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Anes 540b Exam 1 > Nerve + Musculoskeletal Exam > Flashcards

Nerve + Musculoskeletal Exam Flashcards

1
Q

What are the three basic functions of the nervous system?

A

Sensory, Integrative, Motor

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2
Q

Which neurons are specific to the sensory function of the nervous system?

A

Afferent neurons

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3
Q

Which neurons detect internal and external stimuli? On behalf of which function of the nervous system?

A

Afferent neurons; sensory function

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4
Q

Which neurons are specific to the integrative function of the nervous system?

A

Interneurons

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5
Q

Which neurons process, analyze, and store information? On behalf of which function of the nervous system?

A

Interneurons; integrative function

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6
Q

Which function of the nervous system involves interneurons?

A

Integrative

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7
Q

Which function of the nervous system involves afferent neurons?

A

Sensory

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8
Q

Which function of the nervous system involves efferent neurons?

A

Motor

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9
Q

Which neurons respond to integrated decisions? On behalf of which function of the nervous system?

A

Efferent neurons; motor function

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10
Q

Which neurons are specific to the motor function of the nervous system?

A

Efferent neurons

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11
Q

Which neurons carry information to cells of the body?

A

Efferent neurons

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12
Q

What are the two parts of the nervous system?

A

1) Central nervous system

2) Peripheral nervous system

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13
Q

Which nervous system includes the brain and spinal cord?

A

CNS

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14
Q

The CNS includes the:

A

brain and spinal cord

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15
Q

Which nervous system integrates and correlates incoming sensory information?

A

CNS

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16
Q

Which nervous system is responsible for thoughts, emotions, and memories?

A

CNS

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17
Q

Which nervous system controls muscle contraction + glandular secretions?

A

CNS

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18
Q

From where to where does the spinal cord run?

A

From the medulla to the 1st or 2nd lumbar vertebrae

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19
Q

What type of nerve pathways does the spinal cord contain? How do those pathways enter/exit the spinal cord?

A

Motor and sensory nerve pathways

Enter/exit via nerve roots + spinal and peripheral nerves

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20
Q

What mediates reflex activity of the deep tendon reflexes?

A

Spinal cord

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21
Q

Which type of nerve controls deep tendon reflexes?

A

Spinal nerve

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22
Q

What are the five segments of the spinal cord?

A

C1-7; T1-12; L1-5; S1-5; coccygeal

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23
Q

What level is the cauda equina?

A

L1-L2

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24
Q

What does cauda equina mean?

A

horse tail

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25
Q

What is cauda equina syndrome?

A

Back pain and saddle anesthesia at S3-S5

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26
Q

In cauda equina syndrome, which parts of the body feel pain?

A

Perineum, external genitalia, anus

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27
Q

Where are most lumbar punctures performed?

A

At the L2-L4 interspace

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28
Q

Which nervous system includes spinal nerves, cranial nerves, ganglia, and sensory receptors?

A

PNS

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29
Q

Parts of the peripheral nervous system?

A

Somatic nervous system
Autonomic nervous system
Enteric nervous system

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30
Q

Which aspect of the PNS serves as the “pacemaker of the gut”?

A

Enteric nervous system

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31
Q

How many pairs of cranial nerves are there? How many come from the brainstem?

A

12 pairs; 10 from brainstem

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32
Q

Which cranial nerve is responsible for sense of smell?

A

CN I; olfactory nerve

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33
Q

Which cranial nerve is responsible for visual acuity and visual fields?

A

CN II; optic nerve

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34
Q

Which cranial nerve is responsible for pupillary movements, extraocular movements?

A

CN III; oculomotor nerve

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35
Q

In addition to CN VI, which cranial nerve is responsible for extraocular movements only?

A

CN IV; trochlear nerve

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36
Q

Which cranial nerve is responsible for corneal reflexes, facial sensation, jaw movements, voice and speech?

A

CN V; trigeminal nerve

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37
Q

In addition to CN IV, which cranial nerve is responsible for extraocular movements only?

A

CN VI; abducens nerve

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38
Q

Which cranial nerve is responsible for facial movements, voice and speech?

A

CN VII; facial nerve

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39
Q

Which cranial nerve is responsible for hearing and balance?

A

CN VIII; vestibular nerve

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40
Q

Which cranial nerve is responsible for swallowing and rise of palate, gag reflex?

A

CN IX; glossopharyngeal nerve

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41
Q

Which cranial nerve is responsible for voice and speech, swallowing and rise of the palate, gag reflex?

