Test #5- MS and Neuro Flashcards
DTR reflexes for biceps
C5-C6
DTR reflexes for brachioradialis
C5-C6
DTR reflexes for triceps
C6-C7
DTR reflexes for patellar
L2-L4
DTR reflexes for achilles
S1-S2
DTR responses below normal may imply
myopathies, decreased muscle mass, nerve root impairment
DTR responses above normal are characteristic of
pyramidal tract disease, electrolyte imbalances, hyperthyroidism
new onset radicular pain in older adults is frequently
spinal stenosis
patients with bulging discs are
asymptomatic
triad of Meniere disease
vertigo, hearing loss, and tinnitus
headache is caused by an abnormal metabolism of
serotonin, norepi, and dopamine
Headaches of new onset in the elderly tend to have a
secondary cause (tumor, bleed)
“worse headache of my life”
subarachnoid hemorrhage
Headache worse in the am, deep pain, aggravated by coughing, sneezing
brain tumor
Morning headaches worse in the occipital region
HTN
Headaches worse when bending over, nasal congestions, facial tenderness
sinusitis
Severe headache, tachycardia, diaphoresis
pheochromocytoma
Orbital headache
acute angle glaucoma
diagnostics for headache
CT/MRI, sinus series, CBC, CMP, TSH, EEG, lumbar puncture
risk factors for migraine
family hx, female, alcohol, estrogen replacement
foods that can affect migraines
food containing tryptophan or tyramine (ripe cheese, red wine, chocolate)
neurotransmitter involved in migraine
serotonin
5 phases of migraines
prodrome, aura, headache, termination, postdrome
phase of migraine where pt experiences mood swings, fatigue, food craving, yawning
prodrome
phase of migraine where pt experiences visual disturbances, visual field cuts, flashing lights, zigzag patterns, floaters
aura
phase of migraine where pt experiences unilateral headache that is throbbing, anorexia, N/V, photophobia, vertigo
headache phase that lasts 4-72 hours
phase of migraine that usually occurs with sleep or meds
termination of headache
foods to avoid for migraines
MSG, nitrite-containing food (hot dog), tyramine-containing food
POUND symptoms of migraine
Pulsatile or throbbing One-day duration, or lasts 4-72 hours Unilateral Nausea or vomiting Disabling or intensity causing interruption of daily activity.
this type of headache rarely occurs in children and pregnancy
cluster headache
risk factors for cluster headache
male, age >30, alcohol intake, use of NTG, excessive caffeine/nicotine
commonly referred to as suicide headache
cluster headache
peak and duration of cluster headache
peaks in 15 min, lasts less than 3 hours
characteristics of cluster headache
deep, severe, unilateral, and episodic
associated s/s with cluster headache
lacrimation, rhinorrhea, ptosis, injected conjunctiva
typical time of onset for tension headache
after age 20, before 50
type of headache that involves precranial muscle tenderness
tension type headache
risk factors for tension type headache
stress, worry, jaw-clenching
s/s of tension type headache
bilateral pressure around head, nonthrobbing, palpable muscle tightness, stiffness in neck, upper shoulders, and scalp.
onset and duration of tension type headache
gradual and lasts 30 min-7 days
vertigo is accompanied by
nystagmus and ataxia
vertigo can be caused by
benign positional vertigo, labyrinthitis, and Meniere’s disease
difference b/t syncope and presyncope
in presyncope patient does not lose consciousness
vasovagal syncope is d/t
deceased cardiac output
meds that can cause syncope
antihypertensives antiarrythmics antidepressants diuretics phenothiazines vasodilators.
