Answer: Spinal type of disorder. Conduction spinal syndrome????

Methodology for the study of muscle tone

A technique for studying knee reflexes is a blow with a hammer on the own ligament of the patella below the patella. The result is a contraction of the 4 head muscle of the thigh and extension of the lower leg (Arc L2-L4).

The technique for studying clonus of the foot is to hold the patient’s shin on the weight with one hand, and with the other hand to take the foot by the distal part and quickly extend it in the ankle joint. Clonuses are persistent and prolonged, quickly fading.

Methodology for the study of the pathological Babinski reflex – dashed irritation of the sole (extensor reflex) – abduction of the big toe, dilution of all the others in the form of a fan.

Task number 8

Patient Sh., aged 45, was admitted to the neurological department with complaints of unsteadiness when walking, impaired coordination and speech. In the neurological status, a decrease in muscle tone, intentional trembling, and ataxia were revealed during the heel-knee test on the right. Nystagmus, slurred speech. In the Romberg position, it deviates to the right.

Answer: Cerebellar ataxia. Dynamic. Damage to the cerebellar hemispheres.

Methodology for the study of the heel-knee test – the patient is offered to reach the heel of one leg to the knee of the other, and hold the heel along the lower leg down to the foot, then up to the knee. When the cerebellum is damaged, the heel slips and slips from the tibia to the sides. With a unilateral lesion – on the side of the lesion.

The technique for studying coordination in the Romberg pose is simple and complicated – they suggest standing with outstretched arms with open, then with closed eyes. Complicated test – 1. stand with one foot in front of the other (heel to toe), 2. stand with legs shifted, tilting your head to the sides, 3. stand on your toes, 4. stand on one leg.

The technique for studying diadochokinesis is to stretch your arms in front of you, spread your fingers and alternately do supination and pronation of the hands at the fastest possible pace. With a lesion – adiadochokinesis – movements are sweeping, slow, awkward. More pronounced on the affected side.

Definition of nystagmus – they suggest fixing the gaze on the hammer, which is taken to the sides. Their rhythmic twitching is observed (intentional trembling of the eyeballs – horizontal nystagmus). Stuart Holmes sign

Bend the patient’s hand in the elbow joint with clenched fists, resist, let go sharply, the patient hits his chest with his fist.

Task number 9

Patient Ya., 17 years old, has fast, arrhythmic, involuntary movements of the limbs and torso. She grimaces, smacks her lips, sticks out her tongue. The tone of the muscles of the extremities is reduced.

Answer: Choreic hyperkinesis. The defeat of the external member of the lenticular nucleus (shell), or the defeat of the cerebellar rubro-thalamic connections.

Methodology for the study of muscle tone in the upper limbs

The method of studying the symptom of “eyes and tongue” – they ask the patient to stick out his tongue and close his eyes at the same time, the patient fails to keep his tongue in this position for 10-15 seconds.

Gait study – suggest walking around the room forward and backward in one line, and sides (flank gait) with open and closed eyes. Drunken gait – legs wide apart, swaying uncertainly. The defeat of the worm is swaying in different directions. The defeat of the hemispheres – in the direction of defeat.

Methodology for the study of Westphal’s symptom – the phenomenon of the foot – the doctor maximally unbends the foot of the patient lying on his back. Normally, the foot returns to its original position, with akinetic-rigid syndrome, the foot freezes in the given lesion. With hyperkinesis, the patient cannot hold his leg for a long time due to excessive movements.

Task number 10

Patient D., aged 64, walks with small steps, the body is tilted forward, the arms and legs are bent. The face is mask-like, the speech is quiet, monotonous. Hypertonicity, stereotypical “counting coins” type tremor.

Answer: akinetic-rigid syndrome (amyostatic, parkinsonism). The defeat of the pale ball and black substance. Against the background of general stiffness and poverty of voluntary movements, a small rhythmic tremor of the hands is often observed, resembling the movement of fingers when counting coins or rolling pills. Sometimes shaking head yes-yes, no-no. Trembling of the eyelids, tongue, lower jaw, less often of the body. Trembling at rest, increases with excitement, subsides with purposeful movement.

