Musculoskeletal Practical 1

Question 1

Test Cranial Nerve I

Answer 1

Olfactory

Smell various odors with each nostril (vision occluded), such as coffee, lavender, vanilla

Question 2

Test Cranial Nerve II

Answer 2

Optic

Visual Acuity via Snellen eye chart 20’ away, confrontation via medial and lateral fields of vision

Question 3

Test Cranial Nerve III

Answer 3

Oculomotor

Inspect pupils for symmetry; pupillary response to light; ability to track movement in six fields of gave (“H”)

Question 4

Test Cranial Nerve IV

Answer 4

Trochlear

Inspect pupils for symmetry; pupillary response to light; ability to track movement in six fields of gave (“H”)

Question 5

Test Cranial Nerve V

Answer 5

Trigeminal
Clench the teeth, clinican palpates the temporal and masseter muscle; pinprick testing with three branches of sensory nerves

Question 6

Test Cranial Nerve VI

Answer 6

Abducens

Inspect pupils for symmetry; pupillary response to light; ability to track movement in six fields of gave (“H”)

Question 7

Test Cranial Nerve VII

Answer 7

Facial

Inspect patient’s face at rest, in conversation, and smiling; note an asymmetry

Question 8

Test Cranial Nerve VIII

Answer 8

Vestibulocochlear
Balance testing assess the vestibulospinal reflex; VOR can be assessed by testing the ability of the eyes to follow a moving object; cochlear component can be tested by rubbing fingers equidistant from the patients ears and assess the response

Question 9

Test Cranial Nerve IX

Answer 9

Glossopharyngeal

Gag Reflex

Question 10

Test Cranial Nerve X

Answer 10

Vagus
Clinician notes any hoarseness and nasal tones in the patients voice; patient requested to open mouth and say “ahhh” while clinician watches the movements of the soft palate and pharynx

Question 11

Test Cranial Nerve XI

Answer 11

Accessory
Clinician notes any atrophy or asymmetry in the trapezius muscle; patient is asked to shrug shoulders and strength of muscle contraction is noted

Question 12

Test Cranial Nerve XII

Answer 12

Hypoglossal
Clinician inspects tongue as it lies on the floor of the mouth, looking for fasciculation; patient asked to stick out tongue and move it from side to side; clinician notes asymmetry

Question 13

What nerve root does the biceps reflex test?

Answer 13

C5

Question 14

What nerve root does the brachioradialis nerve root test?

Answer 14

C6

Question 15

What nerve root does the triceps reflex test?

Answer 15

C7

Question 16

What nerve root does the quadriceps reflex test?

Answer 16

L4

Question 17

What nerve root does the achilles reflex test?

Answer 17

S1

Question 18

Test Babinski reflex

Answer 18

Stroke the lateral side of the foot

Positive= great toe extension and abduction of the other toes

Question 19

Test Oppenheim reflex

Answer 19

Stroke anteromedial tibial surface

Positive= extensor toe sign

Question 20

Test Hoffman reflex

Answer 20

Pinch distal phalanx of middle finger

Positive= adduction and opposition of thumb with slight flexion of fingers

Question 21

Test Lhermitte reflex

Answer 21

Patient in long sitting, passive flexion of neck

Positive=electric-shock like sensation radiating down spinal column to UE or LE

Question 22

Test Chaddock reflex

Answer 22

Stroke lateral foot beneath lateral malleolus

Positive= extensor toe sign and abduction

Question 23

Test Shaefer sign

Answer 23

Sharp, quick squeeze of the achilles tendon

Positive= extensor toe sign

Question 24

Test for clonus

Answer 24

Sudden wrist extension or dorsiflexion

Positive= more than 3 involuntary beats

Question 25

What are the main components of the Cyriax Upper Quarter Screening Exam?

Answer 25

``` Postural Assessment AROM Myotomes Reflexes Dermatomes Cord ```

Question 26

What must you test in the AROM of the Upper Cyriax?

Answer 26

Cervical spine motion Shoulder motions Elbow motions Wrist motions

Question 27

What at the myotomes that need testing in the Upper Cyriax

Answer 27

``` Cervical Rotation (C1) Scapular Elevation (C2,C3,C4) Shoulder Abduction (C5) Elbow Flexion and Wrist Extension (C6) Elbow Extension and Wrist Flexion (C7) Thumb Extension (C8) Finger Abduction (T1) ```

Question 28

What are the main components of the Cyriax Lower Quarter Screening Exam?

Answer 28

``` Postural Assessment AROM Myotomes Reflexes Neural Dermatomes Cord ```

Question 29

What must you test in the AROM of the Lower Cyriax?

Answer 29

Lumbosacral motion Hip motions Knee motions Ankle motions

Question 30

What are the myotomes that need testing in the Lower Cyriax

Answer 30

``` Hip Flexion (L1,L2) Knee Extension (L3, L4) Ankle Dorsiflexion (L4) Great Toe Dorsiflexion (L5) Heel Walking (L4, L5) Foot Eversion (S1) Toe Raises (S1) Knee Flexion (S2) ```

Question 31

What neural components must be tests in the Lower Cyriax?

Answer 31

Straight Leg Raise (L4,L5,S1 root mobility) | Femoral Nerve Stretch (L3 root mobility)

Question 32

What the components of the patient history?

Answer 32

``` Patient demographic and general idea of the pt History of current condition Location of Pain Behavior of symptoms Aggravating Factors Easing factors Nature of symptoms Occupation/school function Past medical history and/or past surgical history Living environment Recreational activties/hobbies ```