neurosensory testing Flashcards
1
Q
the sensory system is
responsible for…
A
receiving &
interpreting information
from the surrounding
environment
2
Q
spinothalamic tract function
A
crude/coarse touch
pain
temperature
3
Q
posterior/dorsal column function
A
light touch ID + localization
fine touch
vibration
proprioception (position sense)
4
Q
2 subtracts of the spinothalamic tract
A
anterior spinothalamic tract
lateral spinothalamic tract
5
Q
2 subtracts of the dorsal column pathway
A
fasciculus gracilis
fasciculus cuneatus
6
Q
where does the posterior column tract cross?
A
it crosses the medulla
7
Q
1st order neuron of the posterior column tract ends in the _____
A
medulla
8
Q
stereognosis
A
object identification
9
Q
graphesthesia
A
writing identification
“what letter am I drawing in your hand”
10
Q
4 examples of higher level posterior column testing
A
stereognosis
graphesthesia
2-point discrimination
point localization
11
Q
where does anterolateral spinothalamic tract cross?
A
crosses 1-2 segments above entry level
“early”
12
Q
1st order neuron of the anterolateral spinothalamic tract ends in the _____
A
spinal cord
13
Q
3 examples of anterolateral spinothalamic tract testing
A
monofilament testing
sharp/dull sensation
temperature
14
Q
4 main types of somatosensory receptors
A
mechanoreceptors
thermal receptors
chemoreceptors
nociceptors
15
Q
4 places of receptor locations
A
exteroceptors
muscle receptors
joint receptors
combination receptors
16
Q
combination receptor function
A
higher level processing involving the cerebral cortex
17
Q
exteroceptor examples
A
hair follicle endings
ruffini endings/merkel cells
pacinian/meissner corpuscles (vibration)
free nerve endings
18
Q
joint receptor examples
A
golgi tendon organ
free nerve endings
ruffini
pacinian
19
Q
sensory grading system (ASIA) rankings
A
0 = absent
1 = impaired
2 = normal
NT = not testable
20
Q
would total numbness be found in dermatomal screening or peripheral nerve screening?
A
peripheral nerve screening
only decreased sensation in dermatome testing
21
Q
myotome of C1/2
A
chin in/up
22
Q
myotome of C3
A
cervical lateral flexion
23
Q
myotome of C4
A
shoulder elevation
24
Q
myotome of C5
A
shoulder abduction
25
myotome of C6
elbow flexion
or
wrist extension
26
myotome of C7
elbow extension
or
wrist flexion
27
myotome of C8
thumb extension
28
myotome of T1
finger abduction/adduction
29
myotome of L2
hip flexion
30
myotome of L3
knee extension
31
myotome of L4
ankle dorsiflexion
32
myotome of L5
great toe extension
33
myotome of S1
ankle plantarflexion
or
eversion
34
myotome of S2
knee flexion
35
in myotomes, why would you observe weakness, but not total paralysis?
muscles tend to be innervated by other nerve roots, not just the one you are testing
36
deep tendon reflex presentation of upper motor neuron legion vs lower motor neuron legion
UMNL = exaggerated reflex
LMNL = minimal or no reflex shown
37
deep tendon reflex grades (0-4+)
0 = no reflex
1+ = minimal response
2+ = normal
3+ = overly brisk response
4+ = extremely brisk response, clonus, or cross-over reaction
38
when to suspect serous pathology in hypertonic patients
when impairment is found bilaterally (B) with a combination of dermatome/myotome changes
39
CNS pathology typically found in hypo or hypertonic?
hypertonic
40
biceps tendon reflex and its nerve root
elbow flexion
C5
41
brachioradialis tendon reflex and its nerve root
elbow flexion
C6
42
triceps tendon reflex and its nerve root
elbow extension
C7
43
patellar tendon reflex and its nerve root
knee extension
L4
44
achilles tendon reflex and its nerve root
ankle plantarflexion
S1
45
CN I name + function (sensory/motor)
olfactory
sensory: smell
motor: n/a
46
CN I testing procedures
block one nostril
pt eyes closed
they should be able to recognize smell of a common
object
47
CN II name + function (sensory/motor)
optic nerve
sensory: vision, contralateral pupillary light reflex
motor: n/a
48
CN II testing procedures
reading Snellen eye chart
peripheral visual field
pupil light reflex-contra
49
basic procedure for snellen eye chart
standing 20' away
one eye closed
can wear glasses
try to read the lowest one
50
pupillary light reflex for CN II
shine the light into one eye, we check the opposite eye
IT SHOULD CONSTRICT
51
CN III name + function (sensory/motor)
oculomotor
sensory: moves eyeball up, down (and all the other movements that VI and IV dont do)
motor: n/a
52
CN III pupillary light reflex
shine light into one eye --> the pupil should constrict (same eye)
53
3 eye movement cranial nerves
CN III = oculomotor
CN IV = trochlear
CN VI = abducens
54
what 2 cranial nerves are responsible for pupillary response
CN II - optic
CN III - oculomotor
55
CN IV function
down + in (look at nose)
56
CN VI function
abducts eyeball
57
CN III eye motor test
draw an H with finger and have pt track the letter with their eyes
(ASK ABT DOUBLE VISION)
58
oculomotor palsy
dilated pupil
ptosis (drooping eyelid)
eye drifting lateral and down
59
CN V name + function (sensory/motor)
trigeminal nerve
motor: jaw clenching and lateral movement
sensory: facial and tongue sensation
60
CN V testing for motor
Palpate masseter and temporalis as patient clenches jaw
61
CN V sensory testing
Light touch assessment along 3 nerve branches
62
CN V reflex testing
Place finger on patient’s chin and lightly tap finger with reflex hammer
(normal should show slight jaw protrusion)
63
CN VII name + function (sensory/motor)
facial nerve
sensory: taste front 2/3 of tongue
motor: facial movements and expressions
64
CN VII autonomic function
saliva
tears
nasal mucosa production
65
CN V reflex
jaw jerk
66
CN VII sensory testing
pt eyes closed
place drops of sweet, sour, or salt onto the pt's tongue
Patient must identify the type of taste
67
CN VII motor testing
have pt raise eyebrows, close eyes shut tight, smile/frown, puff out cheeks
Look for asymmetries!!
