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105 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
a reflex is...?
an automatic response to particular stimuli, involving a simple reflex arc
Why do you test
neurological function ?
to determine if nervous system is intact and functioning &
because we can't see it, so
we must perform functional tests
neuropathy is...?
inflammation or degeneration of the peripheral nervous system
neurological disorders of the lower limb may be due to...?
-injury to CNS or PNS
-metabolic disease
-sensory, motor or autonomic disease
A full neurological examination includes examination of...?
GRAMS CM
Gait
Reflexes
Autonomic
Motor
Sensory
Coordination
Mental state
We do a neurological exam in clinic, what four main types of neuropathy are we assessing?
Motor
Sensory
Autonomic
Coordination
consequences of PNS malfunction..
1. impaired response to environment
2. pathological damage to tissue
3. lack of awareness of injury
a dermatome is...?
the area of skin that is supplied by a
a single, spinal cutaneous nerve
state the nerve supply to the lower limb from the sciatic nerve downwards
Sciatic nerve
divides above Popliteal Fossa
Common Peroneal Nerve, divides into Deep peroneal and superficial peroneal

Tibial nerve (posterior leg) through tarsal tunnel to plantar foot (medial & lateral plantar, medial calcaneal)
name three causes of peripheral neuropathy...
1. Diabetes
2. Alcoholism
3. Trauma
The nervous system is ____ acting and works alongside the slower acting _________ system.
fast

endocrine
the Central Nervous System is...
all structures lying within the brain and spinal cord.
the peripheral nervous system comprises...?
all the nerves that lie outside the brain and spinal cord.
The somatic nervous system has three functions which are...
1. sensory
2. integrative
3. motor
a mechanoreceptor senses...?
touch and pressure
a thermoreceptor senses...?
warmth and cold
a nociceptor senses...?
painful stimuli
a proprioceptor senses...?
position
The area served by a sensory unit is called...?
the sensory field
A "sensory unit" comprises?
Afferent nerve
its Branches and
Receptors
An Upper Motor Neuron is...?
...a motor neuron with its cell body in the cortex and its axon synapsing with the LMN it controls.
A Lower Motor Neuron is...?
...a motor neuron with its cell body in the spinal cord grey matter, which sends impulses to skeletal muscle via its axon.
a neurone which synapses with an UMN in the anterior horn of the spinal cord, and distally with the neuromuscular end plate at the effector muscle
which three reflexes are of most imprtance to lower limb function?
1. Pain withdrawal reflex
2. Crossed extensor reflex
3. Stretch reflex
the five elements of a reflex arc are...?
1. receptor organ
2. afferent nerve
3. Integration centre
4. efferent nerve
5. effector organ
explain the crossed extensor reflex
postural reflex enabling an injured lower limb to be withdrawn, while the remaining limb bears weight
when might the crossed extensor reflex occur?
during gait (swing--stance)
how can you demonstrate the stretch reflex?
by testing the patellar or Achilles tendon reflexes
what does a stretch reflex tell us?
the state of contraction in a muscle
What is the effect of
sensory peripheral neuropathy on gait?
- wide-walking
- high-stepping
- hard-stamping
what muscle group is commonly affected in Charco-Marie-Tooth's disease?
peroneals
nerve function deficit is called...
neuropathy
the five elements of a neurological exam
sensory (function)
motor (function)
autonomic (function)
coordination
consciousness
SMACC!
widespread, symmetrical abnormality of many nerves, in a glove and stocking distribution is called...?
polyneuropathy
abnormality of a single nerve is called...?
mononeuropathy
name some factors that mean a diabetic foot is "at risk"
-deformity
-no feeling (neuropathy)
-no blood (ischaemia)
-hard skin (callus)
-swelling
signs of a hypoglycemic attack are...?
-drowsiness
-confusion
-aggressive behaviour
-loss of consciousness
signs of a TIA?
-speech disorders
-inability to swallow
-visual disturbance
-movement disturbance
why does a syncope occur?
temporary interruption of blood to the brain
what causes CVA?
thrombosis 80%
haemorrhage 20%
TIAs last how long?
1-30 minutes and always less than 24hrs
cause of epileptic fits?
unusual electrical activity in the cortex
may arise from trauma or lesion
examples of "parasthesia"?
-pins and needles
-burning
-pricking
-shooting pains
what does ageing do to nerve conduction speed?
ageing slows the speed of nerve conduction
signs of UMN disease in lower limb?
1. Hyperreflexia
2. Hypertonicity
3. Spasticity
4. Muscle atrophy (slow)
5. No fasiculations
6. Extensor response to Babinski
7. No abdominal reflex
signs of Lower Motor Neuron disease in lower limb?
1. muscles flaccid
2. decreased tone
3. lack of stretch reflexes
4. fasculations
5. profound muscle atrophy
6. specific muscle groups affected
examples of LMN conditions?
Polio
Charcot-Marie-Tooth
Spina Bifida
Ian Dury
examples of UMN conditions?
Multiple Sclerosis
CVA
Cerebral Palsy
leg/foot positions in UMN lesions?
extension of hip & knee
plantarflexion/inversion of foot
scissors gait
The patellar reflex - tests integrity of which pathway?
spinal reflex pathway L3, L4
What manouevre can you ask the patient to do if they are not relaxed for the patellar reflex test?
The Jendrassik manouevre
(clasp both hands and pull)
Achilles tendon reflex - tests what spinal pathway?
spinal reflex pathway S1, S2
Babinksi response
- describe how to do it; and
- describe abnormal/normal response?
stroke surface of foot from heel across to ist MTPJ
normal=PF hallux
abnormal=DF hallux
positive Babinksi test means...?
- possible UMN lesion
- release of inhibitory spinal reflex
symptoms of Parkinsonism?
- festinating gait
- slow or no movement
- mask-like features
- tremors at rest
tests for proprioception?
- Hallux movement with hand
- Romberg's test
- heel-shin test
signs of autonomic neuropathy?
- dry or hyperhidrotic skin
- hypotension/hypertension
- slowing of heart rate
main descending motor pathway?
corticospinal pathway
Babinski reflex - what type of reflex is it?
a superficial reflex
Patellar and Achilles reflexes are what type?
Deep tendon reflexes
What is the Jendrassik's Manoeuvre?
a reinforcement technique used to check whether a reflex is absent
(clench hands in front of chest)
the four categories used to describe reflexes?
Brisk
Absent
Reduced
Normal
brisk
age at which positive Babinski response disappears?
7mths
segmental supply for Achilles reflex (foot PF)?
S1/S2
segmental supply for Patellar reflex?
L3/L4
differerence between a deep tendon reflex and a superficial reflex?
deep tendon reflex = monosynaptic