diagnostics for syncope
CMP, BP in both arms, 24-hr ECG monitoring, neuro exam, tilt test
Bell’s palsy affects CN
VII- facial
causes of Bell’s palsy
idiopathic, viral, exposure to cold, herpes zoster, Lyme disease
risk factors for Bell’s palsy
age > 30, Lyme disease, pregnancy, family hx, DM, herpes zoster
S/S of bell’s palsy
unilateral numbness and paralysis, sensitivity to sound, loss of taste
Diagnostic for bell’s palsy
CT to r/o stroke, EMG testing
trx for bell’s
eyedrops, patch on affected eye at night
trigeminal neuralgia affects CN
5
s/s of trigeminal neuralgia
severe pain in lip, gum, cheek that is worse with touch or changes in temp. pain occurs in bursts.
onset and duration of labyrinthitis
sudden onset that can last for up to 2 weeks. recurrence is common
in labyrinthitis, these are not affected
hearing and tinnitus
labyrinthitis can also cause
N/V, nystagmus
risk factors for stroke
HTN, HLD, DM, obesity, smoking, lack of exercise, alcohol, OCP, CV disease, afib, and carotid artery disease
stroke outcomes are improved it therapy is given within
3 hours of onset of symptoms
most common cause of ischemic stroke symptoms is occlusion of the
middle cerebral artery
Occlusion of the left middle cerebral artery produces
aphasia
occlusion of the right middle cerebral artery produces
neglect to opposite side of body
AHA stroke warning signs
numbness, confusion, vision problems, trouble walking, severe headache
goal BP and A1c for stroke prevention
less than 130/80 and 7%
two kinds of stroke
ischemic and hemorrhagic
TIA is characterized as
cerebral ischemia without infarction that lasts less than 24 hours
Begins with motor symptoms characterized by recurrent contractions of muscles in one part of the body.
partial seizure
begin in one part of the body and progress to contiguous body parts over seconds or minutes.
simple partial seizure
seizure that impairs consciousness
complex partial seizure
Seizure that is bilaterally symmetrical but without local onset
generalized seizure
brief arrest of activity and loss of consciousness.
petit mal seizure
seizure where muscle movements are repetitive.
myoclonic seizure
causes of seizures
alcohol withdrawal, brain tumor, hypoxia, stroke, fever, head injury, meningitis
highest incidence of seizures is in
children and elderly
Inflammation of the brain and spinal cord caused by infection with bacteria, viruses, and fungi.
meningitis
bacterial causes of meningitis
Strep pneumonia, Group B or D Strep, N. meningitides
viral causes of meningitis
enterovirus
Fungal causes of meningitis
candida species, aspergillus
s/s of meningitis
stiff neck, fever, N/V, rash, nuchal rigidity, photophobia
clinical signs of meningitis
Kernig and Brudzinski sign
where complete extension of leg causes neck pain and flexion
Kernig sign
flexion of legs if neck is passively flexed.
Brudzinski sign
CSF in meningitis
turbid with WBC and high protein
CSF in bacterial meningitis
glucose is decreased
Diagnosis of PD is supported by therapeutic response to
levodopa
Parkinson’s is caused by decreased production of
dopamine
risk factors for parkinson’s
age > 60, family hx
S/s of parkinson’s
bradykinesia, muscular rigidity, resting tremor, postural instability
characterized by demyelination of nerve cells in the brain and spinal cord.
Multiple sclerosis
risk factors for MS
family hx and northern european descent
s/s of MS
intermittent; paresthesias, weakness, stiffness to extremities, transient blindness, nystagmus, scanning speech, intention tremor.
diagnostic of MS
MRI
CN I
olfactory- smell
CN II
optic- vision
CN III
occulomotor- pupillary response
CN IV
trochlear- downward, internal rotation of eye
CN V
trigeminal- corneal reflex, facial sensation, jaw movement
CN VI
abducens- lateral deviation of eye
CN VII
facial- facial movement
CN VIII
vestibulocochlear- balance and hearing
CN IX
glossopharyngeal- movement of pharynx
CN X
vagus- gag reflex
CN XI
spinal accessory- shoulder and neck
CN XII
hypoglossal- tongue
abd upper reflex
T8-T10
abd lower reflex
T10-T12
Plantar response (babinksi)
L5, S1
anal reflex
S2-S4
sprain is partial tearing or stretching of
ligaments
Grade III sprain
completely torn ligament, unstable joint
an injury to a muscle or tendon usually associated with improper use or overuse.
