Test #5- MS and Neuro Flashcards
1
Q
DTR reflexes for biceps
A
C5-C6
2
Q
DTR reflexes for brachioradialis
A
C5-C6
3
Q
DTR reflexes for triceps
A
C6-C7
4
Q
DTR reflexes for patellar
A
L2-L4
5
Q
DTR reflexes for achilles
A
S1-S2
6
Q
DTR responses below normal may imply
A
myopathies, decreased muscle mass, nerve root impairment
7
Q
DTR responses above normal are characteristic of
A
pyramidal tract disease, electrolyte imbalances, hyperthyroidism
8
Q
new onset radicular pain in older adults is frequently
A
spinal stenosis
9
Q
patients with bulging discs are
A
asymptomatic
10
Q
triad of Meniere disease
A
vertigo, hearing loss, and tinnitus
11
Q
headache is caused by an abnormal metabolism of
A
serotonin, norepi, and dopamine
12
Q
Headaches of new onset in the elderly tend to have a
A
secondary cause (tumor, bleed)
13
Q
“worse headache of my life”
A
subarachnoid hemorrhage
14
Q
Headache worse in the am, deep pain, aggravated by coughing, sneezing
A
brain tumor
15
Q
Morning headaches worse in the occipital region
A
HTN
16
Q
Headaches worse when bending over, nasal congestions, facial tenderness
A
sinusitis
17
Q
Severe headache, tachycardia, diaphoresis
A
pheochromocytoma
18
Q
Orbital headache
A
acute angle glaucoma
19
Q
diagnostics for headache
A
CT/MRI, sinus series, CBC, CMP, TSH, EEG, lumbar puncture
20
Q
risk factors for migraine
A
family hx, female, alcohol, estrogen replacement
21
Q
foods that can affect migraines
A
food containing tryptophan or tyramine (ripe cheese, red wine, chocolate)
22
Q
neurotransmitter involved in migraine
A
serotonin
23
Q
5 phases of migraines
A
prodrome, aura, headache, termination, postdrome
24
Q
phase of migraine where pt experiences mood swings, fatigue, food craving, yawning
A
prodrome
25
phase of migraine where pt experiences visual disturbances, visual field cuts, flashing lights, zigzag patterns, floaters
aura
26
phase of migraine where pt experiences unilateral headache that is throbbing, anorexia, N/V, photophobia, vertigo
headache phase that lasts 4-72 hours
27
phase of migraine that usually occurs with sleep or meds
termination of headache
28
foods to avoid for migraines
MSG, nitrite-containing food (hot dog), tyramine-containing food
29
POUND symptoms of migraine
```
Pulsatile or throbbing
One-day duration, or lasts 4-72 hours
Unilateral
Nausea or vomiting
Disabling or intensity causing interruption of daily activity.
```
30
this type of headache rarely occurs in children and pregnancy
cluster headache
31
risk factors for cluster headache
male, age >30, alcohol intake, use of NTG, excessive caffeine/nicotine
32
commonly referred to as suicide headache
cluster headache
33
peak and duration of cluster headache
peaks in 15 min, lasts less than 3 hours
34
characteristics of cluster headache
deep, severe, unilateral, and episodic
35
associated s/s with cluster headache
lacrimation, rhinorrhea, ptosis, injected conjunctiva
36
typical time of onset for tension headache
after age 20, before 50
37
type of headache that involves precranial muscle tenderness
tension type headache
38
risk factors for tension type headache
stress, worry, jaw-clenching
39
s/s of tension type headache
bilateral pressure around head, nonthrobbing, palpable muscle tightness, stiffness in neck, upper shoulders, and scalp.
40
onset and duration of tension type headache
gradual and lasts 30 min-7 days
41
vertigo is accompanied by
nystagmus and ataxia
42
vertigo can be caused by
benign positional vertigo, labyrinthitis, and Meniere's disease
43
difference b/t syncope and presyncope
in presyncope patient does not lose consciousness
44
vasovagal syncope is d/t
deceased cardiac output
45
meds that can cause syncope
```
antihypertensives
antiarrythmics
antidepressants
diuretics
phenothiazines
vasodilators.
