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Flashcards in Week 4 Deck (104)
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1

What is the purpose of a neuromuscular(neurologic) screening exam?

It identifies or rules out signs consistent with lower neuron pathology and upper motor neuron pathology

2

A lower motor neuron pathology is classified as a ____

Radiculopathy

3

Examples of an upper motor neuron pathology

Stroke, spinal cord compression, TBI

4

____ uses sensory, motor, and reflex testing to determine the source and location of a neurological dysfunction. It also assist in differential diagnosis of these conditions

A neuromuscular screen

5

What are the components of a basic neurological screening examination?

Motor testing, Somatosensory/sensory testing, reflex testing, central nervous system screen.

6

What are the things to look for in a functional motor observation/ myotome testing?

- Can the patient do what we want them to and how does it relate to their function?
- Issues with tremors
- Fasciculations in muscles
- Atrophy
-1 vs multiple testing to test performance

7

Functional myotomal assessment assesses which ability?

Step up (quads)

8

Functional myotomal assessment L4-5 assesses which ability?

Heel walking

9

Functional myotomal assessment L5-S1 assesses which ability?

Toe walking/ toe raise

10

UE myotome C1-2 assesses which ability?

Neck flexion

11

UE myotome C3 assesses which ability?

Neck sidebending

12

UE myotome C4 assesses which ability?

Shoulder elevation

13

UE myotome C5 assesses which ability?

Shoulder abduction

14

UE myotome C6 assesses which ability?

Elbow flexion

15

UE myotome C7 assesses which ability?

Elbow extension

16

UE myotome C8 assesses which ability?

Thumb abduction

17

UE myotome T1 assesses which ability?

Finger abduction

18

LQ myotome L2-3 assesses which ability?

Hip flexion

19

LQ myotome L3-4 assesses which ability?

Knee extensors

20

LQ myotome L4 assesses which ability?

Ankle dorsiflexors

21

LQ myotome L5 assesses which ability?

Hallux extension

22

LQ myotome S1 assesses which ability?

Ankle plantar flexors

23

What position are motor screening typically done?

In a sitting position

24

What is positive finding?

Significant weakness or diminished resistance relative to the opposite side

25

UQ dermatome C5

Mid deltoid

26

UQ dermatome C6

Radial aspect of 2nd metacarpal

27

UQ dermatome C7

Dorsal aspect of middle finger

28

UQ dermatome C8

Ulna aspect of 5th metacarpal

29

UQ dermatome T1

Medial forearm

30

LQ dermatome L1

Inguinal area

31

LQ dermatome L2

Anterior mid thigh

32

LQ dermatome L3

Medial knee

33

LQ dermatome L4

Medial malleolus

34

LQ dermatome L5

Distal medial dorsum of foot

35

LQ dermatome S1

Lateral border of foot

36

LQ dermatome S2

Medial/ posterior calcaneus

37

A monosynaptic reflex automatically regulates ____

Muscle length

38

In a monosynaptic reflex, tapping of tendon places a quick stretch on muscle and activates _____

Muscle spindle

39

What does the activation of a muscle spindle result in?

Results in contraction of stretched muscle

40

What will tapping a muscle 5-6 times reveal?

Any fatigue or fading response

41

What is an hypo-reflexive reflex show?

Lower motor neuron (possible nerve root compression or neuropathy)

42

What is an hyper-reflexive reflex show?

Upper motor neuron (possible CNS pathology)

43

UQ reflex: C5

Biceps brachii

44

UQ reflex: C6

Brachioradialis

45

UQ reflex: C7

Triceps

46

Positive finding reflex found to be diminished or absent can be correlated with the dermatome and myotome assessment to...?

Determine the presence of nerve root pathology

47

What may hyperactive/reflexive findings indicate?

Upper motor neuron pathology

48

LQ reflex: L2-4

Patellar reflex

49

LQ reflex: S1-2

Achilles reflex

50

What is the response of LQ reflex grade 4+?

Very brisk response; associated with clonus

51

What is the response of LQ reflex grade 3+?

Brisk response; possibly hyper reflexive

52

What is the response of LQ reflex grade 2+?

Normal, average response

53

What is the response of LQ reflex grade 1+?

Low-normal response

54

What is the response of LQ reflex grade 0?

No response

55

What is the response of LQ reflex grade 1+(R)?

Absent response which appears with reinforecement

56

What is the response of LQ reflex grade 0(R)?

No response even with reinforcement

57

Example of a reinforcement technique (R)

Jendrassik maneuver

58

How is the jendrassik maneuver done?

Patient is told to clasps hands together and asked to pull then apart without doing so, while looking away.

59

What does the jendrassik manuever do to the nervous system?

Ramps up the nervous system

60

What is clonus?

