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Physical Dx Final > Neuruo > Flashcards

Neuruo Flashcards

1
Q

CNS

A

Brain (stem and cerebellum) and spinal cord

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2
Q

PNS

A

cranial nerves, spinal and peripheral nerves

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3
Q

Frontal lobe

A

motor cortex, reasoning memory, speaking, emotions

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4
Q

Parietal lobe

A

sensory cortex, reading, understanding spacial relationships

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5
Q

Occipital

A

vision

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6
Q

Cerebellum

A

balance, coordination, fine muscle control

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7
Q

brain stem

A

breathing, bp, HR, swallowing, body temp, digestion

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8
Q

Temporal lobe

A

understanding language, behavior, memory hearing

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9
Q

Spinal vertebrae

A

cervical- 7
Thoracic- 12
Lumbar- 5
Sacral- 5

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10
Q

Sensory pathways

A

Spinothalamic tract

Posterior column

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11
Q

Spinothalamic tract

A

crude touch, pain, temp

travel from periphery to spinal cord and cross to contralateral side BEFORE continuing to brain

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12
Q

Posterior column

A

vibration, proprioception, fine touch

Travel from periphery to spinal cord and stay on the SAME SIDE until reaching the brain stem, then cross

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13
Q

Motor pathway

A

UMN originate in pre-central gyrus (primary motor) and crosses contra-lateral in the medulla
Axons descend to synapse with anterior horn of LMN in PNS

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14
Q

Ataxic

A

gait that lacks normal coordination

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15
Q

Gait that lacks coordination and stability is due to

A

cerebellar disease, loss of positions sense or intoxication

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16
Q

Steppage gait

A

patient drags foot or lifts them high, then foot slaps floor; due to tibialis anterior and toe extensor weakness; LMN/peripheral nerve injury

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17
Q

Spastic Hemiparesis

A

drag toe, circle leg stiffly outward and forward (circumduction), or lean trunk to contralateral side to clear affected leg during walking; affected arm is flexed, immobile and held close to the side, with elbow, wrists and interphalangeal joints flexed;
affected leg extensors are spastic, ankles are plantar flexed and inverted

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18
Q

When do you see spastic hemiparesis

A

stroke

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19
Q

Steppage gait is seen with

A

LMN/peripheral nerve injury

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20
Q

Scissors gait

A

patients advance each leg slowly and thigh tend to cross; stiff gait and short steps

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21
Q

May look like they’re walking through water

A

Scissors gait

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22
Q

Scissors gait is seen with

A

spinal cord disease and spasticity disorders (cerebral palsy)

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23
Q

Sensory ataxia

A

unsteady gait and wide based stance; throw feet forward and outward, first bring down heel then toes with DOUBLE TAP; watch ground; usually have assistive device

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24
Q

Sensory ataxia gait is due to

A

Loss of proprioception (polyneuropathy, posterior column damage)

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25
Q

Parkinsonian Gait

A

Stooped posture with head, arm hip and knee flexion; shuffling, short steps; slow to start; decreased arm swing and stiff turns

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26
Q

Parkinsonian gait

A

due to basal ganglia abnormalities (Parkinson’s disease)

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27
Q

Coordination requires

A

motor
cerebellar
vestibular
sensory

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28
Q

Romberg Test

A

position sense; stand with feet together, eyes closed; abnormal = unable to maintain upright posture

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29
Q

(+) Romberg could mean

A

dorsal column disease (can do with eyes open but not closed); cerebellar ataxia (can’t balance w/ or w/o eyes open)

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30
Q

Pronator drift

A

standing with eyes closed, elevate arms to shoulder level with palms up; firmly tap on arm and patient should bring arm back up;

Abrnomal = unable to keep arms at should heigh and/or arm probates/drifts down

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31
Q

Cause of pronator drift

A

UMN lesion = possible stroke

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32
Q

heel to shin test

A

Place heel at opposite knee, slide down leg then back up; should be able to keep contact with opposite leg

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33
Q

(+) heel to shin test

A 
cerebellar disease (hell overshoots need, or foot oscillates side to side);
Position sense absent (heel lifts too high)
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34
Q

(+) Finger-to-nose test

A

intentional tremor- multiple sclerosis

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35
Q

(+) Rapid alternating movement

A

cerebellar disease: slow, clumsy, irregular movement = dysdiadochokinesis

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36
Q

Dysdiadochokinesis

A

slow, clumsy, irregular movements

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37
Q

A&O x 4

A

person, place, time, situation

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38
Q

Cranial nerves

A 
I: olfactory
II: Optic
III: Oculomotor
IV: Trochlear
V: Trigeminal
VI: Abducens
VII: Facial
VIII: Acoustic
IX: Glossopharyngeal
X: Vagus
XI: Spinal
XII: Hypoglossal
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39
Q

Olfactory (CN I)

A

Function: smell
Test: smell familiar scent
Abnormal: anosmia (head trauma, parkinson disease)

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40
Q

Optic (CN II)

A

Function: Vision
Test: visual field, acuity, funuscopic, pupillary light reflex
Abnormal: visual field defect secondary to retinal emboli, optic neuritis, pituitary tumor, stroke

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41
Q

Oculomotor (CN III)

A

Function: eye movement
Test: EOM’s, pupillary light reflex
Abnormal: vertical and horizontal diplopia; ptosis = CN III palsy

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42
Q

Trochlear (CN IV)

A

Functioin: Superior oblique, downward and internal rotation of eye
Test: EOM’s
Abnormal: vertical diplopia

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43
Q

Trigeminal (V)

A

Function: Motor- temporal, masseter and lateral pterygoids
Sensory: 3 divisions
Test: clench jaw and lateral jaw movement , check facial expression
Abnormal: trigeminal neuralgia

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44
Q

Abducens (VI)

A

Function: lateral rectus, lateral deviation of the eye
Test: EOM’s
Abnormal: Horizontal diplopia, esotropia

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45
Q

Facial (VII)

A

Function: motor- facial movements; sensory: taste anterior tongue
Test: funny faces
Abnormal:
peripheral- bell’s palsy (entire one side)
central- cerebral infarct (spares forehead)

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46
Q

Acoustic (VIII)

A

Function: hearing and balance
Test: gross hearing, gait
Abnormal: disequilibrium, vertigo, nystagmus

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47
Q

Glossopharyngeal (IX)

A

Funciton: motor: pharynx, Sensory: posterior tongue
Test: gag reflex
Abnormal: no gag reflex, loss of taste to posterior 1/3 of tongue

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48
Q

Vagus (X)

A

Motor: palate, pharynx, larynx
Sensory: pharynx, larynx
Cardiac, thorax and abdomen
Test: palate elevation, quality of “ah” and uvula midline
Abnormal: hoarseness, dyspnea, dysarthria, loss of gag reflex

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49
Q

Spinal (XI)

A

Function: SCM and trap
Test: shoulder shrug and head rotation
Abnormal: trap weakness, atrophy and fasciculations = scapular winging

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50
Q

Scapular winging is indicative of

A

Spinal nerve problem

51
Q

Hypoglossal (XII)

A

Funciton: tongue movement
Test: wag tongue
Abnormal: central lesion = tongue deviates away
Peripheral lesion = tongue deviates to weak side

52
Q

Anesthesia

A

absence of touch sensation

53
Q

Hypoesthesia

A

Decreased sensation to touch

54
Q

Hyperesthesia

A

Increases sensitivity to touch

55
Q

Allodynia

A

pain elicited from non-painful stimulus

56
Q

Analgesia

A

absence of pain sensation

57
Q

Hypoalgesia

A

decrease in pain awareness

58
Q

Hyperalgesia

A

Increased sensitivity to pain

59
Q

Lateral upper arm dermatome

A

C5

60
Q

Radial forearm and thumb

A

C6

61
Q

Middle Finger

A

C7

62
Q

Ring and little finger

A

C8

63
Q

Ulnar forearm

A

T1

64
Q

Nipple line

A

T4

65
Q

Umbilicus

A

T10

66
Q

Inguinal region

A

L1

67
Q

Anterior/proximal thigh

A

L3

68
Q

Knee/medial skin

A

L4

69
Q

Lateral shin, dorsal foot to great toe

A

L5

70
Q

Lateral and plantar foot

A

S1

71
Q

Stereognosis

A

ask patient to shut eyes and recognize familiar object in hand

72
Q

Graphesthesia

A

number identification in hand

73
Q

Normal two-point discrimination

A

<5 mm on finger bads

74
Q

Static tremor

A

seen at rest; Parkinson disease (pill-rolling tremor)

75
Q

Postural tremor

A

seen when affected area maintains posture (Hyperthyroid, anxiety, fatigue, benign essential)

76
Q

Intention tremor

A

absent at rest, appear with movement; Multiple sclerosis

77
Q

Pin-rolling tremor

A

Parkinson’s

78
Q

Tic

A

brief, repetitive, twitching

79
Q

What disorders are seen with Tics

A

tourette syndrome, medications

80
Q

Dystonia

A

Twisted posture of large body parts

81
Q

Dystonia is associated with

A

meds, spasmodic torticollis

82
Q

Dyskinesias

A

bizarre, rhythmic, repetitive movement

83
Q

Dyskinesias associated with

A

parkinson disease, psychoses, meds

84
Q

Akathisia

A

inability to sit still; due to meds (antipsychotics, compazine)

85
Q

Chorea

A

brief, jerky, rapid, unpredictable movements; associated with Huntington disease, rheumatic fever

86
Q

Athetosis

A

slow, twisting, writhing movement; cerebral palsy

87
Q

Hypotonia/flaccidity of muscles

A

central and peripheral causes

88
Q

Spasticity of muscles

A

increased muscle tone, velocity dependent; central corticospinal tract disease

89
Q

Rigidity

A

increased resistance throughout ROM; Cog-wheel rigidity– Parkinson’s disease

90
Q

Muscle Strength Grading

A 
0- no muscle contraction
1- visible contraction, no movement
2- joint motion, but not against gravity
3- movement against gravity only
4- movement with some resistance
5- full strength with full resistance
91
Q

Shoulder Abduction

A

C5, axillary nerve

92
Q

Elbow flexion

A

C5, C6; musculocutaneous

93
Q

Elbow extension

A

C6, C7; radial

94
Q

Wrist extension

A

C6, C7; radial

95
Q

Wrist felxion

A

C7, C8; median

96
Q

Finger abduction

A

C8, T1; ulnar

97
Q

Thumb opposition

A

C8, T1; median

98
Q

Test for Radial nerve

A

make fist

99
Q

Test for ulnar nerve

A

spread fingers against resistance

100
Q

Test for median nerve

A

okay sign

101
Q

Hip flexion

A

L2,3; femoral

102
Q

Hip extension

A

L4, 5; gluteal

103
Q

Knee extension

A

L3,4; femoral

104
Q

Knee flexion

A

L5, S1; sciatic

105
Q

Ankle dorsiflexion

A

L4, 5; peroneal

106
Q

Ankle plantar flexion

A

S1; plantar

107
Q

Reflex scales

A 
0- no response
\+1- diminished
\+2- normal
\+3- increased
\+4- hyperactive, associated with clonus
108
Q

Hypoactive DTR

A

diminished or absent

disease of spinal nerve roots or peripheral nerves (LMN)

109
Q

Hyperactive DTR

A

brisk and can be associated with clonus; CNS lesions along descending corticospinal tract (UMN)

110
Q

LMN findings

A

hypoactive
weakness
atrophy
fasciculations

111
Q

UMN findings

A

Hyperactive
weakness
spasticity
positive babinski

112
Q

Biceps DTR tests

A

C5,6

113
Q

Brachioradialis DTR tests

A

C5,6

114
Q

Triceps DTR tests

A

C6, 7

115
Q

Patella DTR tests

A

L4

116
Q

Achilles DTR tests

A

S1

117
Q

Clonus

A

forced dorsiflexion of foot; evaluate for rhythmic oscillations; can be normal if bilateral; if abnormal, check at wrist

118
Q

Abnormal clonus is due to

A

UMN disease

119
Q

Babinski sign

A

L5, S1
Normal for toes to flex
Abnormal: great toe extends and other toes fan out (CNS lesion affecting cotricospinal tract)

120
Q

Superficial abdominal reflex

A

draw towards belly button from each quadrant;
Normal: muscle contracts toward umbilicus
Abnormal: central and peripheral pathologies

121
Q

Cremasteric Reflex

A

stroke proximal medial thigh;
normal: ipsilateral testicle to rise
Abnormal: UMN, LMN; L1,L2 nerve injury; ilioinguinal injury s/p hernia repair

122
Q

Brudzinski

A

Flex patient’s neck
Normal = remain relaxed
Abnormal: hip and knee flexion (meningeal sign)

123
Q

Nuchal rigidity

A

Place hands beind patien’s head and flex head toward chest;
Normal: easy motion
Abnormal: pain and resistance indicating potential meningeal irritation

124
Q

Kernig sign

A

Flex patient’s hip and knee, then straighten knee;
Normal: may have tightness in hamstring
Abnormal = pain pain and resistance indicating meningeal irritation

Physical Dx Final (4 decks)

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