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Exame Físico Ortopedia > Traumatismo Raquimedular > Flashcards

Traumatismo Raquimedular Flashcards

1
Q

What are the possible states of a reflex?

A

Abolished, diminished, present, alive or exalted.

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2
Q

What are the main osteotendinous reflexes that should be tested?

A

Bicipital (C5), estiloradial (C6), tricipital (C7), patellar (L4), aquilean (S1).

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3
Q

What is clonus and how is it obtained?

A

A series of involuntary contractions obtained by passive abrupt tendon stretching.

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4
Q

What are the reflexes evaluated with the use of a stylus?

A

Cutaneous reflexes.

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5
Q

How can unfavorable conditions of the abdominal wall affect reflex evaluation?

A

They can impair reflex evaluation, especially when there is asymmetry.

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6
Q

How are cremasteric reflexes examined?

A

By cutaneous stimulation of the medial and upper parts of the thighs.

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7
Q

What is the expected response for cutaneoplantar reflex?

A

Flexion of the foot.

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8
Q

What are the main neurological motor levels?

A

C2, C3, C4, C5, C6, C7, C8, T1, T2, T3, T4, T5, T6, T7, T8, T9, T10, T11, T12, L1, L2, L3, L4, L5, S1, S2, S3, S4-S5.

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9
Q

How is the neurological motor level graded?

A

0 = Absent, 1 = Visible or palpable contraction, 2 = Active movement without gravity opposition, 3 = Active movement against gravity, 4 = Active movement against some resistance, 5 = Active movement against full resistance.

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10
Q

What is the sensory level for the motor key muscle?

A

L4 - Extensor longus of the hallux.

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11
Q

What are the indications of a complete or incomplete sensory or motor lesion?

A

Complete = absence of any partial function, Incomplete = presence of any partial function.

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12
Q

What does the Babinski sign indicate?

A

Extension of the hallux in patients with corticospinal tract impairment.

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13
Q

How are reflexes graded?

A

0 = Abolished, 1+ = Hypoactive, 2+ = Normoactive, 3+ = Alive, 4+ = Hyperactive.

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14
Q

What are the characteristics of the syndrome of spinal cord compression?

A

Diminished motricity, exalted reflexes, and a sensitive level.

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15
Q

What are the characteristics of the Brown-Séquard syndrome?

A

Diminished motricity on one side and normal reflexes.

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16
Q

What is paraplegia?

A

Paraplegia is a condition characterized by paralysis of the lower limbs and, depending on the level of injury, may also include the trunk, pelvic organs, and lower limbs.

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17
Q

What muscles are evaluated for cervical root injuries?

A

The muscles evaluated for cervical root injuries are flexors of the elbow (C5), wrist extensors (C6), elbow extensors (C7), deep finger flexors in the middle finger (C8), and small abductors of the fingers (T1).

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18
Q

What muscles are evaluated for lumbar root injuries?

A

The muscles evaluated for lumbar root injuries are hip flexors (L2), knee extensors (L3), ankle dorsiflexors (L4), long toe extensors (L5), and ankle plantar flexors (S1).

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19
Q

What is the purpose of opposition maneuvers in evaluating motor function?

A

Opposition maneuvers allow the examiner to assess specific muscle groups by applying resistance to the requested movements of the patient.

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20
Q

What is the standardized examination recommended by the American Spinal Injury Association (ASIA) for evaluating motor function?

A

The standardized examination recommended by ASIA is the assessment of muscle strength using the Medical Research Council scale, ranging from 0 (no visible contraction) to 5 (normal strength).

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21
Q

How is the assessment of motor deficits performed in patients with subtle motor impairments?

A

In patients with subtle motor impairments, the deficit maneuvers should be performed to evaluate specific motor functions of the upper and lower limbs.

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22
Q

What is the maneuver used to assess motor function of the upper limbs?

A

The maneuver used to assess motor function of the upper limbs is the extended limb maneuver, where the patient extends their upper limbs parallel to the ground for 2 minutes.

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23
Q

What is the maneuver used to assess motor function of the lower limbs?

