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104 Cards in this Set
- Front
- Back
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what sensory and motor aspects of the body does the trigeminal (CN 5) control
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-motor to the muscles of mastication
-sensory to entire face via its three divisions |
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what sensory and motor aspects of the body does the facial nerve control (CN 6)
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-motor to the muscles of facial expression
-sensory to the anterior 2/3 tongue (posterior tongue is glossopharyngeal 9) |
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what does the vagus nerve (CN 10) control
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uvual midline, normal voice, gag response
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spinal accessory nerve is motor to what (CN 11)
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motor to SCM and trapezius
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what CN is motor to the tongue
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hypoglossal (CN 12), sensory to the tongue is facial nerve to the anterior and glossopharyngeal to the posterior)
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what nerves roots are associated with iliopsoas and how can you test it
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-T12-L3
- test it by placing your hand on top of the pts thigh and ask them to lift the thigh off the table |
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what nerves roots are associated with adductors and quads
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L2-L4
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what nerves roots are associated with tibialis anterior
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L4
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what nerves roots are associated with abductors, EHL, EDL, EDB
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L5
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what nerves roots are associated with gluteus max, PL, PB, TP, gastroc-soleus
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S1
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what nerves roots are associated with intrinsics
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S2-3
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complete ROM against gravity only (no resistance)
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Fair (3) muscle grading
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how do you test the posterior column
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-vibration, 2 point discrimination and position sense
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how do you test the anterior spinothalamic
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light touch
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how do you test the lateral spinothalamic
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pain and temperature
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what nerve root is associated with deep tendon reflex of patellar tendon
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L4
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achilles reflex is tested how and what nerve root is tested
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-relax the foot and strike the achilles, look for PF
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how do you test C5
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-hold your thumb over the biceps tendon in the cubital fossa and strike your thumb with the hammer
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how do you test the triceps tendon C7
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-strike the back of the elbow, just below the triceps
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what does a grading of 4 of a DTR mean
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clonus (0 is absent)
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when testing DTR, you should also test for clonus in a pt..how
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sharply DF the foot and hold it in DF; feel for oscillations between DF and PF, that would be clonus
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symptoms of L5/S1 disc prolapse
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-pain at posterior thigh that radiates to the HEEL
-sensory loss on lateral foot -absent ankle reflex (S1) |
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symptoms of L4/L5 disc prolapse
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-pain at posterior thigh that radiates to the TOP of the foot
-sensory loss on top of foot -no reflex changes |
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symptoms of L3/L4 disc prolapse
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-pain in the front of the thigh
-sensory loss on anterior thigh -reduced knee reflex (L4) |
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name 4 tests for cerebellar function
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1. rhomburg (pt stands with eyes shut)
2. finger to nose test 3. heel to shin test 4. tandem walking (heel to toe) |
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list the symptoms of UMN
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muscle weakness, spastic muscle tone, hyper-reflex,
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list the symptoms of LMN
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flaccid, fasciculations, decreased tone and reflexes
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what is CMT and what are the clinical symptoms
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-myelin coating on motor and sensory nerves deteriorates resulting in poor nerve conduction, causing muscles to waste and atrophy (peroneal atrophy)
-cavus foot -high steppage gait -stocking glove sensory loss -decreased NCV |
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cavus foot in CMT pts is caused by muscle overpowering; which muscles
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-PL overpowers TA causing a PF medial column
-TP overpowers the PB causing a RF varus -FDL overpowers EDL and intrinsics causing clawtoes |
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Dejerine-Sottas Disease
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-hypertrophic intersititial polyneuropathy (auto recess)
-peripheral nerves are enlarged and sometimes palpable due to onion bulb formation of schwann cells around an area of demyelination -causes distal weakness and sensory loss of LE in childhood or early adulthood |
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freidrichs ataxia
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degeneration of the posterior and lateral columns of the spinal cord causing weakness of the LE
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PB and TA are affected first in CMT, what muscle is usually spared
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PL, which causes PF of 1st ray
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Cerebral palsy
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-non progressive lesion of the largest part of the brain (cerebrum) at birth, during delivery or months after birth
-usually presents with spasticity and scissor gait |
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treatment of CP
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-physical therapy
-surgical intervention to release contractures -muscle relaxants |
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when is Gowers sign seen
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-with Duchennes muscular dystrophy
-pt has to walk his arms up his legs to get off the floor -due to weak proximal muscles (mainly hip and thigh) |
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describe duchennes musclar dystrophy (pseudohypertrophy)
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-inherited myopathy due to slow motor development
-80% show pseudohypertrophy of calf muscles due to fatty deposition seen on biopsy -girdle weakness lead to Gowers sign |
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Becker M.D.
