Ch8-13 Flashcards Preview

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Flashcards in Ch8-13 Deck (171):
1

Dermatome

area of the skin innervated by one nerve root
more specific in the lower extremity

2

Myotome

is the muscle innervated by a single nerve root: more specific in upper extremity

3

sclerotome

embryological association, non-specific pain that corresponds only to a general region

4

Caused by vascular compromise to peripheral nerves: capillaries swell up with glucose and water = narrows lumen

diabetic neuropathy

5

what is the most common pattern of sensory loss in diabetic neuropathy

stocking glove
starts in toes and progresses across foot, up the leg, then to fingertips, hand, arm

6

_______don't need insulin, uses glucose directly via blood

Nerves

7

sensory loss usually begins with what

vibration and proprioception
numbness, pain, tingling of spinothalamic happens later

8

Autonomic loss involves

hypotension, arrhythmia, impaired thermoregulation, altered bowel and bladder function and sexual function

9

motor loss tends to be which in Diabetic neuropathy

upper motor neuron

10

effect on the eye during diabetic neuropathy

back of eye abnormal optic nerve, presence of red dots in eye and yellow spots due to swelling

11

what is diabetic retinopathy

new capillaries are made too fast and they rupture because of poor quality

12

neuropraxia

mild, temporary interruption/compression of nerve transmission without nerve damage

13

what is a traction injury

whiplash injury, stretching leading to tearing of nerves if traction long/strong

14

what is an example of an entrapment inj

carple tunnel

15

wallerian degeneration, axontomesis

when there is nerve damage, distal to site of lesion
the nerve will degenerate and proximal to site of lesion will start to repair

16

what is causalgia

o Complex regional pain syndrome due to a minor injury
o A.k.a. reflex sympathetic dystrophy syndrome, Sudek's atrophy
o Long-term pain along a peripheral nerve following minor injury
o May include a regional osteoporosis
o The more epinephrine, the more pain you feel, the more sympathetic reaction, the more sensitive pain receptor becomes, get better at feeling pain
o The way to break pain cycle is with movement

17

Guillian Barre Syndrome

A.k.a. inflammatory polyneuropathy, a.k.a. acute idiopathic polyneuritis

18

how do you differentiate Gullian Barre from diabetic neuropathy?

Post viral reaction (respiratory, Epstien Barr)

19

Guillian Barre Syndrome

Inflammatory PNS of myelin cells lead to demyelination - lymphocytes after infection go to attack myelin

20

what kind of sensory dysfunction does Gillian Barre have

stocking glove

21

Guillian Barre Syndrom age, resolution, sympton

Weakness comes next LMNL signs
Varying degrees from mild to total (not CNS but ANS)
Ages 30-50 most common
90% self-resolving

22

Autoimmune attack of acetylcholine receptors at NMJ

Myasthenia gravis
need more and more ACh to illicit a response but most receptors get destroyed

23

what demographic is most common for Myasthenia gravis

young women and old men

24

most common places to find weakness for Myasthenia gravis

weakness of eyes (ptosis), lips, face, hands: has most
movement and uses Ach most
Weakness gets worse with repeated use of muscle or later in day

25

what disease has no sensory findings

myasthenia gravis

26

what is typically associated with myasthenia gravis

enlarged thymus or thyroma

27

treatment for myasthenia gravis

thymectomy, immunosupressants and anti-acetylecholinesterase (AchE) drugs
Tensilon: injection that allows patient to move again, very powerful

28

Presynaptic disorder due to inadequate Ach

Eaton Lamber syndrome

29

usually has underlying cancer typically lung

Eaton Lamber

30

symptoms of eaton lamber

Stiffness of back and legs, abset DTR, weakness of lower limbs, ptosis, impotence

31

Spondylosis

degeneration

32

Spondylolysis

fracture of vertebra

33

Spondylolisthesis

translation of vertebra anteriorly

34

most common disc lesion levels

C6,7 L5 S1

35

disc protrusion

bulging of disc into spinal canal

36

disc heriation

nucleus pulposis hanging out of annular fiber

37

radiculopathy/radiculitis

Nerve root pathology
Often a burning or tingling pain: paresthesia
Possible loss of reflexes
Possible motor strength loss
MRS testing: expect to see changes

