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neurosensory testing Flashcards

1
Q

the sensory system is
responsible for…

A

receiving &
interpreting information
from the surrounding
environment

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2
Q

spinothalamic tract function

A

crude/coarse touch
pain
temperature

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3
Q

posterior/dorsal column function

A

light touch ID + localization
fine touch
vibration
proprioception (position sense)

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4
Q

2 subtracts of the spinothalamic tract

A

anterior spinothalamic tract
lateral spinothalamic tract

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5
Q

2 subtracts of the dorsal column pathway

A

fasciculus gracilis
fasciculus cuneatus

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6
Q

where does the posterior column tract cross?

A

it crosses the medulla

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7
Q

1st order neuron of the posterior column tract ends in the _____

A

medulla

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8
Q

stereognosis

A

object identification

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9
Q

graphesthesia

A

writing identification

“what letter am I drawing in your hand”

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10
Q

4 examples of higher level posterior column testing

A

stereognosis
graphesthesia
2-point discrimination
point localization

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11
Q

where does anterolateral spinothalamic tract cross?

A

crosses 1-2 segments above entry level
“early”

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12
Q

1st order neuron of the anterolateral spinothalamic tract ends in the _____

A

spinal cord

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13
Q

3 examples of anterolateral spinothalamic tract testing

A

monofilament testing
sharp/dull sensation
temperature

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14
Q

4 main types of somatosensory receptors

A

mechanoreceptors
thermal receptors
chemoreceptors
nociceptors

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15
Q

4 places of receptor locations

A

exteroceptors
muscle receptors
joint receptors
combination receptors

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16
Q

combination receptor function

A

higher level processing involving the cerebral cortex

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17
Q

exteroceptor examples

A

hair follicle endings
ruffini endings/merkel cells
pacinian/meissner corpuscles (vibration)
free nerve endings

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18
Q

joint receptor examples

A

golgi tendon organ
free nerve endings
ruffini
pacinian

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19
Q

sensory grading system (ASIA) rankings

A

0 = absent
1 = impaired
2 = normal
NT = not testable

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20
Q

would total numbness be found in dermatomal screening or peripheral nerve screening?

A

peripheral nerve screening

only decreased sensation in dermatome testing

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21
Q

myotome of C1/2

A

chin in/up

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22
Q

myotome of C3

A

cervical lateral flexion

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23
Q

myotome of C4

A

shoulder elevation

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24
Q

myotome of C5

A

shoulder abduction

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25
Q

myotome of C6

A

elbow flexion
or
wrist extension

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26
Q

myotome of C7

A

elbow extension
or
wrist flexion

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27
Q

myotome of C8

A

thumb extension

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28
Q

myotome of T1

A

finger abduction/adduction

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29
Q

myotome of L2

A

hip flexion

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30
Q

myotome of L3

A

knee extension

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31
Q

myotome of L4

A

ankle dorsiflexion

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32
Q

myotome of L5

A

great toe extension

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33
Q

myotome of S1

A

ankle plantarflexion
or
eversion

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34
Q

myotome of S2

A

knee flexion

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35
Q

in myotomes, why would you observe weakness, but not total paralysis?

A

muscles tend to be innervated by other nerve roots, not just the one you are testing

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36
Q

deep tendon reflex presentation of upper motor neuron legion vs lower motor neuron legion

A

UMNL = exaggerated reflex
LMNL = minimal or no reflex shown

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37
Q

deep tendon reflex grades (0-4+)

A

0 = no reflex
1+ = minimal response
2+ = normal
3+ = overly brisk response
4+ = extremely brisk response, clonus, or cross-over reaction

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38
Q

when to suspect serous pathology in hypertonic patients

A

when impairment is found bilaterally (B) with a combination of dermatome/myotome changes

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39
Q

CNS pathology typically found in hypo or hypertonic?