68
Bell's Palsy
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
CN VIII name + function (sensory/motor)
vestibulocochlear
sensory: hearing, balance, equilibrium
motor: n/a
70
CN VIII testing
finger rub test
weber test
rinne test
71
weber test
test for CN VIII
place tuning fork on top of head
pt should hear it equally in both ears
72
rinne test
test for CN VIII
tuning fork on mastoid (bone conduction)
tuning fork by ear (air conduction)
73
CN IX name + function (sensory/motor)
glossopharyngeal
sensory: taste for sour/bitter on posterior 1/3 of tongue + sensation of posterior ear drum/ear canal
motor: control of pharynx
74
CN IX autonomic function
saliva production
75
CN IX sensory testing
place drop of sour or bitter liquid on posterior 1/3 of tongue
76
CN IX motor testing
ask patient to swallow (tested w vagus)
test gag reflex (not recommended)
77
CN X name + function (sensory/motor)
vagus
sensory: pharynx and larynx
motor: palate, pharynx and larynx
78
CN X autonomic funciton
regulates HR, breathing, digestion and other involuntary organ actions
79
CN X motor testing
ask pt to open mouth and say "AHHH" to check for any uvula deviations
or
ask pt to swallow multiple times
80
when the tongue deviates, does it deviate toward the weaker or stronger side?
WEAKER
81
CN XI name + function (sensory/motor)
spinal accessory nerve
sensory: n/a
motor: SCM and Traps
82
CN XI testing
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
CN XII name + function (sensory/motor)
hypoglossal
sensory: n/a
motor: tongue movements
84
CN XII testing
pt stick out tongue + note any lateral deviations
(direction tongue points is the side of the legion)
85
when the uvula deviates, does it deviate toward the weaker or stronger side?
STRONGER side
86
MOIs of cerebellar dysfunction (5)
Parkinson's
tumor
trauma to the back of head
chronic alcoholism
infarction
87
global signs of cerebellar dysfunction (5)
ataxia
tremors
hypotonia (little to no reflexes)
dysarthria (hard to make sounds/producing speech)
eye deviations
88
3 things you must test when testing for cerebellar dysfunction
upper extremity
lower extremity
unsupported stance or gait
89
ataxia
lack of control of body movements with decreased coordination
90
dysmetria
error in trajectory due to an abnormal range, rate, and/or force of motion
ex: can't touch nose to finger
91
dysdiadochokinesia
impaired ability to perform rapid altering movements
ex: flipping hands sup/pro quickly
92
3 upper extremity tests for cerebellar dysfunction
rapid alternating movement
finger opposition
finger to nose (eyes open or closed)
93
4 lower extremity tests for cerebellar dysfunction
rapid alternating movements
heel to shin
toe tapping
toe to clinician finger
94
special standing tests for cerebellar dysfunction
romberg test
tandem romberg test
95
romberg test
standing test for cerebellar dysfunction
patient stands unsupported with feet together for 30 seconds
96
tandem romberg test
standing test for cerebellar dysfunction
patient stands tandem for 30 seconds
97
2 ways to get Bell's palsy
untreated ear infection
stress
98
does Bell's palsy affect the ipsi or contralateral side
IPSILATERAL side
99
5 signs of UPPER motor neuron lesions
hyperreflexia
pathologic reflexes (clonus, hoffman's, etc)
increased muscle tone/spasticity
underlying weakness
sensory changes (depends where legion is)
100
clonus
rapid, reflexive, back + forth motion that continues for multiple cycles
101
3 examples of diseases that affect upper motor neurons
Parkinson's
MS
Cerebellar dysfunction
102
4 characteristics of LOWER motor neuron lesions
hyporeflexia
muscle weakness
muscle atrophy
sensory changes along dermatome/peripheral nerve distribution
103
is bell's palsy due to upper or lower motor neuron lesion
LOWER!! because there is weakness/droopiness and atrophy in the face
104
is clonus an example of upper or lower motor legion
UPPER!
uncontrolled, rapid, exaggerated contractions
105
how to test clonus reflexes (and what is a positive test)
moving abkle gently into dorsi/plantarflexion
then
do a rapid motion into dorsiflexion
positive = oscillations/beats into plantarflexion
106
pronator drift test (and what is a positive test)
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
babinski reflex is normal in which population
infants
108
babinski reflex test (and what is a positive test)
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
babinski reflex happens ipsilaterally or contralaterally from legion
CONTRALATERALLY from legion
(anything not in face or head will be contralateral presentation)
110
Hoffman's test (and what is a positive test)
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
shimizu reflex test (and what is a positive test)
reflex hammer is tapped on scapular spine down to acromion process
positive = scapular elevation or humeral abduction
112
order to perform the 8 tests in clinic (out of ALL the ones we learned)
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
