Nerve + Musculoskeletal Exam Flashcards
1
Q
What are the three basic functions of the nervous system?
A
Sensory, Integrative, Motor
2
Q
Which neurons are specific to the sensory function of the nervous system?
A
Afferent neurons
3
Q
Which neurons detect internal and external stimuli? On behalf of which function of the nervous system?
A
Afferent neurons; sensory function
4
Q
Which neurons are specific to the integrative function of the nervous system?
A
Interneurons
5
Q
Which neurons process, analyze, and store information? On behalf of which function of the nervous system?
A
Interneurons; integrative function
6
Q
Which function of the nervous system involves interneurons?
A
Integrative
7
Q
Which function of the nervous system involves afferent neurons?
A
Sensory
8
Q
Which function of the nervous system involves efferent neurons?
A
Motor
9
Q
Which neurons respond to integrated decisions? On behalf of which function of the nervous system?
A
Efferent neurons; motor function
10
Q
Which neurons are specific to the motor function of the nervous system?
A
Efferent neurons
11
Q
Which neurons carry information to cells of the body?
A
Efferent neurons
12
Q
What are the two parts of the nervous system?
A
1) Central nervous system
2) Peripheral nervous system
13
Q
Which nervous system includes the brain and spinal cord?
A
CNS
14
Q
The CNS includes the:
A
brain and spinal cord
15
Q
Which nervous system integrates and correlates incoming sensory information?
A
CNS
16
Q
Which nervous system is responsible for thoughts, emotions, and memories?
A
CNS
17
Q
Which nervous system controls muscle contraction + glandular secretions?
A
CNS
18
Q
From where to where does the spinal cord run?
A
From the medulla to the 1st or 2nd lumbar vertebrae
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
20
Q
What mediates reflex activity of the deep tendon reflexes?
A
Spinal cord
21
Q
Which type of nerve controls deep tendon reflexes?
A
Spinal nerve
22
Q
What are the five segments of the spinal cord?
A
C1-7; T1-12; L1-5; S1-5; coccygeal
23
Q
What level is the cauda equina?
A
L1-L2
24
Q
What does cauda equina mean?
A
horse tail
25
What is cauda equina syndrome?
Back pain and saddle anesthesia at S3-S5
26
In cauda equina syndrome, which parts of the body feel pain?
Perineum, external genitalia, anus
27
Where are most lumbar punctures performed?
At the L2-L4 interspace
28
Which nervous system includes spinal nerves, cranial nerves, ganglia, and sensory receptors?
PNS
29
Parts of the peripheral nervous system?
Somatic nervous system
Autonomic nervous system
Enteric nervous system
30
Which aspect of the PNS serves as the "pacemaker of the gut"?
Enteric nervous system
31
How many pairs of cranial nerves are there? How many come from the brainstem?
12 pairs; 10 from brainstem
32
Which cranial nerve is responsible for sense of smell?
CN I; olfactory nerve
33
Which cranial nerve is responsible for visual acuity and visual fields?
CN II; optic nerve
34
Which cranial nerve is responsible for pupillary movements, extraocular movements?
CN III; oculomotor nerve
35
In addition to CN VI, which cranial nerve is responsible for extraocular movements only?
CN IV; trochlear nerve
36
Which cranial nerve is responsible for corneal reflexes, facial sensation, jaw movements, voice and speech?
CN V; trigeminal nerve
37
In addition to CN IV, which cranial nerve is responsible for extraocular movements only?
CN VI; abducens nerve
38
Which cranial nerve is responsible for facial movements, voice and speech?
CN VII; facial nerve
39
Which cranial nerve is responsible for hearing and balance?
CN VIII; vestibular nerve
40
Which cranial nerve is responsible for swallowing and rise of palate, gag reflex?
CN IX; glossopharyngeal nerve
41
Which cranial nerve is responsible for voice and speech, swallowing and rise of the palate, gag reflex?
