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CPA > Neurological System > Flashcards

Neurological System Flashcards

1
Q

Tone assessment (arm)

A

Assess in muscle groups of shoulder, elbow and wrist
1. Support patient’s arm by holding hand and elbow
2. Ask patient to relax and allow full control of their movement
3. Shoulder (circumduction), elbow (flexion/extension) and wrist (circumduction)

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2
Q

Tone abnormalities?

A

Spasticity
Rigidity
Cogwheeling hypotonia

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3
Q

Spasticity?

A

Pyramidal tract lesions

upper motor neurones exhibit inhibitory effect on lower motor neurones, so inhibition of upper MN = exaggerated muscle tone = hypertonia

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4
Q

Rigidity?

A

Extrapyramidal tract lesions (Parkinson’s)

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5
Q

Hypotonia?

A

Lower motor neurone lesion

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6
Q

Shoulder abduction myotome, muscle and instruction?

A

Myotome - C5

Muscles - deltoid

Instruction - flex elbows, apply downward resistance

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7
Q

Shoulder adduction myotome, muscles and instruction?

A

Myotome - C6 + C7

Muscles - teres major, lat. dorsi, pec. major

Instruction + bring elbows closer to body and apply upwards resistance

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8
Q

Elbow flexion myotome, muscles and instruction?

A

Myotome - C5/C6

Muscles - biceps brachii

Instruction - apply resistance by pushing forearm away

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9
Q

Elbow extension myotome, muscles and instruction?

A

Myotome - C7

Muscles - triceps brachii

Instruction - apply resistance by pushing towards

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10
Q

Wrist flexion myotome, muscles and instruction?

A

Myotome - C6/7

Muscles - flexors of wrist

Instruction - apply resistance downwards

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11
Q

Power scale?

A

MRC Muscle Power Scale

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12
Q

MRC 0/5?

A

No movement

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13
Q

MRC 1/5

A

Barest flicker of movement of muscle, though not enough to move the structure to which it’s attached

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14
Q

MRC 2/5

A

Voluntary movement which is not sufficient to overcome the force of gravity

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15
Q

MRC 3/5

A

Voluntary movement capable of overcoming gravity, but not applied resistance

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16
Q

MRC 4/5

A

Voluntary movement capable of overcoming resistamce

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17
Q

MRC 5/5

A

Normal strength

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18
Q

Biceps reflex

A

C5 + 6

Medial aspect of antecubital fossa

place non-dominant hand over tendon and tap thumb with tendon hammer

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19
Q

Triceps reflex?

A

C7 + 8

Superior to olecranon process of ulna

triceps tendon relaxed, rest elbow in 90 flexion on lap

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20
Q

Supinator reflex

A

C6

Brachioradialis tendon, found on posterolateral aspect of wrist, 4 inches away proximal to base of thumb

position 2 fingers over tendon, tap fingers with tendon hammer

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21
Q

LMN lesion?

A

Areflexia

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22
Q

UMN lesion?

A

Hyperreflexia

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23
Q

C5 sensation?

A

Lateral aspect of lower edge of deltoid muscle

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24
Q

C6 sensation?

A

Palmar side of thumb

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25
Q

C7 sensation?

A

Palmar side of middle finger

26
Q

C8 sensation?

A

Palmar side of little finger

27
Q

T1 sensation?

A

Medial aspect of antecubital fossa, proximal to medial epicondyle

28
Q

Tone steps (leg)

A
  1. Leg roll
  2. Leg lift - quickly lift leg off bed at knee joint, heel should remain in contact with the bed
  3. Ankle clonus - quickly dorsiflex and partially evert foot, clonus is felt but more than 5 is normal
29
Q

T2 sensation?

A

Axilla

30
Q

Hip joint flexion muscles and nerve?

A

Psoas major
Iliacus (sartorius, rectus femoris, pectineus)

Femoral nerve

31
Q

Hip extension muscle and nerve?

A

Gluteus maximus

inferior gluteal nerve

32
Q

Hip abduction muscles and nerve?

A

Gluteus medius and gluteus minimus

superior gluteal nerve

33
Q

Hip adduction muscles and nerve?

A

Adductor longus, adductor brevis, adductor magnus (pectineus, gracilis)

obturator nerve

34
Q

Internal rotation muscles

A

Obturators externus (all adductors, semitendinosus, semimembranosus)

35
Q

External rotation muscles?

A

Piriformis, obturator internus, gemellus superior and inferior, quadratus femoris

36
Q

Knee joint flexion muscles?

