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Lab Final Flashcards

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1
Q

MSRs: C5

A

-Motor: Deltoid
-Sensation: Lateral Deltoid
-Reflex: Biceps

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2
Q

What nerve is the Deltoid innervated by?

A

Axillary Nerve

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3
Q

MSRs: C6

A

-Motor: Biceps & Wrist Extensors
-Sensory: Lateral antebrachium to thumb/index web
-Reflex: Brachioradialis

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4
Q

What nerve is the Biceps innervated by?

A

Musculocutaneous N.

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5
Q

What nerve are the wrist extensors innervated by?

A

Radial N. (Deep Radial N/PIN)

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6
Q

MSRs: C7

A

-Motor: Triceps & Wrist Flexors
-Sensation: Middle finger
-Reflex: Triceps

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7
Q

What nerve is the triceps innervated by?

A

Radial N.

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8
Q

What nerve are the wrist flexors innervated by?

A

Median N.

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9
Q

MSRs: C8

A

-Motor: Finger Flexors
-Sensation: Ulnar aspect of arm & hand
-Reflex: Finger flexors

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10
Q

What nerve are the finger flexors innervated by?

A

Median N.

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11
Q

MSRs: T1

A

-Motor: Finger Abd/Add
-Sensation: Medial brachium & elbow
-Reflex: N/A

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12
Q

What nerve are the Finger Abd/Add muscles innervated by?

A

Ulnar Nerve

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13
Q

MSRs: L4

A

-Motor: Tibialis Anterior
-Sensation: Medial Foot
-Reflex: Patellar

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14
Q

What nerve is tibialis anterior innervated by?

A

The deep fibular (peroneal) nerve (L4, L5)
(a branch of the common fibular nerve)

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15
Q

MSRs: L5

A

-Motor: Ext. Hallucis Longus (“Up and In”)
-Sensation: Dorsal foot; includes web b/w 1st & 2nd toes
-Reflex: Medial Hamstring

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16
Q

What nerve is innervated by Extensor Hallucis Longus?

A

Deep fibular nerve (L5/S1)

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17
Q

MSRs: S1

A

-Motor: Peroneus Longus/Brevis (“Down and Out”)
-Sensation: Lateral Foot
-Reflex: Achilles

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18
Q

What nerve innervates Peroneus Longus/Brevis?

A

Superficial Fibular Nerve (L5,S1)

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19
Q

Plantar Response Test (Babinski)

A
  • Using the blunt end of the reflex hammer, stroke the lateral portion of the plantar surface of the foot beginning at the heel and turning medially until the ball of the foot is reached
    -Positive = Great toe extension
    -If the plantar response yields an equivocal (↔) response OR there is a flexor (↓) response and there are other upper motor signs/symptoms.
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20
Q

Hoffman/Tromner’s

A

-UMN Signs
-Positive=Finger Flexion, Thumb Adduction

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21
Q

Clonus

A

Extra beats of reflex; Count them

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22
Q

Joint Position Sense

A

-Hold the distal phalanx of the 2nd, 3rd, 4th or 5th / 1st toe should be held between your fingers (on the sides of the digit) or fingers
-Test at least one toe or one finger on each side
-Patient states if you moved it up or down

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23
Q

Joint Position Sense is affected primarily by:

A

The posterior columns

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24
Q

Vibration Examination

A

-With a 128 or 256 Hz tuning fork, strike and place the stem of the fork firmly on the distal interphalangeal joint of the 5th finger or of the 5th toe
-Ask your patient to let you know when they feel it stop vibrating – then at some point reach over with your other hand and stop the fork from vibration
-Can move proximally to see if that changes

