Patient Assessment I- Lecture Exam I

Front 1

The (8) parts of a History

Back 1

1. Identifying data
2. Source of history
3. Past history
4. Current health status
5. Exercise and leisurely activities
6. Family history
7. Psychosocial history
8. Review of systems

Front 2

O in OPQRST

Back 2

Onset: when, how, causative factors

Front 3

P in OPQRST

Back 3

Palliative/Provocative: what makes it better, what makes it worse

Front 4

Q in OPQRST

Back 4

Quality of Symptoms: sharp, achy, throbbing, hot, cold, etc.

Front 5

R in OPQRST

Back 5

Radiation of Pain: does the pain travel?

Front 6

S in OPQRST

Back 6

Site of Complaint: can you point to it?

Front 7

T in OPQRST

Back 7

Temporal factors: is it worse at any particular time of day, week, month, season, etc.

Front 8

Differential Diagnosis

Back 8

Formulated from the chief complaint and as you gain history information and examination findings, your differential diagnosis is narrowed by your additional history information, examination findings and further tests

Front 9

Working Diagnosis

Back 9

Formulated by considering all your history, examination and lab test findings

Front 10

4 Components of the CNS

Back 10

* Cerebellum
* Dorsal columns
* Pyramidal system (corticospinal tract, corticobulbar tract)
* Extrapyramidal system (basal ganglia)

Front 11

4 nuclei in cerebellum

Back 11

Dentate (most outside)
Eboliform
Globose
Festigial (most inside)

Front 12

3 major arteries to the cerebellum

Back 12

1) Posterior inferior cerebellar arteries
2) Anterior inferior cerebellar arteries
3) Superior cerebellar artery

(all are branches from Vertebral artery)

Front 13

(5) Cerebellar functions

Back 13

1. Motor memory
2. Check point for frontal lobe in planning movement
3. Fine motor control of all skeletal muscle
4. Reflexive control of eye movements
6. Reflexive control of intrinsic spinal muscles

Front 14

Cerebellar dysfunction: symptoms will present ipsilateral or contralateral to the lesion?

Back 14

IPSILATERAL

Front 15

Cerebellar dysfunction: symptoms will be specific to the area of the lesion or non-specific?

Back 15

SPECIFIC
(somatotopic organization)

Front 16

Anterior lobe of the cerebellum controls what?

Back 16

Torso in relation to the lower extremities

Front 17

Posterior lobe of the cerebellum controls what?

Back 17

Head in relation to the torso

Front 18

Patient should sit or stand for cerebellar testings?

Back 18

STAND! It makes the anterior lobe work harder

Front 19

Decreased muscle tone (hypotonia, ragdoll posture, ataxic gait, pendular deep tendon reflexes) are a result of what area of the CNS?

Back 19

Cerebellum

Front 20

Romberg's position, tandem gait and Babinski Weil test what part of the CNS?

Back 20

Cerebellum

Front 21

Dysarthria and nystagmus will result if what part of the brain is lesioned?

Back 21

Cerebellar vermis

Front 22

Dysdiadochokinesia is a result if what part of the CNS is lesioned?

Back 22

Cerebellum

Front 23

Dysmetria/kinetic tremors (intention tremors) are a result if what part of the CNS is lesioned?

Back 23

Cerebellum

Front 24

Rebound phenomenon checks what part of the brain?

Back 24

Cerebellum

Front 25

(7) Diseases of the Cerebellum

Back 25

1. Vascular infarcts (VBAI)
2. Tumors
3. Cerebellar atrophy
4. HIV
5. MS
6. Chronic alcoholism
7. Lyme disease

Front 26

(5) Causes of Cerebellar dysfunction

Back 26

1. Vascular insufficiency
2. Intoxication
3. Degeneration
4. Tumors (medulloblastomas)
5. Inappropriate sensory information from spine

Front 27

7 Things in an NYCC Recommended Protocol

Back 27

1. Cerebellar exam
2. Cranial nerve exam
3. Bilateral blood pressure
4. Corticospinal exam
5. Good history
6. Vascular exam
7. Written informed consent

Front 28

UMN systems include what (2) tracts?

Back 28

Corticospinal (pyramidal) and corticobulbar (motor cortex to

Front 29

What system is characteristic of these symptoms
- Increased muscle tone
- HYPERreflexia
- Presence of pathological reflexes
- No change in sensation

Back 29

UMN

Front 30

Pathological reflexes for UMNs are reliable or not?

