Lecture Midterm 1 Flashcards
1
Q
What does the O stand for in the acronym “OPQRST”?
A
Onset of injury
2
Q
What does the P stand for in the acronym “OPQRST”?
A
Palliative/Provocative
3
Q
What does the Q stand for in the acronym “OPQRST”?
A
Quality of pain
4
Q
What does the R stand for in the acronym “OPQRST”?
A
Radiation/Referral of pain
5
Q
What does the S stand for in the acronym “OPQRST”?
A
Severity of pain
6
Q
What does the T stand for in the acronym “OPQRST”?
A
Temporal factors (time of day, days of the week, etc.)
7
Q
What term describes a neurological loss from spinal nerve root compression or ischemia with numbness and/or weakness?
A
Radiculopathy
8
Q
The majority of information needed to make a clinical diagnosis comes from what?
A
Patient history
9
Q
What is Dr. Homack’s 1st Law?
A
The treatment must match the diagnosis
10
Q
What is Dr. Homack’s 2nd Law?
A
Every treatment plan has an expiration date
11
Q
What term describes the list of conditions the patient may have based on the symptoms exhibited and the results of the exam?
A
Differential diagnosis
12
Q
What is the presumed cause of the patient’s condition, arrived at by evaluating all assessment information thus far obtained while conducting further diagnostic testing to definitively diagnose the illness?
A
Working Diagnosis
13
Q
What is a clinical red flag that you need to be aware of when taking a history?
A
Thunderclap or sentinel headache
14
Q
What are the possible symptoms associated with a cerebellar dysfunction?
A
- Hypotonia
- Dysmetria
- Ataxia
- Pendular reflex
- Disdiadokinesia
- Rebound phenomenon
15
Q
Why should the patient be in a standing position for cerebellar testing?
A
- Anterior lobe controls the torso in relation to the lower extremity
- Posterior lobe controls the head relative to the torso
16
Q
Why should you take a blood pressure on the left side first?
A
Left side is usually higher due to being closer to the heart
17
Q
What blood pressure finding may indicate a cerebellar problem?
A
Difference of 10mmHg or greater BP from one side to the other
18
Q
Where in the body are the intermediolateral nucleus located?
A
Between T1-L3 in the lateral horn
19
Q
What two procedures can you use to test for hypotonia?
A
Pendular deep tendon reflex and Rag doll posture
20
Q
A patient is performing the Babinski Weil and drifts to the left going forward and going backwards. Where do you expect the lesion to present?
A
Left-sided cerebellum lesion
21
Q
A patient is performing the Babinski Weil and drifts to the left going forward and drifts right going backwards. Where do you expect the lesion to present?
A
Left CN VIII: Vestibulocochlear nerve
22
Q
When performing Romberg’s position, how must the patient be set up?
A
- Eyes open
- Shoes and socks off with feet as close together without touching
- Arms flexed forwards at 90 degrees (palms up)
23
Q
The ability to perform rapid, alternating movements is termed?
A
Diadochokinesia
24
Q
The impaired ability to perform rapid, alternating movements is termed?
A
Dysdiadochokinesia (DDK)
25
The complete inability to perform rapid, alternating movements is termed?
Adiadochokinesia
26
What is the most important thing when testing for DDK?
Test both upper and lower extremity
27
What tests can be performed to look for DDK?
- Finger tapping (piano playing)
- Alternating hand slaps
- Foot tapping
- Seated marching
28
A patient complains about reaching out for an object and can never seem to grab the object. What tests can you perform to test for this phenomenon?
- Patient's finger to own nose
- Patient's nose to doctor's finger
- Heel to knee
- Patient's toe to doctor's finger
29
What is important for the patient to do when performing tests for dysmetria?
Patient must move slowly to bring out a positive finding
30
What is important about a patient that could possibly have Lyme Disease?
False negative on blood tests
31
What is the most common symptoms of a vertebral artery dissection?
Neck pain and stiffness
32
What are the 3 most important reasons to perform examinations?
- Document medical necessity to order tests
- Make an accurate diagnosis
- Establish baselines for outcome measures
33
After a blow to the head, a 42 year old drummer notices his left hand has difficulty maintaining rhythm. This is an example of what condition?
