Lecture Midterm 1 Flashcards
What does the O stand for in the acronym “OPQRST”?
Onset of injury
What does the P stand for in the acronym “OPQRST”?
Palliative/Provocative
What does the Q stand for in the acronym “OPQRST”?
Quality of pain
What does the R stand for in the acronym “OPQRST”?
Radiation/Referral of pain
What does the S stand for in the acronym “OPQRST”?
Severity of pain
What does the T stand for in the acronym “OPQRST”?
Temporal factors (time of day, days of the week, etc.)
What term describes a neurological loss from spinal nerve root compression or ischemia with numbness and/or weakness?
Radiculopathy
The majority of information needed to make a clinical diagnosis comes from what?
Patient history
What is Dr. Homack’s 1st Law?
The treatment must match the diagnosis
What is Dr. Homack’s 2nd Law?
Every treatment plan has an expiration date
What term describes the list of conditions the patient may have based on the symptoms exhibited and the results of the exam?
Differential diagnosis
What is the presumed cause of the patient’s condition, arrived at by evaluating all assessment information thus far obtained while conducting further diagnostic testing to definitively diagnose the illness?
Working Diagnosis
What is a clinical red flag that you need to be aware of when taking a history?
Thunderclap or sentinel headache
What are the possible symptoms associated with a cerebellar dysfunction?
- Hypotonia
- Dysmetria
- Ataxia
- Pendular reflex
- Disdiadokinesia
- Rebound phenomenon
Why should the patient be in a standing position for cerebellar testing?
- Anterior lobe controls the torso in relation to the lower extremity
- Posterior lobe controls the head relative to the torso
Why should you take a blood pressure on the left side first?
Left side is usually higher due to being closer to the heart
What blood pressure finding may indicate a cerebellar problem?
Difference of 10mmHg or greater BP from one side to the other
Where in the body are the intermediolateral nucleus located?
Between T1-L3 in the lateral horn
What two procedures can you use to test for hypotonia?
Pendular deep tendon reflex and Rag doll posture
A patient is performing the Babinski Weil and drifts to the left going forward and going backwards. Where do you expect the lesion to present?
Left-sided cerebellum lesion
A patient is performing the Babinski Weil and drifts to the left going forward and drifts right going backwards. Where do you expect the lesion to present?
Left CN VIII: Vestibulocochlear nerve
When performing Romberg’s position, how must the patient be set up?
- Eyes open
- Shoes and socks off with feet as close together without touching
- Arms flexed forwards at 90 degrees (palms up)
The ability to perform rapid, alternating movements is termed?
Diadochokinesia
The impaired ability to perform rapid, alternating movements is termed?
Dysdiadochokinesia (DDK)
The complete inability to perform rapid, alternating movements is termed?
Adiadochokinesia
What is the most important thing when testing for DDK?
Test both upper and lower extremity
What tests can be performed to look for DDK?
- Finger tapping (piano playing)
- Alternating hand slaps
- Foot tapping
- Seated marching
A patient complains about reaching out for an object and can never seem to grab the object. What tests can you perform to test for this phenomenon?
- Patient’s finger to own nose
- Patient’s nose to doctor’s finger
- Heel to knee
- Patient’s toe to doctor’s finger
What is important for the patient to do when performing tests for dysmetria?
Patient must move slowly to bring out a positive finding
What is important about a patient that could possibly have Lyme Disease?
False negative on blood tests
What is the most common symptoms of a vertebral artery dissection?
Neck pain and stiffness
What are the 3 most important reasons to perform examinations?
- Document medical necessity to order tests
- Make an accurate diagnosis
- Establish baselines for outcome measures
After a blow to the head, a 42 year old drummer notices his left hand has difficulty maintaining rhythm. This is an example of what condition?
Dysdiadochokinesia
What are some symptoms that are associated with an Upper Motor Neuron Lesion (UMNL)?
- Clonus
- Hypertonia
- Pathological reflexes present
- Absent superficial reflexes
- Clasp-knife spasticity
What are some of the general features of the Dorsal columns?