A

The maneuver used to assess motor function of the lower limbs is the Mingazzini maneuver, where the patient flexes the thigh on the torso and flexes the knee, keeping each segment of the lower limb at a 90-degree angle to the other.

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24
Q

What reflexes are important to analyze the presence of spinal shock?

A

The bulbocavernosus and anal reflexes are important in analyzing the presence of spinal shock.

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25
Q

How is the anal reflex tested?

A

The anal reflex is tested by stimulating the perianal region with a needle, resulting in a reflex contraction of the anal sphincter.

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26
Q

How is the bulbocavernosus reflex tested?

A

The bulbocavernosus reflex is tested by stimulating the glans (in males) or the clitoris (in females), resulting in a reflex contraction of the anal sphincter.

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27
Q

What classification system is used after the phase of spinal shock?

A

The classification system used after the phase of spinal shock is the Frankel scale, which categorizes patients based on the presence or absence of motor function and sensation below the level of the injury (Grades A to E).

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28
Q

What does Grade A signify in the Frankel scale?

A

Grade A in the Frankel scale signifies the absence of motor and sensory function below the level of the injury.

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29
Q

What does Grade B signify in the Frankel scale?

A

Grade B in the Frankel scale signifies the absence of motor function but with some preservation of sensory function below the level of the injury.

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30
Q

What does Grade C signify in the Frankel scale?

A

Grade C in the Frankel scale signifies the presence of some degree of motor function but without practical utility.

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31
Q

What are the types of sensitivity that should be evaluated for the topographic diagnosis of spinal cord diseases?

A

Superficial sensitivity (including pain, temperature, and touch), deep sensitivity, and vibratory sensitivity.

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32
Q

How is superficial pain sensitivity assessed?

A

By using a pointed instrument, such as a needle, to lightly stimulate specific dermatomes.

33
Q

How is thermal sensitivity assessed?

A

By using containers of cold and hot water or by spraying small amounts of ether and alcohol on the patient’s skin.

34
Q

How is tactile sensitivity assessed?

A

By using cotton or a brush to stimulate the patient’s body surface, similar to the assessment of superficial pain sensitivity.

35
Q

What are some important points on the body surface used to assess the integrity of corresponding dermatomes?

A

C2 - Occipital prominence, C3 - Supraclavicular fossa, C4 - Acromioclavicular joint prominence, C5 - Lateral border of the antecubital fossa, C6 - Thumb, C7 - Middle finger, C8 - Little finger, T1 - Medial border of the antecubital fossa, T2 - Apex of the axilla, T3 - Third intercostal space, T4 - Nipple line, T6 - Xiphoid process level, T7 - Seventh intercostal space, T8 - Costal margin, T9 - Ninth intercostal space, T10 - Umbilical scar level, T12 - Midpoint of the inguinal ligament, L2 - Anteromedial portion of the thigh, L3 - Medial condyle of the femur, L4 - Medial malleolus, L5 - Proximal portion of the hallux, S1 - Lateral surface of the heel, S2 - Midline of the popliteal fossa, S3 - Ischial tuberosity, S4 and S5 - Perianal area.

36
Q

What is the ASIA scale used for?

A

To assess neurological deficits associated with spinal cord injuries.

37
Q

When did the ASIA scale incorporate the sensory index to its motor score?

A

In 1992.

38
Q

How is deep artresthetic sensitivity assessed?

A

With the patient’s eyes closed, the examiner moves a certain finger and then the examined toe, and the patient should state their position.

39
Q

How is vibratory deep sensitivity assessed?

A

By using a tuning fork on bony prominences, or a palesthesiometer to quantify vibratory intensity.

40
Q

What are the components of a reflex arc?

A

An afferent pathway (peripheral system), an association center (central system), and an efferent pathway (peripheral system).

41
Q

What are the two types of reflexes that can be evaluated?

A

Osteotendinous reflexes (deep tendon reflexes) and superficial or cutaneous reflexes.

42
Q

How are osteotendinous reflexes assessed?

A

In a craniocaudal direction, comparing one side of the patient to the other using a reflex hammer.

43
Q

What is the role of the spinal cord?

A

The spinal cord is the main conductor of sensory and motor information between the brain and the body.

44
Q

How is the gray matter organized in the spinal cord?

