Phys Dx: Neuro Flashcards
senses crude touch, pain, temperature
travel from periphery to spinal cord, cross to contralateral side to join brain.
Spinothalmic tract
vibration, proprioception, fine touch
travels from periphery to spinal cord, stays on same side until brain stem, then crosses
posterior column
spinal injury to spinothalamic tract results in loss of crude touch, pain, temp, where?
Contralateral, below injury
sensory cortex injury to spinothalamic tract results in loss of crude touch, pain, temperature where?
contralateral below injury
spinal injury to posterior column results in loss of fine touch, vibration, proprioception where?
ipsilateral, below injury
sensory cortex injury on the posterior column results in loss of fine touch, vibration proprioception where?
contralateral
upper motor neurons originate in the ______ and cross _______ in the medulla
precentral gyrus, contralateral
Axons descend from UMN and synapse with _______ at the______, then exit cord to target muscle
lower motor neuron, anterior horn
spasticity
hypertonia
hyperreflexia
disuse atrophy
(+) babinski
UMN pathology
flaccidity
hypotonia
hyporeflexia
denervation atrophy
(-) babinski
LMN pathology
patient drags foot or lifts them high
foot slaps the floor
inability to dorsiflex
steppage gait
unilateral steppage gait is caused by…
peroneal nerve injury, spinal nerve compression
bilaterall steppage gait is caused by…
ALS, charco-marie-tooth, peripheral neuropathy
dragging tow
circumduction of leg
ankles plantar flexed and inverted
+/- leaning to contralateral side to clear affected leg during walking
arm fixed, immobile, held close to side
elbow, wrists, IPs flexed
spastic hemiparesis
what causes spastic hemiparesis
stroke, corticospinaltract lesions
each leg advanced slowly
thighs cross
stiff gait, short steps
scissors gait
where is scissors gait commonly seen?
spasticity disorders, cerebral palsy
unsteady gait, wide stance
throwing feet forward and outward
heels touch, then toes with double tap
watch ground
sensory ataxia
what causes sensory ataxia?
peripheral neuropathy
posterior column damage
loss of proprioception
stooped posture with head, arm, hip, knee flexion
shuffling, short steps
slow to start, picks up speed
decreased arm swing
stiff turns
parkinsonian gait
pelvic drop, waddling
trendelenburg gait/myopathic gait
what causes trendelenburg gait
hip abductor weakness
a unilateral trendelenburg gait is indicative of…
spinal nerve compression, superior gluteal nerve injury
bilateral trendelenburg gait is indicative of…
muscular dystrophy
inability to maintain upright posture/ (+) rhomberg indicates what?
posterior column disease, neuropathy
Abnormal pronator drift indicates what?
unm lesion, possible stroke
In heel shin testing, if the heel overshoots the knee or foot oscillates side to side, this indicates…
cerebellar disease
abnormal finger-nose test indicates…
dysmetria: intention tremor/MS or cerebellar disease
abnormal rapid alternative movements test is called dysdiadokinesia. What is this indicative of?
cerebellar disease
Which cranial nerve?
head trauma, parkinsons
CN I
Which Cranial Nerve?
secondary retinal emboli
optic neuritis
pituitary tumor
stroke
CN II
which cranial nerve?
vertical and horizontal diplopia
Ptosis = palsy
CN III
Which cranial nerve?
vertical diplopia
CN IV
Which cranial nerve?
trigeminal neuralgia
CN V
Which cranial nerve?
horizontal diplopia, esotropia
CN VI
Which cranial nerve?
peripheral = bell’s palsy
central = cerebral infarct
CN VII
Which cranial nerve?
disequilibrium, vertigo, nystagmus
CN VIII
Which cranial nerve?
no gag reflex
loss of taste in posterior 1/3
CN IX
Which Cranial Nerve?
hoarseness, dyspnea, dysarthria, lost gag reflex
CN X
Which cranial nerve?
trapezius weakness, atrophy, fasciculations
scapular winging
CN XI
Which cranial nerve?
central lesion if tongue deviates away
peripheral lesion fi tongue deviates to weak side
CN XII
Which cranial nerve produce speech?