- Dorsal
- Afferent
- Sensory
- In going
- Posterior
What are some of the general features of the UMN?
- Ventral
- Efferent
- Motor
- Out going
- Anterior
If pressure is being applied to outside lamination of the spinal cord, what part of the body is most affected?
Lower extremity
What two body parts are good to test for clonus?
Wrist or Ankle
What grades on the Weller reflex grading system are always pathological?
4 (transient clonus) and +5 (sustained clonus)
What term describes the use of another motor movement like clenching the jaw to endure a patellar reflex that wasn’t present before?
Jendrassik Maneuver
What pathological reflex would you find present if you perform the Gordon’s test in the upper extremity?
Extension of the fingers
How do you perform Gordon’s test in the upper extremity?
Briskly compress the pisiform
How do you perform Gordon’s test in the lower extremity?
Briskly compress the calf
What pathological reflex would you find present if you perform Gordon’s test in the lower extremity?
Upward toe sign
What pathological reflex would you find present if you perform Chaddock’s test in the upper extremity?
Extension of the fingers
How do you perform Chaddock’s test in the upper extremity?
Briskly compress the anterior surface of the wrist
How do you perform Chaddock’s test in the lower extremity?
Draw a C around the lateral maleolus of the foot
What pathological reflex would you find present if you perform Chaddock’s test in the lower extremity?
Upward toe sign
What pathological reflex would you find present if you perform Rossolimo’s test in the upper extremity?
Flexion of the fingers
How do you perform Rossolimo’s test in the upper extremity?
Quickly taps on the distal end of the 3rd metacarpal on the palmer surface of the hand
How do you perform Rossolimo’s test in the lower extremity?
Quickly tap on the distal end of the 3rd metatarsal on the plantar surface of the foot
What pathological reflex would you find present if you perform Rossolimo’s test on the lower extremity?
Flexion of the toes
What pathological reflex would you find present if you perform Tromner’s test in the upper extremity?
Flexion of the fingers
How do you perform Tromner’s test in the upper extremity?
Support the patient’s hand and briskly strike the distal end of the 3rd and 4th digits into extension
How do you perform Hoffman’s test in the upper extremity?
Support the patient’s hand pronated and flex the distal end of the 3rd digit into flexion and then let it go
What pathological reflex would you find present if you perform Hoffman’s test in the upper extremity?
OK sign
What tests can be performed in the upper extremity to look for pathological reflexes?
- Gorgon’s
- Chaddock’s
- Rossolimo’s
- Tromner’s
- Hoffman’s
What tests can be performed in the lower extremity to look for pathological reflexes?
- Plantar
- Gordon’s
- Chaddock’s
- Oppenheim’s
- Schaefer’s
- Rossolimo’s
How do you perform the Plantar reflex in the lower extremity?
Briskly stroke the lateral side of plantar surface of foot from heel towards the toes and then towards the medial foot
What pathological reflex would you find present if you perform Oppenheim’s test in the lower extremity?
Upgoing toe sign
How do you perform Oppenheim’s test in the lower extremity?
Stroke proximally to distally along the tibia
How do you perform Schaefer’s test in the lower extremity?
Briskly squeeze the Achille’s tendon
What pathological reflex would you find present if you perform Schaefer’s test in the lower extremity?
Upgoing toe sign
What test can be performed to look for pathological reflexes in the face?
- Snout reflex
- Glabellar reflex
- Palmomental reflex
What pathological reflex would you find present if you perform the Snout Reflex?
Curling of the ipsilateal upper lip
How do you perform the Snout reflex?
Briskly tap on the one side of the phrenoulum, then the other
What pathological reflex would you find present if you perform the Glabellar reflex?
Wincing expression of the face and closing of the eyes
How do you perform the Glabellar reflex?
Briskly tap on the Glabella
What pathological reflex would you find present if you perform the Palmomental reflex?