CN X; vagus nerve
42
Which cranial nerve is responsible for shoulder and neck movements?
CN XI; accessory nerve
43
Which cranial nerve is responsible for tongue symmetry and position, voice and speech?
CN XII; hypoglossal nerve
44
How many pairs of spinal nerves are there?
31 pairs
45
How many cervical nerves are there?
8
46
How many thoracic nerves are there?
12
47
How many lumbar nerves are there?
5
48
How many sacral nerves are there?
5
49
How many coccygeal nerves are there?
1
50
Each spinal nerve has two roots:
Anterior (Ventral) + Posterior (Dorsal)
51
Dorsal root =
sensory
52
Ventral root =
motor
53
How do sensory nerve fibers send an impulse to the spinal cord?
Via peripheral nerve
54
From the spinal cord, where does a signal travel?
To anterior horn where sensory fiber synapses with cell innervating same muscle
55
When does the muscle contract?
When the impulse crosses the neuromuscular junction
56
What completes the reflex arc?
Contraction of muscle
57
Which reflex affects T7-9?
Upper abdominal
58
Which reflex affects T10-11?
Lower abdominal
59
Which reflex affects T12, L1-2 in males?
Cremaster
60
Which reflex affects L4-5, S1-2?
Plantar
61
Which reflexes affect C5-6?
Biceps and brachioradialis
62
How to test biceps reflex?
Put your thumb on patient's biceps tendon and hit it with a hammer; the arm should fly up.
63
How to test brachioradialis reflex?
Have patient pronate arm on their lap and hit inches above wrist; should see subtle rotation
64
Which reflex affects C6-8?
Triceps
65
When you hit the triceps tendon, the patient's arm will move
laterally
66
Which reflex affects L2-4?
Patellar
67
In which direction should toe move during a patellar reflex test?
Downward
68
If a toe moves upward during patellar reflex test:
positive Babinski sign
69
Which reflex affects S1-2?
Achilles
70
A band of skin innervated by the sensory root of a single spinal nerve
dermatome
71
Carpal tunnel syndrome is due to
median nerve compression
72
Example of virus that hibernates in nerve ganglia
Varicella zoster, chicken pox and herpes zoster
73
Herpes zoster manifests itself on what region of body most commonly?
Thoracic
74
Questions you should ask if your patient has h/o seizures?
Type of? Medications? Occur on one side of body? Last seizure?
75
What are the five levels of consciousness?
```
Alert
Lethargy
Obtundation
Stupor
Coma
```
76
Level of consciousness where patient will recognize you when you speak in a normal voice
Alert
77
Level of consciousness where patient will recognize you when you speak in a loud voice
Lethargy
78
Level of consciousness where patient is aroused with gentle shaking
Obtundation
79
Level of consciousness where patient is aroused with painful stimuli
Stupor
80
Level of consciousness where patient is not arousable with painful stimuli
Coma
81
Maximum score on Glasgow coma scale
15
82
Minimum score on Glasgow coma scale
3
83
What are two ways you may assess your patient's attention level?
Ask them to repeat a series of digits.
| Ask them to spell WORLD backwards
84
Best way to test patient comprehension level?
Ask them to follow a three-step command
85
Drawing a clock assesses what part of mental status?
Memory--constructional ability
86
Proverbs assess what part of mental status?
Higher cognitive abilities
87
What are three cortical functions that may be compromised by subpar mental status?
Ideomotor apraxia
Ideational apraxia
Right to left orientation
88
How to test CN I (olfactory)?
Have patient identify familiar odors, one nostril at a time, eyes closed
89
How to test CN II (optic)?
Test visual acuity and visual fields.
90
How to test CN III, IV, VI?
Observe pupil size, shape, and reaction to light.
Check for drooping eyelid.
Test extraocular movements.
91
Which nerve is tested by palpating strength of muscle contractions over temporal and masseter areas while patient clenches teeth?