Back 30

Very highly reliable!

Front 31

Pathological reflexes for UMNs are ipsilateral or contralateral in a corticospinal tract lesion from the cortex to the medulla?

Back 31

CONTRALATERAL

Front 32

Pathological reflexes for UMNs are ispilateral or contralateral in a corticospinal tract lesion below the medulla?

Back 32

IPSILATERAL

Front 33

Which lower extremity pathological reflex does not have an up-going toe sign as a present finding? What is the finding?

Back 33

Rossolimo's
Flexion of the toes

Front 34

Which upper extremity pathological reflex results in extension?

Back 34

Gordon's and Chaddock's

Front 35

Which upper extremity pathological reflex results in flexion?

Back 35

Rossolimo's and Tromner's

Front 36

How are superficial reflexes recorded?

Back 36

Present or absent

Front 37

What can an 'absent' superficial reflex suggest?

Back 37

1. Acute UMNL
2. Sensory (receptor) deficit
3. Motor (effector) deficit (LMN lesion)

Front 38

What is the blood supply to the dorsal columns?

Back 38

Posterior spinal artery

Front 39

Spinal stenosis is common in which part of the CNS?

Back 39

Dorsal columns (but not in the lumbar spine!)

Front 40

6 Conditions that affect the dorsal columns

Back 40

1. MS
2. B12 deficiency
3. B1 deficiency
4. Extramedullary lesion
5. HIV/Syphillis
6. Lyme disease

Front 41

Pathological reflexes for UMNs are ipsilateral or contralateral in a corticospinal tract lesion from the cortex to the medulla?

Back 41

CONTRALATERAL

Front 42

Pathological reflexes for UMNs are ispilateral or contralateral in a corticospinal tract lesion below the medulla?

Back 42

IPSILATERAL

Front 43

Which lower extremity pathological reflex does not have an up-going toe sign as a present finding? What is the finding?

Back 43

Rossolimo's
Flexion of the toes

Front 44

Which upper extremity pathological reflex results in extension?

Back 44

Gordon's and Chaddock's

Front 45

Which upper extremity pathological reflex results in flexion?

Back 45

Rossolimo's and Tromner's

Front 46

How are superficial reflexes recorded?

Back 46

Present or absent

Front 47

What can an 'absent' superficial reflex suggest?

Back 47

1. Acute UMNL
2. Sensory (receptor) deficit
3. Motor (effector) deficit (LMN lesion)

Front 48

What is the blood supply to the dorsal columns?

Back 48

Posterior spinal artery

Front 49

Spinal stenosis is common in which part of the CNS?

Back 49

Dorsal columns (but not in the lumbar spine!)

Front 50

6 Conditions that affect the dorsal columns

Back 50

1. MS
2. B12 deficiency
3. B1 deficiency
4. Extramedullary lesion
5. HIV/Syphillis
6. Lyme disease

Front 51

Patient's problems being WORSE without light signifies a lesion where?

Back 51

Dorsal columns

Front 52

Dorsal column testing should be done with eyes open or closed?

Back 52

CLOSED!

Front 53

2 point discrimination is specific or non specific, and for what area of the brain?

Back 53

NOT specific for the dorsal columns

Front 54

2 point discrimination is a good diagnostic tool or not?

Back 54

Not diagnostic for any level

Front 55

These are all symptoms of what dysfunction?
- Thalamic escape
- Difficulty initiating and inhibiting movements
- Involuntary movement
- Increased movement
- Decreased movement
- Altered muscle tone and posture

Back 55

Basal Ganglia (extrapyramidal)

Front 56

What are dyskinesias associated with basal ganglia dysfunction?

Back 56

- Athetoid movements (flowing)
- Choreas (tics)
- Hemiballism (ballistic)
- Dystonias

Front 57

What are some causes of basal ganglia disorders?

Back 57

- Long term use of medications (usually psychotropic drugs, end in "-ine")
- Head trauma
- Congenital
- Unknown

Front 58

Tone across the elbow resulting in cog wheel rigidity or lead pipe rigidity would be present if what area was lesioned?

Back 58

Basal ganglia

Front 59

Accessing movement via the limbic system partially bypasses what system?

Back 59

Basal ganglia

Front 60

What is a positive Soque's test?

Back 60

Failure to extend extremities