Written exam 4 Study Guide Flashcards
If a patient is dragging or circumducting a weak or spastic leg, what is this called?
Hemiplegia
usually accompanied by a spastic arm flexed at elbow that crosses abdomen
Which type of walk is typically seen in a patient with parkinson’s?
Shuffle- short, hurried steps, head is bowed.
If a patient shuffles into the ER with short, hurried steps, hunched over, which disease might they have?
Parkinson’s
If a patient is walking with a wide-based gait, and they stagger side to side, what could be occuring?
Cerebellar ataxia (poor muscle control/lack of muscle control)
If a patient is slapping their foot on the floor what is this due to in their gait?
Called footdrop-
Due to weakness of dorsiflexers of ankle
If a patient is high-stepping with their gait and their feet slap down firmly, what is this called?
Sensory ataxia
Footdrop vs sensory ataxia
Footdrop- slapping results from weakness of dorsiflexors
Sensory ataxia- pt doesn’t know where thier feet are so they slap down intentionally
Sensory ataxia vs cerebellar ataxia
Sensory- slapping foot down, high steps, pt doesn’t know where their feet are.
Cerebellar ataxia- Pt has wide-based feet that are far apart, staggering from side to side.
What are the 8 dermatomes with their locations?
C6- thumb
C7- Middle finger
C8- Little finger
T4- Nipples
T10-Umbilicus
L4-Medial calves
L5-Big toe
S1-little toe
What does babinski sign indicate
UMN or LMN lesion in CST
Drag object across foot from heel to ball of foot, present sign is dorsiflexion of big toe and fanning of other toes.
What does a positive kernig sign indicate
meningeal infection
Pt lies supine, flex knee and hip to 90 degrees. Fully extend knee. Pain indicates positive
What does a positive brudizinski’s test indicate
Supine pt, flex patient’s neck. If causes flexion of patient’s hips and knees, suggests meningeal irritation
What does Hoffman’s sign indicate
Cervical spinal lesion
Positive hoffman sign is abduction and flexion of thumb/fingers when you pull on distal middle finger during hand pronation
What is romberg test and what does it indicate
- Have patient stand and extend arms with palms facing up, close eyes, see ability to maintain upright
Indicates cerebellar dysfunction and ataxia
What is Pronator drift and what does it indicate
Patient stands with both arms forward, eyes closed, palms up, abnormal is that arm drifts down
indicates ataxia or stroke
If you have a tremor that has an oscillation of 10-12 cycles per second, what kind of tremor is this?
Physiologic
If you have a tremor present at rest but decreased during activity, what kind of tremor is present?
Pathologic- slower like parkinson’s disease, 3-6 times a second.
A tremor that is slow, 2-4 times a second, that increases with movement, what type of tremor does your patient have
Intentional tremor
Involuntary jerky movements of hands and limbs are called what and are signs of which disease
Chorea- Huntington’s disease presents with this.
Where do the cranial nerves attach?
1 and 2 to the forebrain, rest to brainstem
Which cranial nerve extends to the abdomen?
Vagus nerve
Huntington’s disease presents with which type of a tremor?
Chorea- involuntary, jerky movements
Which cranial nerves havve parasympathetic control
3 (oculomotor), 7 (facial), 9 (Glosopharyngeal), 10 (vagus).
If you have a patient who comes to a clinic with anosmia, which cranial nerve is implicated?
CN 1- olfactory
If you have a patient whose pupils do not respond to light, which nerve is likely implicated?
3- oculomotor- parasympathetic response
Which Cranial nerves control eye movements
SO4 LR6, All rest 3
If your patient has trouble with mastication, which nerve is implicated?
Trigeminal- mandibular branch
If your patient is unable to distinguish light and sharp touches on their face, which cranial nerve is likely implicated?
Trigeminal- no sensation
If your patient does not have a corneal reflex, which nerve is likely implicated?
Trigeminal- no eye blink reflex= trigeminal not working to blink eyelid/muscle innervation dysfunctioning
Which nerve controls the sensory function for anterior 2/3 of the tongue?
7- facial
Which nerve controls the sensory function for posterior 1/3 of the tongue
9- glosopharyngeal
If your patient comes in and is not able to make distinct facial expressions, which nerve is likely harmed?
Facial- responsible for raising eyebrows, closing eyes, frowning, smiling, etc
If your patient has dry eyes or dry mouth (xerostomia), which nerve could be implicated?