CN V; trigeminal nerve
92
Which nerve is tested by inspecting for symmetry in facial expressions?
CN VII; facial nerve
93
How to test CN VIII (acoustic)?
Test hearing
94
Which nerves are tested by assessing voice quality, observing swallow, testing gag reflex, and movement of the soft palate and uvula with phonation?
CN IX, X; glossopharyngeal and vagus nerves
95
Which nerve is tested by inspecting for atrophy or fasciculation in trapezius muscles, testing strength and contraction of trapezius and sternomastoid muscles?
CN XI; spinal accessory nerve
96
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?
CN XII; hypoglossal nerve
97
How is muscle strength tested? What defines normal
Graded on scale of 0 to 5
| Score of 5 = normal
98
0 on muscle scale =
no muscular contraction
99
3 on muscle scale =
active movement against gravity
100
5 on muscle scale =
active movement against resistance
101
If you observe your patient making rapid alternating movements, observe their gait, and observe them standing in specific positions, you are testing their:
coordination
102
Under what conditions do you test a patient's sensory system?
Patient's eyes are closed; compare symmetrical areas on patient
103
What are five aspects of the sensory system we test?
```
Light tough
Superficial pain
Temperature
Vibration
Position
```
104
How do you test vibration in sensory exam?
Use a tuning fork over interphalangeal joints of the hands and feet
105
How do you test position?
Use great toe and ring finger; have patients distinguish between whether those two digits are pointing up or down.
106
What are the five discriminative sensations?
```
Stereognosis
Graphesthesia
Two-point localization
Point localization
Extinction
```
107
How to test sterognosis?
Identification of familiar objects in patient's hand
108
How to test graphesthesia?
Write on patient's hand with something blunt and have them identify what number or letter you wrote
109
How to test two-point localization?
Find the minimal distance on a patient's finger or thumb that they are able to discriminate between two points
110
How to test point localization?
Patient identifies where you have touched them briefly
111
How to test extinction?
Simultaneously touch two spots on body and have patient point to location that was touched
112
Which systems are in charge of coordination?
Cerebellar system, motor system, vestibular system + sensory system
113
What are three areas of testing for coordination?
Rapid alternating movements
Point-to-point testing
Equilibrium
114
How to test equilibrium?
Observe normal gait, heel-to-toe, walk on toes and on heels
115
What kind of scale are reflexes graded on?
0-4+ scale
116
Reflex with 4+ grade:
Very brisk, hyperactive with clonus
117
Reflex with 3+ grade:
Brisker than average, possibly indicative of disease
118
Reflex with 2+ grade:
Average, normal
119
Reflex with 1+ grade:
Somewhat diminished, low normal
120
Reflex with 0 grade:
No response
121
Normal reflex grade?
2+
122
A ROM exam can also test?
Strength of muscles
123
Two pairs of possible movements in fingers?
Flexion/extension
| Abduction/adduction
124
Three types of movements in thumbs?
Flexion/extension
Abduction/adduction
Opposition
125
Two types of movements in wrist?
Flexion/extension
| Radial/ulnar deviation
126
Type of movement in wrist?
Pronation/supination
127
Type of movement in elbow?
Flexion/extension
128
Type of movements in shoulder?
Flexion/extension
Internal/external rotation
Abduction/adduction
129
Type of movements in neck?
Flexion/extension
Right/left bending
Right/left rotation
130
Type of movement in toes?
Flexion/extension
131
Type of movements in ankle?
Inversion/eversion
| Dorsiflexion/plantar flexion
132
Type of movement in knee?
Flexion/extension
133
Type of movements in hip?
Flexion/extension
Abduction/adduction
Internal/external rotation
134
Type of movements in spine?
