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nms
nms question-answer
| NMS Question | NMS Answer |
|---|---|
| Characteristics of cerebellar ds | Dysmetria, diadochokinesia, bal/coord impaired, intention tremor, ataxic gait, strength unaffected |
| Common ds that affect cerebellar | MS, alcoholism |
| Tests for Cerebellar Dysfunction | (blank) |
| Tests for Cerebellar Dysfunction | rapid alt of pron/supin.; finger to nose; heel to shin; Romberg |
| Finger to nose sign | intention tremor will be evident |
| heel to shin sign | pt overshoots knee (dysmetria) |
| Romberg sign | Pt is equally unsteady with eyes open or closed |
| damaged area with eyes open unsteadiness in Rombergs | cerebellar |
| area damaged with eyes closed in Rombergs | post. column |
| Charac of posterior column ds | two pt discrim., vibration, position sense, deep touch and pressure all affected |
| Ds affecting post col | MS, Tabes Dorsalis, Leprosy |
| Tests for post col | Tuning fork, alt 2 pt touch with 1 pt touch, push great toe into dorsiflexion then plantar, Romberg Test |
| Tuning fork sign for post col | dec vibratory sense |
| Alt 2 pt touch with 1 pt for post col | can't discriminate betw the two |
| Great toe test for post col | unable to perceive the difference |
| Romberg test for post col | min sway with eyes open, exaggerated with them closed (ddx from cerebellar ds) |
| Wexler Scale 0 | no reflex |
| Wexler Scale 1 | hyporeflexic |
| Wexler scale 2 | normal |
| Wexler scale 3 | hyperreflexic w/o clonus |
| Wexler scale 4 | hyperreflexic w/ transient clonus |
| Wexler scale 5 | hyperreflexic w/ sustained clonus |
| muscle grade 0 | no evidence of contraction |
| muscle grade 1 | evidence of contraction but no mvmt |
| muscle grade 2 | mvmt w/o gravity |
| muscle grade 3 | mvmt w/ gravity |
| muscle grade 4 | slight resistance |
| muscle grade 5 | full resistance |
| Main ascending pathways | spinothalamic |
| spinothalamic fibers | c, a delta, pain & temp |
| where do spinothalamic fibers decussate | w/in 1-2 levels of entry into spinal cord |
| px/temp ipsi or contralateral in spino | contralateral |
| Dorsal col function | proprioception, fine touch, 2 pt, vibration, graphesthesia |
| LMN location | n. to muscle-ventral horn/ant horn |
| lmn type | alpha motor neuron |
| lmn pathway location | final common pathway |
| UMN location | corticospinal tract |
| corticospinal tract decussates in | pyramidal tract (90%) |
| umn mvmt type | voluntary |
| what is the effect of most descending pathways | primitive-reflexive |
| effect of umn lesion | inhibitory effect from corticospinal path will be dampened by inc in dtr |
| signs of umn lesion | inc dtr, spastic paralysis, inc mm. tone, pathological reflexes, absent superficial reflexes |
| signs of lmn lesion | dec dtr, flaccid paralysis, dec mm tone, no pathological reflexes, diminished superficial reflexes |
| ds with waddling gait | MD, polio, dislocated hip |
| steppage gait | toe/foot drop (paralysis of foot dorsiflexors) as in damage to peroneal n. |
| ds with steppage gait | Charcot Marie Tooth syndrome-weak tib ant mm. |
| Scissors gait | spastic paraplegia, knees scrape together |
| type of lesion with scissors gait | umn-seen w/ cerebral palsy |
| stroke affects which side in circumduction gait | same side-hemiparesis |
| Trendelenburg gait | lift leg weak contralateral glut medius-weight shifts over weak G-med, acetabulum and femur support weight |
| Festinating or propulsion gait | forward leaning posture, small shuffling steps seen with Parkinson's, mask like facies |
| Ataxic/tabetic gait | wide, watches feet, slap foot on ground to help fire proprioceptors-dorsal col ds seen with tabes dorsalis |
| Motor ataxia gait | cerebellar dysfunction-irreg. unsteady reeling vertigo wide based steps |
