keep finger still; tell pt to move finger up and bring it back down to the finger
  3. repeat with eye closed
48
Q

bad on rapid alternating movements tells us we have

A

dysdiadokinesia

49
Q

if pt cannot heel or toe walk

A

tests of plantar flexion and dorsi of ankles; thus,

+ for distal muscle weakness in legs OR CST weakness

50
Q

Hop in place on one leg – tests _____ and _____ muscle strength, requires position
sense and cerebellar function

A

proximal and distal

51
Q

Shallow knee bend on each leg– may reveal weakness of what

A

hip extensors
quads
or both

52
Q

Romberg test – generally evaluated with gait and station but is a test of
______________

A

PROPIOCEPTION (sensory)

53
Q

romberg test

A

Romberg Test tests position!!!

Patient stands with feet together and eyes open. Close both eyes for 30-60 seconds. Normal is minimal swaying.

If patient loses balance with
eyes open => cerebellar ataxia.

If pt loses balance with eyes closed, it is a positive
Romberg sign

54
Q

______ – feet crossing over with toes dragged – often seen in cerebral palsy or multiple sclerosis

  • _________ – high steppage, broad based – seen with posterior column damage and peripheral neuropathy
  • ______ – small steps, feet do not leave ground, seen in frontal lobe processes and hydrocephalus
  • ________ – gait is all over the place as if thepatient is falling, but does not fall, usual cause is psychogenic
A
  1. scissoring (CP or MS)
  2. sensory ataxia (PC damage or peripheral neuropathy)
  3. Magnetic (frontal lobe problems or hydrocephalus)
  4. Atasia-abasia (functional)
55
Q

what are the 3 assymmetric gaits?

A
  1. Hemiplegic – usually due to UMN such as stroke. Gait is circumducted (leg
    swing in a circular type pattern), ipsilateral arm swings less
  2. Waddling pelvis – hips sway or “waddle” in a side to side type fashion dt muscle (myopathic) disease
3.  Foot drop – unable to keep foot up during heel walk, can be due to UMN or
LMN lesions (peroneal neuropathy or L5 radiculopathy)
56
Q

Sensory evalulation involves testing for ____

A

dermatomes

57
Q

testing for pain and temp involves the ________ tract . how?

A

Spinothalamic

  1. Pain: pinprick test. If abnormal, do temp test
  2. Temp: cold and hot test tubes
58
Q

Propioception & vibration involves testing ______

A

posterior columns. How?

  1. Propioception/ postion: Grasp sides of
    patient’s big toe between thumb and index
    finger and move it through an arc. With
    patient’s eyes closed as for response of “up”
    or “down.”
  2. Vibration: 128Hz tuning fork, place on
    interphalangeal joints, malleoli
59
Q

Light touch involves testing what pathways; how?

A

both PC and spinothalamic

Use a fine wisp of cotton. Compare 1 area w/ another & bilateral sides

60
Q

Stereognosis

A

cant rexognize shapes of objects or those placed in hands

61
Q

• Graphesthesia

A

cant recognize numbers written on palm

62
Q

• Double simultaneous stimulation (extinction)

A

pt can feel 2 points touching them at once

63
Q

Recognize and discuss what the dermatomal map indicates, specifically shoulder, thumb, little
finger, nipple, umbilicus, hallucis and little toe

A 
Shoulder: C4
Thumb: C6
Little finger: C8
Nipple: T4
BB: T10
big toe: L5
Little toe: S1
64
Q

BS lesion causes

A

ipsilateral sensory loss in face

contralateral sensory loss in body

65
Q

______ reflexes indicate a lesion in the central nervous system.
______ reflexes indicate a lesion in the peripheral nervous

A

HYPERACTIVE: CNS

HYPOACTIVE: PERIPHERAL NS

66
Q

DTR SCALE

A

Graded on a 0-4 scale

  • 4+ = very brisk, hyperactive, w/ clonus (rhythmic oscillation b/w F & E)
  • 3+ = brisker than average, possibly but not necessarily indicative of dz
  • 2+ = average, normal
  • 1+ = somewhat diminished, low normal
  • 0 = no response
67
Q 
Biceps reflex – (\_\_\_)
• Triceps reflex – (\_\_\_)
• Brachioradialis reflex – (\_\_\_)
• Patellar reflex – (\_\_\_\_)
• Achilles reflex – (\_\_\_)
A 
BICEPS: C5
TRICEPS: C7
BR: C6
PATELLA: L4
ACHILLES: S1
68
Q

BABINKSI AND CLONUS ARE SIGNS OF ____ LESIONS

A

UMN

69
Q

THERE ARE 3 SUPERFICIAL STIMULATION REFLEXES. WHAT ARE THEY?

A
  1. ABDOMINAL REFLEX: T10-T12, when you hit the abdomen, the BB should move to where you strike
  2. PLANTAR REFLEX: babinskie normal response of the toe should be plantarflexion. may persist in bbs
  3. ANAL REFLEX (S4/S5): touch areas around butthol and see if it contracts; lesion to cauda equina or sacral region
70
Q

Postural tremor or kinetic tremor

usually due to _________

A

essential tumor

71
Q

rolling pill tremor is d/t

A

BG disease (parkinsons)

72
Q

tremor is

A

rhythmic osscilation of body part d/t contraction of an opposing muscle group and is the MOST COMMON MOVEMENT DISORDER

73
Q

hemiplegia vs hemiparesis

A

hemiparesis-> weakness on one side of body

hemiplegia-> paralysis on one side of bdot

74
Q

recognize the 5 levels of consciousness: Alertness, lethargy, obtundation, stupor, coma

A

Alert: speak to pt in normal tone and they should look at you and respond fully and appropriately

lethargy: speak to the pt LOUDLY; they should look at you, respond and fall asleep
obtundation: shake pt lightly as if they are asleep; alertness and interest is dereased; they open eyes, look at you adn respond but seem confused
stupor: pt has minimal awareness of self or env; apply a painful stimulus, causing the pt to arouse from sleep; may not resond
coma: apply repeated painful stimulus; the paint will not wake up

75
Q

tremors can be resting (static), postural or intention

A

resting tremors: most ob at rest and can disappear with movement. Ex slow, fine pill rolling tremor in parkinsons

postural: tremors that occur when maintaing posture d/t hyperthyroidism, anxiety
intention: tremors thato ccur when VM and get worse with target. Ex. Cerebrallar lesion or MS

76
Q

oral facial dysdokinesia

A

arrythmic movements ot tongue, jaw and face. less often involve LE
can be d/t pyshchotropic drugs

77
Q

tic

A

repetiive coordinated movements that occur at irregular intervals

78
Q

chorea

A

brief, rapid, jerky, irregular and unpredictable that occur at rest or during normal movement

UNLIKE TICS THAT RARELY REPEAT THEMSELVES

79
Q

athetosis

A

twisting, slow movements that involve FACE and distal extremities

seen in CP

80
Q

dystonia

A

similar to athetosis biut often involve larger groups of the body including trunk

PCM II Final Exam (7 decks)

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