Special tests

Question 1

Sensory Exam.pain.which systems?

Answer 1

anterolateral system.caries stimulus from trunk and limbs.

ventral trigeminothalamic tract.carries stimulus(and other sensations) from face.

Question 2

Sensory Exam.anterolateral system.How it do?

Answer 2

crosses the spinal cord, ascends laterally/anteriorly contralaterally.stops in thalamus.then goes to cerebral cortex

Question 3

Sensory Exam.Ventral trigeminothalamic tract.How it do?

Answer 3

crosses to opposite side of medulla.stops mainly in thalamus.then info to the cerebral cortex.

Question 4

sensory exam.pain procedure?

Answer 4

explain.demo feel.pt’s eyes closed.random alternate sharp/dull.pt responds sharp/dull.start in areas lacking sensation.then to normal areas.check same areas on other side.find area with bad sensation,look at proximal/distal areas to see when it gets normal again.compare areas with normal sensed areas like face/neck.map areas of 0absend/1impaired/2normal.dispose sharps in appropriate (sharps) container.

Question 5

referred pain

Answer 5

pain in areas of body that away from the site of pathology.in many cases,pain is referred to more superficially(skin) located structures from visceral structures(heart)

Question 6

sensory exam.light touch.which systems?

Answer 6

anterolateral.trigeminal lemniscus.dorsal column/medial lemniscus pathway

Question 7

Sensory exam.anterolateral system.which stimuli?

Answer 7

pain.non discriminative.temperature

Question 8

type of peripheral receptors.

Answer 8

free nerve endings and c fibers(pain), merkle discs, ruffini endings, hairfollicle receptors (light touch),thermoreceptors (temperature),meissner and pacinian corpuscles (vibration)

Question 9

dorsal column/medial lemniscus pathway

Answer 9

within the spinal cord first order axons stop in the mdulla.axons of 2nd order neurons in medulla cross and ascend the brain stem contralaterally.then stops in thalamus.then goes to cerebral cortex.

Question 10

sensory exam.light touch.procedure?

Answer 10

cotton.pt supine.pts eyes closed.pt says yes each time stimulus felt.jus touch skin,do not swipe skin.start in bad areas first,progress to good.using “time point” A(touched/not touched) and B(not touched/touched).apply in random order.”do you feel the pressure now or now?check same areas on other side.find area with bad sensation,look at proximal/distal areas to see when it gets normal again.compare areas with normal sensed areas like face/neck.map areas of 0absend/1impaired/2normal.

Question 11

sensory exam. monofilament testing.procedure?

Answer 11

supine.eyes closed.forced choice response{do you feel presure now(point A) or now(point B)?}Random order.push monofilament until the shaft of it bends and should maintain this contact for 1.5 sec.plantar surfaces of at least the great toe and the 3rd and 5th metatarsal heads.failure to detect stimulus=sensory impairment/increased risk for plantar ulcers in patients with diabetes.

Question 12

hyperesthesia

Answer 12

a heightened resonse to sensory input

Question 13

hyperpathia

Answer 13

extreme sensitivity to pain

Question 14

neuralgia

Answer 14

shocklike pain along a dermatome or peripheral nerve distribution

Question 15

dysesthesia/paresthesia

Answer 15

numbness, tingling,burning in the absence of stimulation

Question 16

sensory exam.temperature

Answer 16

demo feel of two test tubes in good sensed area.hot 45degrees celsius/cold(crushed ice and water).very high temp are more associated with pain.neck is an area where sensation is usually good.pts eyes closed supine.have pt respond with “hot” or “cold”remains in contact with skin 2 secs.irregular order.start in areas lacking sensation.then to normal areas.check same areas on other side.find area with bad sensation,look at proximal/distal areas to see when it gets normal again.compare areas with normal sensed areas like face/neck.map areas of 0absend/1impaired/2normal

Question 17

sensory exam.vibratory sensation. procedure?

Answer 17

use a 128 Hz tuning fork, and non vibratin tuning fork(to discriminate that the pt is feeling the vibration and not just the sensation of the fork).strike the tins with opposite hand.apply perpendicularto bony prominences and hold it there.pt says when it is felt(trialA) and when it has stopped(trial B)(on-off method). at least 4 trials done on each body prominence and the number of correct responses out of he total trials assigned as the patients score.for peripheral neuropathy,each great toes is tested for four trials. 3/8 or lowere=peripheral neuropathy 7/8 8/8=ruled out