Dysdiadochokinesia
34
What are some symptoms that are associated with an Upper Motor Neuron Lesion (UMNL)?
- Clonus
- Hypertonia
- Pathological reflexes present
- Absent superficial reflexes
- Clasp-knife spasticity
35
What are some of the general features of the Dorsal columns?
- Dorsal
- Afferent
- Sensory
- In going
- Posterior
36
What are some of the general features of the UMN?
- Ventral
- Efferent
- Motor
- Out going
- Anterior
37
If pressure is being applied to outside lamination of the spinal cord, what part of the body is most affected?
Lower extremity
38
What two body parts are good to test for clonus?
Wrist or Ankle
39
What grades on the Weller reflex grading system are always pathological?
4 (transient clonus) and +5 (sustained clonus)
40
What term describes the use of another motor movement like clenching the jaw to endure a patellar reflex that wasn't present before?
Jendrassik Maneuver
41
What pathological reflex would you find present if you perform the Gordon's test in the upper extremity?
Extension of the fingers
42
How do you perform Gordon's test in the upper extremity?
Briskly compress the pisiform
43
How do you perform Gordon's test in the lower extremity?
Briskly compress the calf
44
What pathological reflex would you find present if you perform Gordon's test in the lower extremity?
Upward toe sign
45
What pathological reflex would you find present if you perform Chaddock's test in the upper extremity?
Extension of the fingers
46
How do you perform Chaddock's test in the upper extremity?
Briskly compress the anterior surface of the wrist
47
How do you perform Chaddock's test in the lower extremity?
Draw a C around the lateral maleolus of the foot
48
What pathological reflex would you find present if you perform Chaddock's test in the lower extremity?
Upward toe sign
49
What pathological reflex would you find present if you perform Rossolimo's test in the upper extremity?
Flexion of the fingers
50
How do you perform Rossolimo's test in the upper extremity?
Quickly taps on the distal end of the 3rd metacarpal on the palmer surface of the hand
51
How do you perform Rossolimo's test in the lower extremity?
Quickly tap on the distal end of the 3rd metatarsal on the plantar surface of the foot
52
What pathological reflex would you find present if you perform Rossolimo's test on the lower extremity?
Flexion of the toes
53
What pathological reflex would you find present if you perform Tromner's test in the upper extremity?
Flexion of the fingers
54
How do you perform Tromner's test in the upper extremity?
Support the patient's hand and briskly strike the distal end of the 3rd and 4th digits into extension
55
How do you perform Hoffman's test in the upper extremity?
Support the patient's hand pronated and flex the distal end of the 3rd digit into flexion and then let it go
56
What pathological reflex would you find present if you perform Hoffman's test in the upper extremity?
OK sign
57
What tests can be performed in the upper extremity to look for pathological reflexes?
- Gorgon's
- Chaddock's
- Rossolimo's
- Tromner's
- Hoffman's
58
What tests can be performed in the lower extremity to look for pathological reflexes?
- Plantar
- Gordon's
- Chaddock's
- Oppenheim's
- Schaefer's
- Rossolimo's
59
How do you perform the Plantar reflex in the lower extremity?
Briskly stroke the lateral side of plantar surface of foot from heel towards the toes and then towards the medial foot
60
What pathological reflex would you find present if you perform Oppenheim's test in the lower extremity?
Upgoing toe sign
61
How do you perform Oppenheim's test in the lower extremity?
Stroke proximally to distally along the tibia
62
How do you perform Schaefer's test in the lower extremity?
Briskly squeeze the Achille's tendon
63
What pathological reflex would you find present if you perform Schaefer's test in the lower extremity?
Upgoing toe sign
64
What test can be performed to look for pathological reflexes in the face?
- Snout reflex
- Glabellar reflex
- Palmomental reflex
65
What pathological reflex would you find present if you perform the Snout Reflex?
Curling of the ipsilateal upper lip
66
How do you perform the Snout reflex?
Briskly tap on the one side of the phrenoulum, then the other
67
What pathological reflex would you find present if you perform the Glabellar reflex?
Wincing expression of the face and closing of the eyes
68
How do you perform the Glabellar reflex?
