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38 Cards in this Set
- Front
- Back
If you were doing a neurovascular exam of the feet, what nerves would you be testing? |
L4, L5, S1
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Describe the L4 dermatome |
Big toe and the foot proximal to this (volar and dorsal side), medial calf to knee
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Describe the L 5 dermatome |
Middle 3 toes and the foot proximal to this (volar and dorsal, although avoids the heel), lateral calf to knee
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Describe the S1 dermatome |
1 Silly little toe! And the foot proximal to this, the heel (+ a touch higher in the midline calf)
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What nerves allow (a) standing on tiptoes (b) standing on heels (c) squat and stand up again |
(a)Toes = S1 (b) Heels = L4, L5 (c) squat= L3, L4
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What nerves are involved in the (a) knee jerk (b) ankle jerk (c)plantar reflex? |
(a) Knee jerk- L3, L4 (b) 2 silly ankle jerks - S1, S2 (c)L5, S1, S2
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What are the four mail peripheral nerves in the leg? |
Lateral cutaneous nerve of the thigh, femoral nerve, sciatic nerve, common peroneal nerve
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How would lateral cutaneous nerve entrapment present? Where would it get trapped? |
Numbness (+ or - pain) over anteriorlateral thigh. No motor issues.
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What is the differential diagnosis for lateral cutaneous nerve entrapment and how can dermatomal testing help? |
Similar area to L2, but L2 dermatome sweeps over the lateral buttock to the lumbar spine. (The lateral cutaneous nerve does not supply the buttock at all).
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The femoral nerve is supplied by which lumbar nerve roots? |
L2, L3, L4,
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What area will be numb in a femoral nerve lesion? |
(numbness over medial knee and a good 10cm above and below this; note, L3 and L4 dermatomes supply this area and meet at the knee)
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What weakness would you find and reflex deficits in a femoral nerve lesion? |
Absent knee jerk and week knee extension (+ slight hip flexion weakness)
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What nerves supply the sciatc nerve? |
L4-S2
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What muscles does the sciatic nerve supply? |
Hamstrings + everything below the knee
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What is the sensory distribution for the sciatic nerve? |
Entire posterior thigh+leg +entire volar foot (impaired with a proximal lesion)
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What motor deficits would you get with a sciatic nerve lesion? |
Footdrop, knee flexion weakness
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What reflexes would be affected by a sciatic nerve lesion? |
Absent plantar reflex, intact knee jerk.
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DDx foot drop (8) |
Common peroneal nerve palsy, sciatic nerve palsy, lubrosacral plexus lesion, L4/L5 root lesion. Peripheral motor neuropathy, distal myopathy, motor neuron disease, stroke.
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What nerves supply the common peroneal nerve? |
L4, L5, S1
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What is the relationship between the sciatic and common peroneal nerve? |
CPN is the terminal branch of the sciatic nerve
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What sensory area does the common peroneal nerve cover? |
Entire dorsal foot (esp. medial side) and lower anterior leg to mid-shin
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What motor deficits will a common peroneal nerve lesion cause? |
Foot drop, weak dorsiflexion and eversion.
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What reflex would be affected by a common peroneal nerve lesion? |
None
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What does an L5 nerve root lesion cause? |
Weakness of knee flexion and foot inversion
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What sporting injury may cause a common peroneal nerve lesion? |
Colateral ligament tear of the knee
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What injury can cause a permanent sciatic nerve palsy? |
Hip dislocation
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What is the differential diagnosis for a foot drop? (Stroke, 4 lesions, 3 diseases) |
[1] Common peroneal nerve palsy, sciatic nerve palsy, lumbrosacral plexus lesion, L4, L5 lesion [2] Peripheral motor neuropathy, distal myopathy, motor neuron disease
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What steps would you take in examining gait (4)? |
[1] Normal gait with a turn [2] Heel-toe (midline cerebellar lesion) [3] tip toe (s1) [4] heel walk (L4 or L5)
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What 2 tests might you do while examining gait? |
[1] Romberg (proprioceptive loss; if unstead before closing eyes, vestibular or cerebellar dysfunction) [2] stand from squat or sitting
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Describe the gait of hemiplegia |
Foot drop, leg swung in a lateral arc
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Describe the gait of spastic paraparesis |
Scissor gait
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Describe the gait of parkinsons |
Hesitancy starting, shuffling, freezing, festination, propulsion, retropulsion
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Describe the gait of a cerebellar lesion |
A drunken wide-based gait or reeling on a narrow base, staggers towards affected side
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Describe the gait of a posterior column lesion |
Clumsy slapping down of the feet on a broad base
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Describe the gait of footdrop |
High-stepping gait
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Describe the gait of proximal myopathy |
Waddling
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Describe the gait of prefrontal lobe lesion (apraxic) |
Feet appear glued to floor (but move more easily when pt is supine)
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Describe the gait of a functional movement disorder |
Bizzare and inconsistent
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