38

spinal stenosis is bad why

encroaches IVF or spinal canal

39

lumbar stenosis

neurologic claudication
Bilateral leg pain and weakness with walking due to vascular or Neurologic claudication = position of antalgia
Vascular claudication = pain with antalgia all the time
Most likely cause is degeneration
neurological problem (LMNL signs)

40

cervical stenosis

gives LMNL and radicular signs in upper extremity and long
tract (UMNL) signs in the lower extremity - Similar finding to ALS except sensory findings present

41

causes of radiculopathy/radiculitis

disc lesion
osteophytes
spinal stenosis
trauma
diabetes
abscess/ neoplasm/ metastasis
infection/inflammation

42

neurofibromatosis

a.k.a. Von Racklinghausen's disease - formation of fibrous
scar tissue on a nerve

43

Cauda Equina Syndrome

Compression of the cauda equina by a space occupying lesion affecting multiple nerve roots

44

symptoms of cauda equina syndrome

urinary incontinence, fecal incontinence, impotence, lack of deep tendon reflexes, muscle atrophy, saddle anesthesia, foot drop (inability to dorsiflex), bilateral
sciatica

45

is cauda equina a medical emergency

yes

46

what are the primary causes of cauda equina syndrome

Resulting from vertebral fractures, subluxations, disc herniations and or disc protrusions occurring centrally (median disc lesion - thus affects both sides)
canal stenosis, luxation, tumors, any space occupying lesion

47

Compression of SC at T12-Ll

Conus Medularis

48

what differentiates conus medularis from cauda equina

Possible upper motor neuron signs in sacral cord (Babinski)
Changes in sensory and motor in the legs bilaterally

49

Viral infection of anterior horn cells (LMN)
All muscles atrophy and waste away
Developmentally bones don't grow on that side especially if affect children

Polio

50

Two vaccines were developed for polio

Semi-alive viruses swallow - sensitize entire digestive tract - IgA gets sensitize to polio = Increase 1st line of defense
Total dead virus injected into muscle - Doesn't strengthen IgA via digestive tract

51

Genetic degeneration of muscle fibers
As you get older muscles die and wither
Classic presentation: patients in teenage years begin to get weakness in shoulders and hips and spread distally

muscular distrophy

52

as muscular distrophy reaches hands and feet prognosis

fatal

53

Affects young children and they don't typically live past 20's, mostly affects boys

Duchaine's muscular dystrophy

54

cervical plexus levels

C1-5
Innervates neck muscles
Sensory of neck and top of shoulder

55

anterior division of brachial plexus controls

flexors

56

posterior division of brachial plexus controls

extensors

57

medial and lateral cords control

pecs

58

musculocutaneous nerve arises from what

lateral cord
innervating in general the anterior arm and cutaneous part is in forearm but never crosses wrist
Biceps, Coracobrachialis, Brachialis

59

median N arises from what

medial and lateral cords
Innervates finger flexors (flexor carpi radialis, palmaris longus), thumb, and pronator teres

60

ulnar n arises from what

medial cord
Innervates hypothenar eminence, flexor carpi ulnaris, DAB, PAD

61

axillary n arises from

posterior cord
Innervates hypothenar eminence, flexor carpi ulnaris, DAB, PAD

62

radial N arises from

posterior cord
Innervates triceps (arm extensors), brachioradialis (flexes, but extends in other animals), wrist and finger extensors

63

iliohypogastric nerve is from

L1
sensory over the abdomen down to pubic symphysis, often cut during abdominal surgery because it's a cutaneous nerve

64

Ilioinguinal Nerve is from

L1
sensory to inguinal ligament, often cut during surgery

65

lateral femoral cutaneous nerve is from

L1
the "PI Ilium" nerve

66

genitofemoral N is from

L1-2
sensory to upper inner thigh and motor to the cremaster
muscle.