strain
If increased ROM occurs at any injured joint, suspect
severe tear of rupture of ligament
s/s of sprain
pain and swelling around joint, redness, bruising, audible pop at time of injury, discomfort on weight bearing
suspicion of fracture if there is
exquisite tenderness, pain, inability to bear weight
trx for sprains
Rest, Ice every hour x20 min for first 24 hours, then 4x/day, compression, and elevation
pain meds for sprains
NSAIDs for adults, acetaminophen for children
inflammation of synovial membrane
bursitis
bursitis occurs in areas where
friction is likely to occur
Bursitis is often secondary to
calcific tendonitis
risk factors for bursitis
trauma, overuse, gout, RA, OA, obesity, age
s/s of bursitis
aching pain and swelling over joint, decreased ROM,
entrapment neuropathy of the median nerve at the wrist d/t inflammation of wrist tendons, transverse carpal ligament, and/or surrounding soft tissue.
carpal tunnel
risk factors for carpal tunnel
age 40-60, repetitive movement of wrist, weight gain, pregnancy, arthritis, hypothyroidism
s/s of carpal tunnel
paresthesias affecting fingers (esp at night), dull/aching and weakness, affected hand cool to touch.
clinical tests for carpal tunnel
phalen and tinel test
test where pt holds flexed fingers against each other with wrists flexed at a 90 degree angle for 60 seconds. Considered positive for CPS if paresthesia occurs.
Phalen’s test
test where you percuss over the median nerve on the volar aspect of the wrist. Considered positive for CPS if paresthesia occurs.
Tinel’s test
diagnostic for CPS
nerve conduction studies, EMG
if CPS is untreated then there is a risk of
permanent loss of function to affected hand
Deposition of monosodium urate (MSU) crystals in joints and other connective tissue causing acute or chronic inflammation
gouty arthritis
causes of gouty arthritis
overproduction or underexcretion of uric acid, dietary excess of purine, alcoholism
gouty arthritis is common in
men > 45 years old
meds that can cause gouty arthritis
ASA, nicotinic acid, diuretics, cyclosporine
risk factors for gouty arthritis
alcoholism, renal disease, psoriasis, family hx, obesity, HTN
most commonly affected in gouty arthritis
MTP of first toe
s/s of gouty arthritis
acute joint pain and swelling, warmth and erythema
elevated in gouty arthritis
ESR and WBC
in an acute attack of gouty arthritis, the uric acid is
normal.
not useful in diagnosing gouty arthritis
uric acid level
allopurinol
decreased production of uric acid
med for acute attacks of gouty arthritis
NSAID
desirable level of uric acid
less than 7 mg/dl
Progressive destruction of the articular cartilage and subchondral bone accompanied by osteophyte formation and sclerosis
osteoarthritis
OA is confined to the
joints only
risk factors for OA
age > 40, obesity, overuse of joints, family hx, hemophilia, Paget’s disease
s/s of OA
asymmetrical joint pain, morning stiffness less than an hr
nodes in OA
Heberden’s and Bouchard’s nodes
node in distal interpharyngeal joints
Heberden
node in proximal interpharyngeal joints
Bouchard
in OA, inflammation markers are
negative
med considered first line for OA
Tylenol
An autoimmune disease that is systemic, frequently progressive, and is characterized by inflammation and thickening of synovial membrane
RA
risk factors for RA
white, native american, age 30-50
juvenile onset of RA begins at
1-3 years
s/s of RA
weakness, anorexia, weight loss, lymphadenopathy, low-grade fever
in RA, joint pain and stiffness occur
at rest and with movement that lasts > 1 hour in morning
these 4 symptoms must be present for at least 6 weeks to diagnose RA
morning stiffness > 1 hour, swelling of 3 or more joints, swelling of at least 1 joint in hand/wrist, and symmetrical joint swelling
