Nerve & Musculoskeletal Exam

Question 1

Three basis functions of the nervous system

Answer 1

Sensory - afferent neurons, detects internal and external stimuli

Integrative - interneurons, processes information, analyzes and stores

Motor - efferent neurons, carry information to the cells in the body, responds to integrated decisions

Question 2

The _______ nervous system integrates and correlates incoming sensory information, thoughts, emotions, memories, muscle contractions and gladular secretions.

A. Peripheral

B. Somatic

C. Autonomic

D. Enteric

E. Central

Answer 2

E. Central

Question 3

The cauda equina are nerve roots that fan out starting at:

A. T1 - T2

B. T3 - T4

C. L1 - L2

D. L3 - L4

Answer 3

C. L1 - L2

(therefore, most lumbar punctures are performed at L2 - L4 interspaces)

Question 4

The ________ nervous system includes all nervous tissue outside the CNS as spinal nerves, cranial nerves, ganglia, and sensory receptors.

Answer 4

Peripheral nervous system

Question 5

Matching time!

1. Somatic Nervous System A. Involuntary actions
2. Autonomic N System B. “brain of GI duct”, involuntary
3. Enteric Nervous System C. Voluntary responses

Answer 5

1. Somatic Nervous System - C. Voluntary responses
2. Autonomic Nervous System - A. Involuntary actions
3. Enteric Nervous System - B. “brain of GI duct”, involuntary

Question 6

The cranial nerves are part of the _____ Nervous System

A. Central NS

B. Peripheral NS

C. Somatic NS

D. Autonomic NS

Answer 6

B. PNS

(ha! sounded out, it sounds like “penis”)

Question 7

Each spinal nerve (of which there are 31 pairs) has a ______ root and a ______ root.

Answer 7

Anterior (ventral) root - motor fibers

Posterior (dorsal) root - sensory fibers

Question 8

The reflex arc starts with ______ nerve fibers sending an impulse to the spinal cord where it synapses with the cell of the _______ neuron that innervates the same muscle.

Answer 8

Sensory ; motor

Question 9

T/F

Regarding spinal reflexes, when the impulse crosses the neuromuscular junction, the muscle suddenly contracts which completes the reflex arc.

Answer 9

True

Question 10

T/F

A reflex can involve as few as 2 neurons.

Answer 10

True, a reflex is an involuntary, stereotypical response that may involve as few as 2 neurons, 1 afferent (sensory) and 1 efferent (motor), across a single synapse

Question 11

How do you test the reflex of the cremaster (in males) and what spinal levels does this test?

Answer 11

Stroke inner thigh of male patient (prox to dist) – normal would be the testicle and scrotum rising to the side that was stroked.

It tests T12, L1, L2

Question 12

How do you test superficial plantar reflexes and what spinal levels does this test?

Answer 12

Look for Babinski sign…dorsiflexion of the great toe with or without fanning of other toes – This is an expected response if less than 2 years, but a sign of pyramidal tract disease in others

It tests levels L4, L5, S1, S2

Question 13

How do you test the deep reflexes of the biceps and what spinal levels does it test?

Answer 13

With arm partially flexed at elbow with palm down, place you thumb or finger on the biceps tendon and strike with reflex hammer

It tests levels C5, C6

Question 14

How do you test the deep reflexes of the brachioradialis and what spinal levels does it test?

Answer 14

With the patient’s hand on abdomen or lap, forearm partially pronated and strike the radius 1-2 inches above the wrist

It tests levels C5, C6

Question 15

A _______ is a band of skin innervated by the sensory root of a single spinal nerve. Adjacent ones may overlap.