```
46
diagnostics for syncope
CMP, BP in both arms, 24-hr ECG monitoring, neuro exam, tilt test
47
Bell's palsy affects CN
VII- facial
48
causes of Bell's palsy
idiopathic, viral, exposure to cold, herpes zoster, Lyme disease
49
risk factors for Bell's palsy
age > 30, Lyme disease, pregnancy, family hx, DM, herpes zoster
50
S/S of bell's palsy
unilateral numbness and paralysis, sensitivity to sound, loss of taste
51
Diagnostic for bell's palsy
CT to r/o stroke, EMG testing
52
trx for bell's
eyedrops, patch on affected eye at night
53
trigeminal neuralgia affects CN
5
54
s/s of trigeminal neuralgia
severe pain in lip, gum, cheek that is worse with touch or changes in temp. pain occurs in bursts.
55
onset and duration of labyrinthitis
sudden onset that can last for up to 2 weeks. recurrence is common
56
in labyrinthitis, these are not affected
hearing and tinnitus
57
labyrinthitis can also cause
N/V, nystagmus
58
risk factors for stroke
HTN, HLD, DM, obesity, smoking, lack of exercise, alcohol, OCP, CV disease, afib, and carotid artery disease
59
stroke outcomes are improved it therapy is given within
3 hours of onset of symptoms
60
most common cause of ischemic stroke symptoms is occlusion of the
middle cerebral artery
61
Occlusion of the left middle cerebral artery produces
aphasia
62
occlusion of the right middle cerebral artery produces
neglect to opposite side of body
63
AHA stroke warning signs
numbness, confusion, vision problems, trouble walking, severe headache
64
goal BP and A1c for stroke prevention
less than 130/80 and 7%
65
two kinds of stroke
ischemic and hemorrhagic
66
TIA is characterized as
cerebral ischemia without infarction that lasts less than 24 hours
67
Begins with motor symptoms characterized by recurrent contractions of muscles in one part of the body.
partial seizure
68
begin in one part of the body and progress to contiguous body parts over seconds or minutes.
simple partial seizure
69
seizure that impairs consciousness
complex partial seizure
70
Seizure that is bilaterally symmetrical but without local onset
generalized seizure
71
brief arrest of activity and loss of consciousness.
petit mal seizure
72
seizure where muscle movements are repetitive.
myoclonic seizure
73
causes of seizures
alcohol withdrawal, brain tumor, hypoxia, stroke, fever, head injury, meningitis
74
highest incidence of seizures is in
children and elderly
75
Inflammation of the brain and spinal cord caused by infection with bacteria, viruses, and fungi.
meningitis
76
bacterial causes of meningitis
Strep pneumonia, Group B or D Strep, N. meningitides
77
viral causes of meningitis
enterovirus
78
Fungal causes of meningitis
candida species, aspergillus
79
s/s of meningitis
stiff neck, fever, N/V, rash, nuchal rigidity, photophobia
80
clinical signs of meningitis
Kernig and Brudzinski sign
81
where complete extension of leg causes neck pain and flexion
Kernig sign
82
flexion of legs if neck is passively flexed.
Brudzinski sign
83
CSF in meningitis
turbid with WBC and high protein
84
CSF in bacterial meningitis
glucose is decreased
85
Diagnosis of PD is supported by therapeutic response to
levodopa
86
Parkinson's is caused by decreased production of
dopamine
87
risk factors for parkinson's
age > 60, family hx
88
S/s of parkinson's
bradykinesia, muscular rigidity, resting tremor, postural instability
89
characterized by demyelination of nerve cells in the brain and spinal cord.
Multiple sclerosis
90
risk factors for MS
family hx and northern european descent
91
s/s of MS
intermittent; paresthesias, weakness, stiffness to extremities, transient blindness, nystagmus, scanning speech, intention tremor.