A

CN X; vagus nerve

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42
Q

Which cranial nerve is responsible for shoulder and neck movements?

A

CN XI; accessory nerve

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43
Q

Which cranial nerve is responsible for tongue symmetry and position, voice and speech?

A

CN XII; hypoglossal nerve

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44
Q

How many pairs of spinal nerves are there?

A

31 pairs

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45
Q

How many cervical nerves are there?

A

8

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46
Q

How many thoracic nerves are there?

A

12

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47
Q

How many lumbar nerves are there?

A

5

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48
Q

How many sacral nerves are there?

A

5

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49
Q

How many coccygeal nerves are there?

A

1

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50
Q

Each spinal nerve has two roots:

A

Anterior (Ventral) + Posterior (Dorsal)

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51
Q

Dorsal root =

A

sensory

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52
Q

Ventral root =

A

motor

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53
Q

How do sensory nerve fibers send an impulse to the spinal cord?

A

Via peripheral nerve

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54
Q

From the spinal cord, where does a signal travel?

A

To anterior horn where sensory fiber synapses with cell innervating same muscle

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55
Q

When does the muscle contract?

A

When the impulse crosses the neuromuscular junction

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56
Q

What completes the reflex arc?

A

Contraction of muscle

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57
Q

Which reflex affects T7-9?

A

Upper abdominal

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58
Q

Which reflex affects T10-11?

A

Lower abdominal

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59
Q

Which reflex affects T12, L1-2 in males?

A

Cremaster

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60
Q

Which reflex affects L4-5, S1-2?

A

Plantar

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61
Q

Which reflexes affect C5-6?

A

Biceps and brachioradialis

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62
Q

How to test biceps reflex?

A

Put your thumb on patient’s biceps tendon and hit it with a hammer; the arm should fly up.

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63
Q

How to test brachioradialis reflex?

A

Have patient pronate arm on their lap and hit inches above wrist; should see subtle rotation

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64
Q

Which reflex affects C6-8?

A

Triceps

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65
Q

When you hit the triceps tendon, the patient’s arm will move

A

laterally

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66
Q

Which reflex affects L2-4?

A

Patellar

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67
Q

In which direction should toe move during a patellar reflex test?

A

Downward

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68
Q

If a toe moves upward during patellar reflex test:

A

positive Babinski sign

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69
Q

Which reflex affects S1-2?

A

Achilles

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70
Q

A band of skin innervated by the sensory root of a single spinal nerve

A

dermatome

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71
Q

Carpal tunnel syndrome is due to

A

median nerve compression

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72
Q

Example of virus that hibernates in nerve ganglia

A

Varicella zoster, chicken pox and herpes zoster

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73
Q

Herpes zoster manifests itself on what region of body most commonly?

A

Thoracic

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74
Q

Questions you should ask if your patient has h/o seizures?

A

Type of? Medications? Occur on one side of body? Last seizure?

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75
Q

What are the five levels of consciousness?

A 
Alert
Lethargy
Obtundation
Stupor 
Coma
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76
Q

Level of consciousness where patient will recognize you when you speak in a normal voice

A

Alert

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77
Q

Level of consciousness where patient will recognize you when you speak in a loud voice

A

Lethargy

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78
Q

Level of consciousness where patient is aroused with gentle shaking

A

Obtundation

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79
Q

Level of consciousness where patient is aroused with painful stimuli

A

Stupor

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80
Q

Level of consciousness where patient is not arousable with painful stimuli

A

Coma

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81
Q

Maximum score on Glasgow coma scale

A

15

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82
Q

Minimum score on Glasgow coma scale

A

3

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83
Q

What are two ways you may assess your patient’s attention level?

A

Ask them to repeat a series of digits.

Ask them to spell WORLD backwards

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84
Q

Best way to test patient comprehension level?

A

Ask them to follow a three-step command

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85
Q

Drawing a clock assesses what part of mental status?

A

Memory–constructional ability

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86
Q

Proverbs assess what part of mental status?

A

Higher cognitive abilities

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87
Q

What are three cortical functions that may be compromised by subpar mental status?

A

Ideomotor apraxia
Ideational apraxia
Right to left orientation

88
Q

How to test CN I (olfactory)?

A

Have patient identify familiar odors, one nostril at a time, eyes closed

89
Q

How to test CN II (optic)?

A

Test visual acuity and visual fields.

90
Q

How to test CN III, IV, VI?

A

Observe pupil size, shape, and reaction to light.
Check for drooping eyelid.
Test extraocular movements.

91
Q

Which nerve is tested by palpating strength of muscle contractions over temporal and masseter areas while patient clenches teeth?