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25
The vibration examination is affected by:
The posterior columns
26
Two-Point Discrimination
-Using a bent paper clip, see how far apart the two ends must be placed on the hands in order to be perceived as two stimuli. (Normal: 2 to 4 mm on fingertips, 4 to 6 mm on dorsum of fingers, 8 to 12 mm on palm, 20 to 30 mm on dorsum of hand)
27
Two-Point Discrimination is affected by:
A lesion above the thalamus (usually parietal lobe)
28
Stereognosis
Have the patient identify by palpation without vision various small objects, e.g., pen, comb, or coin.
29
Stereognosis is affected by:
a lesion above the thalamus (most often the parietal lobe)
30
Topesthesia
Test the patient’s ability to localize stimulation by touching him/her lightly in various places and have the patient state where he/she was touched.
31
Topesthesia is affected by
A lesion above the thalamus (most often parietal lobe)
32
Grapesthesia
Trace an “8” or “4” in the patient’s palm when his/her eyes are closed. Ask the patient to identify.
33
What is grapesthesia affected by?
A lesion above the thalamus (usually the parietal lobe)
34
Double Simultaneous Stimulation/Sensory Extinction
Touch one or both arms and have the patient state if he/she feels “1” or “2” arms being touched.
35
What is Double Stimultaenous Stimulation/Sensory Extinction affected by:
A lesion above the thalamus (usually the parietal lobe)
36
What can you do to help/distract the patient if we have 5/5 strength but can’t elicit a reflex (usually b/c of nerves)?
Jendrassik Maneuver (Reinforcement or Distraction) -“Mary had a little lamb”, have patient interlace hands and pull apart…
37
Oppenheim’s
Stroke the blunted end of the reflex handle along the antero-lateral tibia from the infrapatellar area to the ankle.
38
Chaddock’s
Stroke the blunted end of the reflex handle around the lateral malleolus following along the lateral edge of the foot.
39
Gordon’s
Squeeze the calf muscles
40
Schaeffer’s
Squeeze the Achilles tendon
41
Hoffman’s Sign
-While supporting the patient’s hand, force the distal phalanx of the middle finger into flexion and then allow it to suddenly “flick” into extension
42
Positive of Hoffman’s Sign
A positive response is finger flexion and thumb adduction and is a sign of an upper motor neuron disorder.
43
Tromner’s Sign
While supporting the patient’s hand, sharply flip the pad of the middle finger upward several times.
44
Tromner’s Sign: Positive
A positive response is finger flexion and thumb adduction and is a sign of an upper motor neuron disorder.
45
Sign’s of Hypocalcemia
Chvostek’s & Trousseau’s Sign
46
Chvostek’s Sign
Tapping over the facial nerve just anterior to the ear causes contraction of the facial muscles.
47
Trousseau’s Sign
Compressing the upper arm with a blood pressure cuff for up to four minutes causes the hand and wrist to go into marked flexion.
48
Release Reflexes
-These reflexes are normally present in newborns and disappear with maturation of the central nervous system. -Their presence in adults signifies diffuse brain disease or pyramidal tract disorders.
49
“Prehensile” Reflexes include:
Sucking, Grasp & Rooting Reflex
50
What is the most reliable test for dementia?
Grasp reflex
51
Sucking Reflex
Touching the lips or corner of the mouth causes a sucking movement. (Prehensile reflex)
52
Grasp Reflex
-Stroking the palm causes the hand to reflexively grasp. *The grasp reflex is rarely observed in normal individuals and is felt to be the most reliable sign of cortical disinhibition (which is not normal for age)*. -Seen especially in Alzheimer’s dementia
53
Rooting Reflex
Stroking the corner of the mouth or cheek with a tongue blade elicits a reflexive turning of the head/neck toward the stimulus. (Prehensile Reflex)
54
“Nocioceptive” reflexes
-Palmomental, Snout & Glabellar Reflex
55
Palmomental Reflex
Tapping the thenar eminence of the hand causes the chin muscles to contract. (Nocioceptive Reflex)
56
Snout Reflex
Tapping the middle of the upper lip causes a marked contraction of the lips (Nocioceptive Reflex)
57
Glabellar Reflex
-Tapping on the glabella causes the orbicularis oculi to contract (uncontrollable blinking) -This is known as Myerson’s sign and is ssen as an early sign of Parkinson’s Disease
