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In the chief complaint, what does OPQRST stand for? -
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What are the components of a complete examination? -
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NMS 1
Cumulative Exam
| Question | Answer |
|---|---|
| In the chief complaint, what does OPQRST stand for? - | Onset, Provoking/Palliative, Quality of pain, Radiation, Severity, Time |
| What are the components of a complete examination? - | physical exam, chiropractic analysis, special studies, laboratory studies |
| What sign might be present in evaluating the patient for possible upper cervical instability? - | Rust's sign |
| What test might you perform to evaluate the patient for pain threshold? - | Libman's sign |
| What tests might you perform to evaluate the patient for brachial plexus tension? - | Bakody sign, Bikele's sign, Brachial Plexus tension test, Shoulder Depression Test |
| What tests might you perform to evaluate the patient for space occupying lesions? - | Valsalva's maneuver, Dejerine's Sign, Swallowing test, Naffziger's test |
| What are the vertebrobasilar artery functional maneuver exams? - | George's test, Barre-Lieou |
| What tests would evaluate the patient for IVF encroachment? - | Distraction test, Foraminal Compression Test, Jackson Compression Test, Maximum Cervical Compression Test, Spurling's Test |
| What tests evaluate the patient for sprain/strain? - | O'Donoghue Maneuver, Soto-Hall |
| What test evaluates the patient for cervical myelopathy? - | Lhermitte's Test |
| What test evaluates the patient for meningitis? - | Kernig/Brudzinski sign |
| What test for sprain/strain can be performed on any joint in the body? - | O'Donoghue Maneuver |
| Patient spontaneously grasps the head with both hands when lying down or when arising from a recumbant postion- what is this positive sign called, and what does it indicate? - | Rust's sign, severe upper cervical instability |
| The examiner applies thumb pressure to the mastoid process and gradually increases the pressure until the patient states that it is becoming noticeably uncomfortable- what is the sign and what does it tell you? - | Libman's sign- demonstrates unusually low threshold or normal threshold for pain, useful for interpretation of palpation findings |
| The patient when in a seated position will place the palm of the affected extremity on the top of their head, raising the elbow to the level of the ear. What is the sign and what does it tell you? - | Bakody sign- severe radicular symptoms, indicates nerve root irritation, brachial plexus tension |
| What is a positive reverse Bakody sign? - | Patient's chief complaint is exacerbated by placing palm on the top of their head, indicates a thoracic outlet syndrome from interscalenecompression |
| What is the clinical indication for a negative Bakody sign? - | no change in the pain with test, differentiate a nerve root encroachment from a thoracic outlet syndrome |
| The patient is asked to abduct the shoulder to 90 degress and then the elbow is put into full extension- what is the test called, and what is the purpose? - | Bikele's sign, stresses the brachial plexus |
| The patient is asked to abduct both shoulders to 90 degrees and place the hands behind the head, the doctor then pulls the elbows back. What is the test, and what is the purpose? - | Brachial Plexus Tension Test- tractions the brachial plexus |
| Dr. stands in front of the seated patient. Patient is asked to take a breath and bear down as if they were laboring during a strenuous defecation. What is the test, and what does it indicate? - | Valsalva's Maneuver, space occupying lesion |
| Coughing, sneezing, and straining during defecation causes aggravation of radiculitis symptoms. What is the sign, and what does it suggest? - | Dejerine's Sign, space occupying lesion |
| Presence of pain or difficulty swallowing indicates? - | space occupying lesion, ligamentous sprain, muscular sprain, fracture, disc protrusion, tumor, or osteophyte at the anterior portion of the cervical spine |
| What does increased pain during the distraction test indicate? - | muscle spasm |