Methodology for the study of statics and gait –

Handwriting research technique – in case of akinetic-rigid syndrome – small, fuzzy, fading – micrography.

Method for the study of dysmetria – the patient is offered to take the object from the table and then return it to its place. At the same time, excessively sharp, disproportionate movements on the side of the lesion are detected.

The method of diadochokinesis research is to stretch your arms in front of you, spread your fingers and alternately do supination and pronation of the hands at the fastest possible pace. With a lesion – adiadochokinesis – movements are sweeping, slow, awkward. More pronounced on the affected side.

The Foix-Thevenard phenomenon is an incomplete extension of the lower leg in the knee joint in a patient lying on his stomach, after the lower leg was held in the position of extreme flexion, which indicates extrapyramidal rigidity.

Task #11

A patient with signs of spastic tetraplegia was admitted to the emergency room.

Answer: Damage to the spinal cord at the level of C3-C4. Trauma of the cervical spinal cord.

Methodology for the study of muscle strength in the upper limbs

Methodology for studying the tone of the lower extremities

Determine the reflexes: ulnar-extensor – a blow to the tendon of the triceps muscle of the shoulder, which leads to its contraction and extension of the forearm in the elbow joint. Reflex arc: musculocutaneous nerve, VII and VIII cervical segments and roots of the spinal cord., ulnar-flexor – when a neurological hammer hits the tendon of the biceps muscle in the elbow bend. Reflex arc: musculocutaneous nerve, V and VI cervical segments and roots of the spinal cord. The response is muscle contraction and flexion of the arm at the elbow joint.

Determine the knee jerk – a blow with a hammer on your own ligament of the patella below the patella. The result is a contraction of the 4th main muscle of the thigh and extension of the lower leg. The arc closes at the level L2 – L4.

The method for studying the pathological Oppenheim reflex – the extensor reflex – is obtained as a result of pressing the pulp of the thumb along the anterior surface of the tibia from top to bottom. The result is the extension of the big toe, the breeding of all other fingers in the form of a fan.

The technique for studying the Rossolimo reflex on the upper limb – the doctor applies short, jerky blows with his fingertips to the tips of 2-5 fingers of the patient’s hand, which are in the pronation position. The result is a reflex slow flexion of the fingers.

Building №12

A patient with tetraplegia was admitted to the emergency room. Examination revealed peripheral paralysis of the arms and central paralysis of the legs.

Answer: damage to the spinal cord at the level of C5-C8.

Technique for the study of muscle strength from the upper limbs

Technique for the study of muscle tone in the lower extremities

Oppenheim reflex – holding with pressure the pulp of the thumb along the anterior surface of the tibia from top to bottom. The result is the extension of the big toe, the breeding of all other fingers in the form of a fan. (Extenson pathological reflex).

Babinski’s reflex – dashed irritation of the sole. The result is the extension of the big toe, the breeding of the remaining fingers in the form of a fan. (Extensor pathological reflex).

To identify pathological foot reflexes Zhukovsky – a blow with a hammer on the sole under the fingers. The result is flexion of 2,3,4,5 toes. (Flexor pathological reflex).

Problem #13

A patient with lower peripheral paraplegia was admitted to the neurology department.

Answer: damage to the peripheral neuron of the cortico-muscular pathway on both sides, that is, there is a lesion of the anterior horns of the spinal cord, anterior roots, plexuses and peripheral nerves.

Methodology for the study of muscle strength

Methodology for the study of limb tone

Determine the knee reflex – a blow with a hammer on your own patellar ligament below the kneecap. The result is a contraction of the 4th main muscle of the thigh and extension of the lower leg. The arc closes at the level L2 – L4.

Methodology for the study of the Achilles reflex – a hammer strike on the Achilles tendon. The result is a contraction of the 3-headed muscle of the lower leg and plantar flexion of the foot. Arc at the level of L5-S2.

