-
The olfactory nerve is responsible for what sensory action?
smell- tested in one nostril w/ eyes closed
-
anosmia
lost sense of smell
-
parosmia
distorted sens of smell
-
Optic nerve is responsible for what sensory action?
- vision- tested with snellen chart (acuity and visual fields)
- direct light reflex
- indirct light reflex
- accomodation
-
Oculomotor nerve is parasympathetic to what muscles?
- ciliary
- constrictor papillae
-
strabismus is what?
deviation of one or both eyes
-
ptosis
eyelids droop due to weakness or paralysis of levator palpebrae
-
trochlear nerve is motor to what mm?
superior oblique
-
Trigeminal nerve is sensory to:
- the face (V1-3)
- corneal reflex
- oculocardiac reflex
- sensation to anterior 2/3 of tongue
-
trigeminal is motor to:
mm of mastication (V3)
-
Tic Douloureaux is AKA for ___ and has what clinical prentation?
trigeminal neuralgia, shock-like pain to the face lasting less than 2 minutes per episode. Excruciating pain is repetitive, occuring several times a day. pain is typically felt on one side of the jaw or cheek
-
abducens nerve is motor to what mm?
lateral rectus
-
Facial nerve is sensory to
anterior 2/3 of tounge (sweet/salty/sour)
-
facial nerve is motor to
mm of facial expression
-
Bells palsy
- Unilateral facial paralysis caused by trauma, immune or virus- not permanent
- pain behid ipsilateral ear, drooping of eyelid, drooling, dry eye, impairment of taste
-
Vestibulocochlear nerve is sensory to:
vestibular balance: tested with mittlemeyer, barany caloric test, rombergs
-
Meniere's disease aka and clinical presentation
- endolympatic hydrops
- cause is unknown, vertigo, hearing loss, tinnitus
-
glossopharyngeal is sensory to:
- gag, uvula, and carotid reflex
- taste to posterior 1/3 of tongue (bitter tastes)
-
glossopharyngeal is motor to what mm?
stylopharyngeus- elevate pharynx/larynx
-
vagus nerve is sensory to what mm?
epiglottis and laryngeal mm of swallowing
-
vagus nerve is motor to reflexes?
gag reflex, carotid reflex and uvular reflex
-
spinal accessory nerve is motor to ___:
- trapezius & SCM mm
- torticollis aka wry neck
-
hypoglossal nerve is motor to what
tonque mm- deviates to the side of lesion
-
Reflex (definition)
involuntary motor responses to potentially harmful stimuli
-
Reflex testing:
done bilaterally with the NORMAL side tested first
-
westphal's sign=
absence of any DTR - especially patellar (LMNL)
-
Jendrassiks Maneuver: aka Reinforcement test:
Brings out reflexes by cortical distraction
-
DTR: Wexler Scale
- 0- absent w/ reinforcement
- 1- hypoactive w/ no reinforcement or w/ normal reinforcement
- 2= NORMAL
- 3- hyperactive
- 4-hyperactive w/ transient clonus
- 5- hyperactive w/ sustained clonus
-
DTR: NERVE:
- jaw jerk- trigeminal
- biceps- mskcutaneous
- brachioradialis- radial
- triceps- radial
- patella- femoral
- posterior tib- tibial
- medial ham- sciatic
- achilles- tibial
-
Cremasteric reflex (L1)
stroke inner thigh of male, ipsilateral rise in testes
-
geigels reflex
stroke up inner female thigh, pouparts ligament contracts
-
Plantar reflex (L4-S2)
stroke up sole of foot- curling of toes and pulling away of foot
-
ciliospinal reflex
pinch neck while noting dilation of the eyes- sesonry from neck- cerv. symathetics
-
oculocardiac reflex
press on the ye- note slowing of the hr by 10bpm
-
carotid sinus reflex
press on carotid note slowing of heart and decreased pressure
-
Bibinski like response reflexes:
- Chaddock-stroke down lateral malleolus to 5th toe
- Oppenheim- stroke tibial crest to ankle
- Gordons- squeeze calf
- Schafer- squeeze achilles
-
Rossolimo
tap the ball of the foot
-
Muscle Grading:
- 5= normal
- 0= no evidence of contractility
-
DR CUMA:
- Drop Wrist- radial nerve
- Claw Hand- Ulnar nerve
- Median Nerve- Ape Hand
-
Carpal Tunnel Syndrome:
- Site-under flexor retinaculum
- Caused by trauma, obesity, fluid retension, pregnancy, hypothyroidism, RA
- Presents with nocturnal pain, paresthesi of hand, thenar atrophy, and weak opponens: ape hand
- Affects first 3 fingers
- TRMNT: adjust, cock up and splint, diuretic, B6
-
Pronator teres syndrome
- site: between heads of pronator at elbow
- anterior interosseus nerve
- pain on volvar aspect of forearm, first 3 fingers
- trmnt: trigger point therapy, spray and stretch
-
ulnar nerve entrapment
- site: tunnel of guyon, or cubital tunnel
- caused by trauma/microtrauma
- presents w/ p and numbness in last 2 digets
- weakness of add pollicis
- trmnt: adjust tape and support
-
radial nerve entrapment
- aka: wrist drop, erbs palsy, waiters tip deformity, saturday night palsy, crutch palsy,
- site: spiral groove
- caused by trauma, lead poisoning or pressure
- presents w/ loss of triceps reflex, decreased sensation to post/lat 3.5 fingers
-
long thoracic nerve entrapment
- scapular winging
- result of trauma, iatrogenic, idiopathic, paralysis of serratus ant.
