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NEURO > Neurological Examination of Sensation, Reflexes, and Motor Function > Flashcards

Neurological Examination of Sensation, Reflexes, and Motor Function Flashcards

1
Q

what are the three types of primary or basic sensation

A
  1. exteroceptive-external stimuli; light touch, pain temp
  2. proprioceptive-stimuli from muscles, tendons, ligaments, joints, in relation to position and mvmt of body, limbs and digits. important for balance
  3. interoceptive-internal stimuli affecting visceral organs
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2
Q

cortical or combined sensation

A

-simultaneous perception of several basic stimuli integrated and interpreted at the cortical level

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3
Q

define paresthesia

A

pins and needles

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4
Q

define dysesthesia

A

uncomfy hypersensitivity to non-noxious stimuli

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5
Q

when do paresthesia and dysesthesias pop up

A

with various lesions of the sensory system, particularly with peripheral nerve disorders

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6
Q

clinical eval of exteroceptive sensation

A
  • light touch with cotton wisp
  • blunted safety pin for pain
  • cool metallic for temp sensation
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7
Q

how is vibration sensation assesed

A

128hz tuning fork to bony structure (ankle or knuckle)

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8
Q

clinical eval of proprioceptive sensation/position sense

A

raise/lower finger or toe…up/down

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9
Q

define stereognosis

A

tactile recognition of familiar object with eyes closed

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10
Q

define graphesthesia

A

id of numbers traced on palm with pts eyes closed

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11
Q

extinction on dbl simultaneous stimulation

A

d/t a contra parietal cortical lesion

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12
Q

two pt discrimination/fine touch

A

ability to detect simultaneous application of two sharp points separated by a small distance–usually a cortical sensation

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13
Q

in disorders of periph nerves; larger vs smaller sensory fibers

A
  • larger, more myelinated=impaired position sense and vibration
  • smaller, less myelinated=impaired temp and pain (or pin)
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14
Q

lesions of posterior or dorsal columns

A

deficits in position sense, vibration, and 2pt discrimination

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15
Q

lesions of spinothalamic tract

A

deficits in pain (pin) sensation and temp

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16
Q

mononeuropathy vs. polyneuropathy (peripheral neuropathy)

A
  • mono: sensation is decreased or lost in the territory of one peripheral nerve
  • poly: sensation is dec in several peripheral nerves=stocking and glove
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17
Q

spinal cord lesions (myelopathies)

A

-dissociation of sensation is characteristic (with loss of one modality of sensation with preservation of another)

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18
Q

intramedullary spinal cord lesions

A

occur within the sc parenchyma causing suspended or vestlike sensory loss and sacral (dermatome) sparing of sensory deficit

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19
Q

extramedullary spinal cord lesions

A

-compress the sc from outside, creating an initial sensory loss in sacral segments, progressing up “to a level” b/c of lamination of the STT

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20
Q

what causes a hemisensory (hemibody) deficit of basic sensations on the right or left side of the body including the face

A

contralateral THALAMIC lesion or involvement of sensory pathways to the contra parietal lobe

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21
Q

what does a lesions in the contra parietal sensory cortex cause

A

isolated or predominant deficits involving cortical or combined sensation typically occur on one side of the body

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22
Q

C5

A

lateral shoulder

23
Q

C6

A

thumb

24
Q

C7

A

index/middle fingers

25
Q

C8,T1

A

ring/little fingers

26
Q

T4

A

teat pore (nipple)

27
Q

T10

A

umbilicus (belly butTEN)

28
Q

L3,4

A

anterior thigh

29
Q

L5

A

dorsal foot

30
Q

S1

A

lateral foot/sole

31
Q

reflex

A

quick automatic replicable motor response or muscle contraction provoked by a stimulus

32
Q

muscle stretch reflexes (MSR)

