NMS DX Flashcards
1
Q
Pneumonic for Cranial Nerves - sensory or motor:
A
Some Say Marry Money But My Brother Says Big Boobs Matter Most
2
Q
R Corneal Reflex
A
A: 5 (trig)
Int: Pons
E: 7 (fac)
3
Q
R Pharyngeal (Gag)
A
A: 9 (glos)
Int: Medulla
E: 10 (vag)
4
Q
R Palateal (Uvular)
A
A: 9 (glos)
Int: Medulla
E: 10 (vag)
5
Q
R Interscapular
A
A: T2-T7 spinal n
Int: T2-T7 spinal cord
E: Dorsal scapular n
6
Q
R Abdominal
A
A: Up: T7-10, Lo: T11-12
Int: SC T7-T12
E: T7-10, Lo: T11-12
** NORMAL: umbilicus moves toward side stroked
7
Q
R Plantar
A
A: Tibial n.
Int: SC S1-2
E: Tibial n.
8
Q
R Direct Light
A
A: 2 (optic) ips
Int: midbrain
E: 3 (occu) ips
9
Q
R Indirect Light
A
A: 2 (optic) ips
Int: midbrain
E: 3 (occu) contra
10
Q
R Accomodation
A
A: 2
Int: occipital cortex
E: 3
11
Q
R Carotid Sinus
A
A: 9 (glos)
Int: medulla
E: 10 (vag)
12
Q
R Occulocardiac
A
A: 5 (trig)
Int: Medulla
E: 10 (vag)
13
Q
R Ciliospinal
A
A: cervical symp chain
Int: T1-T2 spinal cord
E: cervical symp chain
14
Q
Trigeminal Neuraliga
A
aka Tic Douloureaux
Burning on the face in multiple episodes on jaw or cheek, unilateral
15
Q
Cardinal Fields of Gaze
A
S0-4 LR-6 / 3
Superior Oblique = down and in
16
Q
Parasympathetic of Occulomoter N
A
Ciliary muscles (lens shape) Constrictor papillae
17
Q
Bells Palsy
A
CN 7 (Facial) Ipsilateral facial paralysis - impermanent Can NOT raise eyebrows
**DDX from Stroke (bilateral, forehead wrinkles)
18
Q
Cervical Dystonia
A
AKAs: Torticollis, Wry Neck
- spasm of SCM
- CN 11 lesion
- ipsilateral = lateral flexion, contralateral = rotation
19
Q
Westphal Sign
A
DTR absence
– Jendrassik Man = distractor to help
20
Q
Wexler Scale
A
0 = absent with reinforcement 1+ Hypoactive with no reinforcement or normal with reinforcement -- LMNL 2+ normal 3+ hyperactive -- UMNL 4+ hyperactive w/ transient clonus 5* hyperactive w/ sustained clonus
21
Q
Jaw Jerk DTR
A
Trigeminal (CN 5)
22
Q
Patellar DTR
A
Femoral L4
23
Q
Medial Hamstring DTR
A
Sciatic L5
24
Q
Achilles
A
Tibial S1
25
Cremasteric
Male
A: Femoral N.
E: Genitofemoral N.
26
Geigel's
Female
A: Femoral N.
E: Genitofemoral N.
27
Beevors
A: Up: T7-10, Lo: T11-12
Int: SC T7-T12
E: T7-10, Lo: T11-12
**Normal: Umbilicus stays midline; Pathological: Umbilicus moves away from lesion
28
UMNL
```
spastic paralysis
hyperactive DTR
pathological reflexes
clonus
hypertonic
no superficial reflexes
```
29
LMNL
```
** CN or Nerve Root **
flaccid paralysis
hypoactive / absent DTR
hypotonic
degeneration / atrophy
fasiculations
no superficial reflexes
```
30
PR Gordon's
Squeeze calf below knee
31
PR Schaefer
Squeeze achilles
32
PR Rossolimo
Tap ball of foot
33
PR Gordon's finger
strokes pisiform
34
PR Chaddocks wrist
strokes distal ulnar side of forearm near wrist
35
Muscle Grading
```
5 = Normal: ROM against gravity w/ resistance
4 = Good: ROM against gravity w/ SOME resistance
3 = Fair: ROM against gravity
2 = Poor: ROM no gravity
1 = Trace: no motion, slight contractility
0 = Zero: none
```
36
Erb's Palsy
C5,C6 -- radial n entrapment, too
| Waiter's Tip Deformity: ADDUCTION + INTERNAL ROTATION + WRIST FLEXION
37
Wrist Drop
C7 -- radial n entrapment, too
38
Klumpke's Paralysis
C8-T1 -- lower brachial plexus palsy from childbirth
clas hand deformity with wrist flexion
39
Meralgia Paresthetica
L1-L3
40
Foot Drop
L4-5
41
Cauda Equina
S2-4
42
NR L1-L3
M: Hip flexion
Muscle: Psoas
S: Inguinal Lig, Oblique, Oblique Across
43
NR L2-L4
M: Hip flexion
Muscle: quads + add
44
NR T5-12
M: Trunk flexion
Muscle: REctus Abdominus
S: T5-T12
45
Axillary N.