Task #14

A patient with central lower paraplegia was admitted to the neurology department.

Answer: With spastic paraparesis (paraplegia), hyperreflexia, spasticity, pathological reflexes, synkinesis, protective reflexes are observed. The lesion occurs at the level of the central neurons of the cortico-muscular pathway, that is, there is a lesion in the cortex of the anterior central gyrus.

Methodology for the study of muscle strength

Methodology for the study of limb tone

Determine the knee and Achilles reflex – knee reflex – a milk blow on your own ligament of the patella below the patella. In response – contraction of the 4th head muscle of the thigh and extension of the lower leg. Arc – L2-L4. Achilles reflex – hammer blow on the Achilles tendon. In response – contraction of the 3-headed muscle of the lower leg and plantar flexion of the foot. Arc – L5-S2.

Task #15

A patient with suspected meningitis was admitted to the emergency room.

Answer: clinical manifestations of meningeal syndrome: diffuse headache, aggravated by loud sounds, bright light; pain in the occipital region and along the spine; vomiting not associated with food intake; increased sensitivity to various stimuli.

A technique for studying the rigidity of the muscles of the neck – the doctor puts his hand under the back of the patient’s head and tries to bend his head, he does not succeed, because. the muscles of the back of the head tense reflexively, a gap of 1-3 transverse fingers remains between the chin and the sternum.

Methodology for the study of Kernig’s symptom – the doctor bends the patient’s leg in the hip and knee joints at a right angle, then tries to straighten the leg only in the knee joint. With a positive symptom, this fails because of the reflex tension of the leg flexors.

Methodology for the study of the Brudzinsky symptom:

upper – when trying to bend the patient’s head, his legs bend;

medium – when pressing on the pubis, the patient’s legs bend;

lower – when examining Kernig’s symptom, the other leg is bent on one side.

The technique for studying the zygomatic reflex of Bekhterev – when tapping with a hammer on the zygomatic arch, a headache and a painful grimace of the same half of the face appear.

manipulation should be performed with the patient lying or sitting. When puncturing in the supine position, the patient is placed on his side on a hard table. The legs should be bent and brought to the stomach, the back bent as much as possible, hands should clasp the knees. The most convenient place for puncture is the intervals between III and IV and between II and III lumbar vertebrae. In an adult, the spinal cord ends at the level of the second lumbar vertebra, so the likelihood of damage to the spinal cord during lumbar puncture is minimal. In children, in order to avoid injury to the spinal cord, the puncture should be performed below the third lumbar vertebra. The puncture is performed under local anesthesia, for which a 1-2% novocaine solution is used, which is injected in layers along the puncture in an amount of 5-10 ml. Sometimes the manipulation is carried out without anesthesia. Beer’s needle with a mandrel is inserted strictly along the midline between the spinous processes with a slight upward slope and advanced deep through the ligamentous apparatus. At a depth of 4-7 cm in adults (about 2 cm in children) there is a feeling of failure, which is a sign of penetration of the needle into the subarachnoid space. The outflow of fluid after removing the mandrin indicates the correct execution of the puncture. If the needle rests against the bone, it must be removed, leaving the end in the subcutaneous tissue, after which, changing direction slightly, repeat the introduction. After performing the manipulation, the patient must be asked to roll over on his stomach and stay in this position for at least 2 hours. Seal the puncture with a sterile napkin. The total volume of cerebrospinal fluid in adults is about 120 ml. When extracting it, it should be borne in mind that the daily volume of secretion is 500 ml, a complete renewal occurs 5 times a day. Pain after lumbar puncture may be present due to decreased intracranial pressure, usually disappearing without treatment after 5 to 7 days.

Task #16

The patient is in the hospital with a diagnosis of Osteochondrosis of the lumbar spine. Right-sided radicular syndrome.

Investigation of Neri’s symptom – bending the head forward causes pain in the lower back.