Flexion/extension
Right/left bending
Right/left rotation
135
The ROM the patient is able to accomplish on their own
Active ROM
136
The ROM when the examiner manipulates the joint
Passive ROM
137
Grading of muscle strength is on a scale of:
0-5
138
The muscle can move the joint it crosses through a FROM, against gravity, and against resistance. Score?
5
139
The muscle can move the joint it crosses through a FROM against moderate resistance. Score?
4
140
The muscle can move the joint it crosses through a FROM against gravity but without any resistance. Score?
3
141
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?
2
142
Muscle contraction is seen or identified with palpitation but it is insufficient to produce joint motion even with elimination of gravity. Score?
1
143
No muscle contraction is seen or identified with palpation; paralysis. Score?
0
144
In what type of stroke does a weakened/diseased blood vessel rupture, causing blood to leak into brain tissue?
Hemorrhagic stroke
145
In what type of stroke do blood clots stop the flow of blood to an area of the brain?
Ischemic stroke
146
Another name for stroke?
Cerebral vascular accident (CVA)
147
Common symptoms of CVA?
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
FAST for CVA?
Face
Arms
Speech
Time
149
Hospitals try to get CVA victim from the door of the hospital into surgery in what time frame?
60 minutes
150
If patient has hemorrhagic stroke, what specific medication may be contraindicated?
Activase--contraindicated during active bleed
151
Which specific seizures have an unknown classification?
Epileptic spasms
152
If seizure activity starts in one area of the brain, it is classified as:
focal seizure
153
If seizure activity involves both hemispheres of the brain, it is classified as:
generalized seizure
154
Six types of generalized seizures:
```
Myoclonic
Tonic clonic
Clonic
Tonic
Atonic
Absence
```
155
Types of myoclonic seizures?
Myoclonic atonic
| Myoclonic tonic
156
Types of absense seizures?
Atypical absense
Myclonic absense
Eyelid myoclonia
157
What naturally occurring hormone is a seizure treatment?
Adrenocorticotropic Hormone (ACTH)
158
Which diets are effective for drug-resistant epilepsy?
Ketogenic
| Modified Atkins
159
Alzheimers is defined by the presence of what around the nerve cells in the brain?
Amyloid plaques
160
Along with amyloid plaques, what other degenerations of the brain are present in Alzheimers patients?
Protein strands twist to damage brain cells
| Brain cells die + areas of brain shrink
161
At what age or older are you most at risk for Alzheimers?
65+
162
Which disease manifests as severe cortical shrinkage, severe enlarged ventricles, and severe shrinkage of hippocampus?
Alzheimers
163
Amyloid plaques cause what aspect of the brain to disintegrate?
Microtubules
164
Which aspect of speech is compromised in MS patients?
Dysarthria--difficulty articulating words
165
Which aspect of the throat is compromised in MS patients?
Dysphagia--difficultly swallowing
166
Why might local anesthetics exacerbate symptoms in MS patients?
Due to increased sensitivity of demyelinated axons to local anesthetic toxicity
167
Which neuromuscular blocking drugs may be used in MS patients?
```
Non-depolarizing = non-issue
Depolarizing = w/ caution
```
168
Which aspect of ERAS is especially important for MS patients?
Temperature maintenance
169
Why must depolarizing NMBDs be used with caution in MS patients?
They may exacerbate hyperkalemia in these patients d/t atrophy in muscular tissue
170
Which motor system is effected in Parkinson's patients?
extrapyramidal motor system
171
Which neurons are primarily effected in Parkinson's patients?
Dopamineneurons in the substantia nigra
172
Degeneration of dopamineneurons in substantia nigra leads to:
disruption in the ability to generate body movements
173
Why should you continue dopamine treatment in Parkinson's patients the day of surgery?
To stop them may cause rigidity, affecting ability to ventilate
174
Manifested as flexed joints, tremors, mask-like face, and rigidity
Parkinson's disease
175
Progressive neurodegenerative disorder that exhibits a dominant pattern of inheritance
Huntington's disease
176
Huntington's disease is most common in people of
Western European descent; 15:100,000
177
When do symptoms of Huntington's disease manifest?