-
flaring of the scapular
- dorsal scapular nerve impingement
- injury to rhomboids
-
lateral femoral cutaneous nerve
- meralgia paresthetica
- site: over the pubic brim under inguinal ligament.
- L2/3 nerve roots
- caused by: external pressure, obesity/tight jeans
- burning sensation on anterolateral thigh
-
sciatic nerve entrapment
- site: pelvis hip, popliteal fossa
- caused by: trauma, traction, piriformis, mm spasm
- presents: post butt, thigh, back of leg pain
- weak knee flex and decreased achilles reflex
-
tibial nerve syndrome
- medial plantar nerve
- caused by posteror traumatic ankle deformity
- patient presents w/ burning paresthsia on sole of feet
- trmnt: adjust, orthotic support
-
mortons neuroma
- intermetatarsal neuroma
- site: between 3rd and 4th digit
- pain on toes and dorsum of foot
- test: mortons squeeze
-
common peroneal n:
- site: fibular head
- cause: trauma
- presents: pain on lateral aspect of leg, weak mm or foot drop
- trmnt: adjust
-
deep peroneal n
- anterior compartment syndrome
- affect any mm in the compartment
- s/s similar to charcot marie tooth
-
mallet finger
fingertip curled in- injury which damage or tore the tendon
-
swan neck
hyper flexion of the DIP and hyperextension of the PIP
-
boutonniere deformity
hyperextension of the DIP and hyperflexion of the PIP
-
Dupuytren's contracture
abnormal thickening of the skin, causes last two fingers to curl into palm
-
trigger finger
finger becomes locked in bent position- sheath produces a popping or snapping sound
-
bishop hand
- aka: benediction/papal hand
- wasting of hypothenar eminence and flexion of 4th and 5th digits
-
volkmann's ischemic contracture
claw-like deformity of the hand and all fingers
-
dequervain's tenosynovitis
- inflammation of ext. poll. brev. and abd. poll. long tendons.
- trmnt: bracing of thumb and wrist
- test: finkelstein's test +
-
posterior column
- 2 pt discrim, vibration and jt position
- related to MS, tabes dorsalis, leprosy
-
lateral spinothalamic
- pain and temperature
- related to syringomyelia
-
vetibulospinal
reflexes and postural mm
-
syringomyelia
- long. cyst of the central canal of the SC- weakening around C5-C6
- loss of pain and temp over the shoulders and back: shawl and cape distribution!
-
MS
- demyelination of CNS
- plaques present on MRI
- females 20-40
- worse when moving from Cold to warm climate
- Charcot's triad: scanning speech, intention tremors, nystagmus (SIN)
-
myasthenia gravis
- autoimmune disease in which the body makes anitbodies against the AcH receptors. myoneural junction dysfunction. Weakness: proximal musles (eyes)
- early signs: diplopia, ptosis, dysarthria, fatigue of mm. Worse at end of day.
- females: 20-40 yo
- dx: with tensilon test
- treatment: cholinesterase inhibitor drugs
-
ALS aka: lou Gehrigs dx
- begins int he hands/feet- short life expectancy
- fasiculation, spasticity and increased DTR
- lmnl in the arms
- umnl in the legs
- ddx with lat. canal stenosis
-
PLS aka: combined systems dx
- degen of the post. columns and corticospinal tracts
- b12 def (pernicious anemia)
- (+) Shilling test
- Glove and Stocking Paresthesia
-
Glove & Stocking Paresthesia
PLS
-
Brown Sequard
- partially severed SC
- ipsilateral loss of montor function and dorsal columns
- contralateral loss of pain and temp
-
Cerebral palsy
- non-progressive motor disorder
- anoxia to brain prenatally or during birth
- SCISSOR GAIT
- spastic paraysis (umnl)
- choreiform movements
-
Parkinsons aka Paralysis Agitans
- chronic progressive condition
- loss of dopamine in subst. nigra
- basal gang dysfnx
- resting tremor, mask-like face, festinating gait, cogwheel/lead pipe rigidity
-
Guillain Barre Sundrome aka Landrys paralysis
- associated to recent immunization
- inflammatory polyneuropathy
- seen after illness
- starts in hands and works up
-
Tabes Dorsalis
- clinical cond. of tertiary syphillis
- wasting away of posterior columns
- prostitutes pupil: accomodates but does not respond
- slappage gait
-
muscular dystrophy (Erb duchenne)
- sex link recessive
- boys 3-7
- waddling gait
- gower's sign= roll onto all 4s to help themselves up
- increased CPK, decreased creatinine (in urine)
-
Charcot Marie Tooth
- hereditary disease
- weakness of foot and lower leg
- foot drop- hight step gait
- frequent tripping
- lower leg atrophy
