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nms question/answer

in pt with bilateral sciatica, exacerbation of px occurs with the pt prone and heels approximated to the buttocks: spinal stenosis
px elicited during strength testing in flexion with external leg rotation indicates: iliopsoas strain
In pts with central lumbar stenosis px is relieved in which positions: flexion
a posterolateral disc herniation at which level affects the L5 nerve root: L4, L5
the direct pupillary light reflex tests the integrity of the afferent fibers of the [] CN and the efferent fibers of the [] cranial n. II and ipsilateral III
A pt presents with a recent hx of episodes of severe vertigo, nausea, vomiting, hearing loss and tinnitus provoked by fatigue, the attacks last two hrs: meniere's ds (aka endolymphatic hydrops)
mm. most commonly torn in a rotator cuff injury supraspinatus
varus stress at the knee joint tests the integrity of the [] ligament lateral collateral
px produced by palpating base of shoulder at medial tuberosity and resisting mvmt of the arm while the pt attempts medial rotation of the shoulder with elbow flexed to 90degree most likely indicates [] tendinits bicipital (yergasson's test)
54 yr pt presents with 4 mth hx of persistent cough. he has r. ant. chest discomfort with localized px 1-2" lateral to sternum. No hx of trauma; costochondritis
Pxful arc occurs from 10-20 degrees and again from 90-110 degrees in coronal plane of shoulder abduction is most likely d/t impingement of: supraspinatus tendon
pt with chronic adhesive capsulitis of the shoulder, plapation of the scapula during passive abduction detects [] mvmt of the scapula: early
dx in pt with recent onset of slowly inc weakness and fatigue of facial and chewing mm. accompanied by inc difficulty swallowing: myasthenia gravis
dorsal pedis pulse can be palpated [] to the [] lateral, ext hallicus longus tendon
m/c presentation for a pituitary adenoma bitemporal homonymonus hemianopsia-pituitary at optic chiasm
best defined as failure of mm. coordination to focus on an object of the fovea centralis at the same time in each eye stabismus
px inc by recumbency is most indicative of: neoplastic (tumors inc at night or with rest), hematologic (px inc when standing)
dx for a young pt with hx of urethral discharge, red sore eyes and jt px: reiter's ds (caused by clamydia)
inability to perform a skilled motor activity is: apraxia (don't use it), agnosia(can't recog it), dysarthria (can't speak it)
N. root affected if pt presents with hx of alternating px and numbness in lateral aspect of foot: S1
most likely initial clinical impression of a young pt who can not straighten her knee: torn meniscus (dec ROM), ligament problem (drawer sign)
tracts carries vibration sense posterior column
px temp light touch tract lateral spinothalamic
crude touch tract ventral spinothalamic
N. involved in pronator teres syndrome median
distinctive charac of carpal tunnel from the hx nocturnal px
tapping on which structure would elicit tingling sensation in pt with ulnar neuritis: medial to the olecrannon
pt who has an irreg rate and rhythm when asked to tap his feet repeated on the floor has a lesion of which: cerebellum-rhythmic and repeated
injury to which of the following nerves produces atrophy of the thenar eminence: median-ape hand
weakness of wrist flexion, forearm pronation and thumb opposition suggests: median n. involvement
What structure is involved if tongue deviates to the right when protruded? R. hypoglossal
Intrathecal pressure causes compression of what structure? nerve
What ds does not produce pathological reflex? muscular dystrophy (MS, ALS is a UMNL problem)
Pathological reflexes classically found in the lwoer extremities most likely indicates a lesion where? above C6 (pathological reflex is UMNL occurring above C6)
Ulceration is a common finding in which case of peripheral edema? chronic venous insufficiency
Athetoid mvmt is best described as: slow writhing, involuntary
Chorea mvmt is: slow repetitive (rhythmic) and invol.
Fine rapid tremor is found in: thyrotoxicosis (Grave's ds)...hyperthyroidism
Slow tremor is found in: MS and Parkinson's
What is NOT seen in a UMNL increased superficial reflexes
A 37yr female has px and swelling in her R foot after an inversion sprain nine months ago. Px and swelling are aggravated by standing and walking. Exam shows swelling and tenderness over dorsum. Normal tests. x-ray shows osteopenia thruout tarsals. Reflex sympathetic dystrophy (post-traumatic, infl., osteopenia)
Px occurs at the extreme range of motion is least likely caused by: active contraction of mm.
Pt has 2 yr hx of coldness, weakness and occasional aches and gradual mm. atrophy in entire upper limb. Normal deep tendon reflexes. Subclavian a. stenosis (subclavian steal syndrome); brachial plexus compression (change in reflexes)
Dysarthria, diplopia, dysphagia, binocular visual disturbances, vertigo, ataxia and drop attacks are: vertebrobasilary a. TIAs (both eyes affected), Carotid TIA would NOT have drop attacks, and only ONE eye affected
Maneuver best differentiates functional from structural scoliosis: Adam's sign
AC px is differentiated from glenohumeral jt px by: actively elevating shoulder without abducting the arm (pushing against a wall is for post rib and winged scap)
Loss of deep tendon reflex is not the result of which lesion: pyramidal tract (conscious motor function)
A disc lesion which causes formainal encroachment betw C7 and T1 is likely to result in weakness of: finger flexors [finger ext=C7; forearm ext=C6)
Foot drop may result from damage to which: peroneal-tib ant
Sustained rhythmic alternating contraction and relaxation after sudden dorsiflex of the foot is: clonus
A scissor gait is seen in: cerebral palsy
82 yr male has pitting edema of L leg below knee. There is tenderness to palpation over midline of calf. Swollen area is warm and erythematous: deep vv. thrombosis
At which site are you most apt to find stress fx in foot: 2nd and/or 3rd metatarsal head (aka March's fx) [5th metatarsal=Dancer's fx]
Distinguishes Raynaud's ds from Raynaud's phenomenon: presence of underlying condition
Flexed hip is abd and elicits a palpable click in pt with congenital hip dislocation. What test is it? Barlow's (also Ortalani's)
Lesion of which n. causes inability to extend the thumb? radial
Ortho test performed in the cervical spine is used to check for max dec in the IVF: Spurling's test
Rust's sign: indicates C1 fx (pt. holding back of head)
If the hip and knees flex during passive neck flx with pt supine, what is it? spinal meningitis
65 yr male with deep bone px in spine and ribs precip by mvmt. Lab indicates mild normocytic/chromic anemia, inc ESR, inc IgG, dec IgA and IgM and free lamba light chains detected by 24 hr urine electrophoresis. What is ds? multiple myeloma
Which a. do peripheral aneurysms most commonly occur? popliteal
Event is not part of the stance phase of gait: leg advancement [advancement, stance then pushoff]
Diff during ambulation in dimly lit rooms is most suggestive of dysf in which part of the CNS? posterior col
Created by: pcelvfrdm