xray in RA shows
joint space narrowing, bone erosion, reduced bone density
these are elevated in RA
RF, ESR, ANA, and C-reactive protein
a good measure of RA activity
ESR
post menopausal fractures occur b/c of
lack of estrogren
risk factors for osteoporosis
genetic, estrogen deficiency, calcium deficiency, alcohol and nicotine
Meds that can cause osteoporosis
corticosteroids, anticonvulsants, thyroid supplements
s/s of osteoporosis
asymptomatic until fracture occurs
trx for osteoporosis
1500 mg of calcium and 1000 IU of vit d
describes a disorder of the roots of the spinal nerves d/t compression, inflammation, or tearing of nerve roots at the site of entry into the vertebral canal
radiculopathy
common cause of low back pain
Compression or irritation of a nerve root
discs most commonly affected in low back pain
L4-L5, and L5-S1
s/s of low back pain
pain in back, buttocks, and/or one or both thighs
consider x-ray if patient presents with these with low back pain
age > 50, neuro deficits, hx of cancer, weight loss, substance abuse, trauma
apply heat to back pain after
first 48 hours
med for back pain
NSAIDs
straight leg raise and dorsiflexion of foot indicates
sciatica
migraines are thought to result from a longer period of
vasodilation
triggers for migraines
sounds, odors, estrogen fluctuations with menses
vomiting can be a sign of
increased intracranial pressure
patients with cluster headaches have worse pain when
lying down
tenderness over nodular temporal arteries is a sign of
temporal arteritis
most common type of migraine
migraine without aura
Vasculitis of the ophthalmic and posterior ciliary branches of the internal carotid artery.
temporal arteritis
temporal arteritis affects those who are
more than 50 years old
s/s of temporal arteritis
sharp pain over tender, nodular temporal artery
a preceding headache in temporal arteritis can lead to
blindness that is permanent
temporal arteritis is a
medical emergency
diagnostic of temporal arteritis
ESR greater than 50 mm/hr
OA is more ____ and RA is more ______
degenerative; inflammatory
OA results in
spur development
rheumatoid arthritis nodules
soft and spongy that appear on elbows, forearms, and hands.
characterized by chronic fatigue, generalized musculoskeletal pain, and multiple trigger points of pain on physical exam.
fibromyalgia
fibromyalgia affects mostly
women ages 20-50
s/s of fibromyalgia
pain over trigger points, sleep problems, depression, OCD, and IBS
sharp, burning pain that radiates down the posterior and lateral leg to the foot or ankle.
sciatica
chronic back pain is for more than
3 months
the most common cause of sciatica is
herniated disk
The MCPs are often boggy or tender in
RA
crepitus with flexion and extension of the knee is indicative of
OA
these maneuvers worsen sciatica
coughing and valsalva
Clinical test where you draw the tibia forward and observe if it slides forward from under the femur.
Anterior test drawer
anterior test drawer tests for
ACL tear
clinical test where you push the tibia posteriorly and observe the degree of backward movement in the femur.
posterior test drawer
posterior test drawer tests for
PCL tear
talar tilt test tests for
excessive ankle inversion
clinical test where you apply force medially to the ankle and note the degree of inversion.
talar tilt test
inability to bear weight after four steps and tenderness over the posterior aspects of either malleolus.
ottawa rules for ankle
A click is palpable or audible as the hip is reduced by abduction
ortolani
A palpable click is heard when the hips are guided into mild adduction.
barlow
when the patient lays on stomach and the examiner applies downward pressure to the patient’s foot, internally and externally rotating the lower leg.