Answer 15

Dermatome

Question 16

Symptoms that follow a ________ (like pain or a rash or virus) may indicate a pathology that involves the related nerve root

Answer 16

Dermatome

Varicella zoster is a virus that hibernates in nerver ganglia

Question 17

Common or concerning neruological syptoms

Answer 17

Headache, History of migraines
Dizziness or Vertigo
Generalized, proximal, or distal weakness
Numbness, abnormal or loss of sensations: TIAs CVAs? Any deficits? Nerve injuries? Neuromuscular disorders?
Loss of consciousness, syncope
Seizures
Tremors or involuntary movements

Question 18

Level of consciousness is measured using what scale?

What is the minimum and maximum score that can be given using this scale?

Answer 18

Glasgow coma scale

Max - 15, Min - 3

Question 19

The Glasgo coma scale scores patients based on which three factors?

Answer 19

Eye opening

Verbal response

Motor response

Question 20

How is a patient’s level of consciousness for the Glasgow coma scale evaluated?

Answer 20

_Alert_ = awake and oriented
_Lethargic_ = appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep
_Obtunded_ = opens eyes and looks at you, but responds slowly and is somewhat confused
_Stuporous_ = arouses from sleep only after painful stimuli such as sternal rub or pinching a tendon;  responses are slow or absent
_Comatose_ = unarousable with eyes closed;  no evidence of response to inner need or external stimuli

Question 21

The motor exam observes:

1.

2.

3.

4.

5.

Answer 21

1. Position at rest & with movement
2. Involuntary movements such as tremors, tics, or fasciculations
3. Muscle atrophy and tone, especially at hands, shoulders, thighs
4. Muscle strength by testing flexion and extension of all joints against resistance (scale 0 to 5)
5. Coordination – Test by: flipping hand on thigh as fast as possible, point-to-point movements, gait in multiple patterns (normal, heel to toe, on toes, on heels),

Question 22

T/F

The sensory system exam is done with the patient’s eyes open and compares symmetrical areas

Answer 22

False, it’s done with the patient’s eyes closed

Question 23

When testing sensory pathways, _______ is identifying a familiar objects in the patient’s hand with their eyes closed

Answer 23

Stereognosis

Question 24

When testing discriminative sensory pathways, _______ is when you “write” on a patient’s hand with something blunt and they are to identify the number or letter you have written.

Answer 24

Graphesthesia

Question 25

T/F
Deep tendon reflexes are graded on a 0 to 4+ scale

Answer 25

True

4+ very brisk, hyperactive, with clonus
3+ brisker than average, possibly but not necessarily indicative of disease
2+ average, normal
1+ somewhat diminished, low normal
0 no response

Question 26

T/F
When doing a musculoskeletal strength exam, always compare left side to right side.

Answer 26

True

Question 27

During the musculoskeletal exam, ______ range of motion:

• The ROM the patient is able to accomplish on their own
• Ask the patient to move the joint through a FROM
• Note any limitations, increased/decreased ROM

Answer 27

Active range of motion

Question 28

During the musculoskeletal exam, _____ range of motion:

• The ROM when the examiner manipulates the joint
• Ask the patient to relax while you support the extremity and move it through the FROM
• Note any limitations, increased/decreased ROM
• Use special tests as needed

Answer 28

Passive range of motion

Question 29

Levels of assessing muscle strength:

A score of __ is when the muscle can move the oint it crosses through a FROM, against gravity, and against full resistance applied by the examiner.

A score of ___ is when the muscle can move the joint it crosses through a FROM against gravity but without any resistance.

Whereas a score of ___ is when muscle contraction is seen or identified with palpaation, but it is insufficient to produce joint motion even with elimination of gravity.

Answer 29

5 ; 3 ; 1

Question 30

When assessing cortical function like striking a match, testing _____ _____.

Answer 30

ideomotor apraxia

Question 31

Muscle strength graded on scale __ to ___.

Answer 31

0 to 5

0 no contraction

3 active movement against gravity

5 active movement against resistance, normal

Question 33

When testing for coordination, testing 4 systems:

Answer 33

• cerebellar
• motor
• vestibular
• sensory

Question 34

To assess attention: (2)

Answer 34

digit repetition

spell WORLD backwards