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PD Neuro Part 2 Flashcards

1
Q

Primary sensations

A 
Light (superficial) touch
Pressure (deep touch)
Vibration
Position of joints
Pain
Temperature 
Touch
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2
Q

Which sensory functions are spinothalamic tract?

A

Pain
Temperature
Crude touch

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3
Q

Which sensory functions are dorsal column?

A

Light touch
Pressure
Vibration, position of joints

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4
Q

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

A

Each major peripheral nerve

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5
Q

Routine exam

A 
Hands
Lower arms
Abdomen
Feet
Lower legs
Face (while testing CNs)
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6
Q

General considerations of exam

A

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

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7
Q

Where is strong stimulus needed?

A

Back

Buttocks

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8
Q

With each type of sensory stimulus, there should be:

A

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

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9
Q

What to do if sensory impairment is found

A

Map boundaries by the distribution of major peripheral nerves or dermatomes

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10
Q

Cortical sensory functions

A 
Stereognosis
Two point discrimination
Extinction phenomenon
Graphesthesia
Point location
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11
Q

Abnormality of previous functions

A

Lesion in cerebral cortex or posterior columns of spinal cord

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12
Q

Superficial touch

A

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

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13
Q

Superfcial pain

A

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

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14
Q

When to test temp and deep pressure?

A

When superficial pain is not intact

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15
Q

Temperature testing

A

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

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16
Q

Deep pressure

A

Firmly squeeze muscle body

Expect discomfort

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17
Q

Vibration

A

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

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18
Q

Sites tested for vibration

A 
Sternum
Shoulder
Elbow
wrist
Finger joints
Shin
Ankle 
Toes
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19
Q

Position of joints

A 
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
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20
Q

Stereognosis

A

Ability to identify an object by touch and manipulation

Use familiar object for patient to identify

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21
Q

Tactile agnosia suggests…

A

Parietal lesion

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22
Q

Two point discrimination

A

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

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23
Q

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

A

Fingers have more sensation than palm

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24
Q

Extinction

A

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

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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

Physical Diagnosis (10 decks)

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