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nms
nms question-answer
| NMS Question | NMS Answer |
|---|---|
| Agraphesthesia | inability to recognize traced or written letters/numbers/outlines on the skin |
| Asterognosis | inability to recognize familiar objects by sense of touch |
| Baragnosis | inability to distinguish between two different weights |
| Pallenesthesia | loss of vibratory sensation felt on the skin or bone |
| Akinesthesia | loss of sense of motion: extent, direction and weight |
| Dysesthesia | Abnormal sensations on the skin. Numbness, tingling, burning or cutting pain |
| Paresthesia | abnormal sensations on the skin. Numbness, prickling, tingling, increased sensitvity |
| Agnosia | loss of comprehension of auditory, visual or other sensations with senory spheres intact |
| Aphasia | loss of ability to communicate through speech, writing or signs |
| Akinesia | loss of muscle movement |
| Apraxia | dec vol motor func, cerebrum |
| Tests of tetany | Chvostecks, Trousseau's, Erb's |
| Chvosteck's | tapping over facial n. (TMJ) causes spasmodic facial contraction ipsi, inc Ca |
| Trousseau's | compression of the brachial a. causes carpopedal (wrist) spasm |
| Erb's | Galvanic stim causes ionic contraction |
| Babinski response | dorsiflex of big toe and fanning of other 4 toes |
| Babinski test | upward plantar stroke of the foot from lat to med |
| Chaddocks | C shaped stroke around lat maleoulus |
| Oppenheim | stroke tib ant |
| Gordon's | squeeze calf musculature |
| Schaefer's | sqeeze the achilles tendon |
| Jaw jerk sign signif | CN V lesion |
| Westphal's sign | loss of any one dependent reflex |
| Homan's sign | diffuse calf px or behind knee upon forced dorsiflex of the ft, indicates thrombophlebitis |
| Sx of carpal tunnel | Night px, possibly caused by lunate sublux, median n. compression |
| Sx of meralgia paresthetica | Ant lat thigh px; involves the lat fem cut n., L2-L3 n. roots |
| Horner's Syndrome sx | Ptosis, myosis, anhydrosis; interruption fo the c/s sympathetic chain |
| Tic Douloureaux sx | 5th CN involvement; bouts of severe lancinating px along distrib of the trigeminal |
| Bell's palsy sx | 7th CN; unilat facial paralysis of sudden onset |
| Erb's palsy sx | UMN lesion; paralysis of mm. of shoulder and upper arm; C5-C6 roots-axillary n. |
| Klumke's palsy sx | LMN lesion; atrophic paralysis of the forearm; C8-T1 roots |
| Stretch reflex | involves 1 interneuron that synapses with input sensory n. to output LMN |
| Dorsal Root ganglion | origination of most primary neurons of the sensory nn. |
| Sprain/strain | T in strain think tendon; active vs. passive test w/ O'Donohue's maneuver-passive=sprain, active=strain |
| Causalgia | first sign burning px long a peripheral n. distribution |
| Neuralgia | Px along the course of a n. |
| Neuritis | infl of n. w/ px, paresthesia or anesthesia, paralysis, diminished reflexes |
| Radiculitis | infl of spinal n. root; dermatomal and sharp px |
| When are superficial reflexes lost? | lost w/ both UMN and LMN lesion |
| Ciliospinal reflex | pupil dilation following pxful stim to skin of neck; autonomic modulation |
| Corneal reflex | CN V afferent; CN VII efferent |
| What are the 4 palsies? | Cerebral, Bell's, Erb's, Klumpke's |
| What action indicates the presence of intrathecal px? | jolt of back px when sneezing |
| Tx for 10yo female w/ mild back px after PE. Finding is 15 degree scoliosis, w/ apex at T9, T10. What is tx? | manipulation |
| tx protocol for scoliosis? | less than 20deg=monitor and adjust, 20-40deg=brace (Millwakee), greater than 40deg=surgery and Herrington rods |
| 13 yo female w/constant low grade midback px, aggravated playing volleyball; shoulders becoming rounded. Dx | Scheuerman's ds...active teenager, schmorl's node (form of compression fx) |
| Rule out DDX for Scheurman's finding: | AS-never in female teenagers, Reiter's Syndrome only in males, DISH (diffuse idiopathic skeletal hyperostosis) is in middle age |
| Sx for tendinitis | chief complaint-px reproduced during resistive m. testing; O'Donoghue's |
| Dx for dizziness w/ nausea, progressive hearing loss and ringing in the ears: | Meniere's Syndrome aka endolymphatic hydrops (tinitis, vertigo, deafness) |
| Dx for recent onset of photophobia w/ severe generalized HA, fever and malaise: | Meningitis (inf of the cerebral spinal fluid d/t presence of glucose and NO leukocytes) |
| Dx for difficulty during ambulation in dimly lit rooms | most suggestive of dysfunc in dorsal col |
| Common sign of dorsal col or cerebellum | difficulty ambulating |
| diff amb w/ eyes closed | cerebellum |
| diff amb w/ eyes open (light off) | dorsal col-proprioception problem |
| ataxia is sign of | cerebellar lesion |