A

CN V; trigeminal nerve

92
Q

Which nerve is tested by inspecting for symmetry in facial expressions?

A

CN VII; facial nerve

93
Q

How to test CN VIII (acoustic)?

A

Test hearing

94
Q

Which nerves are tested by assessing voice quality, observing swallow, testing gag reflex, and movement of the soft palate and uvula with phonation?

A

CN IX, X; glossopharyngeal and vagus nerves

95
Q

Which nerve is tested by inspecting for atrophy or fasciculation in trapezius muscles, testing strength and contraction of trapezius and sternomastoid muscles?

A

CN XI; spinal accessory nerve

96
Q

Which nerve is tested by inspecting for tongue midline with protrusion and directed movements of tongue, observing quality of speech, and testing strength of tongue?

A

CN XII; hypoglossal nerve

97
Q

How is muscle strength tested? What defines normal

A

Graded on scale of 0 to 5

Score of 5 = normal

98
Q

0 on muscle scale =

A

no muscular contraction

99
Q

3 on muscle scale =

A

active movement against gravity

100
Q

5 on muscle scale =

A

active movement against resistance

101
Q

If you observe your patient making rapid alternating movements, observe their gait, and observe them standing in specific positions, you are testing their:

A

coordination

102
Q

Under what conditions do you test a patient’s sensory system?

A

Patient’s eyes are closed; compare symmetrical areas on patient

103
Q

What are five aspects of the sensory system we test?

A 
Light tough
Superficial pain
Temperature
Vibration
Position
104
Q

How do you test vibration in sensory exam?

A

Use a tuning fork over interphalangeal joints of the hands and feet

105
Q

How do you test position?

A

Use great toe and ring finger; have patients distinguish between whether those two digits are pointing up or down.

106
Q

What are the five discriminative sensations?

A 
Stereognosis
Graphesthesia
Two-point localization
Point localization
Extinction
107
Q

How to test sterognosis?

A

Identification of familiar objects in patient’s hand

108
Q

How to test graphesthesia?

A

Write on patient’s hand with something blunt and have them identify what number or letter you wrote

109
Q

How to test two-point localization?

A

Find the minimal distance on a patient’s finger or thumb that they are able to discriminate between two points

110
Q

How to test point localization?

A

Patient identifies where you have touched them briefly

111
Q

How to test extinction?

A

Simultaneously touch two spots on body and have patient point to location that was touched

112
Q

Which systems are in charge of coordination?

A

Cerebellar system, motor system, vestibular system + sensory system

113
Q

What are three areas of testing for coordination?

A

Rapid alternating movements
Point-to-point testing
Equilibrium

114
Q

How to test equilibrium?

A

Observe normal gait, heel-to-toe, walk on toes and on heels

115
Q

What kind of scale are reflexes graded on?

A

0-4+ scale

116
Q

Reflex with 4+ grade:

A

Very brisk, hyperactive with clonus

117
Q

Reflex with 3+ grade:

A

Brisker than average, possibly indicative of disease

118
Q

Reflex with 2+ grade:

A

Average, normal

119
Q

Reflex with 1+ grade:

A

Somewhat diminished, low normal

120
Q

Reflex with 0 grade:

A

No response

121
Q

Normal reflex grade?

A

2+

122
Q

A ROM exam can also test?

A

Strength of muscles

123
Q

Two pairs of possible movements in fingers?

A

Flexion/extension

Abduction/adduction

124
Q

Three types of movements in thumbs?

A

Flexion/extension
Abduction/adduction
Opposition

125
Q

Two types of movements in wrist?

A

Flexion/extension

Radial/ulnar deviation

126
Q

Type of movement in wrist?

A

Pronation/supination

127
Q

Type of movement in elbow?

A

Flexion/extension

128
Q

Type of movements in shoulder?

A

Flexion/extension
Internal/external rotation
Abduction/adduction

129
Q

Type of movements in neck?

A

Flexion/extension
Right/left bending
Right/left rotation

130
Q

Type of movement in toes?

A

Flexion/extension

131
Q

Type of movements in ankle?

A

Inversion/eversion

Dorsiflexion/plantar flexion

132
Q

Type of movement in knee?

A

Flexion/extension

133
Q

Type of movements in hip?

A

Flexion/extension
Abduction/adduction
Internal/external rotation

134
Q

Type of movements in spine?

