Podcast
Questions and Answers
What is a common assessment method for evaluating muscle tone?
What is a common assessment method for evaluating muscle tone?
In the drop arm test, an arm that suddenly drops indicates hypotonia.
In the drop arm test, an arm that suddenly drops indicates hypotonia.
True
What method is used to assess muscle tone in myopathy by elevating the patient's shoulders?
What method is used to assess muscle tone in myopathy by elevating the patient's shoulders?
Gower's method
In a hypertonic patient, the arm during the drop arm test will __________.
In a hypertonic patient, the arm during the drop arm test will __________.
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Match the assessment methods with their descriptions:
Match the assessment methods with their descriptions:
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What kind of speech is characterized by explosive separation of syllables?
What kind of speech is characterized by explosive separation of syllables?
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Pseudobulbar palsy involves bilateral pyramidal tract lesions.
Pseudobulbar palsy involves bilateral pyramidal tract lesions.
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What is the term for decreased smell perception?
What is the term for decreased smell perception?
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Facial expression is affected by lesions of cranial nerve ______.
Facial expression is affected by lesions of cranial nerve ______.
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Match the cranial nerve to its function:
Match the cranial nerve to its function:
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Which type of speech is expressionless and monotonous?
Which type of speech is expressionless and monotonous?
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Which neurological condition is more common in the 3rd and 4th decades of life?
Which neurological condition is more common in the 3rd and 4th decades of life?
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Motor neuron disease (M.N.D.) is more common in females than in males.
Motor neuron disease (M.N.D.) is more common in females than in males.
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Dysphagia is typically associated with damage to the glossopharyngeal nerve.
Dysphagia is typically associated with damage to the glossopharyngeal nerve.
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What is the significance of handedness in neurological evaluations?
What is the significance of handedness in neurological evaluations?
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What condition causes difficulty in mastication due to abnormal face sensation?
What condition causes difficulty in mastication due to abnormal face sensation?
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In cases of peripheral neuropathy, a history of ________ is significant.
In cases of peripheral neuropathy, a history of ________ is significant.
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Which condition is associated with trauma leading to paraplegia?
Which condition is associated with trauma leading to paraplegia?
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Match the type of complaint with its category.
Match the type of complaint with its category.
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Urban areas have a higher prevalence of nutritional diseases than rural areas.
Urban areas have a higher prevalence of nutritional diseases than rural areas.
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What are the key factors to include in the present history of a patient?
What are the key factors to include in the present history of a patient?
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What is the expected response when tapping the glabella in a normal adult?
What is the expected response when tapping the glabella in a normal adult?
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In the case of hemiplegia, the paralysis is always on the opposite side of the body.
In the case of hemiplegia, the paralysis is always on the opposite side of the body.
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What type of reflex is tested by tapping the glabella?
What type of reflex is tested by tapping the glabella?
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In hearing tests, __________ testing involves comparing air conduction with bone conduction using a tuning fork.
In hearing tests, __________ testing involves comparing air conduction with bone conduction using a tuning fork.
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What sensation is examined on the anterior two-thirds of the tongue?
What sensation is examined on the anterior two-thirds of the tongue?
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Match the hearing test with its description:
Match the hearing test with its description:
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In a patient with Parkinsonism, blinking will stop after tapping the glabella multiple times.
In a patient with Parkinsonism, blinking will stop after tapping the glabella multiple times.
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What happens during the caloric test?
What happens during the caloric test?
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What is barognosis?
What is barognosis?
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Fasciculation is a spontaneous contraction of a single muscle fiber.
Fasciculation is a spontaneous contraction of a single muscle fiber.
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What should the position of a patient be during the observation for motor assessment?
What should the position of a patient be during the observation for motor assessment?
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True hypertrophy is associated with an increase in _______ power by muscle strength testing.
True hypertrophy is associated with an increase in _______ power by muscle strength testing.
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Match the types of involuntary movements with their description:
Match the types of involuntary movements with their description:
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What differentiates true hypertrophy from pseudo hypertrophy?