M: Arm ABduc
Muscle: Deltoid + Teres Minor
S: Lateral arm
Disorder: GH dislocation
46
Radial N.
M: Wrist/Finger Extension + Thumb Abd
Muscle: Wrist/Finger extensors + Triceps
S: dorsal web b/w thumb and index
Disorder: Wrist Drop, Crutch Palsy, Erbs Palsy
47
Musculocutaneous N.
M: elbow flexion
Muscle: biceps, brachialis, coracobrachialis
S: lateral forearm
Disorder: impingement
48
Median N.
M: pincher grip, thumb opposition
Muscle: wrist/thumb flexors, thenar, thumb abd
S: distal radial hand, 2nd digit
Disorder: carpal tunnel, pronator teres, ape hand
49
Ulnar N.
M: pinky + thumb adduction
Muscle: finger ab/add + thumb add
S: distal ulnar hand, 5th digit
Disorder: Claw hand
50
Dorsal Scapular N.
M: elevate + retract scap
Muscle: rhomboids + lev scap
S:
Disorder: Flaring of Scap
51
Lateral Femoral Cutaneous N.
Lateral Thigh --> Meralgia Paresthetica
52
Saphenous N.
Anteromedial knee + Medial Leg
53
Obturator N.
M: Hip Adduction
Muscle: Hip Adductor muscles
S: Medial thigh
Disorder: Impingement
54
Femoral N.
M: Hip flexion, Knee extension
Muscle: Psoas + Quads
S: Anteromedial thigh + leg
Disorder: Impingement
55
Sciatic N.
M: Knee Flexion
Muscle: Hamstrings
S:Ant/Post Leg, Sole/Dorsum of foot
Disorder: Piriformis Syndrome
56
Peroneal N.
M: Foot Dorsiflexion / Inv / Ev
Muscle: Tib Ant, Toe extens, peroneals
S: Anterior Leg + Dorsum of Foot
Disorder: Fib Head Fx
57
Medial Plantar N.
M: Toe flexion
Muscle: Toe flexor muscles
S:
Disorder: Tarsal Tunnel Syndrome
58
Peripheral Nerve Entrapments:
DR CUMA
```
Drop Wrist
Radial N.
Claw Hand (aka pope hand)
Ulnar N.
Median N.
Ape Hand (thenar atrophy)
```
59
Dermatogenous
Sensory distribution of a Nerve Root
60
Myotogenous
Muscle
61
Scleratogenous
Facet / Joints --- embryological sclerotomes
62
Radicular
Dermatome of a nerve root
63
Referred
Along scleroderm origination...share a pathway
64
```
Types of pain for:
Muscle
Nerve
Circulation
Bone Cx
Scleratogenous
Myofascial
```
Muscle - cramping / spasm / ache / dull
Nerve - shooting / radiating / burning
Circulation - THROBBING / PULSATING
Bone Cx - CONSTANT / DEEP / BORING / NOCTURNAL
Scleratogenous - poorly localized / dull ache
Myofascial - trigger points
65
```
Referred Pain Sites:
Gallbladder
Pancreas
Heart
Intestines
Appendix
Kidney
Ureter
Bladder
```
```
Gallbladder: RT shoulder + Inf Scap
Pancreas - T10 epigastric
Heart - LF shoulder + med LF arm
Intestines - periumbilical
Appendix - early = epigastric; late = RLQ
Kidney - flank
Ureter - groin
Bladder - suprapubic area
```
66
3 Night Pains
C's
- Cancer
- Carpal Tunnel
- Cluster Headache
67
Carpal Tunnel Syndrome
```
Median N (1st 3 digits)
Flexor Retinaculum
Cause: fluid retention due to pregnancy
Thenar atrophy + Ape Hand (weak opp poll)
Nocturnal Pain
Adjust Lunate
Grip strength (ONLY med n)
```
68
Pronator Teres Syndrome
```
Median N (1st 3 digits)
--> Ant Inteross N.
