Written exam 4 Study Guide Flashcards by Sophia Timm

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

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Which type of walk is typically seen in a patient with parkinson’s?

Shuffle- short, hurried steps, head is bowed.

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If a patient shuffles into the ER with short, hurried steps, hunched over, which disease might they have?

Parkinson’s

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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)

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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

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If a patient is high-stepping with their gait and their feet slap down firmly, what is this called?

Sensory ataxia

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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

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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.

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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

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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.

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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

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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

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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

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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

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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

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If you have a tremor that has an oscillation of 10-12 cycles per second, what kind of tremor is this?

Physiologic

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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.

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A tremor that is slow, 2-4 times a second, that increases with movement, what type of tremor does your patient have

Intentional tremor

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Involuntary jerky movements of hands and limbs are called what and are signs of which disease

Chorea- Huntington’s disease presents with this.

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Where do the cranial nerves attach?

1 and 2 to the forebrain, rest to brainstem

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Which cranial nerve extends to the abdomen?

Vagus nerve

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Huntington’s disease presents with which type of a tremor?

Chorea- involuntary, jerky movements

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Which cranial nerves havve parasympathetic control

3 (oculomotor), 7 (facial), 9 (Glosopharyngeal), 10 (vagus).

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If you have a patient who comes to a clinic with anosmia, which cranial nerve is implicated?

CN 1- olfactory

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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

1. Vertigo 2. 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

1. Alertness 2. Lethargy 3. Obtundation 4. Stupor 5. 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?

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?

Muscle activation against examiner's resistance with FROM is which classification of muscle strength?

How do you asssess muscle tone

Perform PROM (passive ROM)