Smell coffee or mint one nostril at a time with eyes closed. Anosmia is loss of smell. Parosmia is distorted sense of smell.
How do we test CN 1?
1. Snell chart for visual acuity 2. Direct Light Reflex (CN II and CN III) 3. Indirect (Consensual) Light Reflex (CN II and III) 4. Accommodation - Eyes converge, pupils constrict, lens convexity
How do we test CN 2?
1. Direct and indirect light reflex 2. Accommodation 3. Testing 6 cardinal fields of gaze
How do we test CN 3?
LR6, SO4, All others 3 CN 6: Lateral Rectus CN 4: Superior Oblique CN 3: All others
What muscles and CN's are tested with the 6 cardinal fields of gaze.
CN III (Oculomotor)
Ptosis can be caused by an issue with what cranial nerve?
Superior oblique testing (up down)
How do we test CN IV?
Sensory: Touch forehead, cheekbone, and chin with cotton wisp (testing divisons 1-3). Corneal Reflex (CN V afferent, CN VII efferent). Jaw jerk erflex. Oculocardiac Reflex (CN V afferent, CN X efferent) press on eyeball decrease HR. General sensation to the anterior 2/3 of the tongue. Motor: Muscles of mastication
How do we test CN V?
Extreme, sporadic, sudden burning, or shock-like
Trigeminal Neuralgia feels like what?
Abducens Motor: Lateral Rectus Muscle
How do we test CN VI?
Sensory: Taste of anterior two thirds of tongue (sweet, sour, salty) Muscles: Muscles of facial expression
Sensory: Gag Reflux (CN IX afferent, CN X efferent), Uvula reflux (CN IX afferent, CN X efferent), carotid reflix/massage carotids and heart drops (CN IX afferent, CN X efferent), taste to posterior 1/3 of tongue (bitter) Motor: Stylopharyngeus muscle elevated pharynx and larynx; dilates pharynx to permit swallowing
How do we test CN IX?
Sensory: Epiglottis and laryngeal muscles of swallowing (palate, pharynx, contracting muscles) Motor: Gag Reflex, cartoid reflux, uvular reflex
How do we test CN X?
Motor: Trapezius and SCM muscles
How do we test CN XI
Motor; Tongue muscles. Stick out tongue. Will deviate to the side of the lesion.Look for atrophy and fasciculations.
How do we test CN XII?
Absence of any DTR, especially patellar.
0+: Absent with reinforcement (Jendrassik's) 1+: Hypoactive with no reinforcement or normal wtih reinforcement 2+: Normal 3+: Hyperactive 4+: Hyperactive with transient clonus 5+: Hyperactive with sustained clonus
What scale is used to assess deep tendon reflexes?
Muscle: Nerve: Circulation: Bone Cancer: Sclerotogenous: Myofascial:
Right shoulder, inferior scapula
Gallbladder issues refer to where?
spine at T10-T12 level
Pancreas issues refer to where?
Intestinal issues refer to where?
Early: Epigastric Late: RLQ
Appendix issues refer to where?
Ureter issues refer to where?
Kidney issues refer to where?
Bladder issues refer to where?
Weak opponens pollicis
Ape hand appearance caused by what muscle weakness?
Entrapment of anterior interosseous nerve between the heads of pronator teres at the elbow
Pain and paresthesia on the volar aspect of forearm, lateral palm, and lateral digits. Pain will be aggravated with pronation, wrist flexion.
Will have thenar atrophy
Pronator Teres Syndrome (etiology and symptoms)
Pinch grip test
How do we test for Pronator Teres Syndrome?
Tunnel of guyon (under hook of hamate) and cubital tunnel.
What are the two most common places for ulnar nerve entrapment?
tingling in last two fingers and weakness of adductor pollicus (resulting in claw hand) and hypothenar atrophy
Ulnar nerve entrapment presents with what?
Sensory pain in posterior buttocks, thigh, leg down to floor. Weakn knee flexion and decreased achilles reflex (DDX with facet).
Sciatica presents with...
Deep Peroneal nerve
What nerve is involved in anterior compartment syndrome of the calf?
A deformity in which the fingertip is curled in and cannot straighten itself. This deformity usually results from injury, which either damages the tendon or tears the tendon from the bone.
Hyper-flexion of the DIP and hyper-extension of the POP. Seen with RA.
Swan Neck Deformity
Hyper-extension of the DIP and hyper-flexion of the PIP. Seen with RA.
An abnormal thickening underneath the skin of the palm and fingers. Causes the last two fingers to curl into the palm. Later on, the middle finger may become involved.
A finger becomes locked in a flexion position. The finger locked in a flexed position. The finger locks when one of the tendons that flex the fingers becomes inflamed and swollen. To straighten the finger, a person must force the swollen area into the sheath to produce a popping or snapping.
Inflammation of the extensor polliciis brevis and abductor pollicis longus tendons on the side of the wrist at the base of the thumb. Can be brought on by simple strain injury. Treated by bracing the thumb and wrist. (Finkelstein's test is positive)
De Quervain's Tendosynovitis
What ortho test is positive in De Quervain's Tendosynovitis?
Pain and temperature
The lateral spinothalamic tract does what?
Lateral spinothalamic tract
Where do you find syringomylias?
Crude light touch
Anterior spinothalamic tract
Sensory and motor interpretation, language, etc
Balance, coordination, etc
Two point discrimination, vibration, and joint position sense.