What differentiates true hypertrophy from pseudo hypertrophy?
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Recognition of texture involves differentiating among various _______ such as cotton and silk.
Recognition of texture involves differentiating among various _______ such as cotton and silk.
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Static tremors appear during movement and disappear at rest.
Static tremors appear during movement and disappear at rest.
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Study Notes
Neurological Sheet
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Personal History
- Name: Used to familiarize and document the patient.
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Age: Certain neurological diseases manifest at specific ages.
- Progressive muscular Dystrophy: Common in 1st & 2nd decades.
- MS: More prevalent in 3rd & 4th decades.
- Cerebrovascular strokes: Higher occurrence in 5th & 6th decades.
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Sex:
- Motor neuron disease (M.N.D.): More common in males.
- Migraine: More frequent in females.
- Contraceptive pills can cause headache and depression.
- Marital status: Consider implications for sterility, impotence, or stillbirths (as in syphilis).
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Occupation: Certain occupations are more susceptible to particular neurological disorders.
- Disc prolapse: Commoner in drivers.
- Lead neuropathy: More common in printers.
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Residence:
- Migraine: More prevalent in urban areas.
- Nutritional diseases: More common in rural areas.
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Special habits:
- Alcohol: Can lead to peripheral neuropathy.
- Smoking: Increases risk of cardiovascular diseases.
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Handedness:
- In right-handed individuals (over 90% of the population), the dominant hemisphere is the left.
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Chief Complaint:
- Document the patient's concerns in their own words.
- Order complaints based on perceived severity.
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Present History:
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Analyze the Complaint:
- Includes onset, course, duration, and sequence of events.
- Provide a chronological and detailed account of the neurological condition.
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Analyze the Complaint:
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Past History:
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Trauma:
- Severe trauma can cause paraplegia, quadriplegia, cauda lesions, and coma.
- Mild head trauma may lead to subdural hematoma in individuals with a history of alcoholism.
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Fever:
- Can be an indicator of meningitis, encephalitis, and myelitis.
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Diabetes Mellitus:
- Characterized by polyuria, polydipsia, polyphagia, and weight loss.
- Can lead to peripheral neuropathy, cranial nerve palsy, and impotence.
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Hypertension:
- Symptoms include headache, tinnitus, and epistaxis.
- Can result in hemiplegia, cerebral hemorrhage, and encephalopathy.
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T.B. :
- Signs include haemoptysis, night fever, night sweats, weight loss, appetite loss, and anti-TB drug intake.
- Can cause paraplegia (Potts).
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Trauma:
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Examination of the Cranial Nerves:
- Cranial nerves: Each nerve should be examined individually, focusing on function and symptom presentation in case of lesions.
- I- Olfactory Nerve: Sensory; Responsible for smell. Lesions may cause anosmia (loss of smell) and parosmia (distorted smell).
- II- Optic Nerve: Sensory; Responsible for vision. Lesions may result in decreased visual acuity and field defects.
- III, IV, VI- Ocular Nerves (Occulomotor, Trochlear, and Abducent): Motor and Autonomic (for eye movement). Lesions can lead to diplopia (double vision).
- V - Trigeminal Nerve: Sensory and Motor; Responsible for facial sensation, mastication, and jaw movement. Lesions may cause difficulty in mastication, abnormal facial sensation, and decreased jaw movement.
- VII - Facial Nerve: Sensory, Motor, and Autonomic; Responsible for facial expression, taste, and tear production. Lesions may cause facial drooping, difficulty with taste, and decreased tear production.
- VIII - Cochleo-Vestibular Nerve: Sensory; Responsible for hearing and balance. Lesions may cause hearing loss, tinnitus (ringing in the ears), and vertigo (dizziness).
- IX - Glossopharyngeal Nerve: Sensory, Motor, and Autonomic; Responsible for taste, gag reflex, and swallowing. Lesions may cause difficulties with swallowing, dysarthria (difficulty speaking), dysphonia (hoarseness), and nasal regurgitation.