A

hypertonic

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40
Q

biceps tendon reflex and its nerve root

A

elbow flexion
C5

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41
Q

brachioradialis tendon reflex and its nerve root

A

elbow flexion
C6

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42
Q

triceps tendon reflex and its nerve root

A

elbow extension
C7

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43
Q

patellar tendon reflex and its nerve root

A

knee extension
L4

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44
Q

achilles tendon reflex and its nerve root

A

ankle plantarflexion
S1

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45
Q

CN I name + function (sensory/motor)

A

olfactory

sensory: smell
motor: n/a

46
Q

CN I testing procedures

A

block one nostril
pt eyes closed
they should be able to recognize smell of a common
object

47
Q

CN II name + function (sensory/motor)

A

optic nerve
sensory: vision, contralateral pupillary light reflex
motor: n/a

48
Q

CN II testing procedures

A

reading Snellen eye chart
peripheral visual field
pupil light reflex-contra

49
Q

basic procedure for snellen eye chart

A

standing 20’ away
one eye closed
can wear glasses
try to read the lowest one

50
Q

pupillary light reflex for CN II

A

shine the light into one eye, we check the opposite eye

IT SHOULD CONSTRICT

51
Q

CN III name + function (sensory/motor)

A

oculomotor

sensory: moves eyeball up, down (and all the other movements that VI and IV dont do)
motor: n/a

52
Q

CN III pupillary light reflex

A

shine light into one eye –> the pupil should constrict (same eye)

53
Q

3 eye movement cranial nerves

A

CN III = oculomotor
CN IV = trochlear
CN VI = abducens

54
Q

what 2 cranial nerves are responsible for pupillary response

A

CN II - optic
CN III - oculomotor

55
Q

CN IV function

A

down + in (look at nose)

56
Q

CN VI function

A

abducts eyeball

57
Q

CN III eye motor test

A

draw an H with finger and have pt track the letter with their eyes
(ASK ABT DOUBLE VISION)

58
Q

oculomotor palsy

A

dilated pupil
ptosis (drooping eyelid)
eye drifting lateral and down

59
Q

CN V name + function (sensory/motor)

A

trigeminal nerve

motor: jaw clenching and lateral movement
sensory: facial and tongue sensation

60
Q

CN V testing for motor

A

Palpate masseter and temporalis as patient clenches jaw

61
Q

CN V sensory testing

A

Light touch assessment along 3 nerve branches

62
Q

CN V reflex testing

A

Place finger on patient’s chin and lightly tap finger with reflex hammer

(normal should show slight jaw protrusion)

63
Q

CN VII name + function (sensory/motor)

A

facial nerve

sensory: taste front 2/3 of tongue
motor: facial movements and expressions

64
Q

CN VII autonomic function

A

saliva
tears
nasal mucosa production

65
Q

CN V reflex

66
Q

CN VII sensory testing

A

pt eyes closed
place drops of sweet, sour, or salt onto the pt’s tongue

Patient must identify the type of taste

67
Q

CN VII motor testing

A

have pt raise eyebrows, close eyes shut tight, smile/frown, puff out cheeks

Look for asymmetries!!

68
Q

Bell’s Palsy

A

peripheral facial nerve impairment that causes:

  1. motor-paralysis of half the face (motor loss on side of affected nerve)
  2. loss of taste on front 2/3 of tongue
  3. loss of tear production + reduced saliva (parasympathetic)
69
Q

CN VIII name + function (sensory/motor)

A

vestibulocochlear

sensory: hearing, balance, equilibrium
motor: n/a

70
Q

CN VIII testing

A

finger rub test
weber test
rinne test

71
Q

weber test

A

test for CN VIII
place tuning fork on top of head
pt should hear it equally in both ears

72
Q

rinne test

A

test for CN VIII
tuning fork on mastoid (bone conduction)
tuning fork by ear (air conduction)

73
Q

CN IX name + function (sensory/motor)

A

glossopharyngeal

sensory: taste for sour/bitter on posterior 1/3 of tongue + sensation of posterior ear drum/ear canal
motor: control of pharynx

74
Q

CN IX autonomic function

A

saliva production

75
Q

CN IX sensory testing

A

place drop of sour or bitter liquid on posterior 1/3 of tongue

76
Q

CN IX motor testing

A

ask patient to swallow (tested w vagus)
test gag reflex (not recommended)

77
Q

CN X name + function (sensory/motor)

A

vagus

sensory: pharynx and larynx
motor: palate, pharynx and larynx

78
Q

CN X autonomic funciton

A

regulates HR, breathing, digestion and other involuntary organ actions

79
Q

CN X motor testing

A

ask pt to open mouth and say “AHHH” to check for any uvula deviations
or
ask pt to swallow multiple times

80
Q

when the tongue deviates, does it deviate toward the weaker or stronger side?