Voluntary motor, flexors of the hands and feet
Balances reflexes and postural muscles.
Muscle tone and synergy to proximal flexors of the extremities
Muscle tone and synergy to voluntary extensor of the extremities
Crosses at medullary pyramids and travels to flexors of the extremities
Lateral Corticospinal (where does it cross?)
Crosses at the segmental level and then to the flexors of the trunk
Pathological longitudinal cyst of central canal of spinal cord. Fluid filling cavities expand in adult years.
Loss of sense of pain and temperature over the shoulders and back in a cape like distribution.
Demyelination of the CNS (Oligodendrocytes myelinate) producing demyelination of the spinal cord and later on the brain. BOTH motor and sensory cords are affected. Most common in females aged 20-40. Worse when moving from cold to warm climates.
Diplopia, scotomas, transient blindness, optic neuritis, pain vertigo, and UMN in the legs causing distal weakness.
Stance Phase: 60%. Here one leg is supporting itself. This phase is comprised of heel strike (heel hits ground), foot strike (when heel of the foot is on the ground), toe off (when up on toe and about to kick off) Swing Phase: 40%. One leg is swinging. Is made up of early swing and late swing.
Describe gait cycle.
Iliopsoas and rectus femoris
What muscles are responsible for gait acceleration?
Hamstrings (which is why they are pulled by athletes who decelerate quickly)
What muscles are responsible for gait deceleration?
Dorsiflexors (anterior tibial group: tibial anterior etc, deep fibular nerve). This muscle group eccentrically contracts and lowers the foot to the ground. Quadriceps ecentrically contract to absorb energy as knee goes into 5 degrees of flexion; this prevents the knee from buckling.
What muscles are responsible for gait's Heel strike?
Abductors to contract to hold body up. As center of body moves forward the plantar flexors (triceps surae: gastrocnemius, soleus, and plantaris) contract to push body ahead.
What muscles are responsible for foot strike in gait?
Quadriceps concentrically contract to help the plantar flexors push body ahead by elongating lower limbs.
What muscles are responsible for Toe off in gait?
Propulsion/festinating/shuffling gait is seen in what condition?
Cerebral palsy (knee crosses midline)
Scissor gait is seen in...
Waddling gait is seen in...
Anterior compartment syndrome, foot drop, etc
Steppage Gait is seen in...
Posterior column disease
Slappage/sensory ataxia gait is seen in...
Stroke (swinging, unilateral, spastic hemplegia)
Circumduction/hemiplegic gait is seen in...
Spastic gait is seen in...
Cerebellum issues. Wide based gait.
Drunken/Motor ataxic gait is seen in.....
_____% of flexion and extension occurs at C0-C1
____% of rotation occurs between C1-C2
Look at Orthopedic tests flashcards or look at page 15 of Neuromuscular diagnosis section.
Patient extends the head back. Examiner slightly abducts arm and then applies downward traction on arm while taking pulse.
Positive: Alteration in amplitude of radial pulse Indicates: Cervical rib issues
Patient actively abducts shoulder to 90 degrees, with elbow flexed to 90 degrees and then extends the shoulder. Now the patient extends the elbow.
patient supine with affected leg raised slowly while hand is under the lumbosacral portion of the spine. Repeat on other side.
Positive: Pain Indicates: 0-30 SI joint, 30-60 Lumbosacral joint, 60-90 lumbar spine or contralateral SI joint
Meniscal tear, swelling will occur how soon after injury?
Patellofemoral tracking disorder. Patella is being pulled laterally by vastus lateralis muscle. Walking downstairs is most provocative. Tested via clark's and fouchet's
AVN, knee locks out on extension. Wilson's sign.
Prepatellar bursitis after repetitive pressure on the knee
Patient is supine with the leg in the 90/90 position. Dr. applies pressure to lateral femoral condyle while extending the knee.
positive: Pain over area of pressure indicates: TFL syndrome
Noble Compression Test
MC birth defect where heel is elevated and foot is turned inward. Called clubfoot at birth.
Metatarsal stress fracture
Patient kneels on table 18 inches from floor, bends forward at the trunk, and touches the floor. Doctor holds ankles.
Positive: Patient refuses to perform. Indicates: Malingering
Burn's Bench Test
Patient Supine. Doctor places one hand under each heel and asks patient to lift affected limb.
Positive: Dr doesn't feel the affected side pressing downward. Indicates: Malingering
Patient is sitting upright on the edge of the table or chair which has no backrest. Examiner faces the patient and usually under the guise of "checking circulation" extends the patient's legs below the knee one at a time so the limb is parallel to the floor.
Positive: No pain when there had been a positive SLR. Indicates: Malingering
At beginning of case history, ask patient to point to the site of pain on the back; examiner marks it with a skin pencil. Later on, patient is again asked to point to the site of pain.
Positive: Patient does not point to the same point. Indicates: Malingering.
Doctor takes resting pulse rate. Dr. then applies pressure over painful area and takes pulse rate again.
Positive: Increase of 10 beats per minute. Indicates: Not a malingerer. Real pain.
Patient asked to go from a side lying position to a seated position.
Positive: Localized thoracolumbar pain and lack of ROM Indicates: AS, IVD syndrome, or severe sprain/strain
When arising from seated position, patient turns to prone position and then climbs up themselves.
Indicates Muscular dystrophy
Dr. applies finger pressure over mastoid process. Pressure increased until patient expresses discomfort. Determines pain threshold of patient.