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Neuro Flashcards

1
Q

What is tone?

A

A state of partial contraction present in a muscle in its passive state.

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2
Q

What is spasticity?

A

A state of increased tone of a muscle.

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3
Q

What is fasciculation?

A

Involuntary contractions or twitchings of groups of muscle fibers.

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4
Q

Upper Motor Neuron is characterized by?

A

UMN:

(1) + tone/spasticity.
(2) ↑ reflexes.
(3) − atrophy.
(4) − fasciculations.

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5
Q

Lower Motor Neuron is characterized by?

A

LMN:

(5) ↓ tone.
(6) + flaccidity.
(7) − reflexes.
(8) + atrophy.
(9) + fasciculations.

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6
Q

UMN disease is often the result of what 2 things?

A

stroke

brain injury

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7
Q

LMN disease can involve what 3 things?

A

Spinal Cord
Peripheral Nerve
Muscle

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8
Q

UE motor testing: First inspect the muscle for what 3 things?

A

(1) abnormal movements.
(2) bulk versus atrophy.
(3) tone versus spasticity versus flaccidity.

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9
Q

UE motor testing: Pronator Drift.

(1-4) Explain procedure.

(5) What is this test very sensitive for?
(6) Where might a patient with a + pronator drift have a lesion?

A

(1) Arms out straight.
(2) Palms up.
(3) Eyes closed.
(4) Watch for DRIFT of arm downward OR more subtle PRONATION.
(5) UE weakness.
(6) contralateral corticospinal tract lesion.

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10
Q

UE motor testing: Deltoids.
(1) Innervation?
(2-3) Explain procedure.

A

(1) C5.
(2) Arms straight or out to side.
(3) Don’t let me push them down.

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11
Q

UE motor testing: Biceps.
(1) Innervation?
(2-3) Explain procedure.

A

(1) C5,6.
(2) Make a muscle.
(3) Don’t let me straighten your arm.

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12
Q

UE motor testing: Triceps.
(1) Innervation?
(2-3) Explain procedure.

A

(1) C6,7.
(2) Straighten your elbow.
(3) Don’t let me bend it.

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13
Q

UE motor testing: Wrist extensors.
(1) Innervation?
(2-3) Explain procedure.

A

(1) C6,7.
(2) Put hand up like you’re trying to stop traffic.
(3) Don’t let me pull your hand down.

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14
Q

UE motor testing: Wrist flexors.
(1) Innervation?
(2-3) Explain procedure.

A

(1) C6, 7.
(2) Flex wrist.
(3) Don’t let me lift up your hand.

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15
Q

UE motor testing: Test for grip (finger flexion).
(1) Innervation?
(2-3) Explain procedure.

A

(1) C8.
(2) Give pt your index finger.
(3) Ask them to squeeze as hard as they can.
Won’t hurt you squeezing just one or two fingers

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16
Q

UE motor testing: Intrinsic muscles of the hand.
(1) Innervation?
(2-3) Explain procedure.

A

(1) T1.
(2) Fan fingers out.
(3) Don’t let me squeeze them back together.

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17
Q

UE motor testing: Test thumb opposition.
(1) Innervation?
(2-3) Explain procedure.

A

(1) C8, T1.
(2) Touch tip of thumb to pinky.
(3) Don’t let me separate them.

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18
Q

LE motor testing: Hip flexion.
(1) Innervation?
(2-4) Explain procedure.

A

(1) L2,3.
(2) Supine
(3) Lift leg off exam table.
(4) Don’t let me push your leg down.

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19
Q

LE motor testing: Adduction of hips.
(1) Innervation?
(2-3) Explain procedure.

A

(1) (L2,3,4).
(2) Spread legs.
(3) Try to bring them together while you hold apart.

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20
Q

LE motor testing: Abduction of hips .
(1) Innervation?
(2-3) Explain procedure.

A

1) (L4,5).
(2) Hold legs together.
(3) Ask pt to spread legs.

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21
Q

LE motor testing: Knee extension.
(1) Innervation?
(2-4) Explain procedure.

A

(1) (L3,4).
(2) Have pt lift leg.
(3) Examiner supports upper thigh.
(4) Examiner tries to bend knee against resistance.

22
Q

LE motor testing: Knee flexion.
(1) Innervation?
(2-3) Explain procedure.

A

(1) (L5, S1).
(2) Have pt flex knee.
(3) You try to straighten it against resistance.

23
Q

LE motor testing: Dorsiflexion of the foot.
(1) Innervation?
(2-3) Explain procedure.

