Nerve & Musculoskeletal Exam Flashcards
(34 cards)
Three basis functions of the nervous system
Sensory - afferent neurons, detects internal and external stimuli
Integrative - interneurons, processes information, analyzes and stores
Motor - efferent neurons, carry information to the cells in the body, responds to integrated decisions
The _______ nervous system integrates and correlates incoming sensory information, thoughts, emotions, memories, muscle contractions and gladular secretions.
A. Peripheral
B. Somatic
C. Autonomic
D. Enteric
E. Central
E. Central
The cauda equina are nerve roots that fan out starting at:
A. T1 - T2
B. T3 - T4
C. L1 - L2
D. L3 - L4
C. L1 - L2
(therefore, most lumbar punctures are performed at L2 - L4 interspaces)
The ________ nervous system includes all nervous tissue outside the CNS as spinal nerves, cranial nerves, ganglia, and sensory receptors.
Peripheral nervous system
Matching time!
- Somatic Nervous System A. Involuntary actions
- Autonomic N System B. “brain of GI duct”, involuntary
- Enteric Nervous System C. Voluntary responses
- Somatic Nervous System - C. Voluntary responses
- Autonomic Nervous System - A. Involuntary actions
- Enteric Nervous System - B. “brain of GI duct”, involuntary
The cranial nerves are part of the _____ Nervous System
A. Central NS
B. Peripheral NS
C. Somatic NS
D. Autonomic NS
B. PNS
(ha! sounded out, it sounds like “penis”)
Each spinal nerve (of which there are 31 pairs) has a ______ root and a ______ root.
Anterior (ventral) root - motor fibers
Posterior (dorsal) root - sensory fibers
The reflex arc starts with ______ nerve fibers sending an impulse to the spinal cord where it synapses with the cell of the _______ neuron that innervates the same muscle.
Sensory ; motor
T/F
Regarding spinal reflexes, when the impulse crosses the neuromuscular junction, the muscle suddenly contracts which completes the reflex arc.
True
T/F
A reflex can involve as few as 2 neurons.
True, a reflex is an involuntary, stereotypical response that may involve as few as 2 neurons, 1 afferent (sensory) and 1 efferent (motor), across a single synapse
How do you test the reflex of the cremaster (in males) and what spinal levels does this test?
Stroke inner thigh of male patient (prox to dist) – normal would be the testicle and scrotum rising to the side that was stroked.
It tests T12, L1, L2
How do you test superficial plantar reflexes and what spinal levels does this test?
Look for Babinski sign…dorsiflexion of the great toe with or without fanning of other toes – This is an expected response if less than 2 years, but a sign of pyramidal tract disease in others
It tests levels L4, L5, S1, S2
How do you test the deep reflexes of the biceps and what spinal levels does it test?
With arm partially flexed at elbow with palm down, place you thumb or finger on the biceps tendon and strike with reflex hammer
It tests levels C5, C6
How do you test the deep reflexes of the brachioradialis and what spinal levels does it test?
With the patient’s hand on abdomen or lap, forearm partially pronated and strike the radius 1-2 inches above the wrist
It tests levels C5, C6
A _______ is a band of skin innervated by the sensory root of a single spinal nerve. Adjacent ones may overlap.
Dermatome
Symptoms that follow a ________ (like pain or a rash or virus) may indicate a pathology that involves the related nerve root
Dermatome
Varicella zoster is a virus that hibernates in nerver ganglia
Common or concerning neruological syptoms
Headache, History of migraines
Dizziness or Vertigo
Generalized, proximal, or distal weakness
Numbness, abnormal or loss of sensations: TIAs CVAs? Any deficits? Nerve injuries? Neuromuscular disorders?
Loss of consciousness, syncope
Seizures
Tremors or involuntary movements
Level of consciousness is measured using what scale?
What is the minimum and maximum score that can be given using this scale?
Glasgow coma scale
Max - 15, Min - 3
The Glasgo coma scale scores patients based on which three factors?
Eye opening
Verbal response
Motor response
How is a patient’s level of consciousness for the Glasgow coma scale evaluated?
_Alert_ = awake and oriented _Lethargic_ = appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep _Obtunded_ = opens eyes and looks at you, but responds slowly and is somewhat confused _Stuporous_ = arouses from sleep only after painful stimuli such as sternal rub or pinching a tendon; responses are slow or absent _Comatose_ = unarousable with eyes closed; no evidence of response to inner need or external stimuli
The motor exam observes:
1.
2.
3.
4.
5.
- Position at rest & with movement
- Involuntary movements such as tremors, tics, or fasciculations
- Muscle atrophy and tone, especially at hands, shoulders, thighs
- Muscle strength by testing flexion and extension of all joints against resistance (scale 0 to 5)
- Coordination – Test by: flipping hand on thigh as fast as possible, point-to-point movements, gait in multiple patterns (normal, heel to toe, on toes, on heels),
T/F
The sensory system exam is done with the patient’s eyes open and compares symmetrical areas
False, it’s done with the patient’s eyes closed
When testing sensory pathways, _______ is identifying a familiar objects in the patient’s hand with their eyes closed
Stereognosis
When testing discriminative sensory pathways, _______ is when you “write” on a patient’s hand with something blunt and they are to identify the number or letter you have written.
Graphesthesia