| What does relief of pain during the distraction test indicate? - | IVF encroachment or facet capsulitis |
| During the maximum cervical compression test, pain of a radiating nature on the side being tested indicates? - | IVF encroachment |
| During the maximum cervical compression test, pain opposite the side being tested is indicative of? - | muscle stretch or sprain |
| For what test does a positive result yield a classic sign of multiple sclerosis? What are the findings? - | Lhermitte's Test- an electric shock like sensation radiating down the neck and spine |
| What is the segmental innervation tested for gag reflex? - | CN IX and X |
| What is the Peripheral nerve tested with gag reflex? - | CN IX and X |
| What is the segmental innervation tested with Corneal blink? - | CN V and VII |
| What is the peripheral nerve tested with Corneal blink? - | CN V and VII |
| What is the Segmental Innervation tested with Epigastric reflex? - | T5-T7 |
| What is the peripheral nerve tested with epigastric reflex? - | Intercostal |
| What is the proceedure for epigastric reflex? - | Stimulate from sternum towards umbilicus |
| What is the segmental innervation tested with Upper Abdominal reflex? - | T7-T9 |
| What is the peripheral nerve tested with Upper Abdominal reflex? - | intercostal |
| What is the Segmental innervation tested with Middle Abdominal reflex? - | T9-T11 |
| What is the peripheral nerve tested with Middle Abdominal reflex? - | Intercostal |
| What is the segmental innervation tested with Lower abdominal reflex? - | T11-T12 |
| What is the peripheral nerve tested with lower abdominal reflex? - | Intercostal, Iliohypogastric, Ilioinguinal |
| What is the segmental innervation tested with Cremasteric reflex? - | L1-L2 |
| What is the peripheral nerve tested with Cremasteric reflex? - | Ilioinguinal, genitofemoral |
| What is the segmental innervation tested with gluteal reflex? - | L4-S2 |
| What is the peripheral nerve tested with gluteal reflex? - | Inferior Gluteal |
| What is the Segmental innervation tested with Plantar reflex? - | L4-S2 |
| What is the peripheral nerve tested with plantar reflex? - | Tibial |
| What is the segmental innervation tested with Anal reflex? - | S2-S5 |
| What is the peripheral nerve tested with anal reflex? - | Inferior Hemorrhoidal |
| What segmental level is tested with Hoffman sign? - | lesion above C5 in Cortiospinal tract |
| What segmental level is tested with Tromner sign? - | Lesion above C5 in corticospinal tract |
| What segmental level is tested with Rossolimo Sign of the foot? - | Corticospinal tract |
| What segmental level is tested with Babinski sign? - | corticospinal tract |
| What segmental level is tested with Chaddock sign? - | corticospinal tract |
| What segmental level is tested with Oppenheim sign? - | Corticospinal tract |
| What segemental level is tested with Gordon sign? - | Corticospinal tract |
| What segmental level is tested with Schaefer sign? - | Corticospinal tract |
| What response to Hoffmann sign indicates an UMNL? - | Flexion of fingers and adduction of the thumb |
| What response to Tromner sign indicates an UMNL? - | Flexion of fingers and adduction of the thumb |
| What response to Rossolimo sign of the foot indicates an UMNL? - | Plantar flexion of the toes |
| What response to Babinksi sign indicates an UMNL? - | dorsiflexion of the great toe and flaring of the other toes |
| What response to Chaddock sign indicates an UMNL? - | dorsiflexion of the great toe and flairing of the other toes |
| What response to Oppenheim sign indicates an UMNL? - | dorsiflexion of the great toe and flairing of the other toes |
| What response to Gordon sign indicates an UMNL? - | Dorsiflexion of the great toe and flairing of the other toes |
| What response to Shaefer sign indicates UMNL? - | Dorsiflexion of great toe and flairing of the other toes |
| What segmental level is tested with Pupillary Light reflex? - | Afferent: CN II |
| Efferent: CN III | |
| What segmental level is tested with Accommodation reflex? - | CN III |
| What segmental level is tested with Ciliospinal reflex? - | Afferent: Cervicals and CN V |
| Efferent: Cervical sympathetics | |
| What segmental level is tested with Oculocardiac reflex? - | Afferent: CN V |