superficial reflexes = polysynaptic
what is being tested when we test a reflex?
1. afferent and efferent pathways
2. upper and lower motor neurons
what would stop transmission of an impulse across a synapse?
failure to reach the action potential threshold
drop foot - caused by UMN or LMN lesion?
foot drop can result from
UMN and LMN lesions
stroke is upper or lower MN lesion?
Upper motor neuron lesion
how does RA cause peripheral neuropathy?
-
how does Hypothyroidism cause peripheral neuropathy?
-
Name the 6 signs of autonomic peripheral neuropathy
1. dry skin
2. increased callus formation
3. bounding pulses
4. Warm feet
5. Dilated dorsal veins
6. postural hypotension
Why does dry skin occur in autonomic neuropathy?
Denervation of sweat glands
Why do bounding pulses occur in autonomic neuropathy?
vasomotor control of arteries is lost,
causing permanent arterial dilation
Why is the skin warm in autonomic neuropathy?
permanent arterial dilation increased blood flow to the skin
Why would you observe
dilated dorsal veins
in a patient with autonomic neuropathy?
permanently dilated arteriovenous shunts
Why does postural hypotension occur in autonomic neuropathy?
arteries lose the ability to constrict, gravity pulls blood towards lower limbs, causing drop in BP
Name the 5 signs of motor neuropathy
1. high arched feet
2. Clawed toes
3. Altered gait
4. Wasting of intrinsic muscles
5. increased pressure at met heads and apices
Why do feet become highly arched in motor neuropathy?
-
Why do toes become clawed in motor neuropathy?
intrinsic muscle wasting
extensor substitution occurs
Why does gait alter in motor neuropathy?
-
How does Jendrassik's manouevre work?
It removes spinal influence.
What does a reflex arc test?
-
What four areas of function
should you examine in a motor function assessment?
Position
Posture
Muscle Tone/Power
Reflexes
Name four signs relating to muscle behaviour that might indicate a neurological problem.
Spasticity
Rigidity
Clonus
Fasiculations
What is "clonus"?
-
What does testing of deep tendon reflexes indicate?
-
What does a reflex arc test?
it tests both the afferent and efferent parts of the spinal nerve in a given reflex
What four areas should you examine in a motor function assessment?
Position
Posture
Muscle Tone/Power
Reflexes
Name four signs relating to muscle behaviour that might indicate a neurological problem.
Spasticity
Rigidity
Clonus
Fasiculations
What is "clonus"?
-
What does testing of deep tendon reflexes indicate?
-
What does a reflex arc test?
-
What four areas should you examine in a motor function assessment?
Position
Posture
Muscle Tone/Power
Reflexes
Name four signs relating to muscle behaviour that might indicate a neurological problem.
Spasticity
Rigidity
Clonus
Fasiculations
What is "clonus"?
-
What does testing of deep tendon reflexes indicate?
tests the integrity of the CNS and PNS
What is an arteriovenous shunt?
A sphincteric mechanism controlling capillary bed blood flow.
What nerve roots does the Patellar reflex test?
L3,L4
What tract does the Babinski test test?
Corticospinal tract
Why does high muscle tone occur?
disinhibition of spinal influence on LMNs
What (broadly) causes UMNs?
Damage anywhere between the cortex and L1 in the spinal cord
UMNs connect the ____ to the appropriate spinal cord level, from which point the LMNs transmit nerve impulses to the ______.
UMNs connect brain --> spinal cord level
LMNs transmit from spinal cord --> muscles
What descending tract is responsible for skilled movements?
CorticoSpinal = Skilled Movements
extension of hip & knee
circumducted gait
plantarflexed, inverted foot
....upper or lower MN?
Upper Motor Neuron
Hemiplegia