Investigation of the Lasegue symptom (phase 1) – in the patient lying on his back, the straightened leg is lifted up by the heel. In this case, there is an increase in pain in the lumbar region, along the sciatic nerve and a tonic protective tension of the leg extensors.

The study of the symptom of Lasegue (phase 2) – the pain disappears when the leg is bent at the knee joint due to a decrease in the tension of the sciatic nerve.

The study of Matskevich’s symptom – in a patient lying on his stomach, the leg is bent at the knee joint, pain appears on the front surface of the thigh.

The study of Wasserman’s symptom – with the maximum extension of the straight leg in a patient lying on his stomach, pain appears on the anterior surface of the thigh.

Task number 17

Patient Sh, 40 years old, suffered a stroke resulting in a speech disorder. The addressed speech understands, but does not speak.

Specify the lesion site. – posterior sections of the inferior frontal gyrus on the left (field 44).

Name the type of aphasia. – motor aphasia.

The study of impressive speech – they offer to show the named objects, turn to the patient with a request (close their eyes, show their tongue), whether they distinguish correct and incorrect in meaning Phrases with the same type of sound (an elephant is larger than a fly, a fly is larger than an elephant), explores phonemic hearing (similar in sounding syllables (ma-pa, ta-da).

The study of expressive speech – the study of reflected speech (repeat words, syllables, letters), examines automated speech (counting from 1 to 10, letters of the alphabet, months of the year), examines narrative speech (tell complaints, retell an event, a movie).

Praxis study – they are asked to repeat the doctor’s actions, they are asked to fasten a button, light a match, they are asked to show how to use imaginary objects. They are asked to make a house or a geometric figure out of matches.

Counting study – Serial counting: ask the patient to serially subtract seven from 100 (subtract seven from 100, then subtract seven from the remainder 3-5 more times in succession) or three from 30. The number of errors and the time required by the patient to complete the task are noted.

Task #18

A patient with dtagnosis “Hemorrhagic stroke” was admitted to the neurological department.

Conduct a study of pathological (flexor) foot reflexes and pathological symptoms (clonus of the foot and patella) in a patient who has had a hemorrhagic stroke.

Methodology for the study of the pathological reflex Rossolimo – is caused by a short energetic blow to the fingertips (2-5) of the patient’s foot with the doctor’s fingers. The result is flexion of 2,3,4,5 toes. (Flexor pathological stop reflex).

Method for studying the pathological Bekhterev reflex – 1 – tapping with a hammer on the back of the foot at the level of 4 fingers = flexion of 25 toes. 2- tapping with a hammer on the heel or on the tenar = flexion of the toes or fingers.

Methodology for the study of the pathological reflex Zhukovsky – a blow with a hammer under the fingers on the sole = flexion of 2-5 toes. Flexor pathological foot reflex.

Methodology for the study of clonus of the foot and clonus of the patella:

clonus of the foot – with one hand the doctor holds the patient’s shin on weight, and with the other hand he takes the distal part of the foot and quickly unbends it in the ankle joint. M.b. persistent and prolonged, or rapidly fading.

clonus of the patella – a sharp displacement of the patella downwards is carried out in a patient lying on his back with straightened legs u003d the tendon of the 4-headed thigh muscle is stretched, there is a rhythmic contraction of the muscles and a rapid oscillation of the patella down and up.

Task number 19

The patient was diagnosed with dysphagia, dysarthria, nasolalia, hypophonia, paresis of the soft palate, fibrillar twitching of the muscles of the left half of the tongue.

Define the syndrome. – pseudobulbar palsy, bilateral lesion of the central motor neurons of the bulbar nerves.

Examination of the glossopharyngeal nerve – we examine the open mouth of the patient
(we estimate the position of the tongue and soft palate, the degree of their mobility). We check the pharyngeal reflex, soft palate reflex. Investigate the sonority of the voice. We observe the act of swallowing, we examine the taste on the root of the tongue on the right and left with solutions of bitter and salty.

Examination of the hypoglossal nerve – we ask you to show the tongue, pay attention to the position of the tongue, thickness, the presence of fibrillar twitches in the muscles of the tongue. We study the articulation of speech (patter).