In your 40s
178
Disease characterized by abnormal movement, cognitive impairment, mood disorders, and behavioral changes
Huntington's disease
179
Life expectancy of Huntington's patient?
15-18 years after onset of symptoms (mid-fifties to early sixties)
180
A disease characterized by involuntary movements; chorea + dystonia
Huntington's disease
181
Progressive neuromuscular disorder characterized by degeneration of spinal motor neurons
Amyotrophic lateral sclerosis (ALS)
182
Amyotrophic lateral sclerosis (ALS) leads to:
Denervation
Muscle wasting
Paralysis
Death
183
Most common cause of death in patients with amyotrophic lateral sclerosis (ALS)?
Respiratory failure
184
What causes muscle wasting in ALS patients?
Voluntary muscles no longer receive commands from brain; atrophy
185
What is major cause of concern with anesthetics for ALS patients?
Respiratory depression
186
Why is regional anesthesia contraindicated in ALS patients?
May exacerbate disease
187
Acute inflammatory demyelinating polyneuropathy that is usually preceded by an infection such as campylobacter jejuni enteritis
Guillain-Barré syndrome
188
Disease characterized by symmetrical muscle weakness that usually begins in legs an ascends from there, along with paresthesias in hands + feet
Guillain-Barré syndrome
189
Treatment for GBS?
Plasma exchange
| Intravenous immune globulin
190
What types of drugs should be avoided in patients with GBS?
Depolarizing NMBDs
191
Due to risk of autonomic instability, use ___________ ____________ with GBS patients.
invasive monitoring
192
An autoimmune neuromuscular disease leading to fluctuating muscle weakness and fatigue
Myasthenia gravis
193
Which muscles are commonly affected by myasthenia gravis?
Orbicularis oculi
| Masseter
194
Why does myasthenia gravis cause muscle weakness?
Receptors are blocked by antibodies in the body
195
If patient has smoothing out of forehead, drooping eye, and drooping corner of mouth, you may suspect:
Myasthenia gravis
196
Rule regarding depolarizing NMBDs in MG patients?
They will likely require higher dosing
197
Rule regarding non-depolarizing NMBDs in MG patients?
They will likely be hypersensitive; only require 10% of normal dose
198
What type of drug should be avoided in MG patients?
Cholinesterase inhibitors, like neostigmine
199
Most common of several childhood muscular disorders
muscular dystrophy
200
How is muscular dystrophy hereditary?
X-lined recessive trait
201
Onset of muscular dystrophy?
Less than 6 years old; usually discovered around 3 yo
202
Inherited disorder; progressive degeneration of muscle
Muscular dystrophy
203
If child has delays in motor skill milestones, progressive muscle weakness in legs + pelvic muscles, loss of muscle mass, and abnormal bone development, suspect:
Muscular dystrophy
204
At what age do MD patients require a brace to walk?
10 years old
205
At what age are MD patients confined to a wheelchair?
12 years old
206
Life expectancy of muscular dystrophy patient
Most don't live past their 30s due to enlarged heart
207
Which gender gets muscular dystrophy?
Males
208
MD patients' reaction to nondepolarizing NMBDs?
Heightened sensitivity
209
MD patients + sux?
Resistance to blockade and delayed onset
210
Inhalational agents + MD patients?
Reduce neuromuscular transmission
211
Beware of which local anesthetics w/ MD patients?
Ester-derived
212
Spinal cord injury at T6 or higher is called:
Autonomic dysreflexia
213
Autonomic dysreflexia is triggered by:
sustained stimuli at T6 or below
214
Patient with autonomic dysreflexia: at level above site of injury:
Vasodilation; sweating, increased heart rate, headaches
215
Patient with autonomic dysreflexia: at level below site of injury:
Vasoconstriction; pale, cool, no sweating