Briskly tap on the Glabella
69
What pathological reflex would you find present if you perform the Palmomental reflex?
Curling of or pursing of the upper lip
70
How do you perform the Palmomental reflex?
Briskly scrape along the thenar eminence
71
What superficial reflexes can be present during testing and still be considered normal?
- Plantar reflex
- Corneal reflex
- Gag reflex
- Abdominal reflex
72
Upper motor neuron signs may be due to the compression of what portion of the spinal cord?
Anterior corticospinal tract and lateral corticospinal tract
73
How are normal superficial reflex responses properly recorded in health care records?
Present
74
What are some possible conditions to cause lesion and focal demyelination for the spinal cord?
- B1 deficiency
- Multiple Sclerosis
- B12 deficiency
- HIV/Syphillis
- Lyme Disease
- Guillain-Barre
- Spinal canal stenosis
75
When performing dorsal column testing, what must the patient do before testing?
Eyes are closed
76
What term describes the loss of ability to sense vibration?
Appallesthesia
77
What type of tuning fork must be used to test for Appallesthesia?
128 Hz tuning fork
78
What is the progression of body parts you test for Pallesthesia test in the upper extremity?
1. 2nd digit
2. Radial styloid
3. Olecranon
-AC joint/mid-clavicle
79
What is the progression of body parts you test for Pallesthesia in the lower extremity?
1. 2nd toe
2. Medial malleolus (lateral if you can't get to it)
3. Tibial tuberosity
4. ASIS/greater trochanter
80
What tests can be perform to test for proprioception?
Romberg's test or Positional change in digits
81
How do you perform Romberg's Test?
- Patients eyes closed
- Patients shoes and socks off standing with feet as close together without touching
- Have patient flex arms out at 90 degrees and hold for 10 seconds
82
How do you perform Positional Change in Digits?
- Patient's eyes closed
- Hold the the side of patients digits and ask if you moved the digit "towards their nose" or "towards their toes"
83
What tests can be performed to test for deep pressure?
- Abadies
- Biernacki's
84
How do you perform Abadie's test?
- Patient's eyes closed
- Squeeze the Achilles tendon with a soft and harder pressure and ask the patient to distinguish between the two
85
How do you perform Biernacki's test?
- Patient's eyes closed
- Squeeze the triceps tendon with a soft and harder pressure and ask the patient to distinguish the two
86
What term describes the ability to recognize objects by feeling their form, size, and weight while the eyes are closed?
Stereognosis
87
Can stereognosis be tested on the upper extremity and lower extremity?
Only upper extremity
88
What term describes ability to recognize writing on the skin (letters or numbers) purely by the sensation of touch?
Graphesthesia
89
Can graphesthesia be tested on the upper and lower extremities?
Yes, both upper and lower extremity
90
What signs and symptoms are usually associated with a basal ganglia lesion?
- Cogwheel rigidity
- Leadpipe rigidity
- Choreiform/hemiballistic movements
- Mask-like faces
- Festinating gait
- Resting tremors (pill rolling)
91
When testing for tone across the elbow for a basal ganglia lesion, what information should you be aware of?
- No weakness
- Not velocity dependent
- Resistant in both directions
- Cogwheel/leadpipe rigidity
92
When testing for tone across the elbows for an UMN lesion, what information should you be aware of?
- Weakness
- Clasp-knife *spasticity*
- Velocity dependent
- Only one direction
93
What other symptoms might be seen in a patient demonstrating resting tremors
- Festinating gait
- mask-like faces
- choreiform/hamiballistic movements
- Cogwheel rigidity
- Leadpipe rigidity
94
Where does CN I exit the skull?
Cribiform plate
95
What term describes the lack or decrease in sense of smell
Anosmia
96
What term describes the distortion of the sense of smell, as in smelling an odor that isn't present?
Parosmia
97
What term describes the perception of foul odor or stench when none exists?
Cacosmia
98
Where does CN II exit the skull?
Optic foramen
99
When referring to the Snelling eye chart, what is the term for the left eye?
OS
100
When referring to the Snelling eye chart, what is the term for the right eye?
OD
101
When referring to the Snelling eye chart, what is term for both eyes?