| Brown sequard syndrome | hemisection of spinal cord with neuro changes |
| neuro changes with brown sequard | corticospinal ipsi below lesion-spastic paralysis; spinothalamic-contra w/in 1-2 leves below site-dec in px/temp; dorsal col-ataxia, proprio, 2pt, vib discrim ipsi below lesion |
| Amyotrophic lateral sclerosis | motor neuron ds causing LMN signs in upper ext and umn sign in lower ext |
| Myasthenia gravis | sporadic muscular weakness d/t defect at myoneural junction, dec acetylcholine |
| are cranial nn. involved w/myasthenia gravis | yes |
| Tabes dorsalis | ataxia d/t loss of proprioceptive paths |
| Wallenberg | thormbosis of post inf cerebellar artery causing vertigo, nausea, contra hemiparesis, hemianesthesia, loss of hearing, tinnitus & ataxia |
| Barre Lieou | vertigo, tinnitus, nausea assoc w/ vertebral a. disturbance |
| Guillian Barre | acute polyneuropathy w/ muscular weakness and some sensory loss, preceded by nonspecific febrile (usually viral) illness 1-3 wks prior |
| Syringomyelia | chronic progressive ds of the spinal cord, loss of px & temp. Touch and pressure ok; loss of sensation with shawl like distrib. |
| Rotator Cuff muscles | SITS-supraspinatus, infraspinatus, teres minor, subscapularis |
| TFL | pt. externally rotates and abducts leg |
| Perthes test | checks competence of the venous valves of 2 extremities |
| L4/L5 facet syndrome | flank, groin and medial knee px |
| milwaukee brace | scoliosis brace, use indicated if curve is 20 degrees w/rot. |
| what can cause upper teeth px | maxillary sinus |
| what n. is involved in post. compartment | tibial |
| syndromes involving br. of common peroneal n. | superficial peroneal n. lateral compartment-foot eversion; deep peroneal n. ant. compartment-foot dorsiflexion (dermatome betw. 1st/2nd toes); peroneal n. palsy-aka charcot marie tooth syndrome |
| what does shoulder depression test | dural sleeve adhesions |
| what is closed pack | in full ext |
| what is open pack | in full flexion |
| m. involved in tennis elbow | carpi radialis brevis-aka lat. epicondylitis |
| klippel feil syndrome | short web neck, low hairline, dec # of c/s vert with fusion, cns affected |
| signs of cervical rib | symptoms at 4th and 5th metacarpal and medial forearm |
| osteoid osteoma | rare benign bone tumor composed of sheets of osteoid tissue, px relieved by aspirin |
| what n. involves adduction of thumb | ulnar (froment's paper sign) |
| Scheuerman's ds | kyphotic curve unilateral rib curve, schmorl's nodes |
| Acetabula protrusio | femur heads protruding into the pelvic bowl, complication of RA, fracture, Pagets |
| Diabetes mellitus | hip jt changes-most common seen is avascular necrosis |
| Myasthenia gravis | eyelid ptosis, severe facial weakness, recurring ocular fatigue, sx dec with rest |
| Multiple sclerosis | charcot's triad=SIN (scanning speech, intention tremor, nystagmus). Shock like sensation throughout spine (Lhermitte's). Transient blindness with optic disc neuritis |
| Olecranon bursitis | MC associated with gout |
| ['0 | (blank) |
| sx of tarsal tunnel syndrome | numbness in toes |
| cause of ankle pronation | plantar fascitis |
| most common dyscrasia in elderly | multiple myeloma |
| is retinitis pigmentosis assoc w/ sudden vision loss | no |
| amaurosis fugax | sudden transient loss of vision in one eye secondary to optic artery compression |
| subarachnoid hemorrhage | sudden onset like a blow to the head with fevar and nuchal rigidity |
| rhabdomyosarcoma | malignant tumor of skeletal muscle |
| myelopathy | cord problem |
| greatest tension in cervical spine | flexion-soto hall, lindner's, lhermitte's sign |
| sjorgren's disease | xeropthalmia, xerostomia and RA |
| MC location for lower ext bruit | popliteal a. |