A

-elicited by hammer tap of selected tendon

33
Q

tendon tap

A
  1. causes passive stretching of its muscle and neuromuscular spindles
  2. activates Ia sensory nerve fibers (afferent reflex arc)
  3. depolarization of alpha motor neurons (anterior horn cells) at the root level of the sc
  4. contraction on muscle fiver and visible muscle twitch (efferent reflex arc)
34
Q

define clonus

A

reflex followed by repetitive jerking movements

35
Q

MSR

A
  • biceps: C5,6 (pick up sticks)
  • brachioradialis (radial): C5,6
  • triceps: C7,8 (lay them straight)
  • finger flexors: C8,T1
  • quadriceps (patellar, knee jerk): L2,3,4 (kick the door)
  • achilles (ankle jerk): S1,2 (buckle my shoe)
36
Q

abnormalities of MSR

A
  • hyporeflexia/areflexia in polyneuropathy or radiculopathy
  • hyperreflexia in UMN lesion (inhibitory effect on local reflex circuit from descending supraspinal tracts is lessened)
  • asymmetrical hyperreflexia on one side of body 2/2 UMN lesion (corticospinal tract)
37
Q

CN-mediated superficial reflexes

A

-characteristically consensual, w/ b/l response to a u/l stimulus (ex corneal blink reflex)

38
Q

weird cutaneous reflexes that dont involve CN

A

abdominal reflex and cremasteric reflex

39
Q

CN superficial reflexes (4 total)–UNILATERAL afferent and BILATERAL efferent

A
  • pupillary: 2 sine light, 3 pupils constrict
  • corneal: 5 touch cornea, 7 eyes blink
  • palpebral: 5 touch eyelid/lash, 7 eyes blink
  • gag (pharyngeal): 9 touch pharynx, 10 gag
40
Q

Babinski sign

A
  • most important and reliable pathological reflex
  • indicates an UMN (corticospinal tract) lesion in the adult
  • nml in kids 1-2yo
  • not a monosynaptic MSR**
41
Q

meningeal signs

A

Kernig-when resistance to fully extending pt knee
Brudzinski-pts hips and knees flex after passive flex of neck
Lasegue-sign of nerve root irritation or compression

42
Q

pronator drift

A

suggests a subtle proximal upper limb weakness from a corticospinal tract lesion

43
Q

weakness of one limb

A
  • partial: monoparesis

- complete: monoplegia

44
Q

myelopathic weakness

A
  • from a b/l sc lesion may involve both lower limbs from a lesion at the thoracic level
  • partial: paraparesis
  • complete: paraplegia
45
Q

all four limbs weal from a cervical sc lesion

A

partial: quadriparesis
complete: quadriplegia

46
Q

UMN lesion in ipsi sc or contra brain or brainstem causes

A

partial (hemiparetic) or complete (hemiplegic) weakness of the upper and lower limbs on one side

47
Q

in a pt with muscle dz what does the typical myopathic pattern of weakness involve

A

proximal limbs at shoulders and hips

48
Q

in a pt with polyneuropathy (peripheral neuropathy) what is the patter of neuropathic weakness

A

distal-involving feet and later hands

49
Q

what are the two types of hypertonicity

A
  1. spasticity-unequal between agonist and antagonist muscles…clasp-knife spasticity
    - indicates UMN lesions involving pyramidal or corticospinal tract
  2. rigidity-lead pipe rigidity; constant in agonist and antagonist muscles
    - indicates lesion in EPS system
    - cogwheel rigidity-if tremor is present, passive limbs do this
50
Q

hypotonicity

A

decreased muscle tone usually from an afferent sensory or LMN lesion

51
Q

define fasciculation

A

spontaneous d/c of a motor unit (which consists of its LMN, axon, and all the muscle fibers it controls)

  • sign of denervation from a LMN lesion
  • can also occur with muscle fatigue
52
Q

define fibrillation

A
  • spontaneous twitch of an individual muscle fiber-only visible in tongue
  • sign of denervation from a LMN lesion
53
Q

spinal or neurogenic shock

A

in a sudden severe sc injury (typically from trauma), expected UMN clinical signs are initially absent only to gradually emerge days or weeks later
-therefore, in spinal shock paralysis is initially accompanied by diffuse hypotonia and areflexia

NEURO (21 decks)

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