ONA Lecture Midterm 1

Onset of injury

What does the O stand for in the acronym "OPQRST"?

Palliative/Provocative

What does the P stand for in the acronym "OPQRST"?

Quality of pain

What does the Q stand for in the acronym "OPQRST"?

Radiation/Referral of pain

What does the R stand for in the acronym "OPQRST"?

Severity of pain

What does the S stand for in the acronym "OPQRST"?

Temporal factors (time of day, days of the week, etc.)

What does the T stand for in the acronym "OPQRST"?

Radiculopathy

What term describes a neurological loss from spinal nerve root compression or ischemia with numbness and/or weakness?

Patient history

The majority of information needed to make a clinical diagnosis comes from what?

The treatment must match the diagnosis

What is Dr. Homack's 1st Law?

Every treatment plan has an expiration date

What is Dr. Homack's 2nd Law?

Differential diagnosis

What term describes the list of conditions the patient may have based on the symptoms exhibited and the results of the exam?

Working Diagnosis

What is the presumed cause of the patient's condition, arrived at by evaluating all assessment information thus far obtained while conducting further diagnostic testing to definitively diagnose the illness?

Thunderclap or sentinel headache

What is a clinical red flag that you need to be aware of when taking a history?

-Hypotonia

-Dysmetria

-Ataxia

-Pendular reflex

-Disdiadokinesia

-Rebound phenomenon

What are the possible symptoms associated with a cerebellar dysfunction?

-Anterior lobe controls the torso in relation to the lower extremity

-Posterior lobe controls the head relative to the torso

Why should the patient be in a standing position for cerebellar testing?

Left side is usually higher due to being closer to the heart

Why should you take a blood pressure on the left side first?

Difference of 10mmHg or greater BP from one side to the other

What blood pressure finding may indicate a cerebellar problem?

Between T1-L3 in the lateral horn

Where in the body are the intermediolateral nucleus located?

Pendular deep tendon reflex and Rag doll posture

What two procedures can you use to test for hypotonia?

Left-sided cerebellum lesion

A patient is performing the Babinski Weil and drifts to the left going forward and going backwards. Where do you expect the lesion to present?

Left CN VIII: Vestibulocochlear nerve

A patient is performing the Babinski Weil and drifts to the left going forward and drifts right going backwards. Where do you expect the lesion to present?

-Eyes open

-Shoes and socks off with feet as close together without touching

-Arms flexed forwards at 90 degrees

When performing Romberg's position, how must the patient be set up?

Diadochokinesia

The ability to perform rapid, alternating movements is termed?

Dysdiadochokinesia (DDK)

The impaired ability to perform rapid, alternating movements is termed?

Adiadochokinesia

The complete inability to perform rapid, alternating movements is termed?

Test both upper and lower extremity

What is the most important thing when testing for DDK?

-Finger tapping (piano playing)

-Alternating hand slaps

-Foot tapping

-Seated marching

What tests can be performed to look for DDK?

-Patient's finger to own nose

-Patient's nose to doctor's finger

-Heel to knee

-Patient's toe to doctor's finger

A patient complains about reaching out for an object and can never seem to grab the object. What tests can you perform to test for this phenomenon?

Patient must move slowly to bring out a positive finding

What is important for the patient to do when performing tests for dysmetria?

False negative on blood tests

What is important about a patient that could possibly have Lyme Disease?

Neck pain and stiffness

What is the most common symptoms of a vertebral artery dissection?

-Document medical necessity to order tests

-Make an accurate diagnosis

-Establish baselines for outcome measures

What are the 3 most important reasons to perform examinations?

Dysdiadochokinesia

After a blow to the head, a 42 year old drummer notices his left hand has difficulty maintaining rhythm. This is an example of what condition?

-Clonus

-Hypertonia

-Absent superficial reflexes

-Clasp-knife spasticity

What are some symptoms that are associated with an Upper Motor Neuron Lesion (UMNL)?

-Dorsal

-Afferent

-Sensory

-In going

-Posterior

What are some of the general features of the Dorsal columns?

-Ventral

-Efferent

-Motor

-Out going

-Anterior

What are some of the general features of the UMN?

Lower extremity

If pressure is being applied to outside lamination of the spinal cord, what part of the body is most affected?

Wrist or Ankle

What two body parts are good to test for clonus?

+4 (transient clonus) and +5 (sustained clonus)

What grades on the Weller reflex grading system are always pathological?

Jendrassik Maneuver

What term describes the use of another motor movement like clenching the jaw to endure a patellar reflex that wasn't present before?

Extension of the fingers

What pathological reflex would you find present if you perform the Gordon's test in the upper extremity?

Briskly compress the pisiform

How do you perform Gordon's test in the upper extremity?

Briskly compress the calf

How do you perform Gordon's test in the lower extremity?

Upward toe sign

What pathological reflex would you find present if you perform Gordon's test in the lower extremity?

Extension of the fingers

What pathological reflex would you find present if you perform Chaddock's test in the upper extremity?

Briskly compress the anterior surface of the wrist

How do you perform Chaddock's test in the upper extremity?

Draw a C around the lateral maleolus of the foot

How do you perform Chaddock's test in the lower extremity?

Upward toe sign

What pathological reflex would you find present if you perform Chaddock's test in the lower extremity?

Flexion of the fingers

What pathological reflex would you find present if you perform Rossolimo's test in the upper extremity?

Quickly taps on the distal end of the 3rd metacarpal on the palmer surface of the hand

How do you perform Rossolimo's test in the upper extremity?

Quickly tap on the distal end of the 3rd metatarsal on the plantar surface of the foot

How do you perform Rossolimo's test in the lower extremity?