Curling of or pursing of the upper lip
How do you perform the Palmomental reflex?
Briskly scrape along the thenar eminence
What superficial reflexes can be present during testing and still be considered normal?
- Plantar reflex
- Corneal reflex
- Gag reflex
- Abdominal reflex
Upper motor neuron signs may be due to the compression of what portion of the spinal cord?
Anterior corticospinal tract and lateral corticospinal tract
How are normal superficial reflex responses properly recorded in health care records?
Present
What are some possible conditions to cause lesion and focal demyelination for the spinal cord?
- B1 deficiency
- Multiple Sclerosis
- B12 deficiency
- HIV/Syphillis
- Lyme Disease
- Guillain-Barre
- Spinal canal stenosis
When performing dorsal column testing, what must the patient do before testing?
Eyes are closed
What term describes the loss of ability to sense vibration?
Appallesthesia
What type of tuning fork must be used to test for Appallesthesia?
128 Hz tuning fork
What is the progression of body parts you test for Pallesthesia test in the upper extremity?
- 2nd digit
- Radial styloid
- Olecranon
-AC joint/mid-clavicle
What is the progression of body parts you test for Pallesthesia in the lower extremity?
- 2nd toe
- Medial malleolus (lateral if you can’t get to it)
- Tibial tuberosity
- ASIS/greater trochanter
What tests can be perform to test for proprioception?
Romberg’s test or Positional change in digits
How do you perform Romberg’s Test?
- Patients eyes closed
- Patients shoes and socks off standing with feet as close together without touching
- Have patient flex arms out at 90 degrees and hold for 10 seconds
How do you perform Positional Change in Digits?
- Patient’s eyes closed
- Hold the the side of patients digits and ask if you moved the digit “towards their nose” or “towards their toes”
What tests can be performed to test for deep pressure?
- Abadies
- Biernacki’s
How do you perform Abadie’s test?
- Patient’s eyes closed
- Squeeze the Achilles tendon with a soft and harder pressure and ask the patient to distinguish between the two
How do you perform Biernacki’s test?
- Patient’s eyes closed
- Squeeze the triceps tendon with a soft and harder pressure and ask the patient to distinguish the two
What term describes the ability to recognize objects by feeling their form, size, and weight while the eyes are closed?
Stereognosis
Can stereognosis be tested on the upper extremity and lower extremity?
Only upper extremity
What term describes ability to recognize writing on the skin (letters or numbers) purely by the sensation of touch?
Graphesthesia
Can graphesthesia be tested on the upper and lower extremities?
Yes, both upper and lower extremity
What signs and symptoms are usually associated with a basal ganglia lesion?
- Cogwheel rigidity
- Leadpipe rigidity
- Choreiform/hemiballistic movements
- Mask-like faces
- Festinating gait
- Resting tremors (pill rolling)
When testing for tone across the elbow for a basal ganglia lesion, what information should you be aware of?
- No weakness
- Not velocity dependent
- Resistant in both directions
- Cogwheel/leadpipe rigidity
When testing for tone across the elbows for an UMN lesion, what information should you be aware of?
- Weakness
- Clasp-knife spasticity
- Velocity dependent
- Only one direction
What other symptoms might be seen in a patient demonstrating resting tremors
- Festinating gait
- mask-like faces
- choreiform/hamiballistic movements
- Cogwheel rigidity
- Leadpipe rigidity
Where does CN I exit the skull?
Cribiform plate
What term describes the lack or decrease in sense of smell
Anosmia
What term describes the distortion of the sense of smell, as in smelling an odor that isn’t present?
Parosmia
What term describes the perception of foul odor or stench when none exists?
Cacosmia
Where does CN II exit the skull?
Optic foramen
When referring to the Snelling eye chart, what is the term for the left eye?
OS
When referring to the Snelling eye chart, what is the term for the right eye?
OD
When referring to the Snelling eye chart, what is term for both eyes?
OU
What does it mean when a patient’s visual acuity is measured “20/40”?
