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Questions and Answers
What is a common presentation when the parietal lobe is compromised?
What is a common presentation when the parietal lobe is compromised?
What symptom should raise suspicion for multiple sclerosis?
What symptom should raise suspicion for multiple sclerosis?
Which of the following describes Guillain-Barré syndrome?
Which of the following describes Guillain-Barré syndrome?
What physical condition might lead to compromise in the area of the fibular head?
What physical condition might lead to compromise in the area of the fibular head?
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What is Hansen's disease also known as?
What is Hansen's disease also known as?
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Which condition is characterized by demyelination affecting both motor and sensory pathways?
Which condition is characterized by demyelination affecting both motor and sensory pathways?
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What might be the consequence of prolonged compression from cross-legged sitting?
What might be the consequence of prolonged compression from cross-legged sitting?
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What is the general nature of Guillain-Barré syndrome?
What is the general nature of Guillain-Barré syndrome?
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What is the first location to begin the sensory testing of the upper extremity?
What is the first location to begin the sensory testing of the upper extremity?
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During joint position testing, which position typically corresponds to joint extension?
During joint position testing, which position typically corresponds to joint extension?
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What abnormal response can indicate a sensory impairment during temperature discrimination testing?
What abnormal response can indicate a sensory impairment during temperature discrimination testing?
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How should the healthcare provider perform the temperature sensation test?
How should the healthcare provider perform the temperature sensation test?
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What is the purpose of demonstrating joint positions to the patient before testing?
What is the purpose of demonstrating joint positions to the patient before testing?
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What should the examiner avoid doing while performing temperature sensation tests?
What should the examiner avoid doing while performing temperature sensation tests?
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What action should the examiner take if both extremities are affected?
What action should the examiner take if both extremities are affected?
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Which of the following is not considered an abnormal response during sensory testing?
Which of the following is not considered an abnormal response during sensory testing?
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What is the primary purpose of gently touching the patient’s skin during a light touch assessment?
What is the primary purpose of gently touching the patient’s skin during a light touch assessment?
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What spinal tract is primarily involved in transmitting the sensation from light touch?
What spinal tract is primarily involved in transmitting the sensation from light touch?
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Why should clinicians avoid using the other hand to stabilize the limb being tested?
Why should clinicians avoid using the other hand to stabilize the limb being tested?
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Which area is recommended to perform a trial test before formal assessment?
Which area is recommended to perform a trial test before formal assessment?
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If a patient does not register a touch after the second attempt, what should be recorded?
If a patient does not register a touch after the second attempt, what should be recorded?
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What sensation might a patient report during a light touch assessment?
What sensation might a patient report during a light touch assessment?
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What is the recommended action if the touch is misapplied in a sweeping motion?
What is the recommended action if the touch is misapplied in a sweeping motion?
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What is the primary purpose of testing graphesthesia?
What is the primary purpose of testing graphesthesia?
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What patient preparation step is crucial before beginning the light touch assessment?
What patient preparation step is crucial before beginning the light touch assessment?
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Which method is recommended for beginning point localization testing?
Which method is recommended for beginning point localization testing?
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What distance apart do individuals normally need to discriminate between two separate points?
What distance apart do individuals normally need to discriminate between two separate points?
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What should be done if the patient is inaccurate in identifying drawn numbers?
What should be done if the patient is inaccurate in identifying drawn numbers?
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Which area of the body can be tested for point localization?
Which area of the body can be tested for point localization?
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What sensory function must remain intact for accurate point localization testing?
What sensory function must remain intact for accurate point localization testing?
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What term refers to the inability to recognize numbers drawn on the skin?
What term refers to the inability to recognize numbers drawn on the skin?
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What is a key requirement for performing the graphesthesia test effectively?
What is a key requirement for performing the graphesthesia test effectively?
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What is the primary purpose of assessing protective sensation in patients?
What is the primary purpose of assessing protective sensation in patients?
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How are the monofilaments classified in terms of sensitivity?
How are the monofilaments classified in terms of sensitivity?
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What is the appropriate angle for placing the monofilament during testing?
What is the appropriate angle for placing the monofilament during testing?
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What is the main distinction between proprioception and kinesthesia?
What is the main distinction between proprioception and kinesthesia?
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For how long should pressure be maintained on the skin when using a monofilament?
For how long should pressure be maintained on the skin when using a monofilament?
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Why should distal segments not be held on the ventral and dorsal aspects during testing?
Why should distal segments not be held on the ventral and dorsal aspects during testing?
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What is a sign that a patient might be at risk for developing foot ulcers?
What is a sign that a patient might be at risk for developing foot ulcers?
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What should a patient do during the joint position test?
What should a patient do during the joint position test?
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Which of the following statements is true regarding the assessment of protective sensation?
Which of the following statements is true regarding the assessment of protective sensation?
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What are the implications of testing enough areas during the protective sensation assessment?
What are the implications of testing enough areas during the protective sensation assessment?
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Which statement about testing positions is incorrect?
Which statement about testing positions is incorrect?
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What is important to avoid when applying the monofilament during protective sensation testing?
What is important to avoid when applying the monofilament during protective sensation testing?
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What is the purpose of assessing limb position and muscle action?
What is the purpose of assessing limb position and muscle action?
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Which of the following tests does not require motor activity from the patient?
Which of the following tests does not require motor activity from the patient?
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Why is it important to allow full access to the assessment areas?
Why is it important to allow full access to the assessment areas?
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What happens if position sense is normal in distal areas during assessment?
What happens if position sense is normal in distal areas during assessment?
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Study Notes
Neuromuscular Examination
- Introduction: The sensory system receives and interprets information from the surrounding environment, including visual, auditory, taste, smell, and somatosensory information.
- Somatosensory Function: Includes light touch, temperature, pain, vibration, joint position, and discriminative sensation. Loss of this function can impact self-care and injury prevention.
- Fundamental Concepts: Peripheral receptors in the skin, muscles, ligaments, or joints transmit stimulus information to the spinal cord via afferent nerves. Messages ascend either through posterior columns (for fine touch, vibration, and position) or the spinothalamic tract (for crude touch, pain, and temperature).
- Spinal Nerve Root Integrity: 31 pairs of spinal nerves exit the spinal cord at intervertebral foramina. Each nerve root has sensory (dermatome) and motor (myotome) components.
- Dermatomes: Specific areas of skin supplied by a single nerve root. Testing commonly involves light touch.
- Myotomes: Muscles and muscle groups supplied by a single nerve root. Testing involves assessing strength against resistance.
- Deep Tendon Reflexes (DTRs): Monosynaptic reflexes, involving one afferent and one efferent component. Evaluated for strength, graded on a scale of 0-4+. Abnormal findings can indicate CNS or PNS damage. Side-to-side differences are significant.
- Coordination: Involves adequate joint range of motion, strength, neural pathways, and cognitive processing. Cerebellar dysfunction is a common cause of coordination difficulties.
- Cranial Nerve Assessment: 12 pairs of cranial nerves that emerge from the forebrain and brainstem. Each has unique sensory, motor, or combined functions.
- Upper Motor Neuron (UMN) Tests: Evaluating for increased muscle tone/spasticity, hyperactive reflexes, and pathological reflexes. Tests include assessing muscle tone (resistance to passive movement), deep tendon reflexes (strength), and pathological reflexes (e.g. Babinski, Hoffmann).
- Important Considerations: Be aware of individual variation, potential impact of medications, cognitive status, or emotional factors when evaluating coordination, reflexes, or sensation. Professional evaluation and referral are crucial when atypical findings emerge.
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