Phys Dx Final Flashcards by Alora Marshall

Spinothalamic tract

crude touch, pain, temperature

How well did you know this?

Not at all

Perfectly

Spinothalamic tract

from periphery to spinal cord, crosses to CONTRALATERAL side before getting to brain

How well did you know this?

Not at all

Perfectly

Posterior (dorsal) column

vibration, proprioception, fine touch

How well did you know this?

Not at all

Perfectly

Posterior (dorsal) column

stays on SAME side until reaching brain stem, then crosses

How well did you know this?

Not at all

Perfectly

Spinal injury to the spinothalamic tract

Contralateral loss of crude touch, pain, temp BELOW injury

How well did you know this?

Not at all

Perfectly

Spinal injury to the posterior column

Ipsilateral loss of fine touch, vibration, proprioception BELOW injury

How well did you know this?

Not at all

Perfectly

SENSORY cortex injury to either Spinothalamic tract OR Posterior column

both are Contralateral loss if it’s a sensory cortex injury (rather than at a spinal injury)

How well did you know this?

Not at all

Perfectly

Upper motor neurons originate in

pre central gyrus and cross over in the medulle

How well did you know this?

Not at all

Perfectly

Axons of upper motor neurons descent to synapse with the Lower motor neuron at the

anterior horn, then exit spinal cord

How well did you know this?

Not at all

Perfectly

Upper motor neuron

Spasticity
HYPERtonia
HYPERreflexia
Disuse atrophy (later on)
\+ Babinski

How well did you know this?

Not at all

Perfectly

Lower motor neuron

Flaccid
HypOtonia
HpOflexia
Denervation atrophy
- Babinski

How well did you know this?

Not at all

Perfectly

Tandem gait

Heel to toe

How well did you know this?

Not at all

Perfectly

Steppage gait

AKA Neuropathic gait

How well did you know this?

Not at all

Perfectly

Steppage gait/Neuropathic gait

“Foot drop”
Pt drags foot or lifts it high, then foot SLAPS on floor

Unilateral –> Peroneal nerve injury, spinal nerve ocmpression

Bilateral –> amyotrophic lateral sclerosis (ALS),C harcot-Marie- Tooth disease and peripheral neuropathies

How well did you know this?

Not at all

Perfectly

Spastic Hemiparesis

Drag toe, circumduct outward and forward

Arm flexed, immobile, held close to the side (all UE joints flexed)

Corticospinal tract lesions

Stroke

How well did you know this?

Not at all

Perfectly

Scissor Gait

thighs tend to cross
advance legs slowly
stiff gait and short steps
Spasticity disorders like Cerebral Palsy

How well did you know this?

Not at all

Perfectly

Sensory Ataxia

everything is shaky. unsteady gait and wide based stance

throw feet forward and outward with DOUBLE TAP

watch ground

d/t loss of proprio

Peripheral neuropathy
Posterior column damage

How well did you know this?

Not at all

Perfectly

Parkinson Gait

Stooped posture with head, arm hip, and knee flexion

Decreased arm swing, stiff turns

d/t Basal Ganglia abn, Parkinson

How well did you know this?

Not at all

Perfectly

Trendelenburg Gait

AKA Myopathic gait

Pelvic drop leads to waddling gait

Hip aBductor

Unilateral –> spinal nerve compression, superior gluteal nerve injury

Bilateral –> muscular dystrophy

How well did you know this?

Not at all

Perfectly

Romberg test fail

Posterior column dz

Neuropathy

How well did you know this?

Not at all

Perfectly

Pronator drift fail

Upper motor neuron lesion

Possible Stroke

How well did you know this?

Not at all

Perfectly

Heel to shin fail

Heel overshoots knee: Cerebellar dz

Heel lifts too high: Position sense

How well did you know this?

Not at all

Perfectly

Finger to nose fail

Dysmetria/past pointing

Intention tremor- Multiple sclerosis
Cerebellar dz

How well did you know this?

Not at all

Perfectly

Rapid alternating movements

Dysdiadokinesia- slow,clumsy, irreg movements

Cerebellar dz

How well did you know this?

Not at all

Perfectly

Recent memory

3 words, repeat in 5 min

Remote memory

3 presidents

CN4

Trochlear

CN9

Glossopharyngeal

CN12

Hypoglossal

Asosmia

loss of smell | Head trauma, Parkinson

Loss of optic fx

Visual field defect 2 degree retinal emboli, optic neuritis, Pituitary tumor, Stroke

Occulomotor

Eye movement Abnormal: Vertical and horizontal diplopia CN3 palsy= Ptosis

CN4 Trochlear

Function: downward, internal movement of eye Abnormal: vertical diplopia

CN6 Abducens

Function: lateral deviation of eye Abnormal: horizontal diplopia, esotropia

CN7 Facial

Abnormal: Peripheral- Bell's palsy Central- Cerebral infarct

CN9 Glossopharyngeal

Abnormal: | no gag reflex, loss of taste posterior 1/3 tongue

CN10 Vagus

Abnormal: | Hoarseness, dyspnea, dysarthria, loss of gag reflex

CN12 Hypoglossal

Abnormal: Central lesion: tongue deviates away Peripheral lesion: tongue deviates to weak side

_____thesia

touch

_____gesia

pain

Allodynia

pain elicited from non painful stimulus

Sensory SCREENING exam

routine physical | Check sharp, dull, and vibratory sense distally, then move proximally as needed

Sensory PROBLEM FOCUES exam

Pt c/o intermittent neck pain and N/t travelling into RUE: | evaluate sensation BILATERALLY in a DERMATOMAL PATTERN

