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Phys Assessment

pt presents with numbness of the pinky + ring finger, hypothenar eminence... where/what should you test? sensory integrity of ulnar nn (C8-T1)
pt complatns of sensory distrubances on the thenar eminence, palmar side of index, middle and radial half of ring finger. what do u suspect? median nn involvement, C6-8, T1
what type of sensory dysfunction is linked to diabetes? sensory loss is often an early symptom and presents in a glove and stocking distrubtion, referring to the typical involvement of hands and feet. this is a type of "peripheral neuropathy"
what type of sensory dysfunction is linked to MS presents with unpredictable or scattered pattern of sensory involvement. this is a type of "peripheral neuropathy"
what type of sensory dysfunction is linked to SCI? presents with more DIFFUSE pattern of sensory involvement below lvl of lesion, typically BILAT but not necessarily symetrical.
with a SCI sensory data contribute to determining the relative completeness of the injury, and the existence of ___ __ _______ _____ zones of partial perservation (areas distal to a complete lesion that retain partial innervation)
with an SCI, you are also checking for symmetry/asymmetry of lesion and the presence of a ______ sensation below the nuerological level of lesion (a defining feature of an incomplete lesion) sacral
contralateral loss or impairment of pain and tem perception is suggestive of lesions in what tract? ANTEROLATERAL
if the pt has deficits in two point discrimination sensation and vibration, but not pain and temp, what column would you suspect the lesion is in? DORSAL column
your pt has weak muscles (motor loss) and sensation dificulty. what do you suspect? nerve root involvemnt.
your pt has significant sensory impairments characterized by a diffuse pattern of inovolvement (head/trunk/limbs) and has sensory ataxia and impariments of fine motor control and motor learning. where do you think the injury is? CNS lesion (CVA, brain injury) * these pts present a significant threat of injury to anesthetic limbs, meaning an inability to determine the temp of bath water.
your pt is 82 y/o is falling, diminished light touch and having some cognitive problems. what do you suspect? they are just old. ;) age associated cognitive decline is more likely due to widespread damage to myelin sheaths than to actual loss of these neurons, so the msg is signifcantly slowed. (the distance btwn nodes of Ranvier increase with age in PNS, pg 127)
pt has numbness in outer thigh. what should you suspect? check nerve root L2-4 AND peripheral nn-lateral femoral cutaneous nn. so check to see if motor involvement by doing MMTs! if not, then its the peripheral sensory nn
what MUST you check in ur pt before starting Active, pt. involved PT arousal,Attention Orientation, Cognitive and then, Memory, hearing, visual acuity.
what two things must you pt be "green" in Arousal to start Active PT? ALERT + Lethargic (drowsiness is okay)
what does obtuned mean somnolent state, needs stimuatlion to remain conscious, unproductive. Maybe you could just give caregiver trng (yellow in the arousal category)
what is stupor semicoma, responds to noxious only
can reflexes be present when a pt is in a coma yes. this does not mean u can do Active PT with them
what are some qs to ask to determine the pt's attentiveness? ask them to spell their name or an object backwards, repeat words. attention deficit will be apparent when the order of letters is confused.
after orientation, now ask orientation q's. Person (what is ur name, how old are u, ,when were u born), Place (do you know where u are right now, what kind of place is this, do you know what city/state we are in), what city/town do you live?) Time (what day of the wk?, what time is it, is it pm/am)
___ is defined as the process of knowing and includes both awareness and judgement cognition
how do you test for cognition "fund of knowledge" (sum total of a persons learing and experience in life), calculation ability, proverb interpretation
how do u test memory Test Long term + Short Term! long term: rqst bday, # siblings. Short term: list of 3 words or # or short sentence. then have pt repeat, then in 5 mins (all 3), in 30 mins (2/3)
how is visual acuity tested snellen chart from 20ft w/glasses + peripheral field vision (sit infront of pt, with arms extended + gradually bring to midline of pts face. pt Id's when PTs finger is first seen. note DIFERENCES btwn R + L visual field. can check Depth perception too.
y is visual acuity so impt? could affect their safety! red flag if its off
why do you test the dif types of sensory receptors? to determine the pathway or what is involved
what are the three divsions of sensory receptors 1. exteroceptors (superficial) 2. Proprioceptors (deep) 3. Combined cortical (both!)
what do superficial/exteroceptors sense perception of pain, temp, light touch, pressure
what do deep/proprioceptors sens deep sensations and position sense, vibration of muscles, tendons, ligs, joints, fascia.
what are the combined cortical sensations? they require both types of info- superficial and deep. these sensations include sterognosis (what the object is), two point, barognosis (weight), graphesthesia (written letter), tactile localization, texture.
sensations have also been classified according to their pathway to higher centers. name the 2: anterolateral spinthalamic + Dorsal Column Medial Leminsical System
what type of sensory goes up the anterolateral pathway? since it initiates self protective reactions, it responds to stimuli that is potentially harmful in nature. mainly THERMAL + NOCICEPTIVE info (pain, temp, crude touch, tickle, itch, + sexual sensations). note: the fibers are SLOW, SMALL + UNMYELINATED.
what type of sensory goes up the Dorsal Column Medial Leminsical System? this system is involved with discrimintive sensations + responds to stimuli such as DISCRIMINTIVE TOUCH, VIBRATION, PRESSURE, MOVEMENT, POSIT SENSE, JOINT AWARENESS. note: these fibers are large, MYLINATED, and FAST!
