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73 Cards in this Set
- Front
- Back
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Frontal lobe
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behavior, judgement, mood, motor
planning, motor cortex, some language (Broca’s area dominant hemisphere – motor / “expression” of sentence structure, pleurals, tense |
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Parietal lobe
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Sensory processing
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Temporal lobe
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Temporal lobe- Auditory processing, memory, some
language (Wernicke’s area dominant hemisphere – comprehension / “fluent jargon”) |
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Occipital lobe
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viasual
visuospatial |
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Thalamus
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visual, auditor, sensation
no motor pathways |
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Extrapyramidal tracts that effect movmenet
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Globus pallidus, putamen, and caudate
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Cortical and subcortical regions examine
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cognition, language,
vision, sensory processing, movements and tone, and gait |
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Basal ganglia
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Automated movment
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thalamus
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P
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Brainstem
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Midbrain, Pons, Medulla
Contains cranial nerves, arousal centers (sleep and wakefulness), descending motor tracts, ascending sensory tracks, and respiratory centers |
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Cerebellum
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important for coordinated movments and smoothness of movment
Cerebellum has tracks from the spinal cord and pons and sends tracks to midbrain |
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Cerebaellar tests examine:
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Examination includes assessment of
cranial nerves, gait and cerebellar function |
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Death with spinal cord severed at what level?
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C5
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Diseases of the spinal cord are called
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Myelopathies
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Transmission of motor information from the CNS through what tracts?
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Corticospinal
Extrapyramidal Cerebellar |
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Transmission of sensory information to the CNS through what tracts?
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Spinothalamic
Posterior columns |
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Corticospinal tract
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voluntary movment
synapse at anterior horn |
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Spinothalamic tract carries
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light touch, pain , temp, pressure
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Posterior columns carry
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vibration, proprioception, discriminitive touch
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Spinal cord myelopathies examinatino involves
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assessing gait and
Romberg, reflexes, and tone. |
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myelopathies are characterized by
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Spasticity
Positive rhomberg Sensory levels |
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Cranial Nerves
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OOOTTAFVGVAH
I- Olfaction- smell II-Optic- vision III-Oculomotor- eye movement IV-Trochlear- eye movement V-Trigeminal- sensation and taste VI-Abducens- eye movement VII Facial- facial motor, and some taste VIII Acoustic (Vestibulocochlear)- hearing and balance IX- Glossopharyngeal- soft palate X Vagus- soft palate, voice, swallowing XI Spinal Accessory- motor to trapezii XII Hypoglossal- tongue movement |
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Disease of peripheral muscles are called
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Myopathies
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Elemtns of the muslce/motor exam:
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bulk, strength, tone
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Muscle disease distribution
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proximal
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Diseases that affect the NMJ are characterized by
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proximal weakness
and fatigability that is improved with rest |
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examinng NMJ principal component is
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The principal component of the exam is
checking the strength of certain muscles and for fatigability (e.g., ptosis) |
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Peripheral nerves
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diseases involving peripheral nerves
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Peripheral neuropathy exam components
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light touch, pin prick, vibration, rpopriocetpion, muscle strength
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UE most important peripheral nerves
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In the upper extremity, most
important are the median, ulnar, radial, musculocutaneous, and axillary nerves |
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LE most important peripheral nerves
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portant are the femoral,
obturator, sciatic, tibial and peroneal nerves |
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brachial plexus
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all spinal roots under clavicle C5-C8
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Lumbosacral plexus
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pelvis
L3-S1 roots |
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Plexopatheis
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Plexopathies are characterized by loss
29 of reflexes, widely distributed weakness and multifocal numbness with or without pain Most plexopathies are caused by compression or infiltration |
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Plexopathy tests
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strength, motor reflexes
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ROOT diseases
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Radiculopathies
compression or mechanical cause C5-8 lancinating dysesthetic pain, weakness loss of reflexes L3-S1- lower extremities |
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Nerve root numbers
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Cervical – 8 pairs
Thoracic – 12 pairs Lumbar – 5 pairs Sacral – 5 pairs Coccygeal – 1 pair |
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Reflexes
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Biceps Reflex: (C5, 6)
• Triceps Reflex: (C7, 8) • Patellar Reflex: (L3, 4) • Achilles Reflex: (S1, 2) |
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Radiculopathy exam includes
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strenght, sensation, reflex
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Mental status exam
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behavior
orentation level of consciousness |
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dimentia
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MSE testing score <24
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serial 7s tests what?
