WEEK 2 OBJECTIVE ASSESSMENT

Question 1

What are the 6 types of sensory testing?

Answer 1

Light and deep
Hot and cold
Two-point discrimination 
Sharp and blunt
Stereognosis
Propioceptive

Question 2

What does sensory testing test?

Answer 2

The sensory receptor (1st order neurone), synapse at sensory tract in spinal cord (2nd order neurone), synapse at sensory tract in thalamus (3rd order neurone), synapse at sensory cortex.

Question 3

What is a muscle spindle?

Answer 3

Within the muscle, responds to length (stretch) & velocity & prevents overstretch of a muscle. STRETCH RECEPTORS.

Question 4

What is a golgi tendon?

Answer 4

Different to muscle spindles; instead of responding to stretch they respond to muscle tension.

Question 5

What are the sensory receptors?

Answer 5

Pacinian corpuscles, free nerve endings, ruffini endings & golgi type endings (in joints), merkle’s discs, meissner corpuscles.

Question 6

What do pacinian corpuscles respond to? (in muscles and joints)

Answer 6

Vibration, pressure, and pain.

Mechanical deformation - sensory info is relayed.

Question 7

What do free nerve endings respond to?

Answer 7

Crude touch (light touch), superficial pressure. (sharp blunt)

Question 8

What do ruffini endings and golgi type endings (in joints) respond to?

Answer 8

Sustained pressure, mechanical deformation, angle change within a joint. (proprioception)

Question 9

What do merkle’s discs respond to?

Answer 9

Light touch and superficial pressure. (sharp/blunt)

Question 10

What do meissner corpuscles respond to?

Answer 10

Fine discriminative touch & vibration

Question 11

Nociceptors detect pain. What is the difference between A delta fibres and C fibres?

Answer 11

A delta: ‘fast pain’, tissue damage and extreme cold (pain)

C fibres: ‘slow pain’, dull, ache, poorly localised and extreme hot (pain).

Question 12

What does the dorsal column transmit?

Answer 12

Proprioception, pressure (Golgi tendon, muscle spindles, ruffini endings)
vibration, discriminative touch (Meissner’s corpuscles)
TESTS: Proprioception, two-point discrimination, light touch

Question 13

What does the spinothalamic tract transmit?

Answer 13

Pain, temperature, crude touch, pressure (nociceptors, free nerve endings, pacinian corpuscle)
TESTS: Hot & cold, sharp/blunt

Question 14

What does the spinocerebellar tract transmit?

Answer 14

Proprioception, posture, balance, co-ordination (golgi tendon, muscle spindles)
TESTS: stereognosis

Question 15

What are the two coordination tests? And how are they carried out briefly?

Answer 15

Finger to nose and heel to shin.

FAILED TESTS = ATAXIA, coordination receives info through spinocerebellar tract & dorsal column

Question 16

What are deep tendon reflexes?

Answer 16

AKA stretch reflex or mytactic reflex and is activation of muscle spindles.

Question 17

How do you test deep tendon reflexes?

Answer 17

Elicited with reflex hammer
Patient and muscles are relaxed
Tendon is put on a slight stretch
E.g. brisk tap to tendon
Test 3-6 times

Question 18

What would hyporeflexia suggest?

Answer 18

There is a lower motor neuron lesion which leads to a decreased activity of reflexes.

Question 19

What would hyper-flexia suggest?

Answer 19

There is an upper motor neuron lesion which leads to increased activity of reflexes.

Question 20

What are the special reflex tests and what nerve root are they testing?

Answer 20

Biceps - C5,6
Triceps - C6-8
Supinator - C5-7
Quads - L2-L4
Achilles - Gastroc, Soleus - S1,2
Babinski reflex

Question 21

What is the monosynaptic motor reflex?

Answer 21

Muscle spindles pick up sensation of stretch & velocity and the info travels down sensory neurones and synapses at the dorsal root ganglia then synapses in the spinal cord with motor neurone -> stimulated -> muscle contraction.

Question 22

How should the procedure start in any cutaneous testing?

Answer 22

Explain the procedure, give sensory input (possibly cheek due to unaffected cranial nerves). Test affected side first, then unaffected and during the test give no feedback. Standardised patient sitting. Skin should be fully exposed.

Question 23

Explain the procedure of light and deep touch.

Answer 23

1. Explanation
2. Ask patient to close eyes (visual input disturbs ability to process sensory input)
3. Identification
4. Move from distal to proximal, lightly stroke area with cotton wool and for increased pressure touch use hand. Alternate randomly.
5. Ask patient to identify if light or deep.
6. Alternate from side to side, ask where you are touching them, ask if some touch feels the same or different.

Question 24

Explain the procedure of sharp/blunt testing.

Answer 24

1. Gain informed consent as this test could be painful for some.
2. Start distally in affected limb, using equal pressure, alternate sharp and blunt.
3. Test affected then unaffected sides, following this, alternate between sides in a random sequence.
4. Note down areas where patient got consistently wrong including the limb, whether it was sharp or blunt etc.

Question 25

Explain the procedure of two-point discrimination testing.

Answer 25

1. Start in area where patient had trouble identifying sharp/blunt/light/deep. 2. Test affected then unaffected using equal pressure. 3. Ask if they feel one or two points of pressure.

Question 26

Explain the procedure of hot and cold testing.

Answer 26

1. Start distally in arm/leg randomly alternate between hot and cold with firm pressure for short, equal times. 2. Allow patient to respond between each stimulus. 3. Note correct responses and wrong ones too.

Question 27

How do you carry out reflex testing?

Answer 27

Feet should be off the floor, thumb over tendon and tap thumb with hammer.