-
alzheimers
mental deterioration, amnesia, depression, anxiety rigidity
-
Huntington's chorea
- neurodegenerative genetic disorder
- affects mm coordination
- cognitive decline
- dementia
-
Heel strike:
- rectus femoris
- unstable knee gait
-
mid stance
quads, glues, unstable knee/lurching gait
-
flat foot
- foot dorsiflexor
- slappage gait
-
-
swing phase of gait: 3 steps
- initial- toe off through knee flex/quads
- mid- max knee flex through tibia perpendicular to ground, ankle dorsiflexors, steppage gait
- terminal- tibia through heel strike, hamstrings
-
Propulsion/festinating/shuffling gait
parkinsons, small shuffling steps
-
scissor gait
cerebral palsy, knee crosses body when walking
-
waddling gait
muscular dystrophy
-
steppage- high step gait
anterior comp. syndrome, foot drop, l4 lesion, paralysis of ant. tibia
-
trendelenburg
weak glute med, lurching and drastic pelvic tilt
-
slappage gait
posterior column diseases, sensory ataxia
-
circumduction/hemiplegic
stroke, swing-unilateral-spastic hemiplegia
-
-
antalgic cgait
avoid provoking pain
-
drunken gait
wide based gait- cerebellar
-
50% of flex/ext occurs between _ and _
occ and C1
-
50% of rotation occurs between:
c1/C2
-
TOS can be related to what structures
- tinlging into 4/5th digits
- - adsons:scalene anticus
- - modified adsons: scalene medius
- -costoclavicular, edens: 1st rib and clavicle
- - wrights, hyperabduction: pec minor and axillary nerve
- - halsteads: cervical rib
-
Rotator cuff MC torn:
supraspinatus
-
Rotator cuff
- - Supraspinatus: AB
- - Infraspinatus: EX
- - teres minor: EX
- - Subscap: IN
-
Lateral epicondilitis
- aka: radio-humeral bursitis, tennis elbow
- affects: extensor carpi radialis brevis!
-
medial epicondilitis
- aka: little leagures elbow, golfers elbow
- affects:flexor carpi ulnaris
- treatment: transverse massage, ultrasound underwater, counterforce brace
-
Carpal tunnel treatment
- vitamin B6 (natural diuretic)
- cock-up splint
- adjust lunate
-
finkelsteins is positive: adjust?
scaphoid
-
+ elys sign indicates
rectus femoris contracture
-
+ elys test indicates
hip lesion, iliopsoas irritation or inflammed lumbar NR
-
MC mm of knee injured is
vastus medialis
-
terrible triad
- aka: unhappy triad
- mcl, acl, medial meniscus
-
Dreyers test indicates
fractured patella
-
wilsons test indicates
osteochondritis dissicans
-
pes planus
- flat foot- talar head displaced medially
- exercise/orthotics
-
talipes equinovarus
- MC birth defect/ heel elevated and foot turned inward
- AKA: Club Foot
-
pes cavus
- high arch- toes in flexion
- orthotics stretch out
- prone to march fractures
-
mortons neuroma
tumor on the nerve MC between 3 and 4th metatarsal heads
-
metatarsal stress fracture aka:
march frx
-
plantar fascitis
heel spur pain when walking in the morning. improves throughout the day.
-
tarsal tunnel syndrome
pain and burning on sole of foot (medial plantar nerve)
-
achilles tendon rupture
+ thompsons test aka Simmond's trauma
-
Sprain/Strain Grading (*inversion MC sprain)
- 1) no ligamentous tear. slight swelling and decreased ROM.
- 2) incomplete/partial rupture. lots of swelling, bruising, almost no ROM.
- 3) complete tear. surgical case. *REFER* to orthopedist
-
Meningeal irritation
patient presents w/ fever, HA, photophobia, and nuchal rigidity
-
Meningitis evaluation of CSF:
- increase in protein indicates VIRAL
- decrease in glucose indicates BACTERIAL
-
Rust sign
the pat spont. grasps head with both hands when rising from the recumbent position. indicates cervical instability due to sprina/strain, frx, RA
-
sound on webers does not lateralize this means
normal hearing
-
sensorneural loss what happens
sound lateralizes to the good/uninvolved ear
-
webers lateralize to R
sensorneural loss on L or Conductive hearing loss on R
-
Rhinorhea and lacrimation in a 35 yo male indicates what HA
cluster
-
elderly suboccipital headach goes away after waking
hypertension HA
-
sudden onset of HA
subarchnoid HA
-
patient w/ emphysema will hear what on auscultation
decreased breath sounds, hyperresonant sounds
-
17 yo wheezing= ____ fremitis
decreased
-
increase tactile fremitis indicates
pneumonia
-
L mid axillary sounds
vesicular
-
increse in indirect bilirubin indicates ___ anemia
hemolytic
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