92
diagnostic of MS
MRI
93
CN I
olfactory- smell
94
CN II
optic- vision
95
CN III
occulomotor- pupillary response
96
CN IV
trochlear- downward, internal rotation of eye
97
CN V
trigeminal- corneal reflex, facial sensation, jaw movement
98
CN VI
abducens- lateral deviation of eye
99
CN VII
facial- facial movement
100
CN VIII
vestibulocochlear- balance and hearing
101
CN IX
glossopharyngeal- movement of pharynx
102
CN X
vagus- gag reflex
103
CN XI
spinal accessory- shoulder and neck
104
CN XII
hypoglossal- tongue
105
abd upper reflex
T8-T10
106
abd lower reflex
T10-T12
107
Plantar response (babinksi)
L5, S1
108
anal reflex
S2-S4
109
sprain is partial tearing or stretching of
ligaments
110
Grade III sprain
completely torn ligament, unstable joint
111
an injury to a muscle or tendon usually associated with improper use or overuse.
strain
112
If increased ROM occurs at any injured joint, suspect
severe tear of rupture of ligament
113
s/s of sprain
pain and swelling around joint, redness, bruising, audible pop at time of injury, discomfort on weight bearing
114
suspicion of fracture if there is
exquisite tenderness, pain, inability to bear weight
115
trx for sprains
Rest, Ice every hour x20 min for first 24 hours, then 4x/day, compression, and elevation
116
pain meds for sprains
NSAIDs for adults, acetaminophen for children
117
inflammation of synovial membrane
bursitis
118
bursitis occurs in areas where
friction is likely to occur
119
Bursitis is often secondary to
calcific tendonitis
120
risk factors for bursitis
trauma, overuse, gout, RA, OA, obesity, age
121
s/s of bursitis
aching pain and swelling over joint, decreased ROM,
122
entrapment neuropathy of the median nerve at the wrist d/t inflammation of wrist tendons, transverse carpal ligament, and/or surrounding soft tissue.
carpal tunnel
123
risk factors for carpal tunnel
age 40-60, repetitive movement of wrist, weight gain, pregnancy, arthritis, hypothyroidism
124
s/s of carpal tunnel
paresthesias affecting fingers (esp at night), dull/aching and weakness, affected hand cool to touch.
125
clinical tests for carpal tunnel
phalen and tinel test
126
test where pt holds flexed fingers against each other with wrists flexed at a 90 degree angle for 60 seconds. Considered positive for CPS if paresthesia occurs.
Phalen's test
127
test where you percuss over the median nerve on the volar aspect of the wrist. Considered positive for CPS if paresthesia occurs.
Tinel's test
128
diagnostic for CPS
nerve conduction studies, EMG
129
if CPS is untreated then there is a risk of
permanent loss of function to affected hand
130
Deposition of monosodium urate (MSU) crystals in joints and other connective tissue causing acute or chronic inflammation
gouty arthritis
131
causes of gouty arthritis
overproduction or underexcretion of uric acid, dietary excess of purine, alcoholism
132
gouty arthritis is common in
men > 45 years old
133
meds that can cause gouty arthritis
ASA, nicotinic acid, diuretics, cyclosporine
134
risk factors for gouty arthritis
alcoholism, renal disease, psoriasis, family hx, obesity, HTN
135
most commonly affected in gouty arthritis
MTP of first toe
136
s/s of gouty arthritis
acute joint pain and swelling, warmth and erythema
137
elevated in gouty arthritis
ESR and WBC
138
in an acute attack of gouty arthritis, the uric acid is
normal.