Examination of the vagus nerve – similar to the study of the glossopharyngeal nerve + determine the frequency and rhythm of the pulse and breathing.

Method for studying the tone of the trapezius muscle – we examine the tone by probing the muscle on both sides, we examine it in order to detect atrophy.

Method for studying the strength of the muscles of the clavicular-mastoid muscle – we ask the patient to turn his head to the sides.

Problem #20=22

The patient noticed the asymmetry of the face in the morning. Examination revealed asymmetry of the nasolabial folds, drooping of the corner of the mouth, a positive “sail” symptom, a positive “exclamation mark” symptom, and a positive Bell’s sign.

Specify the level of damage. – damage to the peripheral neuron of the facial nerve.

What nerve is affected? – facial nerve

Name the nature of paresis. – peripheral paresis of facial muscles on the side of the focus.

Determine the “symptom of the sail” – we ask the patient to puff out his cheeks – the cheek sails.

Determine the symptom of the “exclamation mark” – we ask you to bare your teeth, the corner of the mouth is pulled back and it is skewed to the healthy side (paralysis of m. risorius).

Determine the symptom “Bela” – when closing the eyes, the eyeball turns up and only the albuginea is visible in the gaping palpebral fissure.

The definition of the symptom of “eyelashes” – when closing the eyes on the healthy side, the eyelashes are completely absorbed into the closed eyelids, and on the side of the lesion, their tips are visible.

Task number 21

In a patient with pneumonia during treatment, the temperature rose sharply to 39.5 C. Symptoms increased in the form of severe headache, photo and sound phobia. Examination revealed positive meningeal symptoms.

Check for meningeal symptoms.

Stiff neck – the doctor puts one hand under the back of the patient’s head and tries to bend his head. In the presence of rigidity, this fails, since the muscles of the back of the head tense up reflexively, a gap of 1-3 transverse fingers remains between the chin and the sternum.

Kernig’s symptom – the doctor bends the patient’s leg in the hip and knee joints, then tries to straighten the leg in the knee joint. This cannot be done with a positive symptom.

Brudzinsky’s symptom – upper – when trying to bend his head, his legs bend. Medium – when pressing on the pubis, the patient’s legs bend. Lower – when checking the symptom of Kernig on the one hand, the other leg is bent.

Mendel’s symptom – pressure on the anterior wall of the external auditory canal causes pain and a painful grimace on half of the face, even in an unconscious patient.

Bekhterev’s symptom – when tapping with a hammer on the zygomatic arch, a headache and a painful grimace of the same half of the body appear.

Task number 22

The patient has scrambled speech, nystagmus, bilateral intentional trembling, bilateral adiadochokinesis, “drunk gait”.

Where is the pathological focus located? – cerebellum, damage to the cerebellar hemispheres.

The study of nystagmus – looking at the malleus.

Examination of the test for diadochokinesis – they are asked to stretch their arms in front of them, spread their fingers and do alternate supination and pronation at the fastest possible pace. With damage to the cerebellum, these movements become sweeping, slow, awkward. More pronounced on the affected side.

Test for proportionality – on the side of the lesion of the cerebellum, excessive rotation of the hand is noted – dysmetria (hypermetry) when turning the palms down with the hands extended with the palms up.

Methodology for the study of coordinating tests – Romberg’s posture, blind and flank gait, finger-nose test, adiadochokinesis.

Task number 23

The patient suddenly developed unsteadiness when walking, dizziness. On examination: unstable in the Romberg position, performs coordinating tests with dysmetria on both sides (with closed and open eyes), adiadochokinesis.

What is the syndrome in the patient? – cerebellar ataxia.

Specify the lesion site. – cerebellum.

Romberg’s posture research technique – they offer to stand with outstretched arms with open, then with closed eyes. Complicated test – 1. stand with one foot in front of the other (heel to toe), 2. stand with legs shifted, tilting your head to the sides, 3. stand on your toes, 4. stand on one leg.