CN IX, X, XII
sensory exam should take place bilaterally in a dermotomal pattern for…
problem focused visits
Name that dermatome…
lateral upper arms
C5
Name that dermatome…
radial forearm and thumb
C6
Name that dermatome…
Middle finger
C7
Name that dermatome…
ring and little finger
C8
Name that dermatome…
Ulnar forearm
T1
Name that dermatome…
Nipple line
T4
Name that dermatome…
umbilicus
T10
Name that dermatome…
Inguinal region
L1
Name that dermatome…
Anterior proximal thigh
L3
Name that dermatome…
Knee/medial shin
L4
Name that dermatome…
Lateral shin, dorsal foot to great toe
L5
Name that dermatome…
Lateral and plantar foot
S1
abnormal body positioning could indicate…
mono or hemiparesis/stroke
a static tremor is seen…
at rest
A tremor that is seen when affected area attempts to maintain posture
postural tremor
a tremor absent at rest, appears with movement
intention tremor
intention tremor is seen in…
MS
a static tremor is seen in…
parkinsons
postural tremor is seen in
hyperthyroid, anxiety, fatigue, essential tremor
brief, repetitive twitching present in tourette’s syndrome or with medications…
tic
twisted posture of large body parts
caused by medications or spasmodic torticollis
dystonia
twisted tony
bizarre, rhythmic, repetitive movements seen in parkinson’s, psychosis and with certain mediations
dyskinesias
Dis kenny is at the crazy park off his meds,
inability to sit still common with antipsychotics and compazine
akathisia
“crazy aunt kathy”
brief, jerky, rapid and unpredictable movements common in huntington’s disease and rheumatic fever
chorea
there’s no RHEUM for HUNTINGTON to CHOREAGRAPH
slow, twisting, writhing movements common in cerebral palsy
athetosis
With cerebral palsy you twist slow at the toe
rigidity is increased resistance throughout range of motion.
cog-wheel rigidity is common in…
parkinson’s disease
Muscle strength testing…
No muscle contraction
grade 0
Muscle strength testing…
visible contraction, no joint movement
grade 1
Muscle strength testing…
joint motion, but not against gravity
grade 2
Muscle strength testing…
movement against gravity only
grade 3
Muscle strength testing…
movement with some resistance
grade 4
Muscle strength testing…
full strength, full resistance
grade 5
Shoulder abduction nerves…
C5
axillary
elbow flexion nerves
C5, C6
musculocutaneous
elbow extension nerves
C6, C7
radial
wrist extension nerves
C6, C7
radial
wrist flexion nerves
C7, C8
median
Finger abduction nerves
C8, T1
ulnar
thumb opposition nerves
C8, T1
median
hip flexion nerves
L2, L3
Femoral
Hip extension nerves
L4, L5
Gluteal
Knee extension nerves
L3, L4
Femoral
Knee flexion nerves
L5, S1
Sciatic
ankle dorsiflexion nerves
L4, L5
Peroneal
ankle plantar flexion nerves
S1
Plantar
DTR +1 =
diminished
DTR + 2 =
normal
DTR + 3 =
incrased
DTR + 4 =
hyperactive, with clonus
Hypoactive DTRs
weakness
atrophy
fasciculation
this indicates…
spinal nerve root, peripheral nerve diseases
Hyperactive DTRs
clonus
weakness
spasticity
(+) babinski
this indicates…
CNs lesions on descending corticospinal tract
Biceps DTR tests…
C5, C6
Brachioradialis DTR tests
C5, C6
Triceps DTR tests
C6, C7
Patella DTR tests
L4
Achilles DTR tests
S1
normal superficial abdominal reflex…
muscle contraction towards umbilicus
abnormal superficial abdominal reflex indicates…
central and peripheral pathology
abnormal cremasteric reflex indicates…
UMN, LMN pathology
L1, L2 injury
Ilioinguinal injury
do you draw labs during a sports physical?
no