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-similar pattern of muscle weakness as Duchenne but less aggressive
-pts walk until age 35 and have longer life spans |
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name and describe 5 muscular dystrophys
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1. duchenne
2. becker 3. fascioscapulohumeral M.D. facial and shoulder muscle weakness, mildy progresses to LE 20-30 yrs later 4. Myotonic M.D. presents with tonic muscle spasms and foot drop 5. Limb girdle M.D. dx of exclusion due to inconsistent features |
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syringomyelia
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-cyst or cavity forms in the spinal cord
-MC in cervical spinal cord |
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syringomyelia symptoms
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-muscle atrophy
-loss of sensation -neurogenic osteoarthropathy (charcot) -loss of DTR |
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classification of neuropathies (mneumonic)
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DANG THRAPISTS
-Diabetic -Alcoholic -Nutritional (vit B) -Guillan barre -Toxic (drugs, chemicals) -Hereditary (CMT, Freidrich) -Recurrent -Amyloidosis -Poryphyria -Infectious (leprosy, HIV, zoster, lymes) -Systemic -Tumor |
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PD is a progressive disorder characterized by cytoplasmic eosinophilic inclusions where
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-in the substantia nigra
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list the symptoms of PD
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-rigidity
-resting tremor -bradykinesia -loss of postural reflexes -dementia in 50% of pts |
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drug tx for PD
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-levodopa
-carbidopa (dopa carboxylase inhibitor so more dopa reaches the brain) -amantadine; antviral -bromocriptine - dopamine agonist -pergoglide; dopamine agonist -selegiline; MAO-B inhibitor |
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what is the MC presenting symptom in MS
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optic neuritis
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Epilepsy is a chronic condition of recurring seizures; what two types are they divided into
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1. focal or partial originate from a localized portion of brain
2. general -any focal seizure may evolve to a secondary generalized seizure |
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status epilepticus
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recurring seizures, one following another without full recovery from preceeding seizure
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name the two types of partial (focal) seizures
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1. simple focal; focal motor, sensory or autonomic loss
2. complex focal; this is simple focal followed by impaired conciousness |
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name the 5 types of generalized seizures
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1. absent (petit mal); impairment of concisouness only
2. myoclonic seizures 3. tonic 4. tonic clonic 5. atonia (astatic) |
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generalized seizure: Petit mal type
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impairment of conciousness only, lapse in awareness
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generalized seizure: myoclonic type
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rapid brief contracture of muscles (similar to when your foot jerks as you are falling asleep)
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what is a genrealized seizure
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electrical impulse involves both sides of the brain and may cause loss of conciousness
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what is a partal (focal) seizure
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electrical impulse effects only a portion of the brain; causes a loss of concisouness in complex partial seizure
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generalized seizure: tonic type
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stiffening of limbs (tonic muscles)
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generalized seizure: tonic clonic type
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-consists of stiffening of the limbs (tonic phase), then jerking of the limbs and face (clonic face)
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generalized seizure; atonia(astatic) type
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abrupt loss of muscle tone
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treatments for epileptics (seizures)
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Dilantin (phenytoin)
Tegretol (carbamazepine) Clonazapam Depakote (valproic acid) Gabapentin (neurontin) |
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etiology of MG
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-Ach receptor antibodies destroy the receptor sites on the postsynaptic membrane resulting in mini end plate potential that are reduced in size and number
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hallmark symptoms of MG
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-exercise induced fatigue
-double vision and ptosis (eye droop) and difficult chewing |
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what type of muscle does MG affect
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skeletal
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what test and drug is used to dx MG
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-Tensilon test with Edrophonium
-5% of pts have an associated thymoma |
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tx for MG
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-antcholinesterase meds (pyridostigmine)
-immunomodulators (Immuran or Cellcept) -removal of thyroid gland |
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lambert eaton syndrome
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-defect in NM transmission due to decreased number of Ach packets released at the post synaptic terminal
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what meds should be used with caution in LES pts
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-aminoglycosides
-tetracyclines -bc they are NM blocking agents |
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etiology of Guillain Barre
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infection, surgery, immunization, or pts with SLE and lymphomas
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symptoms of guillan barre
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-rapidly progressing symmetrical motor weakness that can lead to respiratory paralysis
-stocking glove parasthesia -dec DTR -recover in 2-4 weeks |
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decreased relaxation of muscle following a sustaned contraction
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myotonia
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brief, irregular twitches
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fasciculations
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what grade do you give a normal reflex
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2+ (absent is 0, hyperreflexive clonis is 4+)
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myoclonus
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invountary sudden and rapid unpredicatbale jerks (faster then chorea)
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tardive dyskinesia
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-choreiform movements affecting primarily the tongue, lips and face
-tardive means delayed and dyskinesia means abnormal movt |
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what drug can cause tardive dyskinesia
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-dopamine antagonists (anti psychotics) like clozapine, haloperidol, chlorpromazine
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what is equinus gait and when is it seen
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-gait has swing phase ankle PF with no heel contact
-seen with CP, CMT, MD, schizophrenia, osseous block of ankle, habitual toe walking |