A

The gray matter is organized into segments containing sensory and motor neurons.

45
Q

What is the cone medullaris?

A

The cone medullaris is the most distal part of the spinal cord.

46
Q

What is the cauda equina composed of?

A

The cauda equina is composed of paired lumbosacral nerves that originate in the cone medullaris.

47
Q

What are the three components evaluated in a neurological examination?

A

The three components evaluated in a neurological examination are motor function, sensory function, and reflexes.

48
Q

What is the term for an area of the skin innervated by sensory axons within each segmental nerve?

A

The term for this is ‘dermatome’.

49
Q

What does the term ‘level neurological’ refer to?

A

The term ‘level neurological’ refers to the most distal segment of the spinal cord with normal sensory function and antigravitational motor function on both sides of the body.

50
Q

What does the term ‘level sensory’ refer to?

A

The term ‘level sensory’ refers to the most distal segment of the spinal cord with light touch and deep sensitivity function.

51
Q

What does the term ‘level motor’ refer to?

A

The term ‘level motor’ refers to the most distal segment of the spinal cord with motor function of at least 3 strength, provided that the level above has a normal strength of 5.

52
Q

What is the ‘level skeletal’?

A

The ‘level skeletal’ refers to the level at which the greatest spinal damage is detected through radiological examination.

53
Q

What is the difference between a complete and incomplete lesion?

A

A complete lesion refers to the absence of motor and sensory function in the lowest sacral segment, while an incomplete lesion indicates partial preservation of sensory and/or motor function below the neurological level.

54
Q

Define tetraplegia.

A

Tetraplegia is the decrease or loss of motor and/or sensory function in the cervical segments due to neural element damage within the spinal canal.

55
Q

Define paraplegia.

A

Paraplegia is the decrease or loss of motor and/or sensory function in the thoracic or sacral segments of the spinal cord.

56
Q

What is the name of the syndrome characterized by compromised motor function and decreased sensation on the same side?

A

Síndrome centromedular

57
Q

What is the motor function like in the region affected by the centromedullary syndrome?

A

diminished

58
Q

What happens to the reflexes below the lesion in the centromedullary syndrome?

A

exaggerated

59
Q

How is the sensation affected on the opposite side in the centromedullary syndrome?

A

painful sensation is compromised

60
Q

How is motricity affected in the region affected by spinal transection syndrome?

A

absent (acute phase)

61
Q

What happens to the reflexes in the region of spinal transection syndrome after the end of the spinal shock?

A

they become exaggerated

62
Q

What happens to the sensation in the region affected by spinal transection syndrome?

A

absent

63
Q

What is the motricity like in the syndrome of the cauda equina?

A

absent or decreased

64
Q

What happens to the reflexes in the syndrome of the cauda equina?

A

absent

65
Q

What happens to the sensation in the syndrome of the cauda equina?

A

absent

66
Q

What is the motricity like in the anterior spinal artery syndrome?

A

decreased

67
Q

What happens to the reflexes in the anterior spinal artery syndrome?

A

exaggerated

68
Q

How is sensation affected in the anterior spinal artery syndrome?

A

loss of pain and temperature sensation, preserved touch sensation

69
Q

What is the motricity like in the spinal shock syndrome?

A

absent

70
Q

What happens to the reflexes in the spinal shock syndrome?

A

absent

71
Q

What is the sensation like in the spinal shock syndrome?

A

absent

72
Q

What can be the effects of a radicular lesion on motricity?

A

possible compromise of a specific muscle group

73
Q

What can be compromised in a radicular lesion?

A

a single reflex

74
Q

What can be altered in the area corresponding to the innervation of a root in a radicular lesion?

A

sensation may be altered

75
Q

What is the name given to the situation when a plexus is compromised?

A

plexus lesion

76
Q

What happens to the motricity when a plexus lesion occurs?

A

more than one root that forms the plexus is compromised

77
Q

What happens to the reflexes in a plexus lesion?

A

more than one root that forms the plexus is compromised

78
Q

What happens to the sensation in a plexus lesion?

A

more than one root that forms the plexus is compromised

Exame Físico Ortopedia (14 decks)

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