PCP Week 5 Workbook Questions

1. Unlike extremity reflexes which use muscle spindles to trigger the response,
most superficial reflexes are cutaneous reflexes, provoked by a tactile
stimuli to a localized area of skin or mucous membrane.

2. Are superficial reflexes graded? What term is used to describe the

superficial reflexes?

Superficial reflexes aren’t graded. When they are tested, they are either positive and a
contracture occurs or there is an absence or reduction in reflex.

3. What type of problem is it when the superficial reflexes are absent

bilaterally?
Upper Motor Neuron Lesion

4. What type of problem is in when the superficial reflexes are absent

unilaterally?
Lower Motor Neuron Lesion or damage to part of the spinal cord affecting the body
unilaterally.

Case study 1

Jack is a 40-year-old labourer who has decided to change his career. He has decided to
enroll into University and has been undertaking his studies now for around two years. Jack
now presents to you with headaches which seem to be worse with studying. Upon taking
the case history, he mentions his mother suffers the same problem

ASSUME ALL OTHER EXAMINATION AND CASE HISTORY FINDINGS ARE UNREMARKABLE.

Jack has been diagnosed with tension headaches.

1. List the statements (clues) in the case history that aligns with the diagnosis of
tension headaches. Use the script concordance. (Found in Moodle)

If you were thinking And then you find Your hypothesis becomes

Tension headache Aggravated by prolonged +2

sitting at a computer and
inactivity

Cervigoenic headache You find the pain gets 0/-1posture could be

better when they stop affected but he gets better
studying and go back to when he it gets better when
 labelling he goes back to labouring

Cerviogenic headache And then your find the 1- Cervicogenic

pain is bilateral banded headache is
around the head. generally unilateral
depending on the
nerve root

Tension Headache And then your find the 1

pain is bilateral banded
around the head.

Sinus Headache And then your find the -1

pain is bilateral banded
around the head and has
lasted a number of years
and the pain gets worse
when studying

Migraine And then your find the -2 Migraines are normally

pain is bilateral banded unilateral, explosive pain
around the head and has that generally only lasts
lasted a number of years 24hrs

Tumour Pain is around both sides, -2 no other tumour

its bad and been around symptoms and generally
for a long time and gets pain is more localised for a
better when your stop tumour and the pain
studying. wouldn’t stop just when
Jack stops studying.

2. The above case history is incomplete. What further questions or what

information would you need to acquire?
 LOCATION:
 Where exactly is the pain?
 Can you point to wear it is?
 ONSET:
 When and how did the headaches first start?
 Have you experiences any major trauma, ie. a MVA?
DURATION:
 How long have you experiences this pain?
 COURSE
  On average, is the pain getting worse or staying the same since you first
experienced it?
 Is the pain constant or intermittent? How long into studying do you notice it?
 TYPE
 What type of pain do you experience when the headaches start?
 Is it deep, dull, achy, sharp, is it a throbbing pain?
 How severe is the pain on a scale of 1-10?
 RADIATION
 Where does the pain start?
 Does the pain radiate into the arm? If so how far/ what part of arm?
 RELIEVING FACTORS?
 Does anything relieve the pain?
 AGGREVATING FACTORS?
 What else aggravates the pain apart from studying?
 PREVIOUS TREATMENT
 Have you received any other form of treatment for these headaches?
 Have you seen a chiropractor?
 What techniques did they use?
 Do you take any pain relieving medication?
 Was the treatment effective?
 PREVIOUS EPISODES?
 Had you experiences these same headaches prior to enrolling in university?
 ASSOCIATED SYMPTOMS?
 What else happens when you get this pain?
 Is there any other health related problems that you think or have noticed may
be associated or have started at the same time as this problem?

3. List the muscles (trigger points that are likely to refer pain to the head leading
to tension headaches?
 Tight Traps
 Tight Scalene
 Suboccipital muscles
 Levator scapular

For case study 1 indicate the likely outcome

for the following tests. Is it likely to be
positive or negative? Discuss false positives
and negatives.
Pelvic Rock Test Negative – not going to affect the cerebral flow

Hoovers Test Negative

Stoop Test The stoop test is a test for intermittent

claudication which generally occurs in the
thoracolumbar region. Jack’s pain gets worse
when he is seated and better when he is active
and therefore would likely test negative.

Brachial Plexus Nerve Tension Test Pain is referred to the head not the arm so
likely to be negative.

Upper Limb Nerve Tension Test 1 (ULNNT) Pain is referred to the head not the arm so
likely to be negative.

Gluteal Reflexes Jack is unlikely to have diminished gluteal

reflexes

Superficial Visceral Abdominal Reflexes Jack is unlikely to have diminished superficial

visceral abdominal reflexes

Djerine’s Triad (Cough,Valsalva and Sneeze) Possible increased pressure increase.

Lhermittes Sign Jack isn’t experiencing any other symptoms

associated with meningeal irritation and is
unlikely to have had this condition for years
and is therefore likely to test negative for this
test.