Neuromuscular Diagnosis

Anosmia is the __ sense of smell, while parosmia is the __ sense of smell:

Lost, distorted

What are three reflexes that can be used to test the sensory portion of the trigeminal nerve?

Corneal Blink Reflex

Jaw Jerk Reflex

Oculocardiac Reflex

The motor portion of the trigeminal nerve controls what?

Muscles of mastication

Trigeminal Neuralgia aka:

Tic Duloureaux

A pt has extreme, sporatic, sudden burning or shock-like face pain that lasts a few seconds to as long as 2 minutes. What is the dx?

Trigeminal Neuralgia

The abducens nerve controls what muscle?

Lateral rectus

The sensory nerve to facial controls what?

Ant 2/3 of tongue for taste (sweet, sour, salty)

Unilateral facial paralysis caused by trauma, virus, or immune mediated response, drooping eyelid, weakness or paralysis:

Bell's Palsy

What is the difference between Bell's Palsy and a stroke?

Stroke- contralateral motor loss below eye

Forehead does NOT wrinkle

What condition results from an abnormality in the fluids in the inner ear?

Meniere's Disease/Endolymphatic Hydrops

The glossopharyngeal nerve helps with taste where?

Posterior 1/3 of tongue for bitter

With a lesion of the vagus nerve, which direction does the palate and uvula deviate to?

Opposite side of lesion

Torticollis aka Wry neck is due to a spasm of what muscle?

SCM

With hypoglossal nerve lesions, the tongue will deviate to the __________ side.

Same

What is the Westphal's Sign?

Absence of any DTR, especially patellar (LMNL)

Wexler's Scale is used to measure a what?

Deep tendon reflex

What is a normal response on the Wexler's Scale?

2+

When stroking the inner thigh of the male, this is known as the __ reflex, but in females is known as the __ reflex:

Cremasteric

Geigel's

What are afferent and efferent nerves for Cremasteric and Geigel's Reflex?

Afferent= Femoral

Efferent= Genitofemoral

Plantar reflex tests what levels of the spine?

L4-S2

What are upper and lower nerves tested with Beevor's Sign (partial sit up looking at umbilicus):

Upper= T7-T9

Lower= T10-T12

What are the characteristics of an UMNL?

Spastic

Hyperactive DTR

Pathological Reflex present

Clonus

Hypertonic

What are the characteristics of a LMNL?

Flaccid

Hypoactive DTR

Hypotonic

Degeneration

Atrophy

Fasciculation

How do you perform the ciliospinal reflex?

Pinch neck while noting dilation of eyes

What is Rossolimo test?

Tap ball of foot for plantar flx of big toe

What is Tromner test?

Sharply tap tips of middle three fingers for flx/abd of thumb and flx of fingers

What is Gordon's Finger test?

Stroke pisiform for flx of wrist/fingers/thumb

What is the motor test for T5-T12?

Trunk Flx

What is the motor test and muscle used for hip flx?

L1-L3/Iliopsoas

What is a disorder of L1-L3 nerve roots?

Meralgia Paresthetica

What motor test can be done for S2-S4?

Anal wink

What is the acronym for peripheral nerve entrapments?

DR CUMA

Drop Wrist

Radial Nerve

Claw Hand

Ulnar Nerve

Median Nerve

Ape Hand

Tarsal tunnel syndrome is due to an entrapment of what nerve?

Medial plantar (br of tibial)

A peroneal nerve can be affected by a fx of what?

Fibular head

A winged scapula is a result of entrapment of what nerve?

Long thoracic

Flaring of the scapula is due to an entrapment of what nerve?

Dorsal scapular

Claw hand is due to entrapment of what nerve?

Ulnar

What disorders relate to an entrapment of the median nerve?

Carpal tunnel

Pronator teres syndrome

Ape hand

What disorders relate to an entrapment of the radial nerve?

Wrist drop

Crutch Palsy

Erb's Palsy

A GH dislocation can cause an entrapment of what nerve?

Axillary

Pain that arises from structures derived from embryological sclerotomes (jt pain):

Scleratogenous

Pain along scleroderm of origination involving more than one kind of tissue (shared pathway)?

referred pain

Scleratogenous pain is described as what?

Poorly localized, dull, ache

Myofascial pain is described as what?

Trgr pts

Circulating pain is described as what?

Throbbing/pulsating

Gallbladder pain gets referred to where?

Right shoulder

Inf Scapular

Pancreas pain gets referred to where?

Spine at T10 (epigastric)

Heart pain gets referred to where?