Lateral upper arms

Radial forearm and thumb

Middle finger

Ring and little finger

Ulnar forearm

Nipple line

Umbilicus

T10

Inguinal region

Anterior/proximal thigh

Knee/medial shin

Lateral shin, dorsal foot to great toe

Lateral and plantar foor

Stereognosis

ask pt to recognize familiar object SterEOG OBJect

Graphesthesia

number identification

Mono or hemiparesis

indicative of STROKE

Static tremor (seen at rest)

Parkinson (pill rolling tremor)

Postural tremor (seen when affected area maintains posture)

Hyperthyroid, anxiety, fatigue, essential tremor

Intention tremor (absent at rest, appears with movement)

Multiple Sclerosis

Tics: brief, repetitive, twitching

Tourette syndrome, medications

Dystonia: twisted posture of large body parts

Medications, spasmodic torticollus

Dyskinesias: bizarre, rhythmic, repetitive movements

Parkinson, psychoses, medications

Akathisisa: inability to sit still

Medications (antipsychotics, Compazine)

Chorea: brief, jerky, rapid, unpredictable movements

Huntington dz, Rheumatic fever

Athetosis: slow, twisting, writhing

Cerebral Palsy

Hypotonia/flaccid

Central and peripheral causes

Spasticity

Central corticospinal tract dz

Rigidity

Cog wheel rigidity: Parkinson

Muscle strength ranking

0: no contraction 1: contraction, no joint move 2: joint motion, but not against gravity 3: mov against gravity only 4: mov w some resistance 5: full strength with full resistance

Shoulder aBduction

C5 root | Axillary nerve

Elbow flexion

C5-6 root | Musculocutaneous nerve

Elbow extension

C6-7 | Radial nerve

Wrist extension

C6-7 | Radial nerve

Wrist flexion

C7-8 root | Meidan nerve

Finger aBduction

C8-T1 root | Ulnar nerve

Thumb opposition

C8-T1 root | Median nerve

Deep tendon reflex

2+ is normal

Hypoactive DTRs

Dz of spinal NERVE ROOTS or PERIPHERAL NERVES may also see: weakness, atrophy, fasciculations

Hyperactive DTRs

lesions along descending CORTICOSPINAL TRACT may also see: weakness, spasticity, + Babinski

Biceps DTR

C5,C6

Brachioradialis DTR

C5, C6

Triceps DTR

C6, C7

Patella DTR

Achilles DTR

Clonus

abnormal up and down Upper motor neuron dz

Babinski

abnormal: CNS lesion affecting corticospinal tract

Superficial abdominal reflex

abnormal: Central and peripheral pathologies

Cremasteric reflex

Abnormal: UMN, LMN L1,L2 injury Ilioinguinal injury s/p hernia repair

Order for abdominal exam

Inspection Auscultation Percussion Palpation

Exam abdomen from

Pt's Right side

Approach to abdominal exam

Clockwise rotation

Diastasis Recti

separation of rectus abdominis muscles abdominal contents form midline ridge obvious with flexion of the neck

Increased peristalsis waves can be indicitave of

intestinal obstruction

Ecchymosis

can be seen in intraperitoneal or retroperitoneal hemorrhage

Portal hypertension

from cirrhosis

Portal HTN

promotes collateral venous circulation radiating from umbilicus to abdominal wall "Caput medusa"

Borborygmi

stomach growling

High pitched, tinkling bowel sounds

can be associated with OBSTRUCTION

Hyperactive bowel sounds

Diarrhea | Peritonitis

Distended abdomen that is tympanic throughout

Intestinal obstruction | Paralytic Ileus

Bladder volume must be >400-600 mL before

dullness appears

Guarding is

voluntary contraction

Rigidity is

involuntary reflex contraction of abdominal wall persists over several exams

Acute cholecystitis

Inflammation of gall bladder +Murphy's sign, tender RUQ

Acute pancreatitis

Epigastric pain often radiating to back

+Psoas, obturator, Rovsing sign

Acute appendiciti

Acute diverticulitis

LLQ pain

normal Aorta size

<3 cm

Brawny edema

non pitting edema

FABer "Patrick's test"

External rotation

Trendelenburg test

have pt raise one knee | weak hip aBductors on other side

FadIR | Internal rotation

test for: IMPINGEMENT

Palpable cord of lower leg

thrombosed vein

Popliteal artery aneurysm

usually d/t Atherosclerotic vascular dz Males >> females >65 YO Most common aneurysm of peripheral vascular system Bilateral over 50% time! Pulsatile swelling behind knee

Bulge sign test of knee

Minor effusion

Ballotement test of knee

MAJOR effusion

Valgus test

MCL

Varus test

LCL

Lachman

most useful, grab both femur and tibia and shift in opposite directions for ACL

Mcmurray test

flex and extent with external and internal rotation of foot external rotation: MEDIAL meniscus internal rotation: LATERAL meniscus

Hinge joints of ankle

Tibiotalar | Subtalar (talocalcaneal)

Pes Planus

flat foot

Pes Cavus

high arch

Where to test for edema

Dorsum of foot, behind medial malleolus, on shins

Palpation of pedal pulse

over 1-2nd metatarsals

2+ brisk

normal pulse

Thompson test

squeeze calf | foot should Plantar flex

Adams forward bend test

always evaluate for LLD to determine if discrepancy is from spine or true LLD is causing curvature

Glaeazzi test

LLD

Straight leg raising test

test for lumbosacral radiculopathy, sciatic neuropathy

Positive straight leg raising

Lasegue's test

Seated straight leg test

also called "flip sign" pt will flip back when leg is straightened