Tina Jones Neurological Shadow Health Review Questions

To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested?

 Correct: The patellar deep tendon reflex involves the sensory and motor nerve fibers associated with spinal segments L2, L3, and L4. Location of abnormal reflexes may be helpful in identifying neurological pathologies of the spine.
  • Achilles
  • Biceps
  • Patellar (Correct Response)
  • Triceps

Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening?

 Correct: Autonomic dysreflexia is the sudden increase in blood pressure caused by dysregulation of sympathetic and parasympathetic nervous systems reacting to a noxious stimulus below the site of spinal injury. Other symptoms include bradycardia, anxiety, blurred vision, headache, flushing, and sweating. The noxious stimulus (pulling of the Foley catheter) should be alleviated to resolve the condition.
  • Odynophagia
  • Febrile reaction
  • Idiopathic spinal reaction
  • Autonomic dysreflexia (Correct Response)

Which of the following is not a common symptom of Parkinson’s disease?

 Correct: Parkinson’s disease is characterized by tremors at rest, bradykinesia, cogwheel rigidity, postural instability, festination, lack of facial expression, reduced arm swing, autonomic and neuroendocrine dysfunctions, and a variety of psychological issues such as depression, anxiety, and sleep disturbances.
  • Lack of facial expression
  • Festination
  • Cogwheel rigidity
  • Intention tremors (Correct Response)

Name at least three ways to assess cerebellar function during a physical exam.

Student Response: 1. Heel-to-shin test 2. The finger-to-nose test 3. Gait and balance assessment

Model Note: The cerebellum is responsible for smooth and accurate coordination of voluntary movements. You can test cerebellar function by assessing gait and by instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements, and Romberg tests.

If Tina had a fever and photophobia, you would have had to test for meningitis. Describe how you would have tested for the Kernig’s sign.

Student Response: meningeal irritation is identified using a test for Kernig’s sign and this is done by flexing the leg at the knee and hip when the patient is supine thus generating a right angle with the flexed knee, and then try to straighten the leg at the knee. If this results in pain and resistance in the lower back, it shows a positive Kernig’s sign indicating the presence of meningeal irritation.

Model Note: The test for Kernig’s sign is used to identify meningeal irritation. To perform the test, flex the leg at the knee and hip when the patient is supine, making a right angle with the flexed knee. Then attempt to straighten the leg at the knee. Resistance and pain in the lower back constitute a positive Kernig’s sign, indicating meningeal irritation.

Suppose you assessed pain sensation over Tina’s left foot, and noticed that she had decreased sensation. How would you have proceeded with your exam?

Student Response: It is important to assess bilateral sensations starting from Tina’s feet and proceeding up the legs because she is at risk for diabetic neuropathy and the sensation should include dull, sharp, and soft touch, vibration, point location, positioning of joints, and temperature. It is also important to determine the extent of her neuropathy and therefore, superficial and deep tendon reflexes of the feet, ankles, and knees should be performed.

Model Note: Because Tina is at risk for diabetic neuropathy, it is important to assess bilateral sensations starting at her feet and proceeding up the legs. Sensation tests should include sharp and dull touch, light touch, vibration, temperature, point location, and positioning of joints. Superficial and deep tendon reflexes of the feet, ankles, and knees should also be assessed to determine the extent of her neuropathy.