Practical examination Part1 Flashcards
What does the nervous system consist of?
The brain and spinal cord = Central Nervous System (CNS)
The Peripheral Nervous system (PNS) *The PNS also includes the autonomic nervous system (involuntary functions)
How many spinal pairs are there?
There are 31 pairs :
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal spinal nerve
What are dermatomes?
The surface of the skin is divided into specific areas called dermatomes
Each dermatome relies on specific pairs of spinal nerves
What does ICE mean?
Presenting Complaint
Employ ICE mnemonic to provide context in which symptoms have arisen
Ideas on what is happening to them
Concern in terms of impact on them
Expectations of the illness and of you, the practitioner
What drugs are used for tremors?
B agonists
lithium
sodium valporate
What drugs are used for peripheral neuropathy?
Chemotherapy
Metronidazole
Amiodarone
Antiretroviral drugs
Parkinsonism drugs?
Neuroleptics
prochloperazine
metoclopramide
Myopathy drugs
Statins
Corticosteroids
Headaches
Glyceryl trinitrate
Epileptic seizures
Tricyclic antidepressants
Phenothiazines
Clozapine
Ataxia
Phenytoin
Carbamazepine
Lithium
What does SOCRATES stand for?
Pain: Site
Onset
Character / Severity
Radiation
Associated symptoms
Timing
Exacerbating / relieving factors
Severity / symptom progression
What is syncope? What are the most common causes?
Syncope is loss of consciousness due to inadequate cerebral perfusion
Commonest causes of TLOC
Vasovagal syncope
Cardiac syncope
Epileptic seizures
Postural hypotension
Functional or psychiatric
What are the causes of dizziness?
Postural hypotension
Cerebrovascular disease
Cardiac arrhythmia
Hyperventilation (anxiety or panic induced)
Infection
Dehydration
Drugs!
What is Vertigo and what causes it?
The illusion of movement - What could be causing this?
Labyrinthitis
Vestibular neuronitis
Meniere’s disease
Head injury
Ischaemia e.g. stroke
Drugs!
What are the three main pathways for examinations?
Sensory
Motor
Integrative
What is Stance and Gait?
Stance and Gait is a multifactorial process which is dependent upon intact;
Visual
Sensory
Corticospinal
Extrapyramidal and cerebellar pathways
Functioning lower motor neurones
Spinal reflexes
Parkinsons humph, posture stopped, foot dragged, one arm imobile, gait is unsteady and wide
What are tests of co-ordination and power?
Co-ordination
Finger –to-nose test
Rapid alternating movements
Heel to shin test
Power
Finger grip strength
Lift leg off bed independently / against resistance
What are motor neurons and how do they work?
Motor Neurones control essential voluntary muscle activity such as;
- speaking, walking, breathing, and
swallowing
Normally, messages from nerve cells in the brain (upper motor neurons) are transmitted to nerve cells in the brain stem and spinal cord (lower motor neurons) and from them onto particular muscles
What is the difference between upper motor neurons and lower motor neurons?
Upper motor neurons direct the lower motor neurons to produce movements such as walking or chewing.
Lower motor neurons control movement in the arms, legs, chest, face, throat, and tongue.
What causes spasticity?
Disruptions in the signals between upper motor neurons and lower motor neurons cause limb muscles to develop stiffness (spasticity)
Movements become slow and effortful, and tendon reflexes such as knee and ankle jerks become overactive. Over time, the ability to control voluntary movement can be lost.
What side effects occur when there is upper motor neurone legions?
Upper motor neurone lesions
If the lesion affects the CNS pathways the lower motor neurones are under the uninhibited influence of the spinal reflex
As a result the motor units have an exaggerated response to;
Tone (spasticity)
Brisk reflexes
Weakness but not wasting
What are the side effects of lower motor neuron lesions?
Lower motor neurone lesions
The presence of a lower motor neurone lesion causes;
Weakness and wasting (muscle fibres)
Reduced tone (flaccidity)
Fasciculation
Reduced or absent reflexes