T/F these two systems are INTERDEPENDENT and INTEGRATED so as to function together. true
what are the types of sensory receptors mechanoreceptors, thermoreceptors, nocioceptors, chemorecpetors (responsible for senses + O2 levels in bood, osmolarity), photic receptors, deep sensory receptors (golgi tendon + muscle spindles)
T/F pain can only be sensed by nociceptors false other types of receptors and nerve fibers contribute to pain. high intensities of stimuli to ANY type of receptors may be percieved as pain
there are many sensory receptors in the layers of skin. name some. free nerve endings, hair follicle endings (wrapped around the hair in the dermis), merkels discs, ruffini endings, Krauses end bulb, meissners corpuscles, pacinian corpuscles
what do free nerve endings sense? pain, temp, touch, pressure, tickle, itch ("they are free to feel just about everything!")
what do hair end organs/follicle endings sense? mechanical movement and touch (ant crawling on skin)
what do merkels discs sense? in HAIRLESS skin, lots in FINGERTIPS. sense low intensity touch, localization, velocity of touch, 2 pt discrimination. ("Merkel has hairless discs")
what do ruffini endings sense/ located deeper + encapsulated endings involved with touch pressure + also found in joint capusles to assits with position sense. (think of ruffles chips, they have deep ridges- for deep pressue)
what do Krause's end-bulb sense? these are low threshold mechanoreceptors- play role in touch + pressure)
what do Meissner's Corpuscles sense? discriminative touch, lots in FINGERS, LIPS, TOES, and areas that require high level of discriminative touch.("meiSSner corpuslces= SPECIAL role in discrimintive touch")
what do Pacinian Corpuscles sense? in subcutanteous + deep tissue- DEEP touch and vibration. "Pacinian had to PASS down to the DEEP layers" ONLY 1 FOR VIBRATION!
what are the deep sensory receptors? muscle spindles, golgi tendons, free nerve endings, pacinian, (+ ruffini- in joints only)
what do muscle spindles sense? muscle length + velocity
what do golgi tendon organs sense? monitor tension
what do the free nn endings sense? pain + pressure in FASCIA
what do pacinian sense? DEEP PRESSURE
what type of sensations + what corresponding receptors travel up the Anterolateral tract? tickle/itch/touch: mechanoreceptors. pain:nociceptors, temp: thermorecptors.
does the information traveling up the anterolateral system have to be localized or precide graduations in intensity? no. more of a crude more primitive system
describe the path of the anterolateral tract- where does it corss, ascend, end? dorsal roots - IMMEDIATELY CROSS- ascend CONTRALATERAL- to VPL of thalamus- to somatosensory cortex via internal capsule.
what are the 3 major tracts of the spinthalmic system and what sensations do they carry? 1. anterior (ventral) carry crude touch/pressure, 2. lateral carries pain and temp, 3. spinoreticular carries diffuse pain sensations.
what kind of receptors send messages up the dorsal column? mechanoreceptors (all the specialized discrimintive senses: Discriminative touch, stereognosis (ID object in hand), tactile, pressure, graphesthesia, 2 pt, proprioception, kinesthesia [eyes closed, u move their arm,they tell u where they are], vibration)
describe the path of the dorsal column tract- where does it corss, ascend, end? it's large and quick, so it's gotta get the message up first! so, into dorsal root- ascend IPSILATERAL - cross @ medulla, then ascend contralateral to medial leminiscus that terminates in the thalmus- to somatic sensory cortex.
the most complex processing of sensory info occurs in the somatosensory cortex which is divided into what 3 main divisions? S1, S2, posterior parietal cortex.
whats S1? where is it? post central gyrus- identification of size, shape, texture of objects (S1- STEP 1, IDENTIFY WHAT IT IS UR HOLDING)
whats S2? where is it? lateral to S1, touches lateral suclcus, innervates temporal lobe. important in tactile memory. (S2- NOW, REMEMBER WHAT THAT OBJECT IS)
whats the posterior parietal cortex do? areas 5+7- integrates S1 + S2. this is located posterior/behind S1 (aka postcentral gyrus)
in a sensory homunculus, is the head or the feet on the lateral portion of the cortex? pg 139- the mouth/head are lateral, moving medial, ending with the feet + genitals most medial
when testing tendon reflexes, what posit do u want the tendon in? position @ mid range to put tendon on relative slack; pt needs to be relaxed.
whats the grading for tendon reflexes? • 0 – none • 1+ present but depressed • 2+avg, normal • 3+ increased, brisker than avg, can be abnormal • 4+ very brisk, hyperactive, with clonus (means abnormal response/jerky)
which CNs are mixed? 5, 7, 9 10 (for CNs 1-12, "Some Say Marry Money, But My Brother Says Big Brain's Matter More) B= both, M= motor only, S= sensory only.
which CNs are purely sensory? 1, 2, 8
which CNs are purely motor? 3, 4, 6, 11, 12
in a tendon reflex, which fibers? in particular are u testing stimulation of the stretch-sensitive 1A afferents of neuromuscular spindle
Created by: tpostrel
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