PD Neuro Part 2 Flashcards Preview

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Flashcards in PD Neuro Part 2 Deck (85):
1

Primary sensations

Light (superficial) touch
Pressure (deep touch)
Vibration
Position of joints
Pain
Temperature
Touch

2

Which sensory functions are spinothalamic tract?

Pain
Temperature
Crude touch

3

Which sensory functions are dorsal column?

Light touch
Pressure
Vibration, position of joints

4

For a completel neurologic evaluation, which peripheral nerves are tested?

Each major peripheral nerve

5

Routine exam

Hands
Lower arms
Abdomen
Feet
Lower legs
Face (while testing CNs)

6

General considerations of exam

Pts eyes are closed
Minimal stimulation initially, gradually until pt becomes aware
Always test contralateral side of body, asking pt to compare

7

Where is strong stimulus needed?

Back
Buttocks

8

With each type of sensory stimulus, there should be:

Minimal differences side to side
Correct interpretation of stimulus
Discrimination of side of body tested
Relative location to last stimuli

9

What to do if sensory impairment is found

Map boundaries by the distribution of major peripheral nerves or dermatomes

10

Cortical sensory functions

Stereognosis
Two point discrimination
Extinction phenomenon
Graphesthesia
Point location

11

Abnormality of previous functions

Lesion in cerebral cortex or posterior columns of spinal cord

12

Superficial touch

Light strokes with cotton wisp
Avoid hair areas
Don't depress skin
Ask for where stimulus was

13

Superfcial pain

Sharp/dull
Allow time between stimuli
Unpredictable pattern
Ask patient: sharp or dull, location?

14

When to test temp and deep pressure?

When superficial pain is not intact

15

Temperature testing

Test tubes of hot and cold water
Ask pt where and whether it is hot or cold
Side to side comparison

16

Deep pressure

Firmly squeeze muscle body
Expect discomfort

17

Vibration

Place stem of vibrating tuning fork against several bony prominences/joints
Begin at most distal joint
Should feel buzzing/tingling sensation
Ask where felt and for how long

18

Sites tested for vibration

Sternum
Shoulder
Elbow
wrist
Finger joints
Shin
Ankle
Toes

19

Position of joints

Proprioception
Hold joint by lateral aspects
Begin with joint in neutral position
Move up or down and ask patient for position of movement
Great toes and a finger on each hand

20

Stereognosis

Ability to identify an object by touch and manipulation
Use familiar object for patient to identify

21

Tactile agnosia suggests...

Parietal lesion

22

Two point discrimination

Use 2 needles and alternate touching pts skin with 1 or 2 points
Find shortest distance the patient cannot identify two points
Depends on area of body tested

23

Why is two point discrimination different depending on area of body?

Fingers have more sensation than palm

24

Extinction

Simultaneously touch two separate parts of the body with a sharp stimuli
Ask patient how many stimuli they felt, and where
Both sensations should be felt

25

Graphesthesia

Using blunt object, trace letter or number on palm
Ask pt to identify figure
Repeat with different figure on other hand

26

Point location

Touch an area of pts skin and withdraw stimulus
Ask pt to point to area touched
Often performed simultaneously when testing superficial touch

27

Assessing motor function

Body position
Involuntary movements
Muscles
Coordination

28

Body position

Observe during movement and at rest

29

Involuntary movements

Tics
Tremors
Fasciculations

30

Muscles

Bulk - normal or atrophy
Tone - normal vs hypotonic or flaccid, vs spasticity or rigidity
Strength - normal vs weakness

31

Coordination

Determines throughout (testing cerebellar function, proprioception, strength)

32

Paresis

Impaired strength
Weakness

33

Plegia

Absence of strength
Paralysis

34

Hemiparesis

Weakness of half of body

35

Hemiplegia

Paralysis of half of body

36

Paraplegia

Paralysis of legs

37

Quadraplegia

Paralysis of all four limbs

38

Assessing motor strength

Assess all major muscle groups for strength, comparing side to side
Graded on scale 0-5

39

Motor strength scale

0 - no muscle contraction
1 - trace of contraction, but no mvmt
2 - Active mvmt of body part with gravity eliminated
3 - Active mvmt against gravity
4 - Active mvmt against gravity and some resistance
5 - Active mvmt against gravity and full resistance

40

Shoulder abduction

C5 + C6
Deltoid main muscle
Innervated by axillary nerve
Pt flexes elbow with arm at 45 degrees
Pt attempts to abduct further against resistance

41

Shoulder adduction

C5 - T1
Pectoralis major main muscle, latissimus dorsi and others also contribute
Pt flex elbow at 45 degrees, have pt adduct against resistance

42

Elbow flexion

C5 + C6
Have pt pull at your hand against resistance

43

Elbow extension

C6 - C8
Have pt push at your hand against resistance

44

Wrist extension

Radial nerve test
C6-C8
Have pt make a fist and resist you pulling it down

45

Grip

C7 - T1
Have pt squeeze your fingers
Test both hands at same time

46

Finger abduction

Ulnar nerve test
C8, T1
Position pts hand with palm down and fingers spread
Try to force fingers together

47

Thumb opposition
When is weakness common?