139
not useful in diagnosing gouty arthritis
uric acid level
140
allopurinol
decreased production of uric acid
141
med for acute attacks of gouty arthritis
NSAID
142
desirable level of uric acid
less than 7 mg/dl
143
Progressive destruction of the articular cartilage and subchondral bone accompanied by osteophyte formation and sclerosis
osteoarthritis
144
OA is confined to the
joints only
145
risk factors for OA
age > 40, obesity, overuse of joints, family hx, hemophilia, Paget's disease
146
s/s of OA
asymmetrical joint pain, morning stiffness less than an hr
147
nodes in OA
Heberden's and Bouchard's nodes
148
node in distal interpharyngeal joints
Heberden
149
node in proximal interpharyngeal joints
Bouchard
150
in OA, inflammation markers are
negative
151
med considered first line for OA
Tylenol
152
An autoimmune disease that is systemic, frequently progressive, and is characterized by inflammation and thickening of synovial membrane
RA
153
risk factors for RA
white, native american, age 30-50
154
juvenile onset of RA begins at
1-3 years
155
s/s of RA
weakness, anorexia, weight loss, lymphadenopathy, low-grade fever
156
in RA, joint pain and stiffness occur
at rest and with movement that lasts > 1 hour in morning
157
these 4 symptoms must be present for at least 6 weeks to diagnose RA
morning stiffness > 1 hour, swelling of 3 or more joints, swelling of at least 1 joint in hand/wrist, and symmetrical joint swelling
158
xray in RA shows
joint space narrowing, bone erosion, reduced bone density
159
these are elevated in RA
RF, ESR, ANA, and C-reactive protein
160
a good measure of RA activity
ESR
161
post menopausal fractures occur b/c of
lack of estrogren
162
risk factors for osteoporosis
genetic, estrogen deficiency, calcium deficiency, alcohol and nicotine
163
Meds that can cause osteoporosis
corticosteroids, anticonvulsants, thyroid supplements
164
s/s of osteoporosis
asymptomatic until fracture occurs
165
trx for osteoporosis
1500 mg of calcium and 1000 IU of vit d
166
describes a disorder of the roots of the spinal nerves d/t compression, inflammation, or tearing of nerve roots at the site of entry into the vertebral canal
radiculopathy
167
common cause of low back pain
Compression or irritation of a nerve root
168
discs most commonly affected in low back pain
L4-L5, and L5-S1
169
s/s of low back pain
pain in back, buttocks, and/or one or both thighs
170
consider x-ray if patient presents with these with low back pain
age > 50, neuro deficits, hx of cancer, weight loss, substance abuse, trauma
171
apply heat to back pain after
first 48 hours
172
med for back pain
NSAIDs
173
straight leg raise and dorsiflexion of foot indicates
sciatica
174
migraines are thought to result from a longer period of
vasodilation
175
triggers for migraines
sounds, odors, estrogen fluctuations with menses
176
vomiting can be a sign of
increased intracranial pressure
177
patients with cluster headaches have worse pain when
lying down
178
tenderness over nodular temporal arteries is a sign of
temporal arteritis
179
most common type of migraine
migraine without aura
180
Vasculitis of the ophthalmic and posterior ciliary branches of the internal carotid artery.
temporal arteritis
181
temporal arteritis affects those who are
more than 50 years old
182
s/s of temporal arteritis
sharp pain over tender, nodular temporal artery
183
a preceding headache in temporal arteritis can lead to
blindness that is permanent
184
temporal arteritis is a
medical emergency
185
diagnostic of temporal arteritis
ESR greater than 50 mm/hr
186
OA is more ____ and RA is more ______
degenerative; inflammatory
187
OA results in
spur development
188
rheumatoid arthritis nodules
soft and spongy that appear on elbows, forearms, and hands.
189
characterized by chronic fatigue, generalized musculoskeletal pain, and multiple trigger points of pain on physical exam.
fibromyalgia
190
fibromyalgia affects mostly
women ages 20-50
191
s/s of fibromyalgia
pain over trigger points, sleep problems, depression, OCD, and IBS
192
sharp, burning pain that radiates down the posterior and lateral leg to the foot or ankle.
sciatica
193
chronic back pain is for more than
3 months
194
the most common cause of sciatica is
herniated disk
195
The MCPs are often boggy or tender in
RA
196
crepitus with flexion and extension of the knee is indicative of
OA
197
these maneuvers worsen sciatica
coughing and valsalva
198
Clinical test where you draw the tibia forward and observe if it slides forward from under the femur.
Anterior test drawer
199
anterior test drawer tests for
ACL tear
200
clinical test where you push the tibia posteriorly and observe the degree of backward movement in the femur.
posterior test drawer
201
posterior test drawer tests for
PCL tear
202
talar tilt test tests for
excessive ankle inversion
203
clinical test where you apply force medially to the ankle and note the degree of inversion.
talar tilt test
204
inability to bear weight after four steps and tenderness over the posterior aspects of either malleolus.
ottawa rules for ankle
205
A click is palpable or audible as the hip is reduced by abduction
ortolani
206
A palpable click is heard when the hips are guided into mild adduction.
barlow
207
when the patient lays on stomach and the examiner applies downward pressure to the patient's foot, internally and externally rotating the lower leg.