Left shoulder and medial arm

Intestinal problem refers pain where?

Periumbilical

Kidney problems refers pain where?

Flanks

Ureter problem refers pain where?

Groin

Bladder problem refers pain where?

Suprapubic area

Carpal Tunnel Syndrome is due to an entrapment under the what?

Flx Retinaculum

Where is numbness/tingling in CTS?

1st three digits

When does a pt with CTS get pain?

Night time

CTS causes weakness to what muscle?

Opponens pollicis (Ape hand deformity)

What splint is good for CTS?

Cock-up splint

What occupations cause Pronator Teres Syndrome?

Carpenters or mechanics

What nerve gets entrapped with Pronator Teres Syndrome?

Anterior Interosseous

Where does the ulnar nerve peripherally get compressed?

Tunnel of Guyon (Hook of hamate) or cubital tunnel on elbow

What deformity is seen with ulnar nerve entrapment?

Claw hand

Erbs Palsy (waiter's tip) is what levels?

C5-C6

Klumpke's Paralysis is what levels?

C8-T1

What fingers get affected by radial nerve entrapment?

Posterolateral 3.5

What can tight jeans/belt cause?

Meralgia Paresthetica

Foot drop is due to entrapment of what nerve?

Common peroneal

What are the sites that can entrap the sciatic nerve?

Pelvis, hip, and popliteal fossa

Where does a pt complain of pain with Morton's Neuroma?

In between third and fourth metatarsals

What syndrome can develop with deep peroneal nerve entrapment?

Anterior Compartment Syndrome (tib ant, ext hallucis longus, ext digit longus, peroneus tertius)

A deformity in which the fingertip is curled in and cannot straighten itself, usually result of injury?

Mallet Finger

What is Swan Neck deformity? What causes it?

Hyperflx of DIP

Hyperext of PIP

RA causes it

What is Boutonniere Deformity? What causes it?

Hyperext of DIP and Hyperflx of PIP

RA causes it

Abnormal thickening underneath the skin of the palm and fingers. Causes last two fingers to curl into palm:

Dupuytren's COntracture

When a finger becomes locked in a flexed position due to inflammation of tendons that flx finger, this is known as what?

Trigger Finger

DeQuervain's Tenosynovitis is due to inflammation of what?

Abductor pollicis longus and ext pollicis brevis

Amyotrophic Lateral Sclerosis aka:

Lou Gehrig's disease

ALS affects what two things?

Corticospinal tract and anterior horn

Where are LMNL and UMNL found with ALS?

LMNL in arms and UMNL in legs

Where does ALS begin?

hands and feet

Posterolateral Sclerosis/Combined Systems Disease is due to degeneration of what two things?

Posterior columns and corticospinal tracts

A glove and stocking paresthesia is prevalent in what condition?

PLS/Combined Systems Disease

What disease is caused by a B12 deficiency?

PLS/Combined Systems Disease

A hemisection (partially severed) spinal cord usually caused by what injury?

Brown-Sequard

With Brown Sequard Syndrome, what gets lost?

Ipsilateral motor fnx and dorsal columns (proprioception)

Contralateral spinothalamic (pain and temp)

Non progressive motor disorder of the cerebral cortex due to anoxia to the brain prenatally or during brith trauma:

Cerebral Palsy

What kind of symptoms are experienced with Cerebral Palsy?

Scissor gait

Spastic paralysis

Athetoid movements

Normal intelligence

What are the symptoms found with Parkinson's disease?

Resting tremor

Mask-like face

Festinating gait

Cogwheel/lead pipe rigidity

Bradykinesia

What is a syndrome that is a result of a recent immunization or recent flu infx?

Guillain Barre Syndrome

Gullain-Barre Syndrome begins where?

Legs

When is a pt likely to die with Gullain Barre Syndrome?

When it reaches the diaphragm

Tabes Dorsalis is a result of what disease?

Tertiary Syphilis

What gets wasted away with Tabes Dorsalis?

Posterior columns

What kind of gait is present with Tabes Dorsalis?

Slappage

Erb Duchenne/Muscular Dystrophy is MC in whom?

Boys aged 3-7

What kind of gait is present in Muscular Dystrophy?

Waddling gait

Where is weakness found with Erb Duchenne?

Proximally

What lab finding is increased with Erb Duchenne (think macho muscle)?

CPK-MM

Hereditary condition that affects both motor and sensory nerves:

Charcot Marie Tooth Disease

What is degenerated with Alzheimer's?

Cortex

Huntington's Chorea is MC in what ages?

35-44