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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
According to whome is there overlap of sensory supply of nerve roots?
Head and Foerster
26
Who later modified the dermatome charts in the extremities and found little to no overlap?
Keegan
27
What specialized receptors are present in the skin, mucous membranes and in the peritrichal endings around the hair follicles?
Tactile disc of Merkel
28
What are the tactile disc of Merkel receptors sensitive to?
light touch or nondiscriminating touch
29
What is Thigmesthesia?
nondiscriminating touch (function of tactile disc of merkel receptors)
30
What is Topesthesia?
Deep touch or discriminating (well localized) touch
31
what is deep touch thought to be initiated by, what receptors?
Hairless portion of the skin known as corpuscles of meissner
32
33
What is considered the least desirable sensation to use for evaluation and localization for neurological lesions and why?
Touch, due to overlap and duplication of function
34
Deficits in light touch would indicate a lesion where?
Peripheral nerve lesions
35
What is the transmission and modulation of noxious stimuli?
Nociception
36
The density of nociceptive fibers is directly proportional to what?
The sensitivity of specific tissues
37
What joint tissues are devoid (lack) nociceptors?
1. Articular cartilage 2. Inner Annulus and nucleus of an intervertebral disc 3. synovial membranes
38
How are nociceptive fibers activated?
by noxious stimulus
39
What are the three categories of possible noxious stimuli?
1. Thermal 2. mechanical 3. chemical
40
What fibers to nociceptive impulses travel along?
slightly ***myelinated A Delta Fibers*** and ***unmyelinated C Fibers***
41
Nociceptive fibers project via the doral root to the what?
Dorsal lateral fasciculus
42
Deficits to pain would indicate a possible lesion where?
peripheral nerve
43
Nerve roots receive stimuli in the __________ pattern. Peripheral nerves receive stimuli in the \_\_\_\_\_\_\_\_\_pattern.
Dermatomal; Peripheral
44
The particular dermatomal or paraspinal level of hyperalgesia will often correlate well with what area?
Area of primary spinal subluxation
45
What is pallanesthesia?
loss of vibratory perception
46
Extreme changes in temperature stumulate what and therefore elicit pain?
free nerve endings
47
What is the most sensitive way of evaluating the sensory and lateral spinothalamic tract?
Hot temperature
48
What is the best method for specialized localization of a deficit in sensation?
Temperature
49
For a sensory temperature test what are the temperatures for cold and hot?
cold = 41 - 50 degrees F (fridge temp) hot = 104 - 113 degrees (sauna temp)
50
Voluntary motor impulses are initiated by what?
Cerebral motor cortex
51
Where is the voluntary motor impulses of cerebral motor cortex specifically initiated?
primarily in the motor cortex of the frontal lobe on the precentral gyrus
52
Is the brain able to shift functions to other areas, called plasticity?
YES
53
What are the 3 areas of muscle integrity that are assessed for the purposes of neurological evaluation?
1. Strength 2. Tone 3. Volume
54
What are muscle fasciculations and why do they occur?
muscle twitches, due to denervated muscle fibers (spontaneous discharge)
55
If fasciculations are not seen by the naked eye but can be demonstrated on electromyography what are they called?
fibrillations
56
What is power classified as?
kinetic, the force exerted in changing position
57
What is static energy?
force exerted in resting movement
58
Which type (kinetic or static) muscle strength is affected most by disease?
Both are usually equally affected
59
Which muscles are stronger in the body?
Antigravity muscles
60
What is the scale for muscle strength testing: 0 = 1 = 2 = 3 = 4 = 5 =
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

NMS 1 Exam 1 (6 decks)

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