- X - Vagus Nerve: Sensory, Motor, and Autonomic; Responsible for gag reflex, voice, and parasympathetic function. Lesions may lead to dysphonia, impaired swallowing, and nasal regurgitation.
- XI - Accessory Nerve: Motor; Responsible for shoulder movement and head rotation. Lesions may cause weakness in shoulder movement and head rotation.
- XII - Hypoglossal Nerve: Motor; Responsible for tongue movement. Lesions may cause tongue weakness, difficulty speaking, and tongue deviation.
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Motor Assessment: Focus on the following elements for proper motor assessment:
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Observation:
- State of muscle: Examine whether muscle is normal, wasted (atrophy), or hypertrophied.
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Muscle wasting: Describe wasting in detail.
- Affected region
- Unilateral or bilateral
- Symmetrical vs. asymmetrical
- Distal vs. Proximal
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Muscle hypertrophy: Distinguish between true and pseudo hypertrophy.
- True hypertrophy: Increase in muscle size AND strength.
- Pseudo hypertrophy: Increase in muscle size BUT decreased strength (common in myopathy).
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Fasciculation or fibrillation: Indications of an irritative motor neuron disorder.
- Fibrillation: Spontaneous contraction of a single muscle fiber (hardly visible).
- Fasciculation: Spontaneous contraction of a group of muscle fibers (visible and palpable).
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Involuntary movements: Describe chorea (uncontrollable jerking movements), athetosis (slow writhing movements), and tremors in detail.
- Static or dynamic: Does the movement occur at rest or during movement?
- Rhythmic or arrhythmic:
- What increases/decreases them: Note factors influencing the movements.
- Muscle Power: Assess the strength of specific muscle groups.
- Muscle Tone: Evaluate the resistance to passive movement.
- Reflexes: Perform both superficial and deep tendon reflexes.
- Range of Motion (ROM): Measure the flexibility of joints.
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Observation:
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Muscle Tone Assessments:
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Methods:
- Shaking
- Drop arm test
- Speed test
- Gower's method
- EMG biofeedback
- Passive movement
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Shaking Methods:
- Used for distal joints (wrist and ankle).
- Hold the limb above the joint and shake it.
- Hypertonia: Decreased resistance to shaking.
- Normal tone: Normal resistance to shaking.
- Hypotonia: Increased resistance to shaking.
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Drop arm test:
- Assess shoulder flexion or abduction.
- Start with the arm at 90 degrees.
- Release the arm.
- Normal: Initial drop followed by catching.
- Hypotonia: Sudden drop.
- Hypertonia: Slow descent or no descent.
- Speed test: Evaluates resistance to movement.
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Gower's method:
- Assess shoulder joint movement in myopathy.
- Elevate the patient's shoulders by grasping under the axilla.
- Normal: Shoulders reach ear level.
- Hypotonia: Shoulders elevate higher than normal, head drops between shoulders.
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EMG biofeedback: An objective measurement of muscle tone using H/M ratio.
- Normal H/M ratio: Around 1.
- Spasticity: Increased H/M ratio.
- Passive movement: Measure the resistance to passive movement.
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Methods:
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Important distinctions in motor assessment:
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Upper Motor Neuron (UMN) lesions:
- Distal more than proximal.
- Antigravity muscles affected (flexors of upper limbs and extensors of lower limbs).
- Hyperreflexia.
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Lower Motor Neuron (LMN) lesions:
- Proximal more than distal.
- Both muscle groups affected (but flexors more than extensors).
- Hyporeflexia.
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Upper Motor Neuron (UMN) lesions:
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Description
Explore the personal history factors that play a role in neurological diseases, including age, sex, marital status, occupation, and residence. Understand the prevalence of various conditions such as muscular dystrophy, migraines, and strokes in different demographics. This quiz aims to enhance your knowledge of how personal history contributes to neurological health.
