Examination of the Sensory of Function

Question 1

Where do the sensory impulses travel through in the brain for sensory of function?

Answer 1

Spinothalamic tract
Posterior columns

Question 2

explain the STT?

Answer 2

1st order neurons: pain, cold, or warm sensation (DORSAL ROOT GANGLION)

2nd order neurons: decussate via ventral commissure

3rd order neuron: Thalamic relay nuclei

Question 3

what does the SST convey?

Answer 3

pain, temperature, crude & light touch

Question 4

what parts of the brain is the SST clinically relevant to?

Answer 4

peripheral neuropathy
ridiculopathy
spinal cord
cerebral cortex - parietal lobe

Question 5

explain the dorsal column-medial lemniscal pathway?

Answer 5

1st order neurons: DRG -> ipsilateral medulla
2nd order: medulla (decussate to CL side)
3rd order: Ventral Posterior lateral thalamus –> Primary somatosensory cortex

Question 6

what does the DCLM convey?

Answer 6

2-point discirmunation
position (proprioception)
vibration
fine touch

Question 7

where is the DCLM clinically relevant?

Answer 7

tabes dorsalis
posterior cord syndrome
subacute degeneration of the spinal cord
brown-squared syndrome

Question 8

untreated syphilis can result to weakness or slow degeneration of dorsal columns & roots to?

Answer 8

Tabes dorsalis

Question 9

What DCLM abnormality is caused by vit B12 def ?

Answer 9

subacute combined degeneration of the spinal cord

Question 10

what peripheral nerve fiber type has touch & vibration sense? what are equipments used during test of these?

Answer 10

A & Beta

Touch = fingers, piece of cotton wool or soft brush
Vibration = tuning fork (128Hz)

Question 11

What peripheral nerve fiber type has sensation of pinrpick, sharp pain, & cold?

Answer 11

A & Delta

Pinprick, sharp pain = Wooden cocktail sticks
Cold = cold object

Question 12

What peripheral nerve fiber type has sensation of warmth? equipment used for this test?

Answer 12

C = warmth

Warmth = warm object (42)

Question 13

what are the necessary body parts to evaluate for examination of sensory function?

Answer 13

dorsum of hands & feet
laeral aspect of upper thighs
inner aspect of upper arms

Question 14

what are abnormal symptoms seen in assessing sensory function?

Answer 14

pain
numbness
tingling sensation

Question 15

what are the important dermatomes from cervical to S1?

Answer 15

C3 = front of neck
T4 = nipples
T10 = umbilicus
C6= thumb
C7 = middle finger
C8 = little finger
T1 = posterior arm
L1 = inguinal
L3/L4 = knee
L5 = =big toe
S1 = pinky toe, posterior aspect of leg & thigh

Question 16

what pattern of sensory loss has it lost throughout the opposite side of the face, arm, & legs?

Answer 16

Thalamic lesion - central from the thalamus up

Question 17

What pattern of sensory loss has CL sensory loss below face & IL loss on the face?

Answer 17

Brainstem lesion

Question 18

What pattern of sensory loss has asymmetrical & dissociation like pain, temp loss but light touch is intact?

Answer 18

Central cord lesion

Question 19

What pattern of sensory losss is a Brown-Sequard syndrome where there is CL pain & temp loss, IL weakness & DC loss below lesion, UMN?

Answer 19

Hemisection of cord or unilateral cord lesion

Question 20

What pattern of sensory loss has loss of modalities below lesion where spinal cord is transected?

Answer 20

transverse cord lesion

Question 21

What pattern of sensory lass has demyelination, loss of proprioception, vibration & light touch?

Answer 21

isolated dorsal column lesion

Question 22

what pattern of sensory loss has cervical root compression, shingles (T5), lumbar root compression (L4) peripherally?

Answer 22

Individual sensory root lesions

Question 23

what pattern of sensory loss has distal, symmetric polyneuropathy where multiple nerves are affected?

Answer 23

Typical glove & stocking distribution

Question 24

What are other sensory losses of Typical glove & stocking distribution?

Answer 24

• Wullerian degeeneration = nerve gets damaged from tip of toes bilaterally to up and back to the root
• peropheral nerve problem
• metabolic & systemic problems

Question 25

what is the presentation of Brown Sequard syndrome?

Answer 25

ST & DCML on the same side but presents CL

Question 26

what type of nerve pattern loss has median nerve innervating the first 3 1/2 fingers on the palmar aspect but the dorsal aspect is only the giners?

Answer 26

Focal neuropathy

Question 27

what are other clin features of focal neuropathy?

Answer 27

ulnar nerve innervates the PINKy side Radial nerve involves 3 1/2 aspects on the dorsal hand

Question 28

what is the order of asssessment for sensory loss?

Answer 28

Superficial (exteroceptive) sensation Proprioceptive (deep) sensation Combined cortical sensations

Question 29

what are the diff superficial sensations?

Answer 29

pain perception temperature awareness touch awareness pressure perception

Question 30

what are the diff deep sensations?

Answer 30

Kinesthesia awareness (proprioception) Vibration proprioception

Question 31

what are the diff combined cortical sensation?

Answer 31

stereogenesis perception tactile localization two-point distribution double simultaneous stimulation graphesthesia recognition of texture barognosis

Question 32

what are the 3 superficial sensations?

Answer 32

light touch sensation temperature pain

Question 33

in what conditions do you see abnormal findings of light touch sensation?

Answer 33

diabetes folic acid def alcoholism

Question 34

in what conditions do you see abnormal findings of pain sensation?

Answer 34

analgesia hypoalgesia hyperalgesia

Question 35

when do you test for temperature sensation?

Answer 35

when pain sensation is abnormal

Question 36

what are the 2 types of deep sensation?

Answer 36

vibration position/kinesthesia

Question 37

what neuro pathway is observed in vibration?

Answer 37

Dorsal column pathway

Question 38

in px with length dependent polyneuropathies & glove & stocking distribution, what is the first site to be affected?

Answer 38

distal sites -> toes

Question 39

what if position sense is intact distally, what does it mean?

Answer 39

proximal position sense is also intact

Question 40

can px with severe dorsal column problems detect kinesthesia?

Answer 40

no

Question 41

what are the main features of gait of sensory ataxia?

Answer 41

"stamp & stick" var degrees of difficult standing & walking intact muscular power (motor strength) no dizziness + Romberg sign loss of position sense & vibratory sense of both lower extremities

Question 42

what are interprative sensory functions that require analysis of indiv sensory modalities by parietal lobes?

Answer 42

cortical sensation

Question 43

what are the diff cortical sensations tested?

Answer 43

Stereognosis - identify obejcts by feel Graphesthesia = number identificaiton 2 point discrimination = paper clips Sensory attention = perceive 2 simultaneous sensory stimuli

Question 44

what are the diff typical patterns in charting?

Answer 44

Thalamic lesion or higher = half of whole body spinal cord lesion = half of upper/lower body peripheral nervous system = peripheries (hands & legs)