| Most crucial info in case hx of pt w/ post traumatic wrist px | color or temp change=vascular change |
| Dx of 14 yo w/ infrapatellar px | Osgood Schlatter |
| What is repetitive dropping of the unsupported side of the pelvis | waddling |
| What predisposes pt to inc thoracic kyphosis | Pott's ds (aka TB of spine) |
| Symptoms atypical of L5 herniated nucleus pulposus | loss of perineal sensation |
| Which n. is affected by L5 herniated disc? | S1 n. |
| Dx for gradually developed elbow px in 25 yo after repetitive use of screwdriver | lat epicondylitis |
| Most likely dx of pt w/ ant chest px of one week duration following a month of repetitive coughing episodes? | costochondritis |
| DDx for costochondritis: | Rib fx (lat chest px), hiatal hernia (epigastric px) |
| What are the postural presentations in normal one year old? | pes planus, genu varus, coxa valgus |
| What abn gait most commonly accompanies dysdiadochokinesia, pendular reflex response and dysmetria | ataxic cerebellar (motor ataxia) |
| What does anatomic R. leg deficiency of 1 cm result in? | lumbar scholiosis w/ spinous deviation-the convexity to R, away from along w/ righting reflex (head tilt, occiput and axis) |
| How does body compensate for weak hip flexors? | leg circumduction (as in stroke) |
| What's the m/c level for discopathy in cervical spine? | C5-6, most motion in cervical spine w/ apex of cervical lordosis |
| M/C present on involved side accompanying a C6-7 disc syndrome: | weak wrist flexors (C6-7;C6 disc and C7 n.), brachioradialis (C6) and weak wrist extensors (C6) |
| Best dx if cervical flex causes bilat radiating px to all extremities | myelopathy (myelo=spinal cord), polyneuropathy (diabetics, peripheral neuropathy) |
| Px during cervical distraction indicates | muscle spasm, relieves radicular px, subclavian steal syndrome (subclavian steals blood supply causing dizziness) |
| Ant scalene mm. is most apt to compromise the content of the thoracic outlet during which maneuver: | Adson's test (ipsi head rotation and ext), medial scalene test (contra head rot and ext-modified Adson's), SCM (same side lat flex, oppo side rot) |
| What n. is affected w/ ant scalene based TOS? | Radial N. |
| What does active hip and knee flex during passive flex of supine pt's neck indicate? | meningeal irritation (seen in Brudzinski's-Soto Hall or Kernig's test) |
| What is diminished triceps reflex assoc w/? | C7, no reflex for C8 |
| What does px on contra side during max cervical compression test indicate? | muscular issue (ipsi side=neural issue) |
| M/C finding w/ osteochondrosis of the secondary epiphysis of the vertebra: | kyphosis (secondary epiphysis of vert=endplate) |
| Heuter Volkmann law | inc pressure on growth plate dec the rate of growth w/in the endochondral ossification zones |
| Risser Ferguson & Cobb's | eval of scoliosis |
| Wolff's Law | inc pressure causes inc density on bone |
| What positive test indicates ankylosis at the costotransverse and costovertebral articulations? | chest expansion |
| What is winging of scap in a standing pt usually d/t? | serratus ant ("SALT-serr ant, long thoracic) your wings" |
| What is indicated by localized px along the lat border of the rib cage during ant to post compression? | rib fx |
| What does hip flex during ext rot of the thigh test? | psoas |
| What m. would be tested during hip flex w/ abduction of thigh? | TFL |
| What are possible causes of px if R lat bending of torso is severly restricted w/ L lumbar paraspinal px and myospasm w/ px radiating to the L buttock? | quadratus lumborum syndrome, px radiating to L buttock indicates sciatic px d/t tightening of piriformis; tightening of QL will cause spasm of piriformis; L5 rot w/ sacrum problem will cause rib subluxation d/t QL |
| What causes weakness of the ext hallicus longus? | L5=L4 disc |
| Cause of dull post thigh px during SLR: | tight hamstrings |
| Where is the lesion if post drawer sign demonstrates hypermobility of the tibia? | post cruciate |
| Injuries most likely to impair forearm rot? | fx of radial head; torn bursa (can not ext); tennis elbow (may be able to rotate forearm) |
| What does ant drawer test performed w/ 15 degrees of ext rot of lower leg evaluate besides ant cruciate lig? | medial collateral lig (drawer test ALWAYS rests ligament); meniscus does not limit motion |
| What are the findings of auditory testing that indicates sensorineural deficit of CN VIII? | Sound which lateralizes to the unoccluded ear; sensorineural deficit (NO hearing), sound which lateralizes to the occluded ear (normal), air to bone conduction ratio of less than 2:1=obstruction |
| A slipped capital femoral epiphysis causes [blank] during passive hip flexion. | abduction |