OU
102
What does it mean when a patient's visual acuity is measured "20/40"?
A patient can read at 20 feet what a normal sighted person can read from 40 feet
103
What does it mean when a patient's visual acuity is measured "20/15"?
A patent can read at 20 feet what a normal sighted person can read at 15 feet
104
What would you suspect to find if there was a lesion of the optic chias from a pituitary tumor?
Bilateral temporal hemianopsia
105
What would you suspect to find if there was a lesion of the optic nerve?
Central vision loss
106
When performing the direct and indirect light reflexes, what nerve is responsible for constriction of the pupils?
CN III: Oculomotor Nerve
107
You perform the indirect and direct light reflex test on your patient and you notice that when you flash the light in her left eye, her right pupil does not constriction. Where would you suspect the lesion to be?
Right CN III
108
What term describes an afferent pupillary defect that shows decreased bilateral pupillary constriction when light is shone in affected eye?
Marcus Gunn Pupil
109
You perform the direct and indirect light reflex test on your patient and you notice when you shine the light in the patient's left eye, both pupils do not restrict. Where would you suspect the lesion could be?
Could be CN II on her left eye or CN III on both eyes
110
What term describes the unequal size of pupils at rest?
Anisocoria
111
What term describes the light source reflection not being placed in the center of the eyeball?
Strabismus
112
A patient comes into your office complaint of double vision. What nerves could be affected in this condition?
CN III, IV, VI
113
What term describes a diplopia present only when both eyes are open?
Binocular diplopia
114
What term describes a diplopia with only one eye viewing?
Monocular diplopia
115
What is the most common sign for a retinoblastoma?
White glow in the pupil of the eye termed "cat's eye"
116
What condition is characterized by a lesion of the stellate ganglion?
Horner Syndrome
117
What are the classic signs and symptoms of Horner Syndrome?
- Miosis
- Ptosis
- Anhydrosis
118
A patient comes into your office complaining of double vision. What test(s) would you perform on the patient to test for this?
Cardinal Fields of Gaze
119
Where does V1 branch of trigeminal exit the skill?
Superior orbital fissure
120
Where does V2 branch of trigeminal exit the skull?
Foramen rotundum
121
Where does V3 branch of trigeminal exit the skull?
Foramen ovale
122
What muscle of mastication is only innervated by CN VII?
Buccinator
123
What muscles of mastication are innervated by CN V?
Temporalis, Masseter, Internal and External pterygoid
124
What is a positive sign if you perform a jaw jerk reflex on a patient?
Teeth slam together or jaw opens up
125
You perform a jaw jerk reflex on a patient and it comes back positive. Where do you suspect the lesion is?
UMN lesion (CN V)
126
What nerve innervates the inferior angle of the jaw?
C2
127
What cranial nerve is responsible for the blink in the Corneal reflex?
CN VII
128
You are testing to see if the patient can differentiate between dull or sharp sensations on the face. You realize the patient cannot feel on the tip of their nose. Where would this lesion be occurring?
Superior part of trigeminal nucleus
129
You are testing to see if the patient can differentiate between dull or sharp sensations. You notice the patient cannot feel a spot on their forehead. Where would you suspect the lesion to be?
Lowest part of trigeminal nucleus
130
When testing for CN VII, what must you instruct the patient to do first to help with your diagnosis?
Raising the eyebrows
131
You are testing facial muscles and you notice that a patient is able to raise their eyebrows, but cannot smile properly. What would you suspect is going on in the patient?
Stroke
132
What term describes a brief episode of loss of blood flow to the brain, usually caused by a partial occlusion that results in temporary neurologic deficit (impairment) that often precedes a CVA?
Transient ischemic attack (TIA)
133
What are some generalized signs and symptoms of a stroke/TIA?
- Sudden headache
- Vision changes
- Disorientation
- Mental impairment
134
When performing a corneal reflex, the patient does not blink when you test the right eye. What condition could you possibly suspect the patient has?
Acoustic neuroma on right side
135
What are the different facial expression you are testing with CN VII?
1. Raise the eyebrows
2. Close the eyes
3. Wrinkle the nose
4. Smile for me
5. Can you frown
6. Puff out your cheeks
136
What term describes a lesion of the LMN on the ipsilateral side and causes eye brow and hemifacial paralysis?
