Tina Jones Neurological Shadow Health Review Questions
To check the spinal levels L2, L3, and L4 in Tina, which reflexes deep in the tendon would need to be tested?
Correct: The knee-jerk deep tendon reflex involves the sensory and motor nerve fibers linked with spinal sections L2, L3, and L4. Locating abnormal reflexes might help in pinpointing neurological issues in the spine.
– Achilles
– Biceps
– Knee (Correct Answer)
– Triceps
Imagine you were about to flush a Foley catheter of a patient who has a spinal cord injury at T4 in a urology clinic. When you moved the leg bag, the patient suddenly turned red and started sweating above the nipple line. What could be happening?
Correct: Autonomic dysreflexia is a sudden rise in blood pressure due to the sympathetic and parasympathetic nervous systems reacting to a painful stimulus below the spinal injury site. Other signs include slow heart rate, nervousness, blurred vision, headache, redness, and sweating. To resolve the condition, the painful stimulus (pulling the Foley catheter) must be relieved.
– Painful swallowing
– Feverish reaction
– Unexplained spinal reaction
– Autonomic dysreflexia (Correct Response)
Which of these is not a common sign of Parkinson’s disease?
Correct: Parkinson’s disease shows tremors at rest, slow movements, jerky rigidity, trouble balancing, shuffling gait, lack of facial expression, reduced arm swinging, and various psychological issues like sadness, fear, and sleep problems.
– Lack of facial expression
– Shuffling gait
– Jerky rigidity
– Tremors when intending to move (Correct Response)
Name at least three ways to check cerebellar function during a physical examination.
Student Response: 1. Walking heel to shin 2. Touching nose with finger 3. Checking walking and balance
Model Note: The cerebellum helps in smooth and precise coordination of voluntary movements. You can check cerebellar function by evaluating gait and instructing the patient to do finger-to-finger, finger-to-nose, heel-to-shin, fast alternating movements, and Romberg tests.
If Tina had a fever and sensitivity to light, you would need to check for meningitis. Explain how you would test for Kernig’s sign.
Student Response: Meningeal irritation is detected using the Kernig’s sign test. This involves bending the leg at the knee and hip when the patient is lying down, creating a right angle with the bent knee, then trying to straighten the leg at the knee. If this causes pain and resistance in the lower back, it indicates a positive Kernig’s sign, suggesting meningeal irritation.
Model Note: The Kernig’s sign test is used to detect meningeal irritation. To perform it, bend the leg at the knee and hip while the patient lies down, making a right angle with the bent knee. Then attempt to straighten the leg at the knee. Resistance and pain in the lower back indicate a positive Kernig’s sign, suggesting meningeal irritation.
Suppose you found decreased sensation in Tina’s left foot when assessing pain sensation. How would you proceed with your examination?
Student Response: It’s important to check both sides starting from Tina’s feet and moving up her legs because she’s at risk for diabetic neuropathy. Sensations to test include dull, sharp, and light touch, vibration, pinpointing, joint positioning, and temperature. It’s also crucial to assess the extent of her neuropathy, so superficial and deep tendon reflexes of the feet, ankles, and knees should be checked.
Model Note: Because Tina is at risk for diabetic neuropathy, it’s vital to test sensations on both sides, starting from her feet and moving up her legs. Sensation tests should cover sharp and dull touch, light touch, vibration, temperature, pinpointing, and joint positioning. Additionally, superficial and deep tendon reflexes of the feet, ankles, and knees should be evaluated to determine the extent of her neuropathy.
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?
- 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?
- Odynophagia
- Febrile reaction
- Idiopathic spinal reaction
- Autonomic dysreflexia (Correct Response)
Which of the following is not a common symptom of Parkinson’s disease?
- 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.