Apley test
208
with the knee extended, the knee is milked downward and pressure is placed behind the lateral margin. A fluid wave is felt.
bulge sign
209
bulge sign is indicative of
knee effusion
210
apley test is to test for
meniscus injury
211
lachman test is to diagnose
ACL tear
212
test where the knee is flexed and externally rotated. Then you pull the tibia forward and push femur back.
lachman tests
213
McMurray test is used to help diagnose for
meniscus tear
214
test where you place the patient supine and internally rotate the foot and apply varus force to the knee, a click may be heard.
McMurray test- lateral meniscus tear
215
test where you place the patient supine and externally rotate the foot and apply vaglus force to the knee, a click may be heard
McMurray test- medial meniscus tear
216
Q angle helps to diagnose for
patellar tendinitis (jumper's knee)
217
Q angle measures the angle between the center of the _____ to the anterior superior ____ and from the center ___ to the ____ ____.
patella; iliac spine; patella; tibial tubercule
218
test when the flexed abducted knee is pushed medially and the ankle is pulled laterally. It is positive if the patient has pain
valgus stress test
219
valgus stress test helps diagnose
MCL tear
220
test when the flexed abducted knee is pushed laterally and the ankle is pulled medially. It is positive if the patient has pain
varus stress test
221
Finkelstein test helps diagnose for
Quervain tenosynovitis
222
when patient flexes fingers over a clenched thumb, then passively deviate wrist ulnarly which can cause pain.
Finkelstein test
223
An Q angle greater than ___ degrees in males and __ degrees in females is positive.
10; 15
224
DTRs in MS are
increased
225
c/o pain with movement
tendonitis
226
varus stress test helps diagnose for
LCL tear
227
rooting reflex occurs in ages
birth to 3-4 months
228
rooting reflex
stroke perioral skin at mouth, mouth will open and baby will turn toward the side and suck
229
moro (startle) reflex occurs in ages
birth to 4 months
230
moro (startle) reflex
lower body and arms should extend and feet flex
231
asymmetric tonic neck reflex occurs in age
birth to 2 months
232
asymmetric tonic neck reflex
turn head to one side. the arm and leg that the head is turned will extend while the other side will flex.
233
trunk incurvation (galant's) reflex occurs in ages
birth to 2 months
234
trunk incurvation (galant's) reflex
support baby prone and stroke one side of the back and the spine should curve in that direction.
235
landau reflex occurs in ages
birth to 6 months
236
landau reflex
suspend baby prone with one hand, the head will lift and spine will straighten.
237
parachute reflex occurs in ages
8 months and doesn't disappear
238
parachute reflex
suspend baby prone and lower head, the arms and legs should extend.
239
positive support reflex occurs in ages
birth to 6 months
240
positive support reflex
hold the baby standing and the baby will stand and bear weight, then sag after 20-30 sec
241
placing and stepping reflex occur in ages
birth to variable
242
placing and stepping reflex
hold baby upright and have one sole touch floor, the other foot should step forward.
243
palmar grasp reflex occurs in ages
birth to 3-4 months
244
plantar grasp reflex occurs in ages
birth to 6-8 months
245
delay or absence in pediatric reflex may indicate
pyramidal tract disease or cerebral palsy.
246
a positive barlow does not indicate
hip dysplasia but laxity.
247
ligaments connect
bone to bone
248
tendons connect
muscle to bone
249
when to screen for osteoporosis
women at age 65 or women with fracture risk.
250
carpal tunnel finger involvement
first 3 fingers, weak thumb abduction
251
age when osteoporotic fractures occur at the same rate in men and women
75
252
medial epicondylitis is called
golfer's elbow
253
Yergason’s sign is to help diagnose for
bicep tendonitis
254
Cozen's test is to help diagnose for
tennis elbow
255
bakers cyst is commonly associated with
RA
256
Testing for vibratory sensation primarily evaluates the function of the
posterior columns
257
A patient with lower motor neuron disease will exhibit
muscle atrophy
258
A patient with upper motor neuron disease will exhibit:
hyperactive DTRs, increased muscle tone
259
The Plantar (Babinski) reflex is normally found in children until the age of:
18 months
260
The meningitis vaccine (MCV4) is usually given
at 11-12 year olds then a booster at 16
261
Patients with lateral epicondylitis typically present with
decreased hand grip
