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NYCC Patient Assessment 1 > Thoracic spine MRS and Meningeal tests > Flashcards

Thoracic spine MRS and Meningeal tests Flashcards

1
Q

What significant history findings can indicate a thoracic spine issue?

A

Difficulty breathing
Chest pain
Substernal burning
Chest pressure
Abdominal pain
Knife-like pain in the lower thoracic spine
Dull ache over thorax
Febrile

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2
Q

Knife like pain in the lower thoracic or lumbar spine with a patient favoring flexion indicates what MSK pathology?

A

Facet syndrome

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3
Q

What is the innervation of serratus anterior?

A

Long thoracic nerve

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4
Q

What is the innervation to the trapezius and sternocleidomastoid?

A

CN XI: Accessory

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5
Q

What is an Adam’s test?

A

Patient with signs of scoliosis is asked to flex forward at the waist

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6
Q

What are positive finding(s) and indication(s) for an Adam’s test?

A

Structural findings such as rib humping do not recede = Structural scoliosis
Structural fidings such as rib humping recede = Functional scoliosis

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7
Q

How is a rib motion test performed?

A

The patient is seated and the doctor stands posteriorly, fingertips of each hand are placed in the costovertebral spaces 2-5. Ask patient to fully inhale and exhale
Repeat along the mid-axillary line for ICS 6-9 and posteriorly for 10-12

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8
Q

What is a positive result for a rib motion test?

A

Asymmetrical rib motion and excursion

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9
Q

The Soto-Hall Test is (Febrile/Afebrile)?

A

Afebrile

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10
Q

How is the Soto-Hall Test performed?

A

With the patient supine, the examiner places knife edge contact or rolled towel on the sternum and flexes the cervical spine

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11
Q

What is a positive finding for a Soto-Hall Test?

A

Report of cervicothoracic spinal pain

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12
Q

What is indicated by a positive finding for a Soto-Hall Test?

A

General cervciothoracic discomfort that may indicate a disc herniation, sprain, strain, fracture, or subluxation

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13
Q

What three tests can be recorded with a patient supine in neck flexion?

A

Brudzinski’s Sign
Lindner’s Sign
Soto-Hall Test

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14
Q

What orthopedic test for cervicothoracic pain can be positive for a clay shovelers fracture?

A

Soto-Hall Test

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15
Q

The Brudzinksi’s Sign is (Febrile/Afebrile)?

A

Febrile

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16
Q

How is Brudzinksi’s sign performed?

A

Same as Soto-Hall but WITHOUT stabilization

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17
Q

What sign is the same as Linder’s sign without the leg pain?

A

Brudzinksi’s sign

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18
Q

The Soto-Hall test has stabilization (TRUE/FALSE)?

A

t

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19
Q

Does the Brudzinski’s Sign involve stabilization?

A

NO

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20
Q

What is a present finding for Brudzinksi’s sign?

A

Knee flexion, lumbar extension, increased head and neck pain (Opisthotonos position)

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21
Q

What sign has a present finding of an opisthotonos position?

A

Brudzinski’s sign

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22
Q

What is indicated by a positive Brudzinski’s sign?

A

Headache and neck pain or stiffness with a fever indicating meningitis

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23
Q

What orthopedic tests can determine meningitis if present or positive?

A

Brudzinksi’s sign
Kernig’s test

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24
Q

Kernig’s test is (Febrile/Afebrile)?

A

Febrile

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25
Q

How is Kernig’s test performed?

A

Examiner flexes the knee and hip of one leg to 90 degrees then attempts to straighten the flexed leg at the knee

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26
Q

What is a positive finding for Kernig’s test?

A

Diffuse pain in the cervicothoracic area, Involuntary flexion of the opposite hip and knee, and/or cervical and lumbar extension

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27
Q

What is indicated by a positive finding for Kernig’s test?

A

Meningeal inflammation

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28
Q

With exception of fever, the chief complaint for meningitis is the same as a dissecting vertebral artery (TRUE/FALSE)?

A

t

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29
Q

What is the common chief complaint in both meningitis and a VBAI?

A

Neck pain and stiffness

30
Q

What test should be used if you are not absolutely certain that the condition a patient has is not in the vertebral artery?

A

Kernig’s test

31
Q

What is L’Hermitte’s Sign?

A

Upon performance of any passive cervical flexion maneuver note any report of shock-like dysesthesias down the spine into any of the extremities
Can be performed as an active test where the patient is seated and asked to drop their head into full flexion

32
Q

L’Hermitte’s Sign is (Active/Passive/Both)?

33
Q

What is a present finding for L’Hermitte’s sign?

A

Report of shock-like dysesthesias down the spine or into any of the extremities

34
Q

What is indicated by a present finding for L’Hermitte’s sign?

A

Cord demyelination or compression

35
Q

What sign is pathognomonic for multiple sclerosis?

