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NMS 1 Exam 1 > Proprioception and cerebellar Examination > Flashcards

Proprioception and cerebellar Examination Flashcards

1
Q

What are the clinically testable proprioceptive functions?

A
  1. motion
  2. position
  3. vibration
  4. Pressure
  5. deep pain
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2
Q

What are the principle receptors for proprioception?

A
  1. neuromuscular and neurotendinous spindles
  2. Golgi tendon organ
  3. four varieties of joint mechanoreceptors
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3
Q

Vibration is best tested by using what instrument?

A

128 or 256 HZ tuning fork

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4
Q

What is pallanesthesia?

A

loss of vibratory perception

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5
Q

If patient fails finger to finger with eyes closed what are the top two DDX that are possible and how would you figure out which one it is?

A
  1. Dorsal column injury
  2. shoulder injury (damaged the proprioceptive fibers)

Have pt perform rhombergs test, if rhombers is negative than is is a shoulder injury that caused a decrease in proprioceptive function of the joint

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6
Q

What is Dyssynergia?

A

Uncoordinated movement

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7
Q

What is Dysmetria?

A

Inaccuracy in measuring distance

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8
Q

What is a good proprioceptive and cerebellar test for bed ridden patients?

A

Heel to shin

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9
Q

What is dysdiadochokinesia?

A

Inability to perform actions properly indicating a cerebellar disfunction

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10
Q

What is the most sensitive proprioceptive and cerebellar test?

A

Tandem Gait

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11
Q

When deep pain is being tested (abadies, pitres, biernackis sign, and deep eyeball pressure) What is usually the problem when pain sensation is diminished?

A

Dorsal column disease (tabesdorsalis)

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12
Q

What are you testing with multimodal sensations?

A

Both superficial and deep sensations

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13
Q

What is the distance that the following locations are able to detect 2-point touch discrimination?

  1. finger tips
  2. dorsum of fingers
  3. palm
  4. dorsum of hand
A
  1. 2-4 mm
  2. 4-6 mm
  3. 8-12 mm
  4. 20-30 mm
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14
Q

Is a sensory exam primarily subjective or objective?

A

Subjective examination

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15
Q

What is the deficit referred to when a primary sensory modality is not working in order?

A

anesthesia or analgesia

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16
Q

Information from the lower part of the body always ascends _______ within the cord

A

medially

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17
Q

Information from the upper part of the body always ascends _______ within the cord

A

Laterally

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18
Q

Superficial sensations are also classified as what? And what are they? (3 of them)

A

exteroceptive or cutaneous sensation

  1. pain
  2. temp
  3. light touch
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19
Q

In what district of the cord are superficial sensations carried?

A

anterolateral district of the cord

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20
Q

What are the testable deep sensations?

A
  1. pain
  2. touch
  3. proprioception
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21
Q

Is deep pain localized or poorly localized?

A

poorly localized

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22
Q

Deep sensations are carried in what district of the cord?

A

posterior

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23
Q

What is the highest level of sensation?

A

multimodal or association cortex sensations

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24
Q

Who determined the distribution of dermatomes?

A

Foerster

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25
Q

According to whome is there overlap of sensory supply of nerve roots?

A

Head and Foerster

26
Q

Who later modified the dermatome charts in the extremities and found little to no overlap?

A

Keegan

27
Q

What specialized receptors are present in the skin, mucous membranes and in the peritrichal endings around the hair follicles?

A

Tactile disc of Merkel

28
Q

What are the tactile disc of Merkel receptors sensitive to?

A

light touch or nondiscriminating touch

29
Q

What is Thigmesthesia?

A

nondiscriminating touch

(function of tactile disc of merkel receptors)

30
Q

What is Topesthesia?

A

Deep touch or discriminating (well localized) touch

31
Q

what is deep touch thought to be initiated by, what receptors?

A

Hairless portion of the skin known as corpuscles of meissner

32
Q
A
33
Q

What is considered the least desirable sensation to use for evaluation and localization for neurological lesions and why?

A

Touch, due to overlap and duplication of function

34
Q

Deficits in light touch would indicate a lesion where?

A

Peripheral nerve lesions

35
Q

What is the transmission and modulation of noxious stimuli?

A

Nociception

36
Q

The density of nociceptive fibers is directly proportional to what?

A

The sensitivity of specific tissues

37
Q

What joint tissues are devoid (lack) nociceptors?

A
  1. Articular cartilage
  2. Inner Annulus and nucleus of an intervertebral disc
  3. synovial membranes
38
Q

How are nociceptive fibers activated?

A

by noxious stimulus

39
Q

What are the three categories of possible noxious stimuli?

A
  1. Thermal
  2. mechanical
  3. chemical
40
Q

What fibers to nociceptive impulses travel along?

A

slightly myelinated A Delta Fibers

and

unmyelinated C Fibers

41
Q

Nociceptive fibers project via the doral root to the what?

A

Dorsal lateral fasciculus

42
Q

Deficits to pain would indicate a possible lesion where?

A

peripheral nerve

43
Q

Nerve roots receive stimuli in the __________ pattern.

Peripheral nerves receive stimuli in the _________pattern.

A

Dermatomal; Peripheral

44
Q

The particular dermatomal or paraspinal level of hyperalgesia will often correlate well with what area?

A

Area of primary spinal subluxation

45
Q

What is pallanesthesia?

A

loss of vibratory perception

46
Q

Extreme changes in temperature stumulate what and therefore elicit pain?

A

free nerve endings

47
Q

What is the most sensitive way of evaluating the sensory and lateral spinothalamic tract?

A

Hot temperature

48
Q

What is the best method for specialized localization of a deficit in sensation?

A

Temperature

49
Q

For a sensory temperature test what are the temperatures for cold and hot?

A

cold = 41 - 50 degrees F (fridge temp)

hot = 104 - 113 degrees (sauna temp)

50
Q

Voluntary motor impulses are initiated by what?

A

Cerebral motor cortex

51
Q

Where is the voluntary motor impulses of cerebral motor cortex specifically initiated?

A

primarily in the motor cortex of the frontal lobe on the precentral gyrus

52
Q

Is the brain able to shift functions to other areas, called plasticity?

A

YES

53
Q

What are the 3 areas of muscle integrity that are assessed for the purposes of neurological evaluation?

A
  1. Strength
  2. Tone
  3. Volume
54
Q

What are muscle fasciculations and why do they occur?

A

muscle twitches, due to denervated muscle fibers (spontaneous discharge)

55
Q

If fasciculations are not seen by the naked eye but can be demonstrated on electromyography what are they called?

A

fibrillations

56
Q

What is power classified as?

A

kinetic, the force exerted in changing position

57
Q

What is static energy?

A

force exerted in resting movement

58
Q

Which type (kinetic or static) muscle strength is affected most by disease?

A

Both are usually equally affected

59
Q

Which muscles are stronger in the body?

A

Antigravity muscles

60
Q

What is the scale for muscle strength testing:

0 =

1 =

2 =

3 =

4 =

5 =

A

0 = complete paralysis

1 = a twitch movement

2 = moderate to severe paresis (11-25%)

3 = moderate paresis (26-50% of normal movement)

4 = mild paresis (51 - 75%)

5 = normal (76-100% of normal movement)

61
Q
A

NMS 1 Exam 1 (6 decks)

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