The method of researching the finger-nose test – they suggest touching the tip of the nose with the index finger with open, then with closed eyes. On the side of the lesion – overshooting, intentional tremor of the hand, hypometry, hypermetry.

Methodology for the study of the heel-knee test – the patient is asked to reach the heel of one leg to the knee of the other, to hold the heel along the lower leg down to the foot, then up to the knee. With damage to the cerebellum – slipping, slipping, with a unilateral lesion – symptoms on the side of the lesion.

Method for the study of dysmetria – I suggest that the patient take from the table, and then return any object to its place, while excessively sharp disproportionate movements are found on the side of the lesion.

The study of nystagmus asks the patient to look at the hammer, which is retracted to the sides, up and down. When the eyes are taken to the sides, a rhythmic twitching (intentional trembling of the eyeballs) is observed.

Task number 24

The patient is concerned about pain in the lower back with irradiation to the left lower limb. On examination: smoothed lumbar lordosis, back muscle tension, pain on palpation of paravertebral points in the lumbar region, more on the left. Positive tension symptoms, reflexes from the lower extremities are alive, S=D.

Specify the level of damage. – damage to the sciatic nerve (acute lumboischalgia).

Symptom Lasegue – the doctor raises the leg of the patient lying on his back, and there is pain in the lower back and along the sciatic nerve.

Symptom Neri – bends the patient’s head and there is pain in the lower back.

Wasserman’s symptom – with the maximum extension of the straight leg in a patient lying on his stomach, pain appears on the anterior surface of the thigh.

Strümpel-Matskevich’s symptom – in a patient lying on his stomach, the leg is bent at the knee joint, pain appears on the front surface of the thigh.

Symptom Sicard – a sharp dorsiflexion of the foot causes pain along the sciatic nerve.

Task number 25

The patient is concerned about burning unpleasant pain in the left side of the chest, accompanied by blisters and redness of the skin in the interscapular region on the left and at the level of the left nipple.

Determine the type of sensory disturbance – peripheral type of sensory disturbance, radicular syndrome with simultaneous damage to the intervertebral ganglion.

Indicate the level of damage – Th4-Th5.

Methodology for the study of kinesthetic feelings – the doctor takes a fold of the patient’s skin with his fingers and moves it up, down, right, left. The patient must determine the direction of movement of the fold.

Methodology for the study of three-dimensional-spatial feeling – stereognostic feeling – recognition of objects by touch.

Examination of pain sensitivity on the torso – with the tip of a pin, light injections are applied to symmetrical parts of the body. The patient should respond with the answer “acutely”, “stupidly”.

The study of temperature sensitivity on the torso – 1 test tube is taken with hot water in 40 grams, the other – with cold 18 grams. Alternately, test tubes are applied to symmetrical parts of the body. The patient reacts – painful or cold.

Study of tactile sensitivity on the torso – the doctor touches the symmetrical parts of the body with a brush or cotton swab.

Task number 26

The patient was taken to the emergency department of the hospital in an excited state, with severe headache, nausea, and vomiting. Objectively: hyperemia of the skin, body temperature 37.5, blood pressure 220/140 mm Hg, sharply positive meningeal symptoms.

Probable diagnosis? Meningitis.

What method of investigation is necessary for making a diagnosis? CSF study.

Investigate meningeal symptoms.

Bekhterev’s symptom – when tapping with a hammer on the zygomatic arch, a headache and a painful grimace of the same half of the body appear.

Mendel’s symptom – pressure on the anterior wall of the external auditory canal causes pain and a painful grimace on half of the face, even in an unconscious patient.

A symptom of neck stiffness – the doctor puts one hand under the back of the patient’s head and tries to bend his head. In the presence of rigidity, this fails, since the muscles of the back of the head tense up reflexively, a gap of 1-3 transverse fingers remains between the chin and the sternum.

Kernig’s symptom – the doctor bends the patient’s leg in the hip and knee joints, then tries to straighten the leg in the knee joint. This cannot be done with a positive symptom.