58
Superficial Reflex: Abdominal
-Affects T8-12 -Dividing the abdomen into quadrants, scrape the skin and observe the umbilicus deviate in that direction. -UL Loss: Lesions in lower thoracic segments/CST lesions -Superficial reflex loss: UMN lesion or thoracic nerve root lesion -In upper motor neuron conditions, this reflex disappears (though it may be absent for other reasons: obesity, post childbirth, aging)
59
Superficial Reflex: Cremasteric
-Affects segments L1-2 -Stroke the inner aspect of the thigh with a sharp object. This will produce a quick elevation of the ipsilateral testicle -This reflex may be absent in the elderly. This reflex is lost in lesions involving the upper lumbar segments of the spinal cord and corticospinal tract lesions. -Mediated by the ilioinguinal and genitofemoral nerves.
60
Superficial Reflexes: Anal
-Affects S2-4 and cauda equina -Lightly stroke or scratch the perianal skin. The external sphincter will contract. -The anal reflex is lost in lesions involving the sacral segments of the spinal cord and the cauda equina
61
Heel Walk
-Affects L4-5, L5 Radiculopathy -Without shoes or socks, ask the pt to walk toward you on their heels (observe that the toes stay up)
62
Toe Walk
-Affects L5-S1 segments, S1 radiculopathy -Without shoes or socks, ask the pt to walk away from you on their toes (observe that the heels stay off the floor)
63
Squat
-Affects L3-4 segments, L4 radiculopathy -Ask the pt to squat at the knees and recover the standing position without aid
64
Signs associated with the corticospinal tract
1. Hyperreflexia 2. Clonus 3. Babinski sign (upgoing great toe) 4. Hoffman’s / Tromner’s present
65
Signs associated with the dorsal columns
1. Vibration sense loss/diminution 2. Joint proprioception loss/diminution 3. Two-point discrimination loss/diminution (not commonly tested) 4. (+) Romberg’s sign
66
Signs associated with the Spinothalamic Tract
1. Pain / Temperature / Light touch changes (hyperalgesia or Hypoalgesia) 2. “Cowl-like” loss of pain and temperature sensation bilaterally: cervical syringomyelia
67
Entrapment of pectoralis major and the subscapularis is indicative of: ___________ entrapment sites
Lower trunk
68
Ligament of Struthers
-Above the elbow, medially, between the supracondylar process (an anomalous bone spur) and the medial epicondyle, present in less than 20% of the population. -Median nerve entrapment (rarely)
69
Lacertus Fibrosis
-Aka the bicipital aponeurosis -Least common cause of pronator syndrome -Covers the median nerve in the cubital fossa
70
Pronator Teres Muscle
-Median nerve passes between the humeral head and the ulnar head
71
Arch of the flexor digitorum superficialis
-Arch of the flexor digitorum superficialis: / Gantzer’s muscle (accessory head of the flexor pollicis longus): -Entrapment of the anterior interosseus nerve.
72
Transverse carpal ligament
-Most common peripheral nerve entrapment site
73
Phalen’s Test
-Hands in full flexion (dorsal surfaces touching each other, fingers pointing inferiorly) reproduce paresthesia -Indicative of: Carpal Tunnel Syndrome (Median Nerve)
74
Reverse Phalen’s Test
-Hands in full extension (praying hands position) reproduce paresthesias. -Indicative of: Carpal Tunnel Syndrome (
75
Tinel’s Test
-Tapping over the nerve reproduces the paresthesias -Indicative of: Tarsal tunnel syndrome/Cubital tunnel syndrome
76
Pinch sign/test
-“OK” sign, tips of the thumb and index finger pressed together collapse. -Indicative of: Compression of the anterior interosseous nerve (median nerve
77
Abductor Pollicis Brevis
-Weakness indicates: Carpal tunnel syndrome
78
Opponens Pollicis
-Weakness indicates: Compression of the recurrent branch of the median nerve
79
Pronator Teres
-Weakness indicates: Weakness of the forearm muscles innervated by the median nerve
80
Flexor digitorum profundus (2nd & 3rd Digits)
Weakness indicates: Ulnar nerve (AIN injury)
81
Intention Tremor would use which test:
-Pen to cap test (Posterior cerebellum is affected)
82
Sharpened Romberg
Feet together->Feet offset (Non-dominant foot moves)->One leg balance
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