A

(1) (L4,5).
(2) Have pt dorsiflex foot.
(3) Examiner tries to pull down.

24
Q

LE motor testing: Plantar flexion of the foot .
(1) Innervation?
(2-3) Explain procedure.

A

(1) (S1).
(2) Have pt push foot against your resistance
(3) “Push down like you are pushing on the gas pedal.”

25
LE motor testing: Extension of the great toe. (1) Innervation? (2-3) Explain procedure.
(1) (L5). (2) Pull great toe back towards head. (3) Examiner tries to straighten
26
LE motor testing: Extension of remaining toes (non-great toes). (1) Innervation? (2-3) Explain procedure.
(1) (L5, S1). (2) Pull toes back towards head. (3) Examiner tries to straighten them.
27
Motor Exam Grading System: (1) System grades strength on a scale of what range?
``` 0= no movement 1= trace or flicker of movement 2= patient able to move when gravity is eliminated 3= patient able to move against gravity 4= some weakness against resistance 5= patient able to move against resistance (normal strength) ```
28
Sensory Exam: Spinothalamic tract definition?
Sensory pathway of the spinal cord that transmits information about PAIN and TEMPERATURE.
29
Sensory Exam: Dorsal (posterior) column definition?
Sensory pathway of the spinal cord that transmits information about POSITION and VIBRATION.
30
Sensory Exam
Test UE, LE, trunk and specific dermatomes if there is a specific problem
31
Sensory Exam--Position test (proprioception)
Runs in the same tract (posterior column) as vibration. Test distal most portion of an extremity and if normal you can assume that proximal proprioception is intact Exquisitely sensitive sense so you can make small movements to test
32
Graphesthesia
draw number in patients palm and have them identify R & L
33
Stereognosis
ability to identify an item by touch alone – paper clip, coin, key – R & L
34
2 point discrimination
ability to identify two separate stimuli that are close together (use EKG calipers or clip)
35
extinction
lesions in the sensory cortex may cause a patient to “extinguish” one of two simultaneous contralateral stimuli
36
Tests for discriminatory senses
extinction 2 pt discrimination stereognosis graphesthesia
37
What does Romberg test test for?
Common misconception that the Romberg is a cerebellar test It is test of position sense not cerebellar function. Loss of coordination is called ataxia Patients who have ataxia as a result of a loss of proprioception will compensate for this loss with visual cues
38
Romberg test
Remove such a patients visual cues and they will fall (or at least lose their balance) Test is performed by having a patient stand with feet together and eyes open looking straight ahead. Then eyes closed The patient with true cerebellar ataxia will not be able to do this without falling
39
What is a positive Romberg test?
Positive Romberg is when patient falls with eyes closed – guard patient, prevent fall or injury!
40
Deep Tendon Reflex
Testing simple spinal reflex – even patients who are deeply comatose may have preserved DTR’s Tap tendon gently to elicit reflex Reflexes should be symmetrical – asymmetrical reflexes could be abnormal
41
How are deep Tendon Reflex recorded
``` 0 = no reflex 1= hyporeflexia – diminished reflex 2 = normoreflexia – normal reflex 3 = hyperreflexia – increased reflex 4 = marked hyperreflexia / clonus Use + or – to connote subtle variations ```
42
2 Superficial Reflexes
Superficial Abdominal Reflexes: Stroke 4 abdominal quadrants lightly and umbilicus will move toward the stimulus ``` Cremasteric Reflex (men only): Stroke inner upper thigh and ipsilateral testicle will move rostrally (superiorly) ```
43
Cerebellar Testing
Tests coordination Rapid Alternating Movements (RAM’s) Finger – nose – finger (FNF) HKS (heel knee shin)
44
How to assess a patients gait
Have patient heel/toe walking Walk on toes Walk on heels
45
Glabellar Sign
tap between eyebrows – abnormal response: pts eyes will blink rhythmically
46
Grasp Reflex
just like babies reflex but in adults this is pathological
47
Palmomental Reflex
scratch palm and patient will purse lips (may be very subtle movement)
48
Snout Reflex
tap mouth and pt will purse lips
49
Asterixis
flapping tremor of the hands seen in liver disease
50
2 Signs of Meningeal Irritation
Kernigs sign – flex hip and knee – straighten knee pt will resist and note pain behind knee (pain is the telling sign) Brudzinski sign – flex neck and patient will draw up hips and knees
51
Babinski Reflex
With patients foot relaxed briskly stroke lateral surface of sole and come across metatarsal heads. Normal response is for great toe to flex or be “down going.” This is called an ABSENT (not negative) Babinski

Neuro PT Assessment (2 decks)

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