Bell's Palsy
137
What part of the face does the superior aspect of CN VII nucleus receive?
Bilateral innervation
138
What positive finding would you see in a patient that performs the Mittlemeyer's test?
Falling or deviation to one side with eyes closed
139
You perform the Swivel Chair Test on a patient and you notice they get dizzy when you turn their head back and forth. You stop and let it calm down and immobilize the patients head and swivel and the dizziness come back. What condition would you suspect this patient has?
Cervicogenic vertigo
140
You perform the Swivel Chair Test on a patient and you notice they get dizzy when you turn their head back and forth. You stop and let it calm down and immobilize the patients head and swivel and the dizziness is absent. What condition would you suspect this patient has?
CN VIII Vestibular dysfunction
141
What device is used for Rinne and Weber hearing tests?
512 Hz tuning fork
142
What term describes the ability of sound to be louder on one side?
Lateralization
143
You perform Weber's test on a patient and they say they hear the sound louder on the right. What does the result mean?
CN VIII damage on the left or air conduction loss on the right
144
What results would you expect when you perform Rinne's test on a normal patient?
Equal bilateral and air conduction is 2x the bone conduction time
145
You perform Rinne's test on a patient's left ear and timed it out 3 seconds on the mastoid and 3 seconds in the air. What would be the cause of the lessened time on the left side when compared to the right?
Neurosensory loss on the left
146
You perform Rinne's test on a patients left ear and hear 10 seconds on the mastoid process, but only hear 4 seconds in the air. What would be the cause of this finding?
Air conduction loss on the left
147
When testing CN XI innervation of the SCM, what would you have the patient do their neck?
Lateral Flexion (ipsilateral) and rotation (contralateral)
148
What term refers to speech difficulty that are contextually normal?
Dysarthria
149
You perform the tongue protrusion test and the tongue deviates to the right side. Where do you suspect the lesion to be?
Right side CN XII lesion
150
You perform the tongue in cheek strength test and the tongue is weak when you press on the right side. Where would you suspect the lesion to be?
Left-sided CN XII lesion
151
What cranial nerve carries sensory (taste) to the anterior aspect of the tongue?
CN VII
152
What exams can be done to test CN III: Oculomotor nerve?
- Direct and indirect light reflex
- Cardinal fields of gaze
- Corneal light reflex
153
What would you look for when assessing for a lesion of CN IX (Glossopharyngeal) and CN X (Vagus)?
- Hoarseness
- Uvular deviation to good side
- Gag reflex
- Swallowing test
154
Multiple sclerosis can first present as __________ which can create a central loss of vision?
Optic neuritis
155
In order to determine if an anterior corticospinal tract lesion is due to compression of the cervical cord, you can repeat tendon reflexes with the patient ________________ noting any changes in your finding?
Looking down
156
What is the purpose of performing Romberg's Test?
Dorsal column lesion
157
What is the purpose of performing Romberg's Position?
Cerebellar lesion
158
Your patient has loss of vision. During your examination you discover your patient has difficulty pointing to a spot without shaking, and identifying objects placed in a closed hand. What is most likely the cause of this?
Posterior circulation compromise
159
What makes up the posterior circulation of the brain?
Spinal cord, brain stem, and occipital lobe
160
What term pertains to the legal aspects that protects doctors and patients?
Medico-legal
161
True of False: An UMN lesion is velocity dependent?
TRUE
162
A patient walks into your office and notice they have a festinating gait. Where would you expect the lesion to be?
Basal ganglia
163
What blood vessels supply the cerebellum?
- Anterior inferior cerebellar artery
- Superior cerebellar artery
- Posterior inferior cerebellar artery
164
True or False: If you patient has a dorsal column lesion, they will have a positive Romberg's position?
FALSE
165
What term describes the use of tapping over the facial muscles or parotid gland causes spasmodic contraction of ipsilateral facial muscles due to hypocalcemia and hyper excitability?
Chvostek Sign
166
What term describes the compression of blood vessels in the upper extremity to stop brachial artery flow leads to spasmodic contraction of the hand and forearm due to low calcium?
Trousseau's Sign