A

Biceps femoris, semitendinosus, semimembranosus and gracilis

37
Q

Knee joint extension muscles?

A

Quadriceps femoris

38
Q

Tremdelenburg test?

A
  1. Position hands on iliac crests
  2. Ask patient to life each foot in turn off of floor
  3. When right foot is raised, left hip abductors are tested. When left foot is raised, right hip abductors tested.
    if there is weakness in abductors, will be unable to stabilise hip on weight bearing femur so pelvis will sag towards unsupported side
39
Q

Quadriceps examination?

A

Knee extension - bend knee and ask patient to straighten whilst applying resistance

femoral nerve

40
Q

Hamstrings examination?

A

Instruct patient to begin flexing the knee towards themselves against resistance

sciatic nerve

41
Q

Assessing doriflexion?

A

Resist by pushing foot downwards
Tibialis anterior, extensor hallucis and extensor digitorum longus
Innervated by deep fibular nerve

42
Q

Assessing plantarflexion?

A

Resist by pushing foot upwards and ask patient to point foot downwards
Innervated by tibial nerve (S1-2)

43
Q

Assessing inversion?

A

Place hand laterally and instruct patient to push against applied resistance
takes place at subtalar joint

44
Q

Assessing eversion?

A

Place hand medial and instruct patient to push against applied resistance

45
Q

Patellar reflex tendon assessment?

A

Assess knee jerk (L3-L4)
legs hanging freely over base
Jendrassik manoeuvre (gritting teeth and flexing both sets of fingers)
Tap patellar tendon with tendon hammer

46
Q

Ankle jerk reflex

A

S1-2 at Achilles tendon
Support leg so hip is slightly abducted, knee is flexed and ankle dorsiflexed

47
Q

Sciatica

A

Caused by herniated lumbar intervertebral disc which compresses on L5-S1 component of sciatic nerve

48
Q

Borders of femoral triangle

A
  1. Inguinal ligament (superior)
  2. Adductor longus (medial)
  3. Sartorius (lateral)
49
Q

Dermatomes L1-S3 innervation?

A

L1 Area of inguinal ligament
L2 Lateral side of thigh
L3 Lower medial side of thigh
L4 Medial side of leg, medial foot and great toe
L5 Lateral side of leg, mid dorsum of foot and middle three toes
S1 Little toe, lateral foot, and sole footprint area
S2 Back of upper leg and whole thigh
S3 Area of gluteal fold

50
Q

Compartment syndrome meaning?

A

Pressure in muscle compartment is so high that the venous drainage becomes blocked - pressure increases such that muscle ischaemia and death can arrive

51
Q

Femoral nerve lesion motor loss?

A

Quadriceps paralysis - weakness of knee
Difficulty climbing up or down stairs

52
Q

Femoral nerve lesion sensory loss?

A

Anterior and medial thigh, medial side of leg and medial border of foot.
Saphenous nerve affected.

53
Q

Obturator nerve lesion motor loss?

A

Paralysis of all adductors
Cross legging affected

54
Q

Obturator nerve lesion sensory loss?

A

Pelvic disease, ovarian tumours may cause pain on medial thigh
Medial cutaneous nerve of thigh

55
Q

Common fibular nerve lesion motor loss?

A

Foot extensors and evertors paralysed
Foot flop
Perineal muscles (lateral compartment)
Tibialis anterior, EDL and EHL

56
Q

Common fibular nerve lesion sensory loss?

A

Loss in anterior and lateral side of leg and dorsal of foot

57
Q

Tibial nerve lesion motor loss?

A

Hamstrings and all posterior muscles of leg and sole of foot
Foot - in dorsiflexed and everted position
Gastrocnemius, soleus, tibialis posterior, FHL + FDL
Intrinsic foot flexors, interossei and lumbricals

58
Q

Tibial nerve lesion sensory loss?

A

Sole of foot

59
Q

Compartment syndrome causes?

A

Fractures, burns, infections or prolonged limb compression

Present with pain, muscle tenderness and swelling

60
Q

Compartment syndrome 6 Ps?

A

Pallor
Pulselessness
Paralysis
Perishingly cold
Pain
Paraesthesia

61
Q

Compartment syndrome examination?

A

Swollen limb and passive movement painful

62
Q

Compartment syndrome treatment?

A

Relieve pressure, all dressings, casts and slings removed
Open fasciotomy - surgical procedure where skin and deep fascia opened along the length of a muscle compartment to relieve pressure

CPA (9 decks)

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