Brudzinsky’s symptom – upper – when trying to bend his head, his legs bend. Medium – when pressing on the pubis, the patient’s legs bend. Lower – when checking the symptom of Kernig on the one hand, the other leg is bent.

Task number 27

The patient was taken to the hospital with suddenly developed weakness and numbness in the left limbs, loss of the left halves of the visual fields against the background of an attack of atrial fibrillation.

Name the syndrome – cerebral capsular syndrome (damage to the posterior thigh of the internal capsule).

Indicate the level of the lesion – the inner capsule on the right side.

Methodology for the study of the elbow flexion reflex – when a neurological hammer strikes the tendon of the biceps muscle in the elbow bend. Reflex arc: musculocutaneous nerve, V and VI cervical segments and roots of the spinal cord. The response is muscle contraction and flexion of the arm at the elbow joint.

The technique for studying the elbow extensor reflex is a blow to the tendon of the triceps muscle of the shoulder, which leads to its contraction and extension of the forearm in the elbow joint. Reflex arc: musculocutaneous nerve, VII and VIII cervical segments and roots of the spinal cord.

Pathological reflexes from the upper limbs – pathological carpal reflexes.

1. The carpal analogue of the Rossolimo symptom – the doctor applies a short, jerky blow to the fingertips of the patient’s hand, which is in the pronation position, with his fingertips – in response, a slow reflex flexion of the fingers of the hand.

2. Zhukovsky’s symptom – a hammer blow in the middle of the patient’s palm – in response, a slow flexion of the fingers of the hand.

3. Symptom of Jacobson-Lask – a blow to the styloid process – slow flexion of the fingers.

Pathological foot flexion reflexes – flexion of 2,3,4,5 toes:

1. Symptom Rossolimo – a short energetic blow to the tips of the toes of the patient’s foot.

2. Bekhterev’s reflex 1 – tapping with a hammer on the back of the foot at the level of 4 fingers.

3. Ankylosing spondylitis 2 – tapping the hammer on the heel or tenar of the patient.

4. Zhukovsky reflex – hammer blow on the sole under the fingers.

Task number 28

The patient complained of unsteadiness when walking and impaired coordination in the lower extremities that occur in the dark. Objectively: the absence of vibration sensitivity and musculo-articular feeling in both lower extremities. Pain and temperature sensitivity is preserved. Dysmetria during coordinating tests and instability in the Romberg position with eyes closed.

Name the syndrome – sensitive ataxia.

Indicate the level of damage – with polyneuritis, damage to the posterior roots and posterior columns of the spinal cord, with damage to the thalamus.

Determine diadochokinesis – the patient is asked to stretch his arms in front of him, spread his fingers and do alternately supination and pronation of the hands at the fastest possible pace. The symptom is more pronounced on the side of the lesion.

Determine the synergy of Babinsky – the patient lying on his back is offered to sit down. At the same time, the legs should be apart, and the arms should be crossed on the chest.

The method of studying vibration sensitivity – the doctor places the leg of a vibrating tuning fork on those parts of the body where the bones are located superficially (ankles, patella, iliac crest, spinous processes, styloid processes, olecranon, clavicle, mastoid processes of the skull) – apallesthesia or hypopallestisia.

The method of studying the muscular-articular feeling – the doctor conducts passive movements in the joints of the patient’s limbs, starting from the terminal phalanges of the fingers, while asking which finger is taken and where the movement is directed. Then it moves on to the proximal joints.

Walking with closed eyes

Task number 29

After implantation of teeth in the upper jaw on the left, the patient developed periodontal disease and severe paroxysmal pain appeared in the entire left side of the face. Attacks are not stopped by non-steroidal anti-inflammatory drugs, provoked by chewing solid food, yawning.

Probable diagnosis? damage to the root or branches of the trigeminal nerve. (trigeminal neuralgia on the left).

A technique for studying the kinesthetic feeling on the face – takes a fold of the patient’s skin and moves it in different directions.

