Post Midterm lab #8

Question 1

Muscle groups should be assessed systematically, how?

Answer 1

proximal to distal in the upper and lower extremities

Question 2

What is the scale for muscle strength?

Answer 2

5 (normal) –> complete range of motion against gravity with full resistance
4(good) –> complete range of motion against gravity with some resistance (Examiner can overcome motion)
3(Fair) –> complete range of motion against gravity without resistance
2(poor) –> complete range of motion with gravity eliminated
1(trace) –> slight contraction, can not move joint
0(zero) –> no contraction, complete paralysis

Question 3

Clinical Case 508: Left leg paralysis, right leg numbness: A 75 year old retired pastry maker was in good health until one year ago, when he started to develop gait difficulties and numbness of his right leg. Recently, he has also experienced urinary urgency with occasional incontinence. Though he started taking laxatives, he experienced problems with bowel movements. At times, the left leg has unexpectedly been not able to support his weight causing him to stumble to maintain balance. He also reported that, in addition to the numbness in the right leg, he also has a constant tingling in the same limb, which he describes as intolerable. Thoughts?

Answer 3

advanced age–> makes you think neoplastic
the fact that its been worsening over a year
the fact that the symptoms are bilateral and not unilateral makes you think more neoplastic over degenerative

Question 4

Exam: Rectal exam showed significantly reduced muscle tone in the external sphincter and weakness of voluntary contraction. Prostate was felt to be enlarged with a highly nodular, irregular surface. Thoughts??

Answer 4

prostate cancer
irregular nodules are indicative of cancer
smooth surface would be more like BPH

Question 5

Neuro exam: Muscle tone was increased in left leg, and the left iliopsoas muscle was weaker than the right (4/5). Right left reflexes were 2+ (average), knee jerk on the left was 3+ (brisker than average), and ankle jerk on right 4+ (very brisk). Plantar response was extensor on the left and flexor on the right. Pinprick and temp sensation showed decreased sensitivity on the right. Vibration and joint position sense were reduced in the left leg and foot. Thoughts??

Answer 5

Pain and temp determine the level of the lesion, symptoms are usually tow levels below level of lesion
T10 showed up so lesion is at T8 on the left
UMN lesion on the left, muscle is still being invervated so therefore LMN are okay.
patient has developed brown-sequard syndrome
if the cancer spreads to the bones patients will present with severe back pain