A patient can read at 20 feet what a normal sighted person can read from 40 feet
What does it mean when a patient’s visual acuity is measured “20/15”?
A patent can read at 20 feet what a normal sighted person can read at 15 feet
What would you suspect to find if there was a lesion of the optic chias from a pituitary tumor?
Bilateral temporal hemianopsia
What would you suspect to find if there was a lesion of the optic nerve?
Central vision loss
When performing the direct and indirect light reflexes, what nerve is responsible for constriction of the pupils?
CN III: Oculomotor Nerve
You perform the indirect and direct light reflex test on your patient and you notice that when you flash the light in her left eye, her right pupil does not constriction. Where would you suspect the lesion to be?
Right CN III
What term describes an afferent pupillary defect that shows decreased bilateral pupillary constriction when light is shone in affected eye?
Marcus Gunn Pupil
You perform the direct and indirect light reflex test on your patient and you notice when you shine the light in the patient’s left eye, both pupils do not restrict. Where would you suspect the lesion could be?
Could be CN II on her left eye or CN III on both eyes
What term describes the unequal size of pupils at rest?
Anisocoria
What term describes the light source reflection not being placed in the center of the eyeball?
Strabismus
A patient comes into your office complaint of double vision. What nerves could be affected in this condition?
CN III, IV, VI
What term describes a diplopia present only when both eyes are open?
Binocular diplopia
What term describes a diplopia with only one eye viewing?
Monocular diplopia
What is the most common sign for a retinoblastoma?
White glow in the pupil of the eye termed “cat’s eye”
What condition is characterized by a lesion of the stellate ganglion?
Horner Syndrome
What are the classic signs and symptoms of Horner Syndrome?
- Miosis
- Ptosis
- Anhydrosis
A patient comes into your office complaining of double vision. What test(s) would you perform on the patient to test for this?
Cardinal Fields of Gaze
Where does V1 branch of trigeminal exit the skill?
Superior orbital fissure
Where does V2 branch of trigeminal exit the skull?
Foramen rotundum
Where does V3 branch of trigeminal exit the skull?
Foramen ovale
What muscle of mastication is only innervated by CN VII?
Buccinator
What muscles of mastication are innervated by CN V?
Temporalis, Masseter, Internal and External pterygoid
What is a positive sign if you perform a jaw jerk reflex on a patient?
Teeth slam together or jaw opens up
You perform a jaw jerk reflex on a patient and it comes back positive. Where do you suspect the lesion is?
UMN lesion (CN V)
What nerve innervates the inferior angle of the jaw?
C2
What cranial nerve is responsible for the blink in the Corneal reflex?
CN VII
You are testing to see if the patient can differentiate between dull or sharp sensations on the face. You realize the patient cannot feel on the tip of their nose. Where would this lesion be occurring?
Superior part of trigeminal nucleus
You are testing to see if the patient can differentiate between dull or sharp sensations. You notice the patient cannot feel a spot on their forehead. Where would you suspect the lesion to be?
Lowest part of trigeminal nucleus
When testing for CN VII, what must you instruct the patient to do first to help with your diagnosis?
Raising the eyebrows
You are testing facial muscles and you notice that a patient is able to raise their eyebrows, but cannot smile properly. What would you suspect is going on in the patient?
Stroke
What term describes a brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment) that often precedes a CVA?
Transient ischemic attack (TIA)
What are some generalized signs and symptoms of a stroke/TIA?
- Sudden headache
- Vision changes
- Disorientation
- Mental impairment
When performing a corneal reflex, the patient does not blink when you test the right eye. What condition could you possibly suspect the patient has?
Acoustic neuroma on right side
What are the different facial expression you are testing with CN VII?
- Raise the eyebrows
- Close the eyes
- Wrinkle the nose
- Smile for me
- Can you frown
- Puff out your cheeks
What term describes a lesion of the LMN on the ipsilateral side and causes eye brow and hemifacial paralysis?
