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PCM 2 final > PNS > Flashcards

PNS Flashcards

1
Q

what should your neuro ROS include?

A

headache
dizziness or vertigo
seizures, tremors, involuntary movements
weakness
numbness
fainting (syncope or near syncope)

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2
Q

3 most common PNS complaints?

A

pain, weakness, numbness/tingling

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3
Q

shoulder nerve levels

A

flexion/abduction C4-5

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4
Q

elbow nerve levels

A

flex = C5 (musculocutaneous n)
extend = C7 (radial)

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5
Q

wrist nerve levels

A

flexion = C7 (median, ulnar)
extend = C6 (radial)

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6
Q

finger nerve levels

A

flex (grip C8, median & ulnar)
(abduct T1 ulnar)

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7
Q

hip nerve levels

A

flex = L2-4 (femoral, L1-3 nerve roots)
extend = L5 (inferior gluteal)

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8
Q

knee nerve levels

A

flex = S1 (sciatic)
extend = L3 (femoral)

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9
Q

ankle nerve levels

A

dorsiflex L4 (deep peroneal)
plantarflex S1 (tibial)

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10
Q

toe nerve levels

A

dorsiflex L5 (deep peroneal)

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11
Q

motor strength exam

A

0 = no movement
1 = muscle twitch without joint movement
2 = movement with gravity eliminated
3 = full strength against gravity only
4 = partial strength against resistance
5 = full strength against resistance

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12
Q

what must the sensory exam include?

A

dermatomal AND peripheral cutaneous

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13
Q

dysesthesia

A

all types of abnormal sensation including pain regardless of stimulant being present or not

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14
Q

paresthesia

A

mostly numb, tingling, pins & needles without pain or apparent stimulus

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15
Q

anesthesia

A

absence of sensation

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16
Q

hypesthesia or hypoesthesia

A

reduced sensitivity

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17
Q

hyperesthesia

A

increased sensitivity

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18
Q

hyperalgesia

A

significant pain in response to mildly painful stimulus

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19
Q

allodynia

A

non painful stimulus, perceived as painful on the skin

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20
Q

5 types of sensation

A
  1. pain
  2. temperature
  3. light touch
  4. proprioception (position)
  5. vibration
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21
Q

discriminative sensory exam

A
  1. stereognosis (identify object by feel)
  2. 2 point discrimination
  3. number identification
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22
Q

DTR levels

A

biceps C5-6
brachioradialis C5-6
triceps C6-7
Patellar L2-4
Achilles S1

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23
Q

grading of DTRs

A

0 = absent
1+ = diminished
2+ = normal/average
3+ = mildly over active
4+ = highly over active

24
Q

examples of common PNS pathology

A

ischemia, bleed, infection, mass, compression, nerve disorder, neuromuscular disorder, muscular disorder, idiopathic

25
Q

UMN sign

A

-paralysis of movement, not muscle
-atrophy from disuse, slight
- spasticity, hypertonic
-DTR increased (loss of superficial reflexes)
-Babinski upgoing

26
Q

LMN sign

A
  • paralysis from muscle atrophy
    -wasting pronounced
  • flaccid, hypotonic (fasciculations may be present)
  • DTR low or absent
27
Q

anterior horn lesion

A

polio, ALS
-fasciculation & weakness in segmental path
-sensation intact
-weak DTR

28
Q

spinal nerve root lesion

A

herniated disc
-weakness then atrophy
-dermatomal sensory changes
-weak DTR

29
Q

peripheral mononeuropathy (lesion)

A

carpal tunnel syndrome, Bell’s Palsy
-weakness in specific peripheral nerve distribution
-sensory loss in corresponding nerve distribution
-weak DTR

30
Q

peripheral polyneuropathy

A

diabetes, alcoholic neuropathy
-distal weakness
-stocking glove distribution sensory loss
-weak DTR

31
Q

NMJ lesion

A

myasthenia gravis
-muscular fatigability
-sensation intact
-DTR intact

32
Q

muscular lesion

A

muscular dystrophy
-weakness, usually in proximal muscles
-sensation intact
-DTR intact or possibly decreased

33
Q

Adson’s test

A

thoracic outlet syndrome
-ext R, abduct & extend arm while palpating pt’s radial pulse –if diminished = positive

34
Q

Roo’s test

A

thoracic outlet syndrome
-arms at goal post, hold for 2 mins, if weak or numbness occur then positive

35
Q

Erb’s Palsy

A

C5-6 lesion leaves arm in waiter’s tip position
-upper brachial plexus injury

36
Q

Klumpke’s Palsy

A

C8-T1 palsy = claw hand position
-lower brachial plexus injury

37
Q

Long thoracic nerve injury

A

winging of scapula
C5-7

38
Q

Median nerve injury/lesion causes

A

-crush injury
-pronator syndrome (pronator teres compressing nerve)
-carpal tunnel syndrome (entrapment of medial nerve in tunnel)
-wrist slashing
-palm injury/laceration

39
Q

ape hand deformity

A

median nerve injury
-C5-6 & C8-T1
-actively attempting a fist & wasting of thenar eminence

40
Q

tinel’s sign

A

-hit wrist with reflex hammer, hitting median nerve, positive if pain or numb

41
Q

phalen’s test

A

reverse prayer, pain and numbness d/t median nerve

42
Q

prayer test

A

put hands in prayer position, pain or numbness d/t median nerve

43
Q

median nerve: anterior interosseous neuropathy

A

pinch grip = “ok” sign –can’t perform

44
Q

causes of ulnar n. injury/lesion

A
  1. fx of humerus near medial epicondyle
  2. cubital tunnel syndrome at elbow
  3. laceration near wrist
  4. entrapment at Guyon’s canal
45
Q

claw hand deformity

A

ulnar n injury
C8-T1
can’t straighten 4th & 5th digits

46
Q

tinel’s sign at elbow

A

“funny bone”
hit with hammer, causes pain and pins at 4th & 5th digits

47
Q

radial nerve injury causes

A
  1. fx of humerus near radial groove
  2. “saturday night palsy” – compression by sleeping with arm under head
48
Q

wrist drop

A

radial n injury
C5-T1

49
Q

sciatic n injury

A

-disc compression L4/L5 nerve roots
-piriformis syndrome
-posterior hip dislocation

sciatica & steppage gait

50
Q

superior gluteal n injury

A

-trauma
-hip replacement surgery
-following IM injection in butt

*trendelenburg gait

51
Q

lateral femoral cutaneous n injury

A
  • compression at iliac crest (belt, seatbelt, large pannus)

-numbness over lateral thigh

52
Q

common fibular n injury

A

-impingement by piriformis
-proximal fibular fx
-stretched from varus stress (with LCL)
-compressed by casting
-surgery

-paralysis of DF & everters, loss sensation anterolateral leg & dorsum of foot,
*foot drop w/ high steppage gait & foot slap

53
Q

superficial fibular/peroneal n injury

A

-proximal fibular fx
-stretched with varus stress
-compressed by casting

-paralysis of foot everters
-NO foot drop
-loss sensation of anterolateral leg & dorsum of foot

54
Q

deep fibular/peroneal n injury

A

-anterior compartment syndrome
-anterior tarsal tunnel syndrome
-pes cavus (high arch)
-tight shoelaces or trauma

-weak DFs, foot drop*

55
Q

medial plantar n injury

A

-entrapment in longitudinal arch
-Jogger’s foot = valgus hindfoot & pes planus

-aching pain in arch & burning/paresthesia in medial plantar surface

PCM 2 final (7 decks)

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