Neuro Exam

Front 1

2 places where the median nerve is subject to entrapment/compression

Back 1

1-carpal tunnel
2-pronator teres

Front 2

what is the significance of loss of sensation in the distrib. of the palmar cutaneous branch of the median nerve??

Back 2

loss of sensation in this distrib. would indicate that the entrapment is pronator teres syndrome since the palmar cutaneous branch does not go through the carpal tunnel.

Front 3

when median neuropathy is suspected based upon history and sensory exam findings, how would the results of muscle testing help you id pronator teres syn. vs. carpal tunnel syn.??

Back 3

in p.t.syn. you would see partial weakness of wrist flexors and full weakness of finger flexors. (this weakness is not exhibited in carpal tunnel syn.)

Front 4

2 sites of entrapment of ulnar nerve

Back 4

1-in medial epicondylar groove
2-in cubital tunnel

Front 5

entrapment sites of radial nerve

Back 5

1-in axilla (crutch palsy)
2-in triangular interval
3-in spiral groove of humerus (sat. night palsy/honeymooner's palsy)
4-in supinator muscle

Front 6

entrapment site of axillary nerve

Back 6

1-quadrangular space

Front 7

entrapment site of musculocutaneous N.

Back 7

1-coracobrachialis m.

Front 8

entrapment site of sciatic N.

Back 8

1-piriformis m.

Front 9

entrapment site of lat. femoral. cutaneous N.

Back 9

1- under inguinal lig. (meralgia paresthetica)

Front 10

entrapment site of common peroneal N.

Back 10

@ fibula neck

Front 11

entrapment site of tibial N.

Back 11

@ medial ankle
tarsal tunnel syndrome

Front 12

area of skin where there is least overlap between the radial nerve's sensory territory and that of other adjacent peripheral nerves?

Back 12

dorsal web of hand

Front 13

radial entrapment site that would result in motor weakness, but not sensory loss?

Back 13

entrapment of the superficial radial branch (branches proximal to the supinator muscle) will spare all sensory branches of the radial N. and result in motor weakness of the hand.

Front 14

what pattern of weakness would suggest myopathy?

Back 14

weakness in the pelvic and shoulder girdles would suggest myopathy. (proximal extremities)

Front 15

gower's sign is...

Back 15

when a pt uses their hands to walk up the legs in rising from a seated position due to weakness of the pelvic girdle musculature. (seen in pts with duchenne's muscular dystrophy)

Front 16

trendelenberg's sign is....

Back 16

caused by gluteus medius weakness, causes inability of supporting leg to hold body weight. + for trendelenberg's sign if the straight leg/hip buckles due to muscle weakness.

Front 17

what special studies should be performed to further evaluate suspected myopathy?

Back 17

EMG
serum studies (elevated CPK)
muscle biopsy

Front 18

what is a group of muscle diseases that have a genetic etiology?

Back 18

muscle dystrophies & duchenne's is the most lethal.

Front 19

3 NMJ diseases & whether they are pre or post junctional...

Back 19

lambert eaton syn.- prejunctional
botulism- prejxnal
myasthenia gravis-postjxnal

Front 20

where is the most common site of initial weakness in myasthenia gravis?

Back 20

bulbar innervated muscles, esp. the extraocular muscles and levator palpabrae. this results in DIPLOPIA and PTOSIS

Front 21

sudden onset of weakness in the LLE would be most suggestive of a CVA involving the ________ artery on the ______ side.

Back 21

anterior cerebral
right
(CVAs of the ACA result in LE weakness and assc. UMN signs contralaterally).

Front 22

what are the sensory findings assc. with a L brown sequard syn @ T10?

also should be able to illustrate.

Back 22

1-loss of tactile sensation (vibration and JPS) ipsilaterally below T10
2-loss of P & T contralaterally below T10
3-loss of all sensory @ T10

Front 23

when a brown sequard syn. exists on the L at T10, which lower ext. would present weakness?
is this UMN of LMN weakness?

Back 23

left
LMN

Front 24

what reflex findings would indicate a UMN lesion?

Back 24

hyperreflexia in deep tendon
pathological reflexes (like babinski)

Front 25

what change in m. tone would be assc. with a UNM lesion?