| thromboangitis obliterans | young males, increased w/ smokers |
| patellar tendonitis aka | jumper's knee |
| athetoid motion | slow, writhing, worm like motion |
| choreiform motion | jerky dance like mvmt (Huntington's-congenital, Syndeham's-strep acquired) |
| MC cause of avascular necrosis of the femoral head | Sickle cell anemia |
| pes planus | flat feet, normal posture in one year old |
| Strabismus | Optic axes can not be directed to the same object |
| what n. serves brachioradialis m. | radial n., C6 |
| what n. goes to nucleus ambiguous | vagus n. |
| subluxation location causing cardiac problems | upper c/s, can influence vagus n. flow to the heart |
| Cervical spine tests | Valsalvas, Dejarines, Milgrams, Naffzigers |
| Test for meningitis | Brudzinski's-leg flexion=meningitis |
| Sheppleman's ipsi vs. contra | ipsi=intercostal neuritis, contra=pleurisy |
| Chest expansion measure | males=2" females=1.5" |
| When is chest exp dec | with AS |
| Beevors indicator | deviation of umbilicus, indicates side and general level of lesion |
| Lhermites finding | shooting px into extremities=MS |
| Where does rib fx px go | lateralizes to side of fx |
| Forrestiere bowstring indicates | ipsi mm. contracts with AS |
| aka for SLR | Leseagues |
| SLR findings | 0-30=hip, 30-60=SI, 60>=n. root; indicates lateral disc bulge |
| WLR aka | Fazjerstsan's |
| WLR findings | indicates medial disc bulge |
| Kemp's findings | Ipsi facet, contra is n. root |
| Ely's finding | lateral fem n. irritation |
| Thomas finding | iliopsoas tension |
| Hibbs finding | SI or hip, depending on site of px |
| Nachlas finding | SI lesion, tight quads, ant thigh px |
| Yeoman finding | ant SI lesion |
| Gaenslen's finding | SI or hip involvement |
| Neri bowing finding | hamstring thightness, not n. root traction |
| Calloway's finding | disloc of humerus |
| Dugas finding | disloc of humerus |
| Apprehension finding | disloc of humerus |
| Codman's finding | rotator cuff tear usually supraspinatus |
| Yergason's finding | bicipital tendonitis or transverse humeral ligament |
| Describe Weber's test | 512 hz tuning fork placed on vertex of skull |
| Weber's test findings | Lateralization indicates air conduction loss on same side or sensorneural loss on side opposite lateralization |
| Describe Rinne's test | 512 hz tuning fork placed on mastoid process, held until pt no longer hears then fork held in air beside ear. |
| Rinne's test findings | neg if air conduction 2x longer than bone; pos if bone conduction longer than air conduction |
| Describe Schwabach's test | after pt can no longer hear air conduction with Rinne's Dr listens to tuning fork for comparison |
| Barany test | labyrinthine test, whirling or calorimetric test |
| Muscle tension HA sx | unvarying dull HA, band like pattern |
| Classic migraine HA sx | aura, throbbing phase, mood change |
| Brain tumor sx | can present as weak lateral rectus m., HA and elevated optic disc |
| Posterolateral sclerosis aka | combined systems ds |
| Posterolateral sclerosis sx | stocking glove distrib, B12 down, complication secondary to pernicious anemia |
| Duchenne's MD sx | 50-100X inc in CPK, mm. wasting, waddling gait |
| Sudeck's atrophy sx | RSDS w/ osteoporosis |
| Hegar's sign | softening of the cervix |
| Best test for polymyositis | tissue biopsy |
| Osteochondritis dessicans sx | jt. mice lateral aspect of the medial compartment of the knee MC site |
| Pelligrini Stieda sx | partial avulsion of the MCL with resultant calcification |
| Order of shoulder dysfunction | tendonitis to bursitis to capsulitis |
| Neurotrophic jt sx | hx, jt effusion, inc sensitivity, inc with DM, not a shooting type px |
| Where is hematogenous osteomyelitis most often located | metaphyseal bone |
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