Dry eyes= Facial
Dry mouth= Facial or Glosopharyngeal
If your patient has a negative shoulder shrug test, which nerve is dysfunctioning?
11- accessory- Innervates Trapezius and SCM
If your patient’s tongue is deviating to the right, which nerve is dysfunctional and on which side of the body?
Right hypoglossal nerve
(same side of the body problem and dysfunction)
If a patient’s uvula is pulled to the left side, which nerve is likely dysfunctioning and on which side of the body?
Likely glosopharyngeal nerve dysfunction on the Right side of the body
(opposite side dysfunction and sign)
What is the inability to perform a voluntary movement in the absece of deficits?
Apraxia
What is the decreased ability to perform a movement?
dyspraxia
What is the inability to construct or draw a simple shape or design
constructional apraxia
If your patient is weak on the right half of their body, how do you describe this?
Right sided hemiperesis
If a patient is paralyzed on the right side of their body, how do you describe this?
Hemiplegia
If a patient is paralyzed on their lower extremities, how do you describe this?
Paraplegia
What is the corticospinal tract responsible for
Voluntary movement, very skilled, discrete, purposful movements
What is the spinothalamic tract responsible for
Pain, temperature, and crude touch transmission
Ascending sensory pathway
What is the DCML tract responsible for
Transmission of vibrations, proprioception, fine touch
Ascending sensory pathway
When is the Jendrassik meneuver helpful
during testing of lower extremity reflexes- distract them
What is the main function of peripheral nerves
Send messages to and from the brain, carry motor output to glands or muscles from brain or send sensory input to the brain.
If a patient says they are feeling like the room is moving, how would you classify this feeling?
as vertigo- a spinning sensation
If a patient says that they feel like they just stood up too fast and will fall over, how do you classify this feeling?
Light-headedness, dizziness
What are the different types of spine deformities
Kyphosis, lordosis, scoliosis
Kyphosis= hunchback
Lordosis= stomach sticks out, lumbar pushed anteriorly
Scoliosis= spine is not straight line, curves laterally
What is active range of motion
Range of motion a joint can move through while patient uses their own muscles (no assistance)
What is PROM
Range of motion a joint can move through when an external force moves the joint without assistance
What is Assistive range of motion
The range a joint can move through with some assistance from an external force or muscle help
What are the bones of the ankle joint
Tibia, fibula, talus
What does articular cartilage do
Smooth tissue covering at the ends of bones, helps reduce friction and absorb shock
What is the synovial membrane
lining inside of joint capsule that produces synovial fluid for lubrication and cartilage nourishment
What does the Joint capsule do
Fibrous tissue, sourrounds joint and holds it together to provide stability
What do ligaments connect
Bones to bones
What do tendons connect
Bones to muscles
Primary function of bursae
fluid-filled sacs that cushion and reduce friction between tissues
Epiphysis vs diaphysis
Ephiphysis= long end
Diaphysis= middle part between ends, contains bone marrow
Number of vertebrae in each section
C= 7
T=12
L= 5
S= 5
Coccyx=4
33 total
If your patient is complaining of right knee pain, do you examine their right or left knee first?
Examine their left knee first- must look at unaffected side first
Varus vs valgus
Varus= pointed away from body
Valgus= pointed toward body (Genu valgum is knees bowing in)
Where does growth of long bones occur
at epiphyses
Where does hematopoiesis occur
in bone marrow
What is genu valgum
knock knees (bowing in, varus)
Frontal Lobe is responsible for
Voluntary skeletal movement, execuitive function, reasoning
The Parietal lobe is responsible for
Processing sensory data (like touch, vibration, pressure, pain, and 2 point descrimination)
The Temporal lobe is responsible for
Perception and determination of sound
The occipital lobe is responsible for
Primary visual center/visual interpretation
What is the primary function of the cerebellum
maintain balance and proprioception
What are the 2 ascending and 1 descending pathway that are relied upon often?
DCML and spinothalamic tracts are ascending
Corticospinal tract is descending
What are the neurons that are largely related and implicated in reflex arcs
Interneurons
What is a bundle of neurons that carry either sensory, motor, or mixed fibers called?
Nerves
_____________ neurons: sensory neurons that carry nerve impulses from sensory stimuli towards the central nervous system and brain.