Bell’s Palsy
What part of the face does the superior aspect of CN VII nucleus receive?
Bilateral innervation
What positive finding would you see in a patient that performs the Mittlemeyer’s test?
Falling or deviation to one side with eyes closed
You perform the Swivel Chair Test on a patient and you notice they get dizzy when you turn their head back and forth. You stop and let it calm down and immobilize the patients head and swivel and the dizziness come back. What condition would you suspect this patient has?
Cervicogenic vertigo
You perform the Swivel Chair Test on a patient and you notice they get dizzy when you turn their head back and forth. You stop and let it calm down and immobilize the patients head and swivel and the dizziness is absent. What condition would you suspect this patient has?
CN VIII Vestibular dysfunction
What device is used for Rinne and Weber hearing tests?
512 Hz tuning fork
What term describes the ability of sound to be louder on one side?
Lateralization
You perform Weber’s test on a patient and they say they hear the sound louder on the right. What does the result mean?
CN VIII damage on the left or air conduction loss on the right
What results would you expect when you perform Rinne’s test on a normal patient?
Equal bilateral and air conduction is 2x the bone conduction time
You perform Rinne’s test on a patient’s left ear and timed it out 3 seconds on the mastoid and 3 seconds in the air. What would be the cause of the lessened time on the left side when compared to the right?
Neurosensory loss on the left
You perform Rinne’s test on a patients left ear and hear 10 seconds on the mastoid process, but only hear 4 seconds in the air. What would be the cause of this finding?
Air conduction loss on the left
When testing CN XI innervation of the SCM, what would you have the patient do their neck?
Lateral Flexion (ipsilateral) and rotation (contralateral)
What term refers to speech difficulty that are contextually normal?
Dysarthria
You perform the tongue protrusion test and the tongue deviates to the right side. Where do you suspect the lesion to be?
Right side CN XII lesion
You perform the tongue in cheek strength test and the tongue is weak when you press on the right side. Where would you suspect the lesion to be?
Left-sided CN XII lesion
What cranial nerve carries sensory (taste) to the anterior aspect of the tongue?
CN VII
What exams can be done to test CN III: Oculomotor nerve?
- Direct and indirect light reflex
- Cardinal fields of gaze
- Corneal light reflex
What would you look for when assessing for a lesion of CN IX (Glossopharyngeal) and CN X (Vagus)?
- Hoarseness
- Uvular deviation to good side
- Gag reflex
- Swallowing test
Multiple sclerosis can first present as __________ which can create a central loss of vision?
Optic neuritis
In order to determine if an anterior corticospinal tract lesion is due to compression of the cervical cord, you can repeat tendon reflexes with the patient ________________ noting any changes in your finding?
Looking down
What is the purpose of performing Romberg’s Test?
Dorsal column lesion
What is the purpose of performing Romberg’s Position?
Cerebellar lesion
Your patient has loss of vision. During your examination you discover your patient has difficulty pointing to a spot without shaking, and identifying objects placed in a closed hand. What is most likely the cause of this?
Posterior circulation compromise
What makes up the posterior circulation of the brain?
Spinal cord, brain stem, and occipital lobe
What term pertains to the legal aspects that protects doctors and patients?
Medico-legal
True of False: An UMN lesion is velocity dependent?
TRUE
A patient walks into your office and notice they have a festinating gait. Where would you expect the lesion to be?
Basal ganglia
What blood vessels supply the cerebellum?
- Anterior inferior cerebellar artery
- Superior cerebellar artery
- Posterior inferior cerebellar artery
True or False: If you patient has a dorsal column lesion, they will have a positive Romberg’s position?
FALSE
What term describes the use of tapping over the facial muscles or parotid gland causes spasmodic contraction of ipsilateral facial muscles due to hypocalcemia and hyper excitability?
Chvostek Sign
What term describes the compression of blood vessels in the upper extremity to stop brachial artery flow leads to spasmodic contraction of the hand and forearm due to low calcium?
Trousseau’s Sign
