NMS Exam 1 VBAI, Cerebellum, Multimodal, Posterior Collumn, Motor Exam and Reflex

T/F VBAI is a contraindication for adjusting

true

What is the first step to VBAI testing?

ausculate the carotid and subclavian arteries

Name the steps in order to rule out (or in) a VBAI.

1. Auscultate

2. Palpate

3. rotate and extend head to one side and count down from 20 to 0

4. repeat on other side

What is a positive sign with the tests for VBAI?

dizziness/ vertigo, nausea, double vision

What is the MC symptom in testing for VBAIs?

dizziness

What is dekleyn test procedure? What is it for?

pt supine, head extended off table and rotated to one side for 15-45 sec.

VBAI with positive

T/F VBAI tests have low sensitivity and specificity meaning they should not always be performed

false

Your patient has a positive swivel chair test and a negative Barre-Lieou test. What does this indicate?

cervicogenic headaches

Your patient has a positive VBAI test. What is the next step?

advanced imaging such as MRA, MRI of brain, doppler to look for plaquing, aneurysm, or AVM

What coordinates movement to make it smooth?

cerebellum

Jerky movements associated with cerebellar dysfunction are called ?

dysdiatotrokonesia

Where in the skull does the cerebellum sit?

posterior fossa of skull

T/F the cerebellar tracts cross once as they travel

false- twice

When do the cerebellar tracts cross?

first- superior cerebellar peduncle in midbrain

second- corticospinal and rubrospinal descent

Cerebellar findings will be ? (ipsilateral or contralateral)

ipsilateral

The cerebellar hemispheres function to control what?

appendicular skeleton movements for fine motor control

What connects the cerebellar hemispheres?

vermis

What does the vermis of the cerebellum control?

gait and axial skeletal functions

What does the flocculonodular lobes control?

eye movements and gross balance

The chaotic and uncoordinated movements that are cardinal signs of cerebellar issues are known as ?

ataxia

Choppy movement is known as ?, illegible handwriting is known as ?, and lack of judgment for distances is known as ?

dyssynergia; dysarthria; dysmetria

Lesions midline to the cerebellum can cause ?

truncal ataxia

What speech pattern is associated with MS?

scanning speech

With cerebellar lesions, the eyes and head will deviate (towards/away) from the side of lesion?

towards

Positive for one of the cerebellar/posterior collumn tests with eyes open and closed indicates what type of lesion?

cerebellar

Positive for one of the cerebellar/posterior column tests with only eyes closed indicates what type of lesion?

dorsal column pathology

What type of lesion would make a patient appear intoxicated?

cerebellar

Overshooting associated with finger to finger test is known as what?

hypermetria

Undershooting associated with finger to finger test is known as what?

hypometria

Which is more common: hypermetria or hypometria?

hypermetria

T/F the finger nose finger test is performed with only eyes open bilaterally

true

Positive heel to shin tests will have ? and ?

dysynergia and dysmetria

T/F Holmes Rebound test is performed with both eyes open and closed

true

Proprioception arises from feedback in:

A) muscles

B) Ligaments

C) Joints

D) all the above

D

What type of info does the posterior column carry?

proprioception, vibratory sense, fine/discriminative touch, deep pain

What type of info does the anterior and lateral spinothalamic tracts carry?

superficial pain, temp, crude touch

Where does info for the posterior columns enter the cord?

DRG

What are the 2 posterior column tracts?

gracilis and cuneatus

Posterior columns ascend ? in spinal cord

ipsilaterally

Where is gracilis located in the spinal column?

below T6

Where is Cuneatus located in the spinal column?

above T6

Where do the secondary sensory axons decussate in?

medial lemniscus

Where do the anterolateral pathways synapse with secondary neurons?

immeadiately in gray matter

T/F anterolateral tracts decussate immeadiately and ascend in the spinothalamic tract

true

Your patient presents with a right anterolateral cord lesion at T8. What sensory losses will we see?

loss of crude touch and temp on the left (contra)

loss of vibratory sensation and fine touch on right (ipsy)

The posterior column is involved with the sensations of ? and ?

tingling and numbness

The anterolateral column is involved with the sensations of ?,?, and ? pain

sharp, burning, searing pain

The area over digit 5 is a part of dermotome ?>

C8

LOOK AT DERMATOMES

Light touch is carried in ? tract

anterior spinothalamic

sharp touch is carried in ? tract

lateral spinothalamic

What should the temperature of water be for a hot temperature evaluation?