A

Flexion/extension
Right/left bending
Right/left rotation

135
Q

The ROM the patient is able to accomplish on their own

A

Active ROM

136
Q

The ROM when the examiner manipulates the joint

A

Passive ROM

137
Q

Grading of muscle strength is on a scale of:

A

0-5

138
Q

The muscle can move the joint it crosses through a FROM, against gravity, and against resistance. Score?

A

5

139
Q

The muscle can move the joint it crosses through a FROM against moderate resistance. Score?

A

4

140
Q

The muscle can move the joint it crosses through a FROM against gravity but without any resistance. Score?

A

3

141
Q

The muscle can move the joint it crosses through a FROM only if the part is properly positioned so that the force of gravity is eliminated. Score?

A

2

142
Q

Muscle contraction is seen or identified with palpitation but it is insufficient to produce joint motion even with elimination of gravity. Score?

A

1

143
Q

No muscle contraction is seen or identified with palpation; paralysis. Score?

A

0

144
Q

In what type of stroke does a weakened/diseased blood vessel rupture, causing blood to leak into brain tissue?

A

Hemorrhagic stroke

145
Q

In what type of stroke do blood clots stop the flow of blood to an area of the brain?

A

Ischemic stroke

146
Q

Another name for stroke?

A

Cerebral vascular accident (CVA)

147
Q

Common symptoms of CVA?

A

Numb or weak feelings in face, hands, arms or legs
Sudden vision difficulties, inability to view or read properly
Confusion, slurred speech, inability to view or read properly
Severe headache appearing suddenly
Dizziness, difficulty walking

148
Q

FAST for CVA?

A

Face
Arms
Speech
Time

149
Q

Hospitals try to get CVA victim from the door of the hospital into surgery in what time frame?

A

60 minutes

150
Q

If patient has hemorrhagic stroke, what specific medication may be contraindicated?

A

Activase–contraindicated during active bleed

151
Q

Which specific seizures have an unknown classification?

A

Epileptic spasms

152
Q

If seizure activity starts in one area of the brain, it is classified as:

A

focal seizure

153
Q

If seizure activity involves both hemispheres of the brain, it is classified as:

A

generalized seizure

154
Q

Six types of generalized seizures:

A 
Myoclonic
Tonic clonic
Clonic
Tonic
Atonic
Absence
155
Q

Types of myoclonic seizures?

A

Myoclonic atonic

Myoclonic tonic

156
Q

Types of absense seizures?

A

Atypical absense
Myclonic absense
Eyelid myoclonia

157
Q

What naturally occurring hormone is a seizure treatment?

A

Adrenocorticotropic Hormone (ACTH)

158
Q

Which diets are effective for drug-resistant epilepsy?

A

Ketogenic

Modified Atkins

159
Q

Alzheimers is defined by the presence of what around the nerve cells in the brain?

A

Amyloid plaques

160
Q

Along with amyloid plaques, what other degenerations of the brain are present in Alzheimers patients?

A

Protein strands twist to damage brain cells

Brain cells die + areas of brain shrink

161
Q

At what age or older are you most at risk for Alzheimers?

A

65+

162
Q

Which disease manifests as severe cortical shrinkage, severe enlarged ventricles, and severe shrinkage of hippocampus?

A

Alzheimers

163
Q

Amyloid plaques cause what aspect of the brain to disintegrate?

A

Microtubules

164
Q

Which aspect of speech is compromised in MS patients?

A

Dysarthria–difficulty articulating words

165
Q

Which aspect of the throat is compromised in MS patients?

A

Dysphagia–difficultly swallowing

166
Q

Why might local anesthetics exacerbate symptoms in MS patients?

A

Due to increased sensitivity of demyelinated axons to local anesthetic toxicity

167
Q

Which neuromuscular blocking drugs may be used in MS patients?

A 
Non-depolarizing = non-issue
Depolarizing = w/ caution
168
Q

Which aspect of ERAS is especially important for MS patients?

A

Temperature maintenance

169
Q

Why must depolarizing NMBDs be used with caution in MS patients?

A

They may exacerbate hyperkalemia in these patients d/t atrophy in muscular tissue

170
Q

Which motor system is effected in Parkinson’s patients?

A

extrapyramidal motor system

171
Q

Which neurons are primarily effected in Parkinson’s patients?

A

Dopamineneurons in the substantia nigra

172
Q

Degeneration of dopamineneurons in substantia nigra leads to:

A

disruption in the ability to generate body movements

173
Q

Why should you continue dopamine treatment in Parkinson’s patients the day of surgery?