Afferent
________________ Neurons carry information from the brain and CNS to the glands and muscles
Efferent
Contrast nerves and ganglia
Nerves are bundles of peripheral axons
Ganglia are bundles of peripheral cell bodies
_____ are axon terminals of motor neurons
motor endings
What do motor endings innervate
effectors (muscle fibers and glands)
What is the ability to perform a motor activity
Praxis
What is the inability to perform a voluntary movement
Apraxia
What is a decreased ability to perform an ability called
dyspraxia
What is the most common neuro complaint
Headache
Dizziness must be classified into which 2 categories
- Vertigo
- Light headedness
If a patient enters your office with hesitant and labored speech, poor articulation, and unaltered comprehension, what are they experiancing?
Expressive aphasia
If a patient enters your office with fluent and rapid words, omitting many words and not making sense, unable to comprehend what you ask them, what are they experiancing?
Receptive aphasia
Is Broca’s aphasia fluent or nonfluent
Non-fluent (expressive)
Is Wernicke’s aphasia fluent or non fluent
Fluent (receptive)
An Extrapyramidal gait is related to
motor activity descending from the cerebral cortex
If your patient is complaining of feeling pins and needles on their leg, what is this condition called?
Paresthesias
4 common causes of neurological pain
Trigeminal Neuralgia
Herpes Zoster
Sciatica
Meningitis
If your patient is feeling severe pain in their face and they constantly feel like they have an electric shock on, what are they experiancing?
Trigeminal Neuralgia
5 clinical levels of consciousness
- Alertness
- Lethargy
- Obtundation
- Stupor
- Coma
What is the acronym and check for dementia?
OMIJA
Orientation
Memory
Intellect
Judgement
Affect
Which cranial nerves connect to the forebrain?
1 and 2
How do you assess CN 2
Acuity- Snellen chart
Visual feild testing
Pupilary response to light
The response of pupils to light is controlled by what
Afferent nerves that travel with CN 2 and efferent nerves from CN 3 to innervate ciliary muscle which controls pupilary size
What are the somatic and visceral motor functions of CN 3
Somatic: Innervates all Eye muscles but LR and SO
Visceral: Innervates ciliary muscle and constricts pupil by contracting, controls shape of lens
How do you assess CN 4
Have the patient look down and in– CN 4 innervates the superior oblique
Which cranial nerve division innervates muscles of mastication
CNV3- Mandibular division
You walk in on a PA student who is stroking a patient’s face with a q-tip, asking the patient to open and close their mouth, and move their jaw from side to side. As a preceptor, you would be concerned, but you know the PA student is checking () nerve, so you are not.
Cranial nerve 5- Trigeminal.
What is the special sensory function of CN 7
taste to anterior 2/3 of tongue
What is the parasympathetic function of CN 7
innervate lacrimal glands, submandibular glands, sublingual salivary glands
What is the sensory function of CN 8
hearing and balance
What is the special sensory function of CN 9
Taste on posterior 1/3 of tongue
What is the motor function of CN 9
Elevate pharynx during swallowing
What is the parasympathetic function of CN 9
Innervate parotid and salivary gland
To test, ask about saliva production or dry mouth
If (WHIICH NERVE) is not working on the right side, the uvula will be pulled to the left.
CN 9
Sensory function of CN 10
Thoracic and abdominal viscera
Taste buds on epiglottis
What is the motor function of CN 10
Skeletal muscles of pharynx and larynx
What is the parasympathetic function of CN 10
Parasympathetic innervation to the heart, lungs, and abdominal viscera
With a light touch, you check the inside of the patient’s external ear. What cranial nerve are you checking?
Vagus
What is the motor function of CN 11
SCM and Trapezius innervation
What is the motor function of CN 12
Innervates tongue muscles
If the right sided CN 12 is dysfunctional, is the tongue sticking out to the right or left?
To the Right- Same side.
What are the 4 qualities of muscle groups
Atrophy, symmetry, fasiculations, tone
When checking a patient’s gait, which part of the brain are you testing
Cerebellar functioning
What are the 3 types of joints
Synovial- Freely moveable
Cartilagionous- Slightly moveable
Fibrous- Immovable
Muscle activation with gravity eliminated, achieving full range of motion, is which classification of muscle strength?
2- weak
Twitching muscle activation without achieving FROM is which classifcation of muscle strength?
1
Muscle activation against gravity with FROM is which classification of muscle strength?
3- fair
Muscle activation against some resistance, FROM is which classification of muscle strength?
4
Muscle activation against examiner’s resistance with FROM is which classification of muscle strength?
5
How do you asssess muscle tone
Perform PROM (passive ROM)