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what is steppage gait and when is it seen
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-swing phase drop foot
-seen with CMT, polio, GB, CVA, paralytic drop foot, fascioscapulohumeral dystrophy |
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trendelenberg gait
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-stance phase of each step leads to contralateral tilt of the pelvis with a deviation of the spine to the affected side
-seen with dislocated hip or weakness of gluteus medius |
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balance comes from the combo of 3 neurological systems; name them
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-proprioception system
-vestibular input -vision |
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Positive rhomberg test
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-pt looses balance when eyes are closed
-closing eyes leaves only 2 systems intact (vestibular and proprioception) so if one of those is not working, pt looses balance |
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if a pt has ataxia with eyes open, then a positive rhomburgs (worse ataxia with eyes closed); what does this mean
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ataxia is probably from loss of proprioception (common in spinal stenosis)
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what senses should you test for the LATERAL spinothalamic tract
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pain and temperature with a pin and ice cube
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what senses should you test for the ANTERIOR spinothalamic tract
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light touch
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dermatome of the anterior thigh
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L1 and L2
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dermatome of the lateral thigh, medial anterior calf and hallux
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L4 - innervates the lateral thigh, then crosses the patella to innervate the medial anterior calf and hallux
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dermatome of L5
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lateral anterior leg and central aspect of the foot plantarly and dorsally
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dermatome of S1
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posterior lateral thigh, leg and lateral border of the foot dorsally and plantarly
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dermatome of the posterior medial thigh and leg and the medial posterior portion of the heel
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S2
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who can MRI's not be performed on
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pts with pacemakers, pregnant pts, metal prostheses
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what is EEG and what is it used for
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-electroencephalography; voltage vs. time recordings of electrical currents in the brain
-used for detecting epilepsy and metabolic and structural encephalopathies -encephalopathy (disease of the brain) |
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symptoms of Friedrichs ataxia
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-cerebellar degeneration leading to:
-gait changes -decreased position and vibratory sense in legs - absent DTR - nystagmus -kyphoscoliosis -pes cavus -hypertrophic cardiomyopathy |
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Brown Sequard Syndrom
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-occurs after hemisection of the spinal cord
-results in ipsilateral spastic paralysis and loss of postural sense -results in contralateral loss of pain and temperature sensations |
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tarsal tunnel syndrome is compression of the posterior tibial nerve or one of its three branches; list the branches
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medial and lateral plantar, medial calcaneal nerves
-medial calcaneal nerve is sensory of heel from posterior tibial or lateral plantar nerve |
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where specifically does the nerve entrapment of tarsal tunnel occur
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- in the porta pedis or lacinate ligament
-porta pedis is canal formed by the abductor hallucis through which the medial and lateral plantar nerves pass |
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medial plantar nerves give sensory and motor to
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-sensory to plantar aspect of the hallux, 2nd,3rd toes, medial half of 4th, medial half of plantar aspect of foot
-motor to abductor hallucis, FDB, FHB, 1st lumbrical |
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lateral plantar nerve gives sensory and motor to
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-sensory to plantar lateral half of 4th toe and medial half of the plantar foot
-motor to QP and ab digit minimi then splits into superfical and deep branch -superficial gives motor to FDMB, and dorsal/plantar interossei of 4th interspace -deep supplies remaining intrinsics of the foot |
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does tarsal tunnel syndrome affect reflexes
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-no
-it intially causes sensory involvement then coldness/numbness from sympathetic activity -then muscle wasting and paresis |
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what can be some etiologies of tarsal tunnel syndrom
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-dilated posterior tibial veins
-trauma; fx, sprain, dislocation -systemic disease (gout, RA, DM) -space occupying lesions -hypertrophy of abductor hallucis -biomechanical; excessive pronation |
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Seddon classification of nerve injury
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-neuropraxia;conduction disturbance with complete recovery
-axonotmesis; incomplete division of supportive tissues of nerve -neurotmesis; complete division of nerve |
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sunderlands classification of nerve injury
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-1st degree; local changes to myelin
-2nd degree: incomplete injury to axons -3rd degree; more severe axonal injury with fibrosis -4th degree; severe neuronal injury, not complete -5th degree; complete transection of nerve |
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seddons classification correlations to sunderlands
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-Seddons neuropraxia (1st degree)
-seddons axonotmesis (2nd and 3rd degree) -seddons neurotmesis (4th and 5th degree) |
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Neurolysis nerve surgery and its indications
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-frees the nerve from adhesions or scar tssue that obstruct the growth or block conduction
-use with 1st or 2nd degree injury when nerves are normal but fibrosed |
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Neurorrhaphy nerve surgery and its indications
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-nerve repair
-use when conservative care fails and nerve fxn deteriorates -when a traumatized nerve is partially or completely severed |
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what is the definition of a neuroma (what is a neuroma made of)
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-neuroma represents hyperplasia of schwann cells, axonal elements and fibroblasts
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where is a mortons neuroma located and why there
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-3rd interspace, plantar to the transverse intermetatarsal ligament
-where the communicating branch of MPN joins the communicating branch of LPN |
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what is Mulders sign
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-clicking heard when lateral pressure is placed on mortons neuroma
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what are the DDx of mortons neuroma
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-met stress fx
-RA -osteochondritis dissecans (freiberg's) -ischemia -tarsal tunnel -nerve root compression -peripheral neuropathy -IM bursitis |