| Efferent: CN X | |
| What segmental level is tested with Carotid Sinus Reflex? - | Afferent: CN IX |
| Efferent: CN X | |
| What segmental level is tested with Bulbocavernousus reflex? - | S3-S4 |
| Describe Nontremorous Hyperkinesia or Chorea - | random, quick movements simulating fragments of normal movements |
| Describe Athetosis - | Slow, writhing movements of the fingers and extremities that may come and go and are usually associated with pyramidal tract signs |
| Describe Dystonia - | slow, alternating contraction and relaxation of agonists and antagonists, with one movement predominating for a long time: causes fixed joint contractures |
| Describe Hemiballismus - | a violent, flinging movement of half of the body |
| Describe Tics - | quick, repetitive movements of the face, tongue, or extremities (associated with emotional stress) |
| Describe Akathisia - | motor unrest manifested as continual shifting of posture and or movement (Parkinson's and psychotropic medication use) |
| What involuntary movement is associated with Parkinson's and psychotropic medication use? - | akathisia |
| Describe epilepsy - | tonic or clonic spasms of all or part of the body |
| Describe Tardive Dyskinesia - | involuntary movements of the face, mouth, tongue, and limbs, onset usually after prolonged use of neuroleptic agents |
| What is the largest single category of involuntary movement? - | Tardive dyskinesias |
| What is the gait called? Patient walks with a wide base, slapping feet, watching legs, uneven spacing of steps, tottering. - | Tabetic or Ataxic gait (Tabetic if certain that it is a posterior column problem) |
| What is the gait called? Affected leg is rigid and is swung from the hip in a semicircle by movements of the trunk, the patient leans to the affected side, and the arm on that side is held in a rigid, semiflexed position. - | Hemiplegic gait |
| What might produce a gait similar to a hemiplegic gait? - | any disorder producing an immobile hip or knee |
| Patient has a very difficult time getting to the bathroom at night with the lights off- feels clumsy and uncertain. What is the gait? - | Tabetic or ataxic gait |
| What gait is characteristic of spastic paraplegia? - | Scissors gait |
| What is the gait called? Legs are adducted, crossing alternately in front of one another with knees scrapping together, stiff, jerky manner in lower extremites, often accompanied by pronounced compensatory motions of the trunk and upper extremities. - | Scissors gait |
| What gait can result from drug poisoning, multiple neuritis, brain tumors, ms, general paresis and acute alcoholism? - | drunken or staggering gait- looks like cerebellar gait |
| What gait sign may be a very, very early sign of Parkinsons? - | doesn't swing arms |
| Muscular dystrophy may produce what type of gait? - | Waddling or clumsy gait |
| What gait results from dislocated hips or difficulty in maintaining the pelvis at a proper angle to the weight-bearing extremity, with slump of the pelvis toward the non-weight bearing side? - | Waddling or clumsy gait |
| What gait may occur with alcoholic neuritis, peroneal nerve injury, poliomyelitis, and progressive muscular dystrophy? - | Steppage gait (footdrop gait) |
| With steppage gait, what other exams would you be likely to find deficits? - | sensory deficits, autonomic deficits (heat deflections) |
| What gait is characterized by marked irregularity and unsteadiness associated with vertigo and a tendency to reel to one side? - | Cerebellar Gait or ataxia |
| What gait is characterized by a foward-leaning posture and short shuffling steps- the patient appears to be chasing their center of gravity? - | Propulsion or Festination Gait (Parkinsonian gait) |
| If the gait is bizarre or fantastic and inconsistant with the patient's actual ability to move the limb voluntarily, it may be termed? - | Hysterical gait |
| What type of conditionl shows such bizarre incoordination that the patient is unable to stand or walk, yet all leg movements can be performed normally while the patient is sitting or is in bed? - | Atasia-Abasia |
| What is the nerve root for Supraspinatus? - | C(4),5,6 |
| What is the named nerve for Supraspinatus? - | Suprascapular N |