81
Q

CN XI name + function (sensory/motor)

A

spinal accessory nerve

sensory: n/a
motor: SCM and Traps

82
Q

CN XI testing

A

ask pt to shrug shoulders –> we try to push down
or
ask pt to slightly flex head and contralaterally rotate –> we test in opposite direction for SCM function

83
Q

CN XII name + function (sensory/motor)

A

hypoglossal

sensory: n/a
motor: tongue movements

84
Q

CN XII testing

A

pt stick out tongue + note any lateral deviations

(direction tongue points is the side of the legion)

85
Q

when the uvula deviates, does it deviate toward the weaker or stronger side?

A

STRONGER side

86
Q

MOIs of cerebellar dysfunction (5)

A

Parkinson’s
tumor
trauma to the back of head
chronic alcoholism
infarction

87
Q

global signs of cerebellar dysfunction (5)

A

ataxia
tremors
hypotonia (little to no reflexes)
dysarthria (hard to make sounds/producing speech)
eye deviations

88
Q

3 things you must test when testing for cerebellar dysfunction

A

upper extremity
lower extremity
unsupported stance or gait

89
Q

ataxia

A

lack of control of body movements with decreased coordination

90
Q

dysmetria

A

error in trajectory due to an abnormal range, rate, and/or force of motion

ex: can’t touch nose to finger

91
Q

dysdiadochokinesia

A

impaired ability to perform rapid altering movements

ex: flipping hands sup/pro quickly

92
Q

3 upper extremity tests for cerebellar dysfunction

A

rapid alternating movement
finger opposition
finger to nose (eyes open or closed)

93
Q

4 lower extremity tests for cerebellar dysfunction

A

rapid alternating movements
heel to shin
toe tapping
toe to clinician finger

94
Q

special standing tests for cerebellar dysfunction

A

romberg test
tandem romberg test

95
Q

romberg test

A

standing test for cerebellar dysfunction

patient stands unsupported with feet together for 30 seconds

96
Q

tandem romberg test

A

standing test for cerebellar dysfunction

patient stands tandem for 30 seconds

97
Q

2 ways to get Bell’s palsy

A

untreated ear infection
stress

98
Q

does Bell’s palsy affect the ipsi or contralateral side

A

IPSILATERAL side

99
Q

5 signs of UPPER motor neuron lesions

A

hyperreflexia
pathologic reflexes (clonus, hoffman’s, etc)
increased muscle tone/spasticity
underlying weakness
sensory changes (depends where legion is)

100
Q

clonus

A

rapid, reflexive, back + forth motion that continues for multiple cycles

101
Q

3 examples of diseases that affect upper motor neurons

A

Parkinson’s
MS
Cerebellar dysfunction

102
Q

4 characteristics of LOWER motor neuron lesions

A

hyporeflexia
muscle weakness
muscle atrophy
sensory changes along dermatome/peripheral nerve distribution

103
Q

is bell’s palsy due to upper or lower motor neuron lesion

A

LOWER!! because there is weakness/droopiness and atrophy in the face

104
Q

is clonus an example of upper or lower motor legion

A

UPPER!
uncontrolled, rapid, exaggerated contractions

105
Q

how to test clonus reflexes (and what is a positive test)

A

moving abkle gently into dorsi/plantarflexion
then
do a rapid motion into dorsiflexion

positive = oscillations/beats into plantarflexion

106
Q

pronator drift test (and what is a positive test)

A

90* shoulder flexion + forearm supination
hold for 20 sec with eyes closed

positive = one or both arms drops out of flexion (usually pronation + drop and sometimes elbow flexion)

107
Q

babinski reflex is normal in which population

108
Q

babinski reflex test (and what is a positive test)

A

patient in supine
scratch starting from heel in a C shape ending by the big toe

positive = the great toe extends and the toes splay (and could withdraw extremity)

109
Q

babinski reflex happens ipsilaterally or contralaterally from legion

A

CONTRALATERALLY from legion
(anything not in face or head will be contralateral presentation)

110
Q

Hoffman’s test (and what is a positive test)

A

relax patient hand
grab 3rd digit at DIP
press down on fingernail then slide off fingernail

positive = thumb flexes and adducts or the second digit flexes
“C” shaped or bear claw looking hand

111
Q

shimizu reflex test (and what is a positive test)

A

reflex hammer is tapped on scapular spine down to acromion process

positive = scapular elevation or humeral abduction

112
Q

order to perform the 8 tests in clinic (out of ALL the ones we learned)

A
  1. dermatome screen
  2. determine derm vs peripheral nerve with PRN
  3. confirm finding with opposite spinal tract
  4. myotome screen
  5. reflex testing
  6. ROM screen
  7. ROM testing
  8. Muscle Testing PRN

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