Palpation of the exit points of the trigeminal nerve – probing the supraorbital, infraorbital and mental points of the trigeminal nerve. (upper points of Valle).

Pain sensitivity on the face – with the tip of a pin, it inflicts light injections on symmetrical parts of the face.

Tactile sensitivity on the face – with a cotton swab or brush on symmetrical parts of the face.

Temperature sensitivity on the face – 2 test tubes with hot 40gr. and cold water 18gr. alternately on symmetrical parts of the face.

Task number 30

The patient complains of weakness, darkening of the eyes when changing body position from horizontal to vertical, unstable stool, increased sweating, especially of the palms and feet, low blood pressure.

Name the syndrome – the syndrome of vegetative-vascular dysfunction.

Indicate the nature of dysfunction – according to the parasympathetic type.

Methodology for the study of orthostatic test – occurs when moving from a horizontal position of the body to a vertical one; Normally, the pulse quickens by 10-12 beats per minute. A more pronounced increase in the pulse indicates the predominance of the tone of the sympathetic nervous system, a decrease in the pulse indicates vagotonia.

Method for determining dermographism – is caused by dashed skin irritation with a blunt object. Normally, a red stripe appears, surrounded by a narrow white border. If the vascular tone is increased, then a white stripe appears.

The technique for examining the Dagnini-Ashner test – after counting the pulse at rest (initial background), with the fingertips, pressure is applied to both eyeballs until a slight pain appears. Exposure 15-20sec. Then the pulse is counted again. Norm – slowdown by 9-12 beats. in 1 min. Increased vagotonic reaction – slowing down more than 12 beats. Weak vagotonic reaction – slowing down by less than 9 beats. There is no reaction. The inverted reaction is the acceleration of the pulse.

Solar reflex research technique – cause by pressing on the epigastric region for 30 seconds. Normally, the number of heartbeats decreases by 4-12 per minute. Increased vagotonic reaction – slowing down more than 12 beats. Weak vagotonic reaction – slowing down by less than 4 beats. There is no reaction. The inverted reaction is the acceleration of the pulse.

Task number 31

The patient complains of pain and numbness in the feet and fingers. The patient has been suffering from type 2 diabetes mellitus for 15 years. Objectively: a decrease in all types of sensitivity in the feet and fingers.

Name the syndrome – polyneuropathic syndrome.

Specify the type of sensory impairment – peripheral type, polyneuritic variant.

Technique for the study of muscular-articular feeling – – the doctor makes passive movements in the joints of the patient’s limbs, starting from the joints of the fingers (flexion, extension, adduction, abduction). At the same time, the patient is asked which finger is taken and where the movement is directed.

Technique for studying the feeling of localization – the doctor touches with a cotton swab or brush or applies a light injection on symmetrical areas of the body and asks him to indicate with his finger the exact place of touch after each irritation.

The technique for studying pain sensitivity in the upper limbs is an injection on symmetrical areas of the skin of the upper limbs.

The technique for the study of temperature sensitivity in the upper extremities – 2 test tubes with cold 18 and hot 40 water on symmetrical areas of the skin of the upper extremities.

Method for studying vibration sensitivity – put the leg of a vibrating tuning fork on areas where the bones protrude (ankles, patella, iliac crest, spinous processes of the spine, styloid processes, olecranon processes, collarbones, mastoid processes of the skull).

Task number 32

The patient is concerned about weakness and numbness in the right hand. The symptoms appeared yesterday morning after the patient slept on the floor while intoxicated. Objectively: it is difficult to extend the hand and fingers, as well as to abduct the thumb. Reduced sensitivity on the back surface of 1-3 fingers of the right hand.

Which nerve is affected? – Radial nerve.

Specify the type of sensory impairment – peripheral type of sensory impairment, mononeuritic variant.

The method of studying the joint-muscular feeling – the doctor makes passive movements in the joints of the patient’s limbs, starting from the joints of the fingers (flexion, extension, adduction, abduction). At the same time, the patient is asked which finger is taken and where the movement is directed.

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