101-113

What should the temperature of water be for a cold temperature evaluation?

41-50

If a patient feels painful sensation with normally nonpainful stimuli this would be called ?

allodynia

An unpleasant, abnormal, or painful sensation would be known as ?

dysesthesia

Myelopathy is an issue with ?

spinal cord

Radiculopathy is a ? issue

nerve root

Neuropathy os a ? issue

peripheral nerve

Myeolapathy is normally (unilateral/bilateral)?

bilateral

Radiculopathy produces an ? examination

abnormal dermatomal

With a posterior cord injury you would see loss of vibration and injry site ? to injury

distal

Radiculopathy is compression of the ? nerve root

dorsal

What are the MC causes of radiculopathy?

disc derangement

pressure from IVF narrowing

What are the observed abnormalities associated with radiculopathy?

numbness and tingling

loss of vibration and position sense

hyporeflexia

sensory loss of dermatomes

Density of nociceptive fibers is directly proportional to ?

sensativity of specific tissues

What are joint tissues devoid of nociceptors?

articular cartilage

Inner annulus and nucleus of IVD

synovial membranes

Which of the following types of pain would the subluxation complex be a part of:

mechanical

thermal

chemical

mechanical

What are some examples of chemical pain?

histamine

prostaglandins

plasma kinins

potassium

serotonin

substance P

Which of the following is faster: A delta or C fibers?

A delta

Which of the following is associated with chronic pain: A delta or C fibers?

Type C

Neuropathic pain is normally ? pain

chronic

What are the common causes of neuropathic pain?

diabetes

posherpetic neuralgia

phantom limb

trigeminal neuralgia

What is the other name for the recurrent meningeal nerve?

sinuvertebral nerve

What does the recurrent meningeal nreve innervate?

outer third of annulus fibrosis

PLL

Dura

Herniated discs typically are displaced?

posterolaterally

Hyperalgesia will often correlate well with an area of ? which is of particular significance to the chiropractor/

subluxation

What 3 things are muscle strength exams evaluating for?

strength

tone

volume

What does a finding of 0/5 for the triceps mean?

complete paralysis

A finding of 1/5 for a deltoid muscle finding indicates what?

twitch of the muscle without any movement

What is a 2/5 muscle strength finding for biceps indicative of?

moderate to severe pesis when gravity eliminated can do some motion

A patient with a 3/5 motor strength test will have what type of movoement?

active movement against gravity completely

What does a 4/5 for muscle strength mean?

resistance of two fingers

What does a finding of 5/5 for muscle strength mena?

normal muscle strength

What is the spinal nerve root for supraspinatus? PRimary?

C4, 5,6

primary-5

What nerve controls supraspinatus?

suprascapular

What is the spinal nerve root for deltoid? PRimary?

C5,6

primary-5

What is the spinal nerve root for biceps? PRimary?

C5-6

both primary

What is the spinal nerve root for brachioradialis? PRimary?

C5-6

both primary

What is the spinal nerve root for wrist extension? PRimary?

C6,7,8

primary-6

What is the spinal nerve root for triceps? PRimary?

C6,7,8

7

What is the spinal nerve root for wrist flexions? PRimary?

C6,7,8

7

What is the spinal nerve root for finger extension? PRimary?

C6,7,8

7

What is the spinal nerve root for finger flexion? PRimary?

C7,8, T1

8

What is the spinal nerve root for finger abduction? PRimary?

C8 T1

T1

What is the spinal nerve root for finger adduction? PRimary?

C8 T1

T1

What is the nerve for deltoid?

axillary

What is the nerve for biceps?

musculocutaneous

What is the nerve for brachioradialis?

radial

What is the nerve for wrist extension?

radial

What is the nerve for triceps?

radial