A

To stop them may cause rigidity, affecting ability to ventilate

174
Q

Manifested as flexed joints, tremors, mask-like face, and rigidity

A

Parkinson’s disease

175
Q

Progressive neurodegenerative disorder that exhibits a dominant pattern of inheritance

A

Huntington’s disease

176
Q

Huntington’s disease is most common in people of

A

Western European descent; 15:100,000

177
Q

When do symptoms of Huntington’s disease manifest?

A

In your 40s

178
Q

Disease characterized by abnormal movement, cognitive impairment, mood disorders, and behavioral changes

A

Huntington’s disease

179
Q

Life expectancy of Huntington’s patient?

A

15-18 years after onset of symptoms (mid-fifties to early sixties)

180
Q

A disease characterized by involuntary movements; chorea + dystonia

A

Huntington’s disease

181
Q

Progressive neuromuscular disorder characterized by degeneration of spinal motor neurons

A

Amyotrophic lateral sclerosis (ALS)

182
Q

Amyotrophic lateral sclerosis (ALS) leads to:

A

Denervation
Muscle wasting
Paralysis
Death

183
Q

Most common cause of death in patients with amyotrophic lateral sclerosis (ALS)?

A

Respiratory failure

184
Q

What causes muscle wasting in ALS patients?

A

Voluntary muscles no longer receive commands from brain; atrophy

185
Q

What is major cause of concern with anesthetics for ALS patients?

A

Respiratory depression

186
Q

Why is regional anesthesia contraindicated in ALS patients?

A

May exacerbate disease

187
Q

Acute inflammatory demyelinating polyneuropathy that is usually preceded by an infection such as campylobacter jejuni enteritis

A

Guillain-Barré syndrome

188
Q

Disease characterized by symmetrical muscle weakness that usually begins in legs an ascends from there, along with paresthesias in hands + feet

A

Guillain-Barré syndrome

189
Q

Treatment for GBS?

A

Plasma exchange

Intravenous immune globulin

190
Q

What types of drugs should be avoided in patients with GBS?

A

Depolarizing NMBDs

191
Q

Due to risk of autonomic instability, use ___________ ____________ with GBS patients.

A

invasive monitoring

192
Q

An autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigue

A

Myasthenia gravis

193
Q

Which muscles are commonly affected by myasthenia gravis?

A

Orbicularis oculi

Masseter

194
Q

Why does myasthenia gravis cause muscle weakness?

A

Receptors are blocked by antibodies in the body

195
Q

If patient has smoothing out of forehead, drooping eye, and drooping corner of mouth, you may suspect:

A

Myasthenia gravis

196
Q

Rule regarding depolarizing NMBDs in MG patients?

A

They will likely require higher dosing

197
Q

Rule regarding non-depolarizing NMBDs in MG patients?

A

They will likely be hypersensitive; only require 10% of normal dose

198
Q

What type of drug should be avoided in MG patients?

A

Cholinesterase inhibitors, like neostigmine

199
Q

Most common of several childhood muscular disorders

A

muscular dystrophy

200
Q

How is muscular dystrophy hereditary?

A

X-lined recessive trait

201
Q

Onset of muscular dystrophy?

A

Less than 6 years old; usually discovered around 3 yo

202
Q

Inherited disorder; progressive degeneration of muscle

A

Muscular dystrophy

203
Q

If child has delays in motor skill milestones, progressive muscle weakness in legs + pelvic muscles, loss of muscle mass, and abnormal bone development, suspect:

A

Muscular dystrophy

204
Q

At what age do MD patients require a brace to walk?

A

10 years old

205
Q

At what age are MD patients confined to a wheelchair?

A

12 years old

206
Q

Life expectancy of muscular dystrophy patient

A

Most don’t live past their 30s due to enlarged heart

207
Q

Which gender gets muscular dystrophy?

A

Males

208
Q

MD patients’ reaction to nondepolarizing NMBDs?

A

Heightened sensitivity

209
Q

MD patients + sux?

A

Resistance to blockade and delayed onset

210
Q

Inhalational agents + MD patients?

A

Reduce neuromuscular transmission

211
Q

Beware of which local anesthetics w/ MD patients?

A

Ester-derived

212
Q

Spinal cord injury at T6 or higher is called:

A

Autonomic dysreflexia

213
Q

Autonomic dysreflexia is triggered by:

A

sustained stimuli at T6 or below

214
Q

Patient with autonomic dysreflexia: at level above site of injury:

A

Vasodilation; sweating, increased heart rate, headaches

215
Q

Patient with autonomic dysreflexia: at level below site of injury:

A

Vasoconstriction; pale, cool, no sweating

Anes 540b Exam 1 (4 decks)

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