| What is the nerve root for Deltoid? - | C5,6 |
| What is the nerve for Deltoid? - | Axillary |
| What is the nerve root for Biceps? - | C5,6 |
| What is the nerve for biceps? - | Musculocutaneous |
| What is the nerve root for Brachioradialis? - | C5,6 |
| What is the nerve for brachioradialis? - | Radial |
| What is the nerve root for Wrist extension? - | C6,7,8 |
| What is the nerve for wrist extension? - | Radial |
| What is the nerve root for triceps? - | C6,7,8 |
| What is the nerve for triceps? - | radial |
| What is the nerve root for wrist flexion? - | C6,7,8,T1 |
| What is the nerve for wrist flexion? - | Median/Ulnar nerve |
| What is the nerve root for finger extension? - | C7,8 |
| What is the nerve for finger extension? - | Radial |
| What is the nerve root for Finger flexion? - | C8,T1 |
| What is the nerve for finger flexion? - | Median/Ulnar nerve |
| What is the nerve root for finger abduction? - | C8,T1 |
| What is the nerve for finger abduction? - | Ulnar nerve |
| What is the nerve root for finger adduction? - | C8,T1 |
| What is the nerve for finger adduction? - | Ulnar nerve |
| What grade for muscle strength testing is given for complete paralysis (no movement of the muscle), 0% of normal movement? - | 0/5 |
| What grade for muscle strength testing is given for a twitch of movement (trace of contraction), 0%-10% of normal movement? - | 1/5 |
| What grade for muscle strength testing is given for moderated to severe paresis (active movement when gravity is eliminated), 11-25% of normal movement? - | 2/5 |
| What grade for muscle strength testing is given for moderate paresis (active movement against gravity), 26-50% of normal movement? - | 3/5 |
| What grade for muscle strength testing is given for mild paresis (active movement against gravity and resistant), 51-75% of normal movement? - | 4/5 |
| What grade for muscle strength testing is given for normal, 76-100% of normal movement? - | 5/5 |
| Definition of Spasticity - | increased muscular resistance felt by the examiner during quick joint movement, which then quickly fades away |
| Spasticity in most clinical circumstances have what lesions associated? - | Upper motor neuron lesion, cortical or pyramidal pathway |
| Definition of Rigidity - | involuntary muscular resistance felt when moving a resting joint and persists as the joint is moved through its entire range of motion |
| What mechanism may be responsible for rigidity? - | muscle spindle mechanism interference from diseased extrapyramidal structures, UMNL |
| Definition of Hypotonia, indications - | decreased muscle tone, neurological damage at the level of the reflex arc (LMNL), cerebellar disease may cause diffuse hypotonia |
| Definition of Deficit Phenomena - | loss of normal neurological function, reductions in muscle tone, muscle stretch reflexes, muscle strength, muscle volume. LMNL produce only deficit phenomena |
| Definition of Release Phenomena - | Exagerations or perversions of normal neurological function and are due to a loss of cortical inhibition. Hyper-reflexia, hypertonia, and pathological reflexes are release phenomena (named due to the release from descending cortical inhibition) |
| What are the standard reflexes performed in the upper extremity? - | biceps, triceps, brachioradialis, finger tap |
| On the Wexler reflex grading system, what is a reflex that is absent with reinforcement? - | 0 |
| On the Wexler reflex grading system, what is a reflex that is hypoactive with reinforcement? - | +1 (+) |
| On the Wexler reflex grading system, what is a reflex that is normal? - | +2 (++) |
| On the Wexler reflex grading system, what is a reflex that is hyperactive? - | +3 (+++) |
| On the Wexler reflex grading system, what is a reflex that is hyperactive with transient clonus? - | +4 (++++ w/transient clonus) |
| On the Wexler reflex grading system, what is a reflex that is hyperactive with sustained clonus? - | +4 (++++ w/sustained clonus) |
| What is the term for a method of reinforcement of the reflexes? - | Jendrassik maneuver (distracting the patient while performing the reflex, for example clench the fist, flex the toes) |
| Unilateral CN 5, 7, and 8 problems may be indicative of what lesion? - | cerebellopontine angle lesion |