Back 25

hypertonicity, spasticity

Front 26

what is the significance of clonus?

Back 26

it is indicative of an UMN lesion and is a quick stretch of the spastic muscles resulting in repetitive contractions. it is a manifestation of increased DTR/muscle stretch activity- a hypersensitivity.

Front 27

weakness/fasiculations would be more suggestive of an _____ lesion?

Back 27

LMN

Front 28

would UMN or LMN lesion be assc. with greater amts. of atrophy?

Back 28

LMN

Front 29

a pt. presents with L hemiplegia w/ sparing of the upper part of the face. where is the most likely site of lesion?

Back 29

R internal capsule (results in weakness of the entire contralateral face excepting the forehead)

Front 30

id 2 lesion lites that can cause paraplegia

Back 30

any spinal cord transection below T1
a LMN lesion like polyneuropathy

Front 31

radial N.

Back 31

triceps, wrist extensors, finger extensors

Front 32

median N.

Back 32

wrist flexors, finger flexors, opponens pollicis

Front 33

axillary N.

Back 33

deltoid, teres minor

Front 34

musculocutaneous N.

Back 34

coracobrachialis and biceps

Front 35

ulnar N.

Back 35

interossei, opponens digiti minimi

Front 36

Peroneal N.

Back 36

inversion and eversion of the foot, heel walk and extensor hallicus longus

Front 37

Femoral N.

Back 37

extension of the knee

Front 38

obturator N.

Back 38

adduction of the hip

Front 39

sensory distrib., radial N.

Back 39

post. arm, forearm, posterolateral hand and 3.5 fingers

Front 40

sensory distrib., median N.

Back 40

lateral palm and 3.5 fingers

Front 41

sensory distrib., axillary N.

Back 41

lateral arm

Front 42

sensory distrib., musculocutaneous N.

Back 42

lateral forearm

Front 43

sensory distrib., ulnar N.

Back 43

ant. and post. medial hand and 1.5 fingers

Front 44

sensory distrib., peroneal N.

Back 44

lateral shin and top of foot

Front 45

sensory distrib., femoral N.

Back 45

ant. thigh , medial shin(via saphenous N.)

Front 46

sensory distrib., obturator N.

Back 46

medial thigh (mid-lower)

Front 47

DTR assc. with the following p. nerve weakness:
triceps, wrist extensors and finger extensors

Back 47

triceps
& brachioradialis
(radial N.)

Front 48

DTR assc. w/ following p. nerve weakness:
biceps and coracobrachialis

Back 48

biceps brachii (musculocutaneous)

Front 49

DTR assc. w/ following p. nerve weakness:
hip flexion and knee extension

Back 49

quadriceps (patellar tendon reflex)
(Femoral N.)

Front 50

DTR assc. w/ following p. nerve weakness:
plantarflexors and evertors

Back 50

achilles
(tibial)

Front 51

what disorder is considered when weakness is present in both feet (& poss. both hands?)?

Back 51

polyneuropathy. in a stocking & glove pattern. paresthesia & sensory alterations begin in feet & then manifest in hands.

Front 52

what patterns of weakness would be suggestive of CNS lesion rather than PNS lesion?

Back 52

CNS= loss of pain and temp sensation
loss of vibration & JPS
loss of tactile sensation

Front 53

L4 dermatome

Back 53

medial shin

Front 54

L5 dermatome

Back 54

lateral shin

Front 55

S1 dermatome

Back 55

lateral foot

Front 56

dermatome of big toe

Back 56

primarily L5

Front 57

dermatome of middle finger

Back 57

primarily C7

Front 58

most common Cspinal NN to dvp radiculopathy

Back 58

C6&7 (this could be due to C5&6 disc herniation)

Front 59

most common low back spinal NN to dvp radiculopathy:

Back 59

L5& S1 (could be due to L4&5 disc herniation)
(disc n-1)

Front 60

other S&S assc. with numbness in the perianal region:

Back 60

(AKA saddle anashtesia, a sign of cauda equina syn.)
urinary retention, fecal elim. problems & impotence caused by parasympathetic impairment)