Heads of pronator teres
MOI: carpenter / mechanic (MALE)
Grip strength (ONLY med n)
```
69
Ulnar N Entrapment
1) Tunnel of Guyon (Pisi + H.Hamate)
2) Cubital Tunnel
Cyclist
Claw Hand deformity
Weak add poll + hypothenar atrophy
Weak wrist flexion on ulnar side
70
Radial N Entrapment
Wrist drop + Erb's Palsy + Saturday Night Palsy + Crutch Palsy
Location = spiral groove
LEAD TOXICITY
no triceps reflex
71
Long Thoracic N. Entrapment
Scapula Winging
Serateous Anterior
"SALT your Wings"
72
Dorsal Scapular N. Entrapment
Scapular Flaring
| Rhomboid mm paralysis
73
Lateral Femoral Cutaneous N. Entrapment
Meralgia Paresthetica
Site: PELVIC BRIM UNDER INGUINAL LIGAMENT
Burning on antero-lateral thigh (ddx nerve root)
Obese + tight jenes + cop
74
Sciatic N. Entrapment
Site: pelvis, hip, popliteal fossa
pain in - post butt, thigh, leg down to floor
Weak knee flexion
Achilles reflex is weak
75
Tibial N. Entrapment
Tarsal Tunnel Syndrome (Medial Plantar N)
Unilateral BURNING PARESTHESIA on bottom of feet
MOI: inversion ankle sprain jamming medial side
76
Morton's Neuroma
3rd and 4th MTs
Narrow toes shoes
Mortons Squeeze
77
Common Peroneal N. Entrapment
Site: Fib Head
Lateral leg pain + weak peroneal mm
FOOT DROP
78
Deep Peroneal N.
```
Anterior Compartment Syndrome = FOOT DROP
Can affect any of the 4 compartments:
1 Tib Ant
2 Ext Hall Long
3 Ext Dig Long
4 Per Tertius
```
79
Mallet Finger
Fingertip curled from injury
80
Swan Neck Deformity
PIP: hyperEXT
DIP: hyperFLEX
RA!!!
81
Boutonniere Deformity
PIP:hyperFLEX
DIP: hyperEXT
RA!!!
82
Dupuytren's Contracture
ABNORMAL THICKENING underneath palm and fingers (not there = ulnar n. lesion)
last 2 fingers curl into palm
83
Trigger Finger
finger locked in flexed position
84
De Queervains Disease
Inflammation of EXTENSOR POLLICIS BREVIS + ABDUCTOR POLLICIS LONGUS
Finklesteins
85
Syringomyyelia
loss of pain and temp on shoulders and back in CAPE LIKE DISTRIBUTION (SHAW LIKE)
86
MS (multiple sclerosis)
```
Female 30s
Demyelination of CNS
Gets better, than worse, better, than worse
optic neuritis causing transient blindness
Leg UPMNL --> distal weakness
(+) LHERMITTE'S TEST
Heat = contra-indicated
CHARCOT'S TRIAD = ITs a SIN to have MS!!
- S = scanning speech
- I = intention tremors
- N = nystagmus
```
87
Myasthenia Gravis
Female 30s
Autoimmune - antibodies against ACh receptors = myoneural junction dysfunction
Muscle weakness at END OF DAY or post exercise
88
ALS
```
Aka Lou Gehrigs Disease
Male 60s
LMNL in arms + UMNL in legs
MOTOR ONLY!!!!!!
Usually begins in hands and feet, life expectancy short
Corticospinal tract + anterior horn
```
89
PLS
```
Combined Systems Disease
Glove + Stocking Paresthesia
(+) SCHILLING TEST!!
Symptoms irreversible
Cause: B12 Deficiency (pernicious anemia)
```
90
Brown Sequard
Same side MOTOR FUNCTION loss
| Opp side PAIN/TEMP loss
91
Cerebral Palsy
Anoxia to brain
SCISSOR GAIT -- legs cross midline
Athetoid = MC
92
Paralysis Agitans
```
Parkinsons Disease
1) Fenestrating Gait 2) Shuffling Gait 3) Propulsive Gait
RESTING TREMORS
FORWARD STOOPED POSTURE
MASKED FACE
```
93
Guillian-Barre Syndrome
PNS inflammatory polyneuropathy!!