| What is indicated by shoulder px produced at 150 degrees of passive abduction? | sternoclavicular joint dysfunction |
| Shoulder px at first 20 degrees abd= | glenohumeral dysfunc |
| Shoulder px at 20-120 degrees abd= | scapulothoracic and glenohumeral |
| Shoulder px after 120 degrees abd= | sternoclavicular |
| What does holding the elbow in ext while performing passive wrist flex and pronation test for? | lat epicondylitis (aka tennis elbow), Mill's and Cozen tests or medial epicondylitis (aka golfer's, little leaguer's) |
| What does px in the region of the sinus tarsi during passive plantar flex and inversion of the foot indicate? | ant talofib problem |
| What is m/c position of ankle sprain? | plantar flex and inversion of foot |
| Sinus tarsi | lat depression of the ft |
| A lesion of the sensory cortex [blanks] the distance betw two recognizable pts in 2 pt discrimination testing: | increases |
| Inability to identify an object by palpating its size and shape: | astereognosis |
| What is indicated by symmetrical defect in the lower quadrant of the visual field? | radiations (1/4 of upper or lower quad of the visual field lost) |
| Optic radiations are d/t? | chiasm, tract, n. |
| DDx for pt presenting with inability to wrinkle the L forehead or close the L eye tightly. The L side of the mouth does not rise during smiling. | LMN lesion of the L facial n.(hyporeflexia), Bell's palsy, stroke, mysthenia gravis |
| Why due cervical neurologic stim produce HA? | d/t upper cervical afferent convergence w/ fibers from the nucleus of CN V (has both sensory and motor) (CN IV and VI are motor only) |
| What lesion does pt have who is unable to look laterally in a cardinal gaze exam? | lesion of abducens |
| Pt. has 20 yr history of DM. Exam indicates hair loss over dorsal aspect of the foot and mid calf of each lower ext. What is the etiology of the hair loss? | chronic arterial insufficiency (shiny tight skin) or peripheral neuropathy (w/ corresponding m. changes) |
| What CN is involved when unable to protrude tongue? | hypoglossal (tongue deviates to WEAK side) |
| What m. is primarily supplied by the V CN? | deltoid (C5 only) (biceps have C5-6 shared innvervation) |
| What does ulnar n. lesion in the arm likely the cause of? | adductino and flexion issues (ext is radial n., supination is brachioradialis) |
| What occurs in both upper and lower motor neuron ds? | muscle weakness |
| Is fasiculation UMN or LMN based? | LMN only |
| Is clonus and hyperreflexia UMN or LMN based? | UMN only |
| What is the sensory innervation for the dorsum of the foot? | L5 |
| What procedure is employed during the physical exam to rule out coarctation of the aorta? | pulse difference betw upper and lower ext (timing of the femoral vs radial pulse) |
| What are the findings if there are aorta issues? | aortic arch: upper pulse asymmetrical (R has blood supply, L doesn't)=cephalic, carotid, subclavian; MI=no pulse or pulse, symmetrical; abd aorta=lower pulse asymmetrical |
| What does dr. do to eval for low px threshold? | applies digital pressure to the pt's mastoid process (Libman's test-px threshold and malingerer test) |
| A pt w/ a lesion of the axillary n. is likely to have dec sensation over what m.? | deltoid |
| Dec sensation over thenar eminence indicates what n.? | median |
| Diminished sensation over axilla indicates what n.? | T2 |
| Diminished sensation over elbow indicates what n.? | T1 (medial and lateral antebrachial) |
| What is the ability to perceive the presence of vibration when a tuning fork is played over a boney prominence called? | pallesthesia (vibration sense) |
| Stimulation of the patellar reflex is initiated by the stretch of what? | muscle spindle |
| What is stretched for touch sensation? | pacinian corpuscle |
| A recent hx of an outburst of severe poorly localized px indicates a lesion of: | thalamus (brain) |
| Localized px indicates issue of: | n. root |
| What tract has a lesion if there is the presence of pathologic reflex in lower ext? | corticospinal |
| Type of lesion indicated by pathologic reflex? | UMN |
| What tracts have lesions if sensory is involved? | spinothalamic and corticobulbar (ascending pathways) |
| Is plantar flex of foot and toes during plantar stimulation normal or abnormal? | normal (UMN lesion = flaring of toes) |
| What CN serves as the afferent limb of the corneal reflex | trigeminal |
| What reflex is diminished by a herniated nucleus pulposus which compresses the n. root betw 3rd and 4th lumbar segment? | knee jerk |
| Ulceration is common finding in which cause of peripheral edema? | chronic venous insufficiency |
| Orthostatic edema | posturally related circulation problem |
| Why is there hair loss with edema problems? | d/t loss of blood flow |
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