A

L’Hermitte’s sign

36
Q

What orthopedic test or sign can be used to determine intercostal neuritis or pleural inflammation?

A

Shepelmann’s sign

37
Q

How is Shepelmann’s sign performed?

A

Ask patient to laterally flex toward the side of pain and then away from the side of pain and determine which movements exacerbate the complaint of thoracic cage pain

38
Q

When is Shepelmann’s sign present? What is indicated?

A

Increase in pain leaning TOWARD the symptomatic side = Intercostal neuritis
Increase in pain leaning AWAY FROM the symptomatic side = Pleural inflammation

39
Q

What is the most common site of AS and what is the 2nd most common site?

A

MC = SI
2nd = GH joint

40
Q

What tests can be used to form a diagnosis of ankylosing spondylitis?

A

Forestier’s Bowstring Sign
Lewin’s Supine Test

41
Q

For Forestier’s Bowstring Sign you must observe the spine with the gown open in the back (TRUE/FALSE)?

42
Q

What is Forestier’s Bowstring Sign?

A

Patient is standing and asked to laterally flex to each side

43
Q

What is the history in a patient with AS?

A

Male in early 20s
Inflammation of SI joints and progressive stiffness moving superiorly
HLA-B27 positive

44
Q

What is a present finding for Forestier’s Bowstring Sign?

A

Contracture or tightening of the musculature ipsilateral to lateral flexion

45
Q

A present finding for Forestier’s Bowstring Sign is contracture of the musculature (Ipsilateral/Contralateral) to the side of lateral flexion?

A

Ipsilateral

46
Q

What is indicated by Forestier’s Bowstring Sign?

A

Ankylosing spondylitis or spinal ankylosis from other causes

47
Q

How is Lewin’s supine test performed?

A

Patient is supine and the examiner stabilizes the distal tibia, the patient attempts to sit up without use of the arms

48
Q

What is a positive finding for Lewin’s supine test?

A

Inability to sit up

49
Q

What is indicated by a positive finding for Lewin’s supine test?

A

Possible AS
Also arthritis or disc herniation in other texts

50
Q

What orthopedic test can assess thoracic motor function?

A

Beevor’s Umbilical migration test

51
Q

What is Beevor’s Umbilical Migration Test?

A

Patients hands behind their head and knees bent while supine. Instruct the patient to raise the gown high enough to observe the umbilicus and then perform partial sit-up

52
Q

What is a positive finding for Beevor’s Umbilical Migration Test?

A

Deviation of the umbilicus toward one quadrant or in a cephalad or caudad direction

53
Q

A positive finding for Beevor’s Umbilical Migration Test will show umbilical migration (Towards/Away from) the lesioned quadrant?

54
Q

What is indicated by a positive finding for Beevor’s Umbilical Migration Test?

A

Abdominal muscle weakness in the quadrants opposite deviation

55
Q

What is the dermatome of the nipple?

56
Q

What is the dermatome of the xiphoid process?

57
Q

What is the dermatome of the umbilicus?

58
Q

What is the dermatome supradjacent to the inguinal region?

59
Q

A thoracic sensory exam is performed how many spinal levels at a time?

60
Q

What superficial reflex can be used for a thoracic reflex test?

A

Superficial abdominal reflex

61
Q

What is a positive finding for a superficial abdominal test?

A

No reflex or asymmetry toward the quadrant stimulated

62
Q

What is indicated by a positive finding for a superficial abdominal test?

A

T7-T9 weakness if upper quadrant
T10-T12 weakness if lower quadrant

63
Q

If the umbilicus fails to move towards the upper quadrants in a superficial abdominal test how is this recorded and what is indicated?

A

Positive superficial abdominal test indicating T7-T9 weakness

64
Q

If the umbilicus fails to move towards the lower quadrants in a superficial abdominal test how is this recorded and what is indicated?

A

Positive superficial abdominal test indicating T10-T12 weakness

65
Q

What motor test is used for testing the T1-T6 MRS?

A

Rib motion test

66
Q

What motor test is used for testing the T7-T12 MRS?

A

Beevor’s Umbilical Migration test

67
Q

What spinal levels is the superficial abdominal reflex used for thoracic MRS reflex testing?

68
Q

How is a posterior thoracic dermatome test performed for thoracic MRS sensory testing?

A

Patient is seated and gown is opened to observe the thoracic spine. Doctor uses W-Wheel to evaluate four levels at a time paraspinally

69
Q

How is a mid-axillary dermatome test performed for thoracic MRS sensory testing?

A

Patient is seated and gown is opened to observe the thoracic spine. Patient is asked to cross arms out in front of them. Doctor uses W-Wheel to evaluate four levels at a time in the mid-axillary line

70
Q

How is an anterior dermatome test performed for thoracic MRS sensory testing?

A

Patient is supine and asked to move gown down to expose clavicular region. Doctor stands at the inferior of the table and compares dermatomes parasternally

NYCC Patient Assessment 1 (15 decks)

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