Linked to recent IMMUNIZATIONS or POST FLU INFECTION
Ascending Paralysis -- can be dangerous if reaches diaphragm
94
Tabes Dorsalis
Teritiary Syphillis
SLAPPAGE GAIT
Pupil irregularities
95
Muscular Dystrophy
```
Erb Duchenne
BOYS 3-7
WADDLING GAIT
PSEUDO-HYPERTROPHY OF CALVES/DELTOIDS
GOWERS SIGN
Increase in CPK, Decrease creatinine
```
96
Charcot Marie Tooth Disease
Hereditary affecting motor and sensory
Foot drop + High-stepped gait
Hammer toes
97
Hungingtons Chorea
MC age of onset 35-44
| Neurodegenerative Genetic Disorder
98
Gait Cycle
STANCE = 60%
- Heel Strike
- Foot Strike
- Toe Off
SWING = 40%
99
Acceleration of Gait
Psoas + Rectus Femoris
100
Deceleration of Gait
Hamstrings ECCENTRICALLY contracting
101
Heel Strike of Gait
Dorsiflexors ECCENTRICALLY contrct
| Quadriceps ECCENTRICALLY contract
102
Foot Strike of Gait
```
Abductors hold body up
Plantar Flexors (gastroc, soleus, plantaris = triceps surae) contract to push body ahead
```
103
Toe Off of Gait
Quadriceps CONCENTRICALLY contract to help plantar flexors push body forward
104
Waddling Gait
Muscular Dystrophy
105
Propulsion Gait
Parkinsons
106
Festinating Gait
Parkinsons
107
Shuffling Gait
Parkinsons
108
Steppage Gait
Anterior Compartment Syndrome = Foot Drop
109
Trendelenburg
Weak glut med
110
Slappage Gait
Posterior Column Disease = TABES DORSALIS
111
Circumduction Gait
Stroke
112
Spastic Gait
UMNL
113
Antalgic Gait
avoidance of pain
114
Drunken / MOtor Gait
Cerebellum problem -- wide based gait
115
Rotator Cuff Tear
```
MC = supraspinatus MC
DX = MRI
```
116
Rotator Cuff Muscles
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
117
Rotator MM: Supraspinatus
ABduction
Suprascapular N
GT insertion
118
Rotator MM: Infraspinatus
EX ROT
Suprascapular N
GT insertion
119
Rotator MM: Teres Minor
EX ROT
Axillary N.
GT insertion
120
Rotator MM: Subscapularis
IN ROT
Subscapular N.
LESSER TUBERCLE INSERTION!!
121
Scapular Motion
Elevation: Trap + Lev Scap
Retraction: Rhomboids (Maj + Min)
Protraction: Serratus Anterior
122
Test for Subclavian Artery + Scalenus Medius Syndrome
Modified Adsons
123
Test for Cervical Rib
Adsons (Scalenus Anticus)
| Halsteads
124
Test for compression of 1st rib + clavicle
Edens or Costoclavicular
125
Test for pec minor syndrome or Axillary A compression
Wrights or Hyperabduction Maneuver
126
Test for TOS
Roos
| Bikele's
127
Ortolanis
baby legs ABducted + Externally rotated
| CHD
128
Barlows
baby legs ADDucted
129
Ligament Tear
Immediate swelling = Intra Articular
130
Meniscus Tear
Swelling 12-24 hours; unable to lock out
| Joint Line
131
Chondromalacia Patella
Runners Kne
Walking downstairs = PAIN
Tests: Clark + Fouchets
132
Jumpers Knee
Patellar tendonitis
133
Housemaids Knee
Prepatellar Bursitis
134
TFL Syndrome
shortened TFL
| running, up/down stairs/hills = PAIN
135
Pes Planus
Flat foot
136
Talipes Equinovarus
MC birth defect
clubfoot
heel elevated, foot inward
137
Pes Cavus
high arch
| March fx = common
138
Metatarsal Stress FX
March FX
139
Sprain / Strain grading
1 no tear..slight swelling and loss of motion
2 partial tear...swelling + brusing...no motion
3 complete tear
140
Burn Bench Test
Malingering Test
141
Lasegue's Sitting
Malingering Test
| ..negative yet + with normal SLR
142
Magnussons
Malingering Test
| different points
143
Mannkopfs Sign
If patient's pulse increases when applying pressure to painful spot, they are NOT malingering
144
AS tests
Chest Expansion Test
Forrestier Bowstring Sign
Lewin Supine Test
Amoss Sign
145
Libman
test for patient's pain threshold
146
Rust Sign
graps head upon sitting from recumbent position
| --> cervical instability, RA
147
Dejerine's Triad
Space occupying lesion
| coughing, sneezing, straining