67

L2-4 divisions combine to create

femoral and obteraror n's

68

Erb Duchene palsy

problem with wrist extension
Traction injury to C5 and C6 nerve roots
Waiter's tip position: the arm cannot abduct and flex
Pulling of neck with baby still in canal or fall on the right shoulder
Bacody's sign

69

middle trunk lesion

very rare
differing distribution: typical C7 or widespread

70

klumpke's paralysis

Caused by falling and hanging on, Pancoast tumor T1 TP or 1st rib fracture
Ulnar nerve signs (CS-T1 signs)
Pulling of brachial plexus forcefully during birth
Hand and finger extension weakness, hypothenar atrophy, numbness along
medial side of forearm and hand
Possible Horner's syndrome
Ulnar claw

71

what is a pancoast tumor

(tumor at lung apex = compressed cervical sympathetic chain = Horner's syndrome and Ulnar nerve sign)

72

best way to find TOS

Roos test (E.A.S.T)

73

location causing TOS

between scalenus anticus and scalenus medius (scalene triangle), between clavicle and first rib, between pectoral minor and coracoid process, entrapment by humeral head

74

TOS because of the scalene triangle

Rib
Adson's test: positive = cervical rib or scalenus anticus
Halstead's test: localize to scalene triangle
Patient complains of weakness, numbness and tingling when working above the head
Possible cervical rib: X-ray

75

Scalene cause of TOS= asym or symptomatic

asym until later in life when subluxated

76

scalene triangle for TOS will or will not cause and swelling

NOT
subclavian vein does not go through scalene triangle = no compression of vein to cause edema (localize to clavicle or pectoral minor)

77

what N is most affected by TOS by scalene triangle

Ulnar nerve is most effected: plexus compressed from above and shifts downward affecting the lowest nerve

78

what tests are affective in determining if TOS is caused by first rib and clavical

Eden's a.k.a. costoclavicular test

o Adjust first rib or clavicle

79

what exacerbates TOS caused by first rib and clavical

raising and externally rotating the arm

80

what if any happens with the hands during TOS caused by first rib and clavical

Involves hand swelling: due to subclavian vein being compressed

81

what is a major cause of TOS caused by first rib and clavical

Caused by large breasts and bra strap, heavy bags on shoulder straps, seat belt injury

82

what is a test that determines TOS between Pectoral minor and coracoid process

Wright's test a.k.a. hyperabduction test: lower thoracic upper lumbar adjustment

83

what is pancost syndrome

Due to apical lung tumor
Classic sign is Horner's syndrome (droopy eye, constricted pupil, no facial sweating)
May invade brachial plexus

84

Radial neuropathy a.k.a. Crutch palsy

Saturday night palsy: entrapment in the arm pit
• Damage in the spiral groove
• Demonstrates wrist drop: weakness of arm, hand, and finger extensors below the shoulder
• Weakness in triceps and tingling down back of arm

85

ulnar neuropathy

caused by entrapment at the elbow

86

tunnel of guyon ulnar neuropathy

Ape hand is median and ulnar nerve compression (hypothenar atrophy with thumb opposition loss)
• Numbness and tingling stops around wrist rather than goes back to root (confined to hand)
• Bench pressers, military pressers

87

scalene triangle will cause what

nerve and vascular obstruction

88

Meralgia paresthetica

"Brittney Spears": low rider jeans over ASIS and tight belt
• Compression of lateral femoral cutaneous nerve
• No motor signs
• Located on lateral femur
• Often associated with PI ilium = collapses femoral canal because it pulls inguinal ligament attached to pubic symphysis
• Causes: weight gain usually men or weight loss (putting on tight jeans)

89

MCA superior division lesion

Motor control of shoulder, arms, hands, face affected
Left side: Broca's area for speech affected

90

MCA inferior division lesion

Sensory to upper part of body affected
Hearing
Wernicke's area: understanding of language

91

MCA deep territory infarction: lenticulostriae arteries

All sensory and all motor on opposite side of body
Due to hypertension

92

MCA stem infarction results in

complete loss

93

ACA infarction

Lower half of the body: feet, legs, hips
• Sensory and motor loss due to branches feeