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Physical Diagnosis > PD Neuro Part 2 > Flashcards

PD Neuro Part 2 Flashcards

1
Q

Primary sensations

A 
Light (superficial) touch
Pressure (deep touch)
Vibration
Position of joints
Pain
Temperature 
Touch
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2
Q

Which sensory functions are spinothalamic tract?

A

Pain
Temperature
Crude touch

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3
Q

Which sensory functions are dorsal column?

A

Light touch
Pressure
Vibration, position of joints

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4
Q

For a completel neurologic evaluation, which peripheral nerves are tested?

A

Each major peripheral nerve

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5
Q

Routine exam

A 
Hands
Lower arms
Abdomen
Feet
Lower legs
Face (while testing CNs)
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6
Q

General considerations of exam

A

Pts eyes are closed
Minimal stimulation initially, gradually until pt becomes aware
Always test contralateral side of body, asking pt to compare

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7
Q

Where is strong stimulus needed?

A

Back

Buttocks

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8
Q

With each type of sensory stimulus, there should be:

A

Minimal differences side to side
Correct interpretation of stimulus
Discrimination of side of body tested
Relative location to last stimuli

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9
Q

What to do if sensory impairment is found

A

Map boundaries by the distribution of major peripheral nerves or dermatomes

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10
Q

Cortical sensory functions

A 
Stereognosis
Two point discrimination
Extinction phenomenon
Graphesthesia
Point location
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11
Q

Abnormality of previous functions

A

Lesion in cerebral cortex or posterior columns of spinal cord

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12
Q

Superficial touch

A

Light strokes with cotton wisp
Avoid hair areas
Don’t depress skin
Ask for where stimulus was

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13
Q

Superfcial pain

A

Sharp/dull
Allow time between stimuli
Unpredictable pattern
Ask patient: sharp or dull, location?

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14
Q

When to test temp and deep pressure?

A

When superficial pain is not intact

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15
Q

Temperature testing

A

Test tubes of hot and cold water
Ask pt where and whether it is hot or cold
Side to side comparison

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16
Q

Deep pressure

A

Firmly squeeze muscle body

Expect discomfort

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17
Q

Vibration

A

Place stem of vibrating tuning fork against several bony prominences/joints
Begin at most distal joint
Should feel buzzing/tingling sensation
Ask where felt and for how long

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18
Q

Sites tested for vibration

A 
Sternum
Shoulder
Elbow
wrist
Finger joints
Shin
Ankle 
Toes
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19
Q

Position of joints

A 
Proprioception
Hold joint by lateral aspects
Begin with joint in neutral position
Move up or down and ask patient for position of movement
Great toes and a finger on each hand
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20
Q

Stereognosis

A

Ability to identify an object by touch and manipulation

Use familiar object for patient to identify

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21
Q

Tactile agnosia suggests…

A

Parietal lesion

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22
Q

Two point discrimination

A

Use 2 needles and alternate touching pts skin with 1 or 2 points
Find shortest distance the patient cannot identify two points
Depends on area of body tested

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23
Q

Why is two point discrimination different depending on area of body?

A

Fingers have more sensation than palm

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24
Q

Extinction

A

Simultaneously touch two separate parts of the body with a sharp stimuli
Ask patient how many stimuli they felt, and where
Both sensations should be felt

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25
Q

Graphesthesia

A

Using blunt object, trace letter or number on palm
Ask pt to identify figure
Repeat with different figure on other hand

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26
Q

Point location

A

Touch an area of pts skin and withdraw stimulus
Ask pt to point to area touched
Often performed simultaneously when testing superficial touch

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27
Q

Assessing motor function

A

Body position
Involuntary movements
Muscles
Coordination

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28
Q

Body position

A

Observe during movement and at rest

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29
Q

Involuntary movements

A

Tics
Tremors
Fasciculations

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30
Q

Muscles

A

Bulk - normal or atrophy
Tone - normal vs hypotonic or flaccid, vs spasticity or rigidity
Strength - normal vs weakness

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31
Q

Coordination

A

Determines throughout (testing cerebellar function, proprioception, strength)

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32
Q

Paresis

A

Impaired strength

Weakness

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33
Q

Plegia

A

Absence of strength

Paralysis

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34
Q

Hemiparesis

A

Weakness of half of body

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35
Q

Hemiplegia

A

Paralysis of half of body

36
Q

Paraplegia

A

Paralysis of legs

37
Q

Quadraplegia

A

Paralysis of all four limbs

38
Q

Assessing motor strength

A

Assess all major muscle groups for strength, comparing side to side
Graded on scale 0-5

39
Q

Motor strength scale

A

0 - no muscle contraction
1 - trace of contraction, but no mvmt
2 - Active mvmt of body part with gravity eliminated
3 - Active mvmt against gravity
4 - Active mvmt against gravity and some resistance
5 - Active mvmt against gravity and full resistance

40
Q

Shoulder abduction

A 
C5 + C6
Deltoid main muscle
Innervated by axillary nerve
Pt flexes elbow with arm at 45 degrees
Pt attempts to abduct further against resistance
41
Q

Shoulder adduction

A

C5 - T1
Pectoralis major main muscle, latissimus dorsi and others also contribute
Pt flex elbow at 45 degrees, have pt adduct against resistance

42
Q

Elbow flexion

A

C5 + C6

Have pt pull at your hand against resistance

43
Q

Elbow extension

A

C6 - C8

Have pt push at your hand against resistance

44
Q

Wrist extension

A

Radial nerve test
C6-C8
Have pt make a fist and resist you pulling it down

45
Q

Grip

A

C7 - T1
Have pt squeeze your fingers
Test both hands at same time

46
Q

Finger abduction

A

Ulnar nerve test
C8, T1
Position pts hand with palm down and fingers spread
Try to force fingers together

47
Q

Thumb opposition

When is weakness common?