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attention span/calculation
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Brief mental status exam
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JOMAC
• Judgment •Orientation •Memory •Affect •Cognition |
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CNI
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Olfactory Nerve (CNI)*:
• Inquire about change in smell • Check for nasal patency • Use familiar substances (cinnamon, coffee, or lemon). No ammonia; triggers CNV • Check each nostril separately: Can they smell something? Can they identify it? |
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CNII
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Optic Nerve (CNII):
• Visual acuity: Assess with pocket Rosenbaum at 14 inches or wall chart at 20 feet • Visual fields: Assess four fields of gaze – superior, inferior, lateral & medial • Funduscopic exam: direct examination of CNII |
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CNIII
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Oculomotor Nerve (CNIII):
• Pupillary responses: check direct & consensual • Eyelid elevation: check for ptosis • EOMS: check in tandem with CNIV & CNVI for conjugate eye movement & nystagmus CNIII: Inferior oblique, superior/inferior & medial rectus Trochlear Nerve (CNIV): Superior oblique Abducens Nerve (CNVI): Lateral rectus |
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CNV
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Trigeminal Nerve (CNV):
• Facial sensation: Check all three divisions (Light touch/Pinprick) • Corneal reflexes: CNV is afferent limb; CNVII is efferent limb • Muscles of mastication: Temporalis & masseter |
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CNVII
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Facial Nerve (CNVII):
• Muscles of facial expression: Evaluate for symmetry (raise eyebrows, close eyes against resistance, puff out cheeks, smile) • Central v. peripheral VII lesion • Taste: use familiar substances (sugar, coffee) |
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CNVIII
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Acoustic (Vestibulocochlear-CNVIII):
• Gross hearing: Whispered word Rubbing fingers • Weber & Rinne testing (512 Hz tuning fork) Assessment for sensorineural v. conductive hearing loss |
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CN IX, X, XI, XII
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Glossopharyngeal Nerve (CNIX): Check in
tandem with vagus nerve (CN X): • Palate elevation: check for symmetry • Gag reflex Spinal Accessory Nerve (CNXI): • Assess integrity of SCM & trapezius Hypoglossal Nerve (CNXII): • Assess for tongue in midline & movement side to side |
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upper extremity add, abudction
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add c5-8
Ab C5-6 |
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upper extremity forearm flex/extend
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flex- C5-6
Extend C6-8 |
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Upper extremity Thumb Abduction Adduction Opposition
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Ab C7,8, T1
Ad C8-T1 Opposition C8-T1 |
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Hip flexion
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L1-L3
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Knee Flexion/extension
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flex- L4-5,
S1-2 |
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Foot dorsi/plantarflexion
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L4-5,
L5, S1-2 |
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Great Toe dorsiflexion/plantarflextion
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dorsi L4-5
Plantar L5-S2 |
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Pronator Drift
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Patient should stand
with arms extended outward and palms up for 20-30 seconds with eyes closed • Watch for pronation of arm and drift downward Useful to detect a subtle contralateral upper motor neuron lesion • e.g., weakness secondary to CVA |
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Rhomberg testing
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Romberg testing: have patient stand
with feet together with eyes open and then closed for 20-30 seconds. • Tests position sense (dorsal column and in some measure sensation in the feet). • Stand close to patient in case they start to fall • Loss of balance = Positive Romberg • Check Romberg before gait testing to avoid a fall |
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all sensory testing=
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eyes closed
distal to proximal |
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Important Dermatomal landmarks
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Upper extremities
• Thumb – C6 • Middle fingers – C7 • Fifth digit – C8 Trunk: Nipple line – T4; umbilicus – T10 Lower extremities: • Anterior thigh – L3 • Anterior shin – L4 • Top of foot – L5 • Bottom of foot – S1 |
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Two point discrimination
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Two-point discrimination:
Move two pins closer together until patient can only appreciate Swartz MH ( 2002) Textbook Physical one point 2mm toes: 3- Swartz, 2002). of Diagnosis: History and Examination Normals: Fingertips: 2mm, 8 mm, palms: 8-12mm, back 40- 60 mm |
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Steregnosis
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identify common object inhand
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Graphestesia
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number on palm
oriented to patient |
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Extinction, double simultaneous stimulation
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Tactile localization (a.k.a.
“extinction” or “double simultaneous stimulation”): • Simultaneously touch two separate sites on opposite sides of the body and ask what was felt |
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Reflex dance
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1, 2… Achilles Reflex: (S1, 2)
3, 4… Patellar Reflex: (L3, 4) 5, 6… Biceps Reflex: (C5, 6) 7, 8… Triceps Reflex: (C7, 8) |
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Reflex scale
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• 0 No response
• +1 Diminished • +2 Normal • +3 Increased • +4 Hyperactive, associated with clonus |
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jendrassik's maneuver
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Reinforcement Technique
If having difficulty eliciting reflexes (diminished or absent) use reinforcement techniques • UE – grit teeth • LE – isometric exercises |
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Cerebellar exmainations
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finger to nose
Heel to shin (slide down) Rapid alternating movements heel/toe walk hop on one foot knee bend on one leg |
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dysidiadochokinesai
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Dysdiadochokinesia: inability to do
RAMs •Slow, but regular think cerebral dysfunction • Fast, but irregular think cerebellar dysfunction |
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heel walk vs toe walk spinal levels
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heeL L5
ToeS S1 |
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Kernig's sign
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patient supine, flex hip
and knee, then attempt to straighten the leg (+)LBP is positive Kernig's |
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Brudzinski's sign
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Brudzinski’s sign: patient supine, place
your hands behind the patient’s neck and attempt to flex the neck toward the chest Involuntary flexion of hips and knees is (+) sign suggesting meningeal irritation |
