NMD

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Author:
werika
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98432
Filename:
NMD
Updated:
2011-09-02 14:04:18
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NBCE
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Neuromuscular diagnosis
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  1. The olfactory nerve is responsible for what sensory action?
    smell- tested in one nostril w/ eyes closed
  2. anosmia
    lost sense of smell
  3. parosmia
    distorted sens of smell
  4. Optic nerve is responsible for what sensory action?
    • vision- tested with snellen chart (acuity and visual fields)
    • direct light reflex
    • indirct light reflex
    • accomodation
  5. Oculomotor nerve is parasympathetic to what muscles?
    • ciliary
    • constrictor papillae
  6. strabismus is what?
    deviation of one or both eyes
  7. ptosis
    eyelids droop due to weakness or paralysis of levator palpebrae
  8. trochlear nerve is motor to what mm?
    superior oblique
  9. Trigeminal nerve is sensory to:
    • the face (V1-3)
    • corneal reflex
    • oculocardiac reflex
    • sensation to anterior 2/3 of tongue
  10. trigeminal is motor to:
    mm of mastication (V3)
  11. 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
  12. abducens nerve is motor to what mm?
    lateral rectus
  13. Facial nerve is sensory to
    anterior 2/3 of tounge (sweet/salty/sour)
  14. facial nerve is motor to
    mm of facial expression
  15. 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
  16. Vestibulocochlear nerve is sensory to:
    vestibular balance: tested with mittlemeyer, barany caloric test, rombergs
  17. Meniere's disease aka and clinical presentation
    • endolympatic hydrops
    • cause is unknown, vertigo, hearing loss, tinnitus
  18. glossopharyngeal is sensory to:
    • gag, uvula, and carotid reflex
    • taste to posterior 1/3 of tongue (bitter tastes)
  19. glossopharyngeal is motor to what mm?
    stylopharyngeus- elevate pharynx/larynx
  20. vagus nerve is sensory to what mm?
    epiglottis and laryngeal mm of swallowing
  21. vagus nerve is motor to reflexes?
    gag reflex, carotid reflex and uvular reflex
  22. spinal accessory nerve is motor to ___:
    • trapezius & SCM mm
    • torticollis aka wry neck
  23. hypoglossal nerve is motor to what
    tonque mm- deviates to the side of lesion
  24. Reflex (definition)
    involuntary motor responses to potentially harmful stimuli
  25. Reflex testing:
    done bilaterally with the NORMAL side tested first
  26. westphal's sign=
    absence of any DTR - especially patellar (LMNL)
  27. Jendrassiks Maneuver: aka Reinforcement test:
    Brings out reflexes by cortical distraction
  28. 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
  29. DTR: NERVE:
    • jaw jerk- trigeminal
    • biceps- mskcutaneous
    • brachioradialis- radial
    • triceps- radial
    • patella- femoral
    • posterior tib- tibial
    • medial ham- sciatic
    • achilles- tibial
  30. Cremasteric reflex (L1)
    stroke inner thigh of male, ipsilateral rise in testes
  31. geigels reflex
    stroke up inner female thigh, pouparts ligament contracts
  32. Plantar reflex (L4-S2)
    stroke up sole of foot- curling of toes and pulling away of foot
  33. ciliospinal reflex
    pinch neck while noting dilation of the eyes- sesonry from neck- cerv. symathetics
  34. oculocardiac reflex
    press on the ye- note slowing of the hr by 10bpm
  35. carotid sinus reflex
    press on carotid note slowing of heart and decreased pressure
  36. Bibinski like response reflexes:
    • Chaddock-stroke down lateral malleolus to 5th toe
    • Oppenheim- stroke tibial crest to ankle
    • Gordons- squeeze calf
    • Schafer- squeeze achilles
  37. Rossolimo
    tap the ball of the foot
  38. Muscle Grading:
    • 5= normal
    • 0= no evidence of contractility
  39. DR CUMA:
    • Drop Wrist- radial nerve
    • Claw Hand- Ulnar nerve
    • Median Nerve- Ape Hand
  40. 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
  41. 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
  42. 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
  43. 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
  44. long thoracic nerve entrapment
    • scapular winging
    • result of trauma, iatrogenic, idiopathic, paralysis of serratus ant.
  45. flaring of the scapular
    • dorsal scapular nerve impingement
    • injury to rhomboids
  46. 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
  47. 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
  48. 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
  49. mortons neuroma
    • intermetatarsal neuroma
    • site: between 3rd and 4th digit
    • pain on toes and dorsum of foot
    • test: mortons squeeze
  50. common peroneal n:
    • site: fibular head
    • cause: trauma
    • presents: pain on lateral aspect of leg, weak mm or foot drop
    • trmnt: adjust
  51. deep peroneal n
    • anterior compartment syndrome
    • affect any mm in the compartment
    • s/s similar to charcot marie tooth
  52. mallet finger
    fingertip curled in- injury which damage or tore the tendon
  53. swan neck
    hyper flexion of the DIP and hyperextension of the PIP
  54. boutonniere deformity
    hyperextension of the DIP and hyperflexion of the PIP
  55. Dupuytren's contracture
    abnormal thickening of the skin, causes last two fingers to curl into palm
  56. trigger finger
    finger becomes locked in bent position- sheath produces a popping or snapping sound
  57. bishop hand
    • aka: benediction/papal hand
    • wasting of hypothenar eminence and flexion of 4th and 5th digits
  58. volkmann's ischemic contracture
    claw-like deformity of the hand and all fingers
  59. dequervain's tenosynovitis
    • inflammation of ext. poll. brev. and abd. poll. long tendons.