Flexion of the toes

What pathological reflex would you find present if you perform Rossolimo's test on the lower extremity?

Flexion of the fingers

What pathological reflex would you find present if you perform Tromner's test in the upper extremity?

Support the patient's hand and briskly strike the distal end of the 3rd and 4th digits into extension

How do you perform Tromner's test in the upper extremity?

Support the patient's hand pronated and flex the distal end of the 3rd digit into flexion and then let it go

How do you perform Hoffman's test in the upper extremity?

"OK" sign

What pathological reflex would you find present if you perform Hoffman's test in the upper extremity?

-Gorgon's

-Chaddock's

-Rossolimo's

-Tromner's

-Hoffman's

What tests can be performed in the upper extremity to look for pathological reflexes?

-Plantar

-Gordon's

-Chaddock's

-Oppenheim's

-Schaefer's

-Rossolimo's

What tests can be performed in the lower extremity to look for pathological reflexes?

Briskly stroke the lateral side of plantar surface of foot from heel towards the toes and then towards the medial foot

How do you perform the Plantar reflex in the lower extremity?

Upgoing toe sign

What pathological reflex would you find present if you perform Oppenheim's test in the lower extremity?

Stroke proximally to distally along the tibia

How do you perform Oppenheim's test in the lower extremity?

Briskly squeeze the Achille's tendon

How do you perform Schaefer's test in the lower extremity?

Upgoing toe sign

What pathological reflex would you find present if you perform Schaefer's test in the lower extremity?

-Snout reflex

-Glabellar reflex

-Palmomental reflex

What test can be performed to look for pathological reflexes in the face?

Curling of the ipsilateal upper lip

What pathological reflex would you find present if you perform the Snout Reflex?

Briskly tap on the one side of the phrenoulum, then the other

How do you perform the Snout reflex?

Wincing expression of the face and closing of the eyes

What pathological reflex would you find present if you perform the Glabellar reflex?

Briskly tap on the Glabella

How do you perform the Glabellar reflex?

Curling of or pursing of the upper lip

What pathological reflex would you find present if you perform the Palmomental reflex?

Briskly scrape along the thenar eminence

How do you perform the Palmomental reflex?

-Plantar reflex

-Corneal reflex

-Gag reflex

-Abdominal reflex

What superficial reflexes can be present during testing and still be considered normal?

Anterior corticospinal tract and lateral corticospinal tract

Upper motor neuron signs may be due to the compression of what portion of the spinal cord?

Present

How are normal superficial reflex responses properly recorded in health care records?

-B1 deficiency

-Multiple Sclerosis

-B12 deficiency

-HIV/Syphillis

-Lyme Disease

-Guillain-Barre

-Spinal canal stenosis

What are some possible conditions to cause lesion and focal demyelination for the spinal cord?

Eyes are closed

When performing dorsal column testing, what most the patient do before testing?

Appallesthesia

What term describes the loss of ability to sense vibration?

128 Hz tuning fork

What type of tuning fork must be used to test for Appallesthesia?

1. 2nd digit

2. Radial styloid

3. Olecranon

-AC joint/mid-clavicle

What is the progression of body parts you test for Pallesthesia test in the upper extremity?

1. 2nd toe

2. Medial malleolus (lateral if you can't get to it)

3. Tibial tuberosity

4. ASIS/greater trochanter

What is the progression of body parts you test for Pallesthesia in the lower extremity?

Romberg's test or Positional change in digits

What tests can be perform to test for proprioception?

-Patients eyes closed

-Patients shoes and socks off standing with feet as close together without touching

-Have patient flex arms out at 90 degrees and hold for 10 seconds

How do you perform Romberg's Test?

-Patient's eyes closed

-Hold the the side of patients digits and ask if you moved the digit "towards their nose" or "towards their toes"

How do you perform Positional Change in Digits?

-Abadies

-Biernacki's

What tests can be performed to test for deep pressure?

-Patient's eyes closed

-Squeeze the Achilles tendon with a soft and harder pressure and ask the patient to distinguish between the two

How do you perform Abadie's test?

-Patient's eyes closed

-Squeeze the triceps tendon with a soft and harder pressure and ask the patient to distinguish the two

How do you perform Biernacki's test?

Stereognosis

What term describes the ability to recognize objects by feeling their form, size, and weight while the eyes are closed?

Only upper extremity

Can stereognosis be tested on the upper extremity and lower extremity?

Graphesthesia

What term describes ability to recognize writing on the skin (letters or numbers) purely by the sensation of touch?

Yes, both upper and lower extremity

Can graphesthesia be tested on the upper and lower extremities?

-Cogwheel rigidity

-Leadpipe rigidity

-Festinating gait

-Resting tremors

What signs and symptoms are usually associated with a basal ganglia lesion?

-No weakness

-Not velocity dependent

-Resistant in both directions

-Cogwheel/leadpipe rigidity

When testing for tone across the elbow for a basal ganglia lesion, what information should you be aware of?

-Weakness

-Clasp-knife spasticity

-Velocity dependent

-Only one direction

When testing for tone across the elbows for an UMN lesion, what information should you be aware of?

-Festinating gait

-Cogwheel rigidity

-Leadpipe rigidity

What other symptoms might be seen in a patient demonstrating resting tremors

Cribiform plate

Where does CN I exit the skull?

Anosmia

What term describes the lack or decrease in sense of smell

Parosmia

What term describes the distortion of the sense of smell, as in smelling an odor that isn't present?

Cacosmia

What term describes the perception of foul odor or stench when none exists?

Optic foramen

Where does CN II exit the skull?

OS

When referring to the Snelling eye chart, what is the term for the left eye?

OD

When referring to the Snelling eye chart, what is the term for the right eye?