Lecture Midterm 2 Review Questions Flashcards
A patient walks into your office holding her neck soon after a car accident. What sign is this and what does it indicate?
Rust sign
instability
Which of the following tests (if positive) would indicate a space occupying lesion? (choose all that apply)
A) Libman’s
B) Triad of Dejerine
C) Valsalva’s
D) Milgram’s
E) Cervical distraction
B) Triad of Dejerine
C) Valsalva’s
D) Milgram’s
Which of the following tests is least invasive and therefore should be done first?
A) Jackson’s lateral flexion compression
B) maximal foraminal compression
C) neutral compression
D) rotary compression
E) extension compression
neutral compression
When concerned about CN III, ask about ____
Photophobia (sensitivity to light because pupils are dilated)
The corticobulbar tract begins in the ____ and ends in the ____
motor cortex
brainstem
Why is cranial nerve testing part of the vertebrobasilar artery insufficiency screening protocol?
vertebral aa supply the brainstem
Damage to the cerebellar vermis could result in ____
truncal ataxia
Which cranial nerves are involved in biting the tongue?
V: trigeminal
XII: hypoglossal
Pathologic reflexes are associated with damage to the ____
corticospinal tract
What is the MOST common symptom of vertebral artery dissection?
A) neck pain & stiffness
B) headache relieved by NSAIDS
C) difficulty swallowing
D) vertebral subluxation
E) balance issues
neck pain & stiffness
Which test differentiates vestibular cause vs. a cerebellar cause of “dizziness”?
A) Mittlemeyer marching
B) Romberg’s test
C) Swivel chair test
D) Babinski-Weil
E) Weber-Rinne test
Babinski-Weil
Your patient has drooping on the right side of the face with sparing of the ability to raise both eyebrows. Which diagnosis is most likely?
A) acoustic neuroma
B) Bell’s palsy
C) vertebral artery insufficiency
D) stroke
stroke
What is the correct reflex for the C6 nerve root?
A) biceps brachii
B) brachioradialis
C) triceps brachii
D) there is no reflex
brachioradialis
Your patient is able to raise their arm into abduction, but cannot resist any over pressure. What is the correct grading for this finding?
A) 0/5
B) 1/5
C) 2/5
D) 3/5
E) 4/5
3/5
Tapping the triceps tendon produces a reflex that has several beats but then stops. What is true for this finding? (Choose all that apply)
A) grade of +3/5
B) grade of +4/5
C) grade of +5/5
D) may be a normal finding
E) indicates an upper motor neuron lesion
+4/5
UMNL (clonus)
Which is the most likely diagnosis for a patient that has pain into the right arm when turning the head to the left?
A) medial scalene TOS
B) middle scalene TOS
C) posterior scalene TOS
D) pec minor TOS
E) hyperextension TOS
middle scalene TOS
What is the most likely cause of popping, clicking and pain in the anterior shoulder with motion?
A) gleno-humeral capsulitis
B) sub-acromial bursitis
C) fractured humeral neck
D) supraspinatus tear
E) transverse humeral ligament tear
transverse humeral ligament tear (or bicipital tendinitis
Which of the following tests would be positive or present for a patient with a partial supraspinatus tear? (choose all that apply)
A) Codman’s test
B) Yergason’s test
C) Dawburn’s pushbutton test
D) Supraspinatus press test
A) Codman’s
D) Supraspinatus press test
Nerve entrapment in the cubital fossa will cause symptoms into what part of the upper extremity?
A) dorsal surface of medial hand & fingers
B) dorsal surface of lateral hand & fingers
C) volar surface of middle hand into the 3rd digit
D) volar surface of lateral hand & fingers
E) volar surface of medial hand & fingers
D) volar surface of lateral hand & fingers
What is the most common site of radial nerve entrapment?
posterior interosseous n. at arcade of frohse
(proximal to supinator in proximal forearm)
The tip of the little finger is the sensory pure patch for what peripheral nerve?
ulnar
What does a 4+J bicep reflex suggest?
A) C5 nerve root compression
B) axillary nerve entrapment
C) corticospinal tract lesion
D) corticobulbar tract lesion
C) corticospinal tract lesion
What reflex corresponds to the nerve that shares the sensory pure patch over the tip of the pinky?
A) there isn’t one
B) there is no primary, but secondary is brachioradialis
C) brachioradialis
D) bicipital
E) triceps
A) there isn’t one (ulnar n)
A finding for cervical capsulitis during the cervical distraction test is:
A) decreased posterio-lateral cervical pain
B) increased pain radiating down the upper extremity
C) increased localized posterio-lateral cervical pain
D) decreased pain radiating down the upper extremity
C) increased localized posterio-lateral cervical pain
If a patient’s tongue deviates left when they stick it out, where is the lesion?
A) CN X on the right
B) CN X on the left
C) CN XII on the right
D) CN XII on the left
D) CN XII on the left
Your patient has sharp pain going down the left leg when she sneezes. What could cause this?
space occupying lesion
What are the tests for a space occupying lesion in order from least to most invasive?
- triad of dejerine
- valsalva
- milgram’s
Interosseous wasting may be a sign of:
A) median nerve damage
B) an apical lung tumor
C) radial nerve damage
D) D5 nerve root impingement
E) carpal tunnel syndrome
B) an apical lung tumor
Your patient has right medial forearm pain when turning her head to the right. What muscle test is most appropriate?
C8: finger flexors
Your patient has right arm pain extending into the index finger when turning his head to the left. Name two tests most useful to evaluate this patient.
- Reverse Adson’s (middle scalene TOS)
- Rotary compression test (IVF encroachment)
Your patient has intense pain over the lateral wrist. Name an appropriate test and the condition you suspect.
Finkelstein’s test for DeQuervain’s tenosynovitis
Your patient has difficulty opening a jar after falling and hitting their head due to weakness. Name the area you suspect is involved and name a test to evaluate that area.
UMNL
- patho. reflexes
- myotonic reflexes
- superficial reflexes
Define hypesthesia
nerve root or peripheral nerve compression
Define hyperesthesia
early nerve root compression
Which digit receives sensory innervation from median, ulnar, and radial nerves?
ring finger (4th)
What nerve root and peripheral nerves may be involved in a patient who can’t crush apples with their right hand anymore?
C8
median n
ulnar n
What nerve root and peripheral nerve may be involved in a patient who can’t disco (ABduct) with their right arm anymore?
C5
axillary n
What nerve root and peripheral nerve may be involved in a patient who can’t turn the throttle on their little jet anymore?
C6
radial n