| Unilateral CN 3,4,5 and 6 problems may be indicative of what lesion? - | cavernous sinus lesion |
| Combined unilateral CN 9,10, and 11 problems may be indicative of what lesion? - | jugular foramen syndrome |
| Combined bilateral CN 10, 11, and 12 problems, if lower motor neuron, may be indicative of what syndrome? - | bulbar palsy |
| Combined bilateral CN 10, 11, and 12 problems, if upper motor neuron, may be indicative of what syndrome? - | pseudobulbar palsy |
| Prominent involvement of eye muscles and facial weakness, particuarly when variable, suggest what syndrome? - | myasthenic syndrome (myoneural junction) |
| What are the patient complaints (unilaterally) for cerebral vascular ischemia? - | neck pain/stiffness, headache, dizziness/vertigo, nausea/vomiting, diplopia |
| During Romberg test, patient falls with eyes open and closed- what is the indication? - | Cerebellar deficit and/or Vestibular Mechanism Deficit |
| During Romberg test, patient falls with eyes closed only- what is the indication? - | Dorsal Column Pathology |
| Hopping on one foot requires? - | intact function of nervous system- long motor and sensory tracts, cerebellum, basal ganglia, and peripheral nerves |
| What is a good way to find minor weakness in the lower extremities? - | Squatting on one foot |
| What are abnormal findings for Finger-to-Nose test? - | Dyssynergia (incoordinate movement) |
| Dysmetria (inaccuracy in measuring distance) | |
| Patting knees rapidly, tapping forefinger of thumb, rapid pronation/supination of hands test for? - | Dysdiadochokinesia (abnormal) |
| Diadochokinesia (normal) | |
| Inability to perform Tandem gait with eyes open indicates? - | cerebellar dysfunction |
| Inability to perform Tandem gait with eyes closed indicates? - | posterior column (proprioception) dysfunction |
| Non-discriminating touch is called? - | Thigmesthesia |
| Discriminating touch is called? - | Topesthesia |
| What receptors are associated with Thigmesthesia? - | Merkle's discs |
| What receptors are associated with Topesthesia? - | Meissner's corpuscles |
| Nociceptive impulses travel, for the most part, along the ______________ fibers and along the __________ fibers. - | slightly myelinated A Delta fibers and unmyelinated C fibers |
| Nociceptive impulses travel along A delta and C fibers which project via the _______ to the _________. - | dorsal root, to the dorsal lateral fasciculus (where they may ascend or descend several cord levels) |
| What terms are used to designate areas insensitive to pain? - | alganesthesia and analgesia |
| What term is used to designate areas having decreased sensitivity? - | hypalgesia |
| What term is used to designate areas showing increased sensitivity? - | hyperalgesia |
| Which is more sensitive- pain or temperature tests? - | Temperature |
| What temperature should cold stimuli be for a temperature examination? - | between 41 degrees and 50 degrees |
| What temperature should hot stimuli be for a temperature examination? - | between 104 and 113 degrees |
| Loss of vibratory perception is referred to as? - | Pallanesthesia |
| Pinching the Achilles tendon to evaluate deep pain and pressure sensation can elicit what sign? - | Abadie's sign |
| Pinching the testicles to evaluate deep pain and pressure sensation can elicit what sign? - | Pitre's sign |
| Pinching the ulnar nerve to evaluate deep pain and pressure sensation can elicit what sign? - | Diernacki sign |
| Loss of pain when placing pressure on the eyeball is usually indicative of what disease? - | dorsal column disease with tabesdorsalis as the classic example |
| The fingertips are capable of detecting 2 point discrimination at a distance of _______. - | 2-4mm |
| The dorsum of the fingers are capable of detecting 2 point discrimination at a distance of ______. - | 4-6mm |
| The palm is capable of detecting 2 point discrimination at a distance of _________ - | 8-12 mm |
| The dorsum of the hand is capable of detecting 2 point discrimination at a distance of ______ - | 20-30mm |
| In extrapyramidal syndromes, which type of power is diminished, and which remains normal? - | kinetic-diminished |
| static-normal |
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