A series of involuntary muscular contractions due to sudden stretching of the muscle (reflex response)

61

___ is normally one little jolt, while _____ continually contracts

*Clonus* is normally one little jolt, while *colonus* continually contracts

62

Clonus is a ______ system disorder

CNS disorder.

63

_____ are specifically diseases or disorders that damage the upper motor neuronsor associated tracts

Clonus

64

Clonus most commonly testing in the ___

Ankle and wrist

65

What clonus is considered abnormal?

Sustained clonus (5 beats or more)

66

How is the Babinski CNS screen done?

- Drag something on the bottom of the foot.
- Normal response- toes flex
- Babinski response

67

What is the babinski response?

The hallux extends and toes fan out

68

What is the hoffman's reflex?

- When you flick distal IP joint of middle finger
- Looking for the index finger and thumb flexion

69

What is the inverted supinator sign?

There will be either a pronation of the forearm of a clasp/flexion of the fingers in a pathologic case

70

What lesion is weakness a sign of?

Upper and lower motor neuron lesion

71

What lesion is atrophy a sign of?

Lower motor neuron lesion and mild atrophy in the upper motor neuron may develop due to disuse over time, but ultimately no

72

What lesion is fasciculations a sign of?

Lower motor neuron lesion

73

What lesion is reflex a sign of?

- Increased in an upper motor neuron lesion

- Decreased in a lower motor neuron lesion

74

What lesion is MM tone a sign of?

- Increased in an upper motor neuron lesion

- Decreased in a lower motor neuron lesion

75

Why do we take a patient's vitals?

- Essential component of every new patient as documented in the Guide to PT practice

- Responsible for screening patients for conditions that may negatively impact their response to our interventions

76

A patient may have abnormal vitals, yet be ___

A patient may have abnormal vitals, yet be *asymptomatic*

77

Types of vital signs

- Traditional and modern/updated

78

Types of traditional vital signs?

- Heart rate
- Blood pressure
- Respiration rate
- Body temperature

79

Characteristics of heart rate vital sign

• Generally normal range is between 60-100 beats per minute (BPM)

• Can take brachial, radial, carotid, femoral or dorsalis pedis pulses

• May do manually or with a pulse oximeter (pulse ox)

80

Characteristics of BP vital sign

o Set up done right: cuff shouldn’t go around clothing

o No reading

o Leg not crossed

o Leaning upright

o Used the bathroom

o No talking

81

What is a normal BP?

Systolic: less than 120
and
Diastolic: less than 80

82

What is an elevated BP?

Systolic: 120-129
and
Diastolic: less than 80

83

What is an hypertension stage 1 BP?

Systolic: 130-139
or
Diastolic: 80-89

84

What is an hypertension stage 2 BP?

Systolic: greater than or equal to 140
or
Diastolic: greater than or equal to 90

85

What is an hypertensive crisis BP?

Systolic: greater than or equal to 180
and/or
Systolic: greater than or equal to 120

86

Types of a modern/updated vitals

- Gait speed
- Waist circumference/ BMI

87

According to white paper, ____ is the 6th vital sign

Walking/gait speed

88

Characteristics of gait speed vital sign

o 20-meter distance

o First 5-meter accelerating

o Time over 10 meters

o Last 5-meter deceleration

89

What is the range of a hazard gait speed?

0-0.6 m/s

90

What is the range of a normal gait speed?

0.6-1m/s

91

What is the range of an above risk gait speed?

1- 1.4 m/s

92

Where is the position for waist circumference measurement?

Waist/abdominal. (above iliac crest). Around the umbilicus

93

What is the measurement is an high risk of a metabolic disorder/cardiovascular disease for men?

Over 40in

94

What is the measurement is an high risk of a metabolic disorder/cardiovascular disease for women?

Over 35in

95

What does BMI stand for and what is it?

Body mass index. A number calculated from a person's weight and height

96

What group of people is BMI not overly accurate for?

Those who are frail or overly muscular

97

Why is BMI not overly accurate for a muscular person?

Because muscle is more dense and it brings more weight

98

BMI of an underweight person

less than 18.5

99

BMI of normal weight

18.5-24.9

100

- BMI of overweight
- Disease risk with optimal waist
- Disease risk w/o optimal waist

- 25 -29.9
- Increased
- High

101

- BMI of obesity class 1
- Disease risk with optimal waist
- Disease risk w/o optimal waist

- 30- 34.9
- High
- Very high

102

- BMI of obesity class 2
- Disease risk with optimal waist
- Disease risk w/o optimal waist

- 35- 39.9
- Very high
- Very high

103

- BMI of obesity class 3
- Disease risk with optimal waist
- Disease risk w/o optimal waist

- Greater than or = to 40
- Extremely high
- Extremely high

104

____ is still possible even though a person has a low BMI, but are no active

Cardiovascular mortality