Week 1 and 2 PCP Workbook Questions

Study Guide Questions: 2.4

1. What does the mnemonic ‘LODCTRRAPPA” stand for? When is it used?

When a person presents with an illness, LODCTRAPPA is used to pinpoint the location and
origin of the pain first. The doctor asks questions to clarify the patient’s chief complaint.

L – location
O – onset
D – duration
C- course
T- type
R – radiation
R – relieving factors
A –Aggravating factors
P – previous treatment
A – associated symptoms

2. Describe what is meant by a system’s review.

This is a brief overview (can be done with the help of a questionnaire) of all the systems of the
body, looking for any related/unrelated or new information pertaining to the patient’s
conditions.

3. What does VIPPIRONEL stand for? When is it used?

After the history, in order to exam/ evaluate all the body systems, the mnemonic VIPPIRONEL
can be followed.

V- vitals
I – inspection (posture, gait, habitus, alertness etc)
P – palpation
P – percussion (if appropriate)
I – instrumental (charts, goniometers, inclinometers, scanning devices)
R – ranges of motion (active, passive)
O – orthopedic tests
N - Neurological tests
E- extra studies (x-rays, CT, MRI
L – lab studies
4. Describe the difference between dermatomes, sclerotomes and myotomes.

A dermatome is a sensory skin area supplied by the sensory component of a single nerve root.
A myotome is the group of muscles innervated by the motor component of a single nerve root
A sclerotome is a vertebrae or rib region supplied by a single nerve root

5. Describe the differences between nerve root pressure and nerve trunk pressure.

Trunks are a combination of motor and sensory fibres of one nerve root, and more distally there is
a redistribution of the fasciculi of various consecutive nerve roots. Minor and intermittent
pressure on a nerve trunk or a plexus causes paraesthesia and numbness. Sudden and serious
tissue damage may provoke neuropathic pain. Constant pressure on a nerve trunk leading to
parenchymatous damage does not usually provoke pain nor paraesthesia but only loss of motor
and sensory function.

The segment of the spinal nerve root which is liable to compression, whether by a disc protrusion,
an osteophytic outgrowth or a narrow lateral recess, is the extrathecal (fluid-filled space between
the thin layers of tissue that cover the brain and spinal cord) part of the intraspinal root. Pressure
on the extrathecal intraspinal nerve root results in a typical set of symptoms (pain and
paraesthesia) and signs (motor and sensory deficit) strictly related to the segment involved.
Contrary to the pins and needles brought on by the release of pressure on a nerve trunk, the
paraesthesiae only appear during the period of compression, and cease immediately thereafter.
Thus compression of a nerve root will cover a wider region of symptoms than the nerve trunk
which is more distal.

6. Describe the differences between spinal cord pressure and peripheral nerve pressure.

A small peripheral nerve is the distal termination of a branching nerve trunk. Peripheral nerves
receive stimuli in a peripheral nerve pattern and thus when compressed numbness, moderation
pain and some paraesthesia, will related to a specific area of supply, which is usually well defined
with clear-cut borders. The pattern is different because multiple nerve roots are combined to form
peripheral nerves.

A typical spineal nerve has more sensory fibres on the outside and more motor fibres on the
inside. The main cause of spinal cord pressure is spinal stenosis and the cervical or thoracic area.
When the cord is compressed over the thoracic region, the paraesthesiae are felt only in the limbs.
In compression at the cervical level, pins and needles will be present in all limbs or in the lower
limbs only. The paraesthesiae are usually bilateral and extend beyond the borders of the areas of
the cutaneous innervation of any peripheral nerve. For instance, the patient may complain of pins
and needles in both hands and forearms at both aspects or in both legs from the knees to all the
toes. However, if they only had peripheral nerve compression they might only experience
numbness in their middle fingers (if C7 was impinged).

7. What are tension signs?

 When nerves are stretches, compressed or contracted they are puts an inflamed nerve root
under further pressure. A positive tension sign is when one or more of these movements
reproduces a pain that is familiar to the patient.

8. Describe what you would find in a typical feature of irritation of the C5 nerve
root.

As there are more sensory fibres of the outside of the nerve root and motor on the
inside. Sensation would be affected first, then motor and reflexes. Neck, shoulder,
scapular pain. Lateral arm paraesthesia. Affects shoulder abduction and elbow
flexion. May be weak shoulder flexion, external rotation & forearm supination.
Decreased bicep reflex.

9. What spinal nerve has no dermatome associated with it?

Each spinal nerve corresponds to a separate dermatome except C1 which has no associated
dermatome.

10. Dermatomes, sclerotomes and myotomes are derived from embryological structures?

The mesoderm of the embryo is adjacent to the notochord and neural tube. It forms, from
internal to external: paired columns of paraxial mesoderm. From the paraxial mesoderm
comes multiple pairs of somites. Each somite differentiates into 3 regions: myotome,
dermatome and sclerotome.

11. Between which two vertebrae does the spinal nerve C7 exit the intervertebral foramen
(IVF)?

Between C6-C7

12. Which choice best describes C7 muscle test, Deep tendon reflex and sensory testing?

 Wrist flexion, triceps deep tendon reflex, and anterior and posterior
middle finger sensory from the wrist to the tip

13. 25-year-old AFL player fell on his shoulder vertically and violently stretched his
neck in the opposite direction. He was later diagnosed with a brachial plexus
injury. His arm is hanging at his side in medial rotation in the ‘waiter’s tip”
position. What results are expected from the neurological examination?

 Hypaesthesia over C5-C6 and weakness of the deltoid, supraspinatus and

infraspinatus, biceps and brachioradialis muscle