Physical Exams 2: Block 1 Flashcards
What are the two motor pathways and what do they control?
Corticospinal (pyramidal)- cerebral cortex connecting to spinal motor neurons to control torso and limbs
Corticobulbar- upper motor neurons of CNs to control muscles of face, head and neck and terminate in the motor neurons in the brainstem
How does the L side of the brain control the R side of the body?
What happens of these motor neurons are damaged?
Corticospinal tracts cross the spinal cord in the medulla
Above- motor impairment on contralateral side
Below- motor impairment on ipsilateral side
Damage to an Upper Motor neuron results in ?
Damage to a Lower Motor neuron results in ?
UMN- increased muscle tone and exaggerated DTRs
LMN- absent muscle tone and DTRs
What neuron tract carries the impulse that inhibits muscle tone?
What is the sequence of flow for sensory pathways?
Corticospinal tract
Impulses from skin/muscle/tendons/viscera
Peripheral nerves/dorsal roots
Spinal cord (pain, temp, position, touch)
Spinothalamic tract/Posterior Column
Sensory cortex of brain
Once sensations like pain, temp and crude touch synapse w/ secondary neurons, how to they get to the thalamus?
How are sensations like postition, vibration and fine touch perceived?
Cross and ascend in Spinothalamic tract
Directly into posterior columns
What type of sensation are and are not sensed in the thalamus?
How is full perception of stimuli achieved?
Perceives pain, cold, pleasant
No fine distinctions are made
Third group of neurons send impulses to sensory cortex and higher discrimination is made
A lesion in the sensory cortex may impair ? but leaves ? intact
What type of PT presentation suggests Dz of posterior columns?
Impaired perception of pain, touch and position; leaves finer discrimination intact (person can’t tell size/shape/texture of object in hand)
Loss of position and vibration senses but other senses are preserved
What Sxs mean transection of spinal cord
What are the 4 guiding questions of a neuro exam?
Loss of all sensation, paralysis and hyperactive DTRs
Does PT have Dz
Is there localization/symmetry
What is the pathophysiology of the finding
Wat is the DDx
General assessment of a PTs mental status starts where?
How is orientation assessed?
How to assess cognitive function?
How intellectual function assessed?
First meeting- LOC, Appearance, Affect
ANO x 3
Long term- presidents
Short term- 3 words
Count back by 7s, spell 5 letter word
Chart on Slide 28
Pg 147-171
Where do CNs 3-12 arise from?
Where do CNs 1 and 2 originate?
Diencephalon and brain stem
Brain
What CNs control pupil constriction, opening eye lid and most EOMs?
Which ones control EOM?
2 and 3
3, 4, 6
What CNs control swallowing, raising of palate and gag reflex
Which ones contribute to voice and speech?
9 and 10
5 7 9 10 12
While assessing EOMs, a loss of conjugate movements in any direction will cause ?
How are nystagmus’ names?
Diplopia
Direction of quick component
Define 3rd nerve palsy?
Define Anisocoria
Ptosis- drooping of upper eye lid
Difference of >0.4mm of pupil diameters
Table 7-10,
Pg 277
A lesion on ? CN causes an absent blinking reflex with the corneal reflex test?
What is the different results of a peripheral injury, like Bell’s Palsy, and a central lesion, like a stroke, on the muscles of the face?
Sensory 5 or Motor 7
Palsy- affects upper and lower face
Stroke- only lower face
What nerves are the motor area and pull the palate up during “aahh”?
How are both motor and sensory areas of these nerves tested?
A lesion here will cause what result to be seen?
9 and 10
Gag reflex
Paralysis causes pulling the uvula to unaffected side
A lesion on ? CN will cause hoarseness or difficulty swallowing during the gag reflex?
What are the functions of CN11?
Unilateral lesion on 10, vagus
Unilateral absence of reflex can mean lesion on 9 or 10
Carry efferent motor fibers to innervate SCM (turn head) and Trap muscles (raise shoulders)
Trapezius muscle weakness with atrophy and fasciculations indicates ?
What type of result will be seen in the shoulder as a result of the muscle’s weakness?
Peripheral nerve d/o
Drooped shoulder, scapula is displaced down and laterally
A unilateral cortical lesion of CN12 causes ? result?
A distal lesion of C12 will cause what tongue result?
Protruded tongue deviates away from side of lesion
Deviates to weak side
Sensory system carries stimuli such as pain/temp, position/vibration, light touch and discriminative sensation through which pathways?
Pain/temp- spinothalamic
Position/vibration- posterior column
Light tough- both paths
Discriminative sensation- cerebral cortex
When testing vibration and sensory sensation, what areas of the body are tested first?
Mapping out dermatomes help with an exam how?
Finger and toe
Localize neurological lesions to a specific level of the spine, particularly in spinal cord injuries
What is the organization that own dermatome mapping?
What are the land mark dermatome levels?
American Spinal Injury Association
C3- front of neck C6- thumb C8- ring and little finger T4- nipples T10- umbilicus L1- inguinal L4- knee L5- anterior ankle/foot L4,L5,S1- posterior ankle and foot S5- perianal