Median nerve
C8, T1
Have pt touch tips of little finger and thumb together
Try to pry apart
Weak opposition common in carpal tunnel syndrome

48

Hip flexion

Iliopsoas
L2 - L4
Pt supine, place hand on thigh and ask pt to raise the leg against resistance

49

Hip adduction

Adductors
L2-L4
Pt supine, place your hands on bed between pts knees and have them try to bring knees together

50

Hip abduction

Gluteus medius and minimus
L4-S1
Place hands on outside of knees and have pt try to spread legs apart

51

Hip extension

Gluteus maximus
S1
With pt prone, have pt push posterior thigh up against your hand
May be more easily tested with pt standing

52

Knee extension

Quadriceps
L2-L4
Support knee in flexion and ask pt to straighten leg against your hand

53

Knee flexion

Hamstrings
L4-S2
With knee flexed and foot on bed, ask pt to keep foot on bed as your try to straighten leg

54

Dorsiflexion

Toes towards head
L4-L5

55

Plantar flexion

Tip toe
S1

56

Extensor hallucis longus

L5 strength test

57

Superficial reflexes

Upper abdominal
Lower abdominal
Cremasteric
Plantar

58

Deep reflexes

Biceps
Brachioradial
Triceps
Patellar
Achilles

59

Upper abdominal

T7-T9

60

Lower abdominal SL

T10-T11

61

Cremasteric SL

T12 - L2

62

Plantar SL

L4-S2

63

Biceps SL

C5-C6

64

Brachioradial

C5-C6

65

Triceps

C6-C7 (C8)

66

Patellar

L2-L4

67

Achilles

S1-S2

68

Upper and lower abdominal reflexes

Pt supine, lightly stroke each quadrant with end of a reflex hammer, or tongue blade
Slight mvmt of umbilicus towards the stimulus should occur
Should be equal bilaterally

69

Cremasteric reflex

Stroke inner tight
Proximal to distal
Testicle and scrotum should rise on same side

70

Babinski sign

Plantar reflex
Use pointed object to stroke lateral side of foot from heel to ball, then across foot to medial side
Some pts withdraw leg, hold ankle
Normal response is plantar flexion of all toes
Babinski sign is present when there is extension of great toe, with or without fanning of other toes

71

When is babinski normal?

Response in children younger than 2

72

Babinski reflex suggests...

CNS lesion in the pyramidal tract

73

DTR

Deep tendon reflexes
Pt relaxed, sitting or lying down
Distract pt with alternate action to relax area to be tested (have pt pull clenched hands apart)
Position limb with only slight tension on tendon to be tapped
Palpate tendon to locate
Use flick of wrist to briskly tap tendon
Compare side to side

74

Scale for DTR

0 - no response
1+ - sluggish or diminished, minimal contraction
2+ - active/expected contraction of muscle
3+ - more brisk than expected, slightly hyperactive
4+ - hyperactive with intermittent or transient clonus

75

Absent DTR indicate...

Neuropathy or lower motor neuron disorder

76

Hyperactive DTR indicate...

Upper motor neuron DO

77

Biceps reflex

Flex pt arm at 45 degrees at elbow
Palpate biceps tendon in antecubital fossa
Place tumb on tendon and fingers under elbow
Strike thumb, not tendon!

78

Brachioradialis reflex

Flew arm at 45 degrees and rest pts forearm on your arm with hand slightly pronated
Strike tendon directly and couple inches above wrist
Elbow will slightly flex, wrist will slightly supinate and fingers will slightly flex

79

Triceps

Sitting, standing, or supine
Hold elbow at 45 degrees

80

Patellar reflex

Flex knee at 90 degrees
allow leg to hand loosely
Strike tendon just below patella

81

Alternative to patellar reflex

Supine with legs bent and feet on table
Supine with one leg bent, one leg extended

82

Achilles reflex

Pt sitting, flex knee to 90 degrees
Keep ankle neutral position by slightly dorsiflexing the foot
Strike achilles tendon at level of ankle malleoli
Contraction of gastrocnemius causes plantar flexion

83

Reinforcement

Jendrassik maneuver
Patient locks fingers together and pulls hard as you tap the quadriceps tendon
Voluntary UMN innervation of arm overflows to increase excitability of LMN pool of the lower extremities (easier to elicit reflex)

84

Clonus

Commonly tested on ankles
Specifically when reflexes are hyperactive
Support pts knee in partially flexed position
Briskly dorsiflex foot
Look and feel for rhythmic oscillations between dorsiflexion and plantar flexion

85

Clonus indicates...

Upper motor neuron disease