    • trmnt: bracing of thumb and wrist
    • test: finkelstein's test +
  60. posterior column
    • 2 pt discrim, vibration and jt position
    • related to MS, tabes dorsalis, leprosy
  61. lateral spinothalamic
    • pain and temperature
    • related to syringomyelia
  62. vetibulospinal
    reflexes and postural mm
  63. 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!
  64. 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)
  65. 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
  66. 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
  67. PLS aka: combined systems dx
    • degen of the post. columns and corticospinal tracts
    • b12 def (pernicious anemia)
    • (+) Shilling test
    • Glove and Stocking Paresthesia
  68. Glove & Stocking Paresthesia
    PLS
  69. Brown Sequard
    • partially severed SC
    • ipsilateral loss of montor function and dorsal columns
    • contralateral loss of pain and temp
  70. Cerebral palsy
    • non-progressive motor disorder
    • anoxia to brain prenatally or during birth
    • SCISSOR GAIT
    • spastic paraysis (umnl)
    • choreiform movements
  71. 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
  72. Guillain Barre Sundrome aka Landrys paralysis
    • associated to recent immunization
    • inflammatory polyneuropathy
    • seen after illness
    • starts in hands and works up
  73. Tabes Dorsalis
    • clinical cond. of tertiary syphillis
    • wasting away of posterior columns
    • prostitutes pupil: accomodates but does not respond
    • slappage gait
  74. 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)
  75. Charcot Marie Tooth
    • hereditary disease
    • weakness of foot and lower leg
    • foot drop- hight step gait
    • frequent tripping
    • lower leg atrophy
  76. alzheimers
    mental deterioration, amnesia, depression, anxiety rigidity
  77. Huntington's chorea
    • neurodegenerative genetic disorder
    • affects mm coordination
    • cognitive decline
    • dementia
  78. Heel strike:
    • rectus femoris
    • unstable knee gait
  79. mid stance
    quads, glues, unstable knee/lurching gait
  80. flat foot
    • foot dorsiflexor
    • slappage gait
  81. toe-off
    • gastroc/soleus
    • flat foot
  82. 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
  83. Propulsion/festinating/shuffling gait
    parkinsons, small shuffling steps
  84. scissor gait
    cerebral palsy, knee crosses body when walking
  85. waddling gait
    muscular dystrophy
  86. steppage- high step gait
    anterior comp. syndrome, foot drop, l4 lesion, paralysis of ant. tibia
  87. trendelenburg
    weak glute med, lurching and drastic pelvic tilt
  88. slappage gait
    posterior column diseases, sensory ataxia
  89. circumduction/hemiplegic
    stroke, swing-unilateral-spastic hemiplegia
  90. spastic
    UMNL
  91. antalgic cgait
    avoid provoking pain
  92. drunken gait
    wide based gait- cerebellar
  93. 50% of flex/ext occurs between _ and _
    occ and C1
  94. 50% of rotation occurs between:
    c1/C2
  95. 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
  96. Rotator cuff MC torn:
    supraspinatus
  97. Rotator cuff
    • - Supraspinatus: AB
    • - Infraspinatus: EX
    • - teres minor: EX
    • - Subscap: IN
  98. Lateral epicondilitis
    • aka: radio-humeral bursitis, tennis elbow
    • affects: extensor carpi radialis brevis!
  99. medial epicondilitis
    • aka: little leagures elbow, golfers elbow
    • affects:flexor carpi ulnaris
    • treatment: transverse massage, ultrasound underwater, counterforce brace
  100. Carpal tunnel treatment
    • vitamin B6 (natural diuretic)
    • cock-up splint
    • adjust lunate
  101. finkelsteins is positive: adjust?
    scaphoid
  102. + elys sign indicates
    rectus femoris contracture
  103. + elys test indicates
    hip lesion, iliopsoas irritation or inflammed lumbar NR
  104. MC mm of knee injured is
    vastus medialis
  105. terrible triad
    • aka: unhappy triad
    • mcl, acl, medial meniscus
  106. Dreyers test indicates
    fractured patella
  107. wilsons test indicates
    osteochondritis dissicans
  108. pes planus
    • flat foot- talar head displaced medially
    • exercise/orthotics
  109. talipes equinovarus
    • MC birth defect/ heel elevated and foot turned inward
    • AKA: Club Foot
  110. pes cavus
    • high arch- toes in flexion
    • orthotics stretch out
    • prone to march fractures
  111. mortons neuroma
    tumor on the nerve MC between 3 and 4th metatarsal heads
  112. metatarsal stress fracture aka:
    march frx
  113. plantar fascitis
    heel spur pain when walking in the morning. improves throughout the day.
  114. tarsal tunnel syndrome
    pain and burning on sole of foot (medial plantar nerve)
  115. achilles tendon rupture
    + thompsons test aka Simmond's trauma
  116. 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
  117. Meningeal irritation
    patient presents w/ fever, HA, photophobia, and nuchal rigidity
  118. Meningitis evaluation of CSF:
    • increase in protein indicates VIRAL
    • decrease in glucose indicates BACTERIAL
  119. 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
  120. sound on webers does not lateralize this means
    normal hearing
  121. sensorneural loss what happens
    sound lateralizes to the good/uninvolved ear
  122. webers lateralize to R
    sensorneural loss on L or Conductive hearing loss on R
  123. Rhinorhea and lacrimation in a 35 yo male indicates what HA
    cluster
  124. elderly suboccipital headach goes away after waking
    hypertension HA
  125. sudden onset of HA
    subarchnoid HA
  126. patient w/ emphysema will hear what on auscultation
    decreased breath sounds, hyperresonant sounds
  127. 17 yo wheezing= ____ fremitis
    decreased
  128. increase tactile fremitis indicates
    pneumonia
  129. L mid axillary sounds
    vesicular
  130. increse in indirect bilirubin indicates ___ anemia
    hemolytic

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