A

Median nerve
C8, T1
Have pt touch tips of little finger and thumb together
Try to pry apart
Weak opposition common in carpal tunnel syndrome

48
Q

Hip flexion

A

Iliopsoas
L2 - L4
Pt supine, place hand on thigh and ask pt to raise the leg against resistance

49
Q

Hip adduction

A

Adductors
L2-L4
Pt supine, place your hands on bed between pts knees and have them try to bring knees together

50
Q

Hip abduction

A

Gluteus medius and minimus
L4-S1
Place hands on outside of knees and have pt try to spread legs apart

51
Q

Hip extension

A

Gluteus maximus
S1
With pt prone, have pt push posterior thigh up against your hand
May be more easily tested with pt standing

52
Q

Knee extension

A

Quadriceps
L2-L4
Support knee in flexion and ask pt to straighten leg against your hand

53
Q

Knee flexion

A

Hamstrings
L4-S2
With knee flexed and foot on bed, ask pt to keep foot on bed as your try to straighten leg

54
Q

Dorsiflexion

A

Toes towards head

L4-L5

55
Q

Plantar flexion

A

Tip toe

S1

56
Q

Extensor hallucis longus

A

L5 strength test

57
Q

Superficial reflexes

A

Upper abdominal
Lower abdominal
Cremasteric
Plantar

58
Q

Deep reflexes

A 
Biceps
Brachioradial
Triceps
Patellar
Achilles
59
Q

Upper abdominal

A

T7-T9

60
Q

Lower abdominal SL

A

T10-T11

61
Q

Cremasteric SL

A

T12 - L2

62
Q

Plantar SL

A

L4-S2

63
Q

Biceps SL

A

C5-C6

64
Q

Brachioradial

A

C5-C6

65
Q

Triceps

A

C6-C7 (C8)

66
Q

Patellar

A

L2-L4

67
Q

Achilles

A

S1-S2

68
Q

Upper and lower abdominal reflexes

A

Pt supine, lightly stroke each quadrant with end of a reflex hammer, or tongue blade
Slight mvmt of umbilicus towards the stimulus should occur
Should be equal bilaterally

69
Q

Cremasteric reflex

A

Stroke inner tight
Proximal to distal
Testicle and scrotum should rise on same side

70
Q

Babinski sign

A

Plantar reflex
Use pointed object to stroke lateral side of foot from heel to ball, then across foot to medial side
Some pts withdraw leg, hold ankle
Normal response is plantar flexion of all toes
Babinski sign is present when there is extension of great toe, with or without fanning of other toes

71
Q

When is babinski normal?

A

Response in children younger than 2

72
Q

Babinski reflex suggests…

A

CNS lesion in the pyramidal tract

73
Q

DTR

A

Deep tendon reflexes
Pt relaxed, sitting or lying down
Distract pt with alternate action to relax area to be tested (have pt pull clenched hands apart)
Position limb with only slight tension on tendon to be tapped
Palpate tendon to locate
Use flick of wrist to briskly tap tendon
Compare side to side

74
Q

Scale for DTR

A

0 - no response
1+ - sluggish or diminished, minimal contraction
2+ - active/expected contraction of muscle
3+ - more brisk than expected, slightly hyperactive
4+ - hyperactive with intermittent or transient clonus

75
Q

Absent DTR indicate…

A

Neuropathy or lower motor neuron disorder

76
Q

Hyperactive DTR indicate…

A

Upper motor neuron DO

77
Q

Biceps reflex

A

Flex pt arm at 45 degrees at elbow
Palpate biceps tendon in antecubital fossa
Place tumb on tendon and fingers under elbow
Strike thumb, not tendon!

78
Q

Brachioradialis reflex

A

Flew arm at 45 degrees and rest pts forearm on your arm with hand slightly pronated
Strike tendon directly and couple inches above wrist
Elbow will slightly flex, wrist will slightly supinate and fingers will slightly flex

79
Q

Triceps

A

Sitting, standing, or supine

Hold elbow at 45 degrees

80
Q

Patellar reflex

A

Flex knee at 90 degrees
allow leg to hand loosely
Strike tendon just below patella

81
Q

Alternative to patellar reflex

A

Supine with legs bent and feet on table

Supine with one leg bent, one leg extended

82
Q

Achilles reflex

A

Pt sitting, flex knee to 90 degrees
Keep ankle neutral position by slightly dorsiflexing the foot
Strike achilles tendon at level of ankle malleoli
Contraction of gastrocnemius causes plantar flexion

83
Q

Reinforcement

A

Jendrassik maneuver
Patient locks fingers together and pulls hard as you tap the quadriceps tendon
Voluntary UMN innervation of arm overflows to increase excitability of LMN pool of the lower extremities (easier to elicit reflex)

84
Q

Clonus

A

Commonly tested on ankles
Specifically when reflexes are hyperactive
Support pts knee in partially flexed position
Briskly dorsiflex foot
Look and feel for rhythmic oscillations between dorsiflexion and plantar flexion

85
Q

Clonus indicates…

A

Upper motor neuron disease

Physical Diagnosis (10 decks)

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