Apley test
with the knee extended, the knee is milked downward and pressure is placed behind the lateral margin. A fluid wave is felt.
bulge sign
bulge sign is indicative of
knee effusion
apley test is to test for
meniscus injury
lachman test is to diagnose
ACL tear
test where the knee is flexed and externally rotated. Then you pull the tibia forward and push femur back.
lachman tests
McMurray test is used to help diagnose for
meniscus tear
test where you place the patient supine and internally rotate the foot and apply varus force to the knee, a click may be heard.
McMurray test- lateral meniscus tear
test where you place the patient supine and externally rotate the foot and apply vaglus force to the knee, a click may be heard
McMurray test- medial meniscus tear
Q angle helps to diagnose for
patellar tendinitis (jumper’s knee)
Q angle measures the angle between the center of the _____ to the anterior superior ____ and from the center ___ to the ____ ____.
patella; iliac spine; patella; tibial tubercule
test when the flexed abducted knee is pushed medially and the ankle is pulled laterally. It is positive if the patient has pain
valgus stress test
valgus stress test helps diagnose
MCL tear
test when the flexed abducted knee is pushed laterally and the ankle is pulled medially. It is positive if the patient has pain
varus stress test
Finkelstein test helps diagnose for
Quervain tenosynovitis
when patient flexes fingers over a clenched thumb, then passively deviate wrist ulnarly which can cause pain.
Finkelstein test
An Q angle greater than ___ degrees in males and __ degrees in females is positive.
10; 15
DTRs in MS are
increased
c/o pain with movement
tendonitis
varus stress test helps diagnose for
LCL tear
rooting reflex occurs in ages
birth to 3-4 months
rooting reflex
stroke perioral skin at mouth, mouth will open and baby will turn toward the side and suck
moro (startle) reflex occurs in ages
birth to 4 months
moro (startle) reflex
lower body and arms should extend and feet flex
asymmetric tonic neck reflex occurs in age
birth to 2 months
asymmetric tonic neck reflex
turn head to one side. the arm and leg that the head is turned will extend while the other side will flex.
trunk incurvation (galant’s) reflex occurs in ages
birth to 2 months
trunk incurvation (galant’s) reflex
support baby prone and stroke one side of the back and the spine should curve in that direction.
landau reflex occurs in ages
birth to 6 months
landau reflex
suspend baby prone with one hand, the head will lift and spine will straighten.
parachute reflex occurs in ages
8 months and doesn’t disappear
parachute reflex
suspend baby prone and lower head, the arms and legs should extend.
positive support reflex occurs in ages
birth to 6 months
positive support reflex
hold the baby standing and the baby will stand and bear weight, then sag after 20-30 sec
placing and stepping reflex occur in ages
birth to variable
placing and stepping reflex
hold baby upright and have one sole touch floor, the other foot should step forward.
palmar grasp reflex occurs in ages
birth to 3-4 months
plantar grasp reflex occurs in ages
birth to 6-8 months
delay or absence in pediatric reflex may indicate
pyramidal tract disease or cerebral palsy.
a positive barlow does not indicate
hip dysplasia but laxity.
ligaments connect
bone to bone
tendons connect
muscle to bone
when to screen for osteoporosis
women at age 65 or women with fracture risk.
carpal tunnel finger involvement
first 3 fingers, weak thumb abduction
age when osteoporotic fractures occur at the same rate in men and women
75
medial epicondylitis is called
golfer’s elbow
Yergason’s sign is to help diagnose for
bicep tendonitis
Cozen’s test is to help diagnose for
tennis elbow
bakers cyst is commonly associated with
RA
Testing for vibratory sensation primarily evaluates the function of the
posterior columns
A patient with lower motor neuron disease will exhibit
muscle atrophy
A patient with upper motor neuron disease will exhibit:
hyperactive DTRs, increased muscle tone
The Plantar (Babinski) reflex is normally found in children until the age of:
18 months
The meningitis vaccine (MCV4) is usually given
at 11-12 year olds then a booster at 16
Patients with lateral epicondylitis typically present with
decreased hand grip