Front 61

mm. tests & DTR's
C5

Back 61

deltoid & biceps
biceps

Front 62

mm.tests & DTRs
C6

Back 62

biceps and wrist extensors
brachioradialis

Front 63

mm. tests & DTRs
C7

Back 63

triceps, wrist flexors, finger extensors
TRICEPS

Front 64

mm.tests & DTRs
C8

Back 64

finger flexors
NO DTR

Front 65

mm. tests& DTRs
T1

Back 65

interossei muscles-finger abduction & adduction
NO DTR

Front 66

mm. tests & DTRs
L1-3

Back 66

iliopsoas: L1-3
cremasteric (superficial rflx)

Front 67

mm. tests & DTRs
L2-4

Back 67

quadriceps
adductors

Front 68

mm.tests. & DTRs
L4

Back 68

anterior tibialis (inversion w/dorsiflexion)
PATELLAR TENDON

Front 69

mm. tests & DTRs
L5

Back 69

dorsiflexors & EHL, E.dig longus
MEDIAL HAMSTRING

Front 70

mm. tests & DTRs
S1

Back 70

plantarflexors, evertors (peroneus longus & brevis)
ACHILLES

Front 71

ortho exams for cervical radiculopathy:

Back 71

bakody's sign
foraminal compression tests & variations: lat flexion (jackson's), ext, rot, max. cervical compression maneuver, modified spurlings, cervical distraction test.
-IVD prolapse: all above tests as well as foraminal compression test in flexion
-intrathecal P tests: valsalva maneuver and Nafzigger

Front 72

ortho exams if low back radiculopathy is expected:

Back 72

SLR, braggard's, bowstring, sitting laseque, bechterew's, neri's bowing, WLR, fajersztahn, kemp's, milgrim's, minor's sign

Front 73

girth assessment:

Back 73

measure UE 3" above & below elbow
LE 6" above & below knee
max normal variation is usually 1"

Front 74

dynamometer

Back 74

hand grip strength meter, tests finger flexion strength.

Front 75

upper limit of dynamometer for normal variation due to hand dominance??

Back 75

15 degrees

Front 76

chaddock's rflx

Back 76

LE, stroke below the lateral malleolus
UE, stroke ulnar side of forearm near wrist

Front 77

gordons and shaeffers rflxes:

Back 77

G= squeeze the gastrochnemius
S=squeeze the achilles tendon

Front 78

rossolimo's reflex

Back 78

tapping the ball of the foot
(response = flexion of foot)

Front 79

hoffman's and tromner's reflexes:

Back 79

H=flicking the 3rd finger downward
T=flicking the 3rd finger up

Front 80

scale for grading muscle strength:

Back 80

5=normal= full ROM against gravity w/full resistance
2=poor=complete ROM w/ NO gravity
0=zero=NO joint motion & no evidence of contractility

Front 81

which gait tests would be helpful in assessing the motor fxns of the L5 &S1 spinal NN?

Back 81

heel walk would assess L5(weak dorsiflexion)
toe walk for S1 (weak plantarflexors)

Front 82

sensory level=

Back 82

the dermatomal level that corresponds with a spinal nerve.

Front 83

stereognosis

Back 83

w/ eyes closed a pt is asked to id a familiar obj placed in hand.
ASTEREOGNOSIS= inability to correctly id

Front 84

graphognosis/graphesthesia

Back 84

draw a # or letter in pts palm & ask them to id.
AGRAPHOGNOSIS= abnormal, + test, the pt cannot id the letter but can feel the touch.

Front 85

extinction

Back 85

double simultaneous stimulation test.
pt can differentiate b/n L & R stimulation separately but when performed simultaneously they only feel one side
=a lesion of the somatosensory assc. cortex opp. the side of extinguished sensation.

Front 86

when a peripheral N or spinal N is compressed, which sensory fxns are usually more susceptible?

Back 86

tactile sensations carried by larger diameter type II fibers. vibration sense, JPS, light touch & pinprick.

Front 87

JPS test

Back 87

checking the pts ability to indicate the direction of small passive mvmts of their jts.
+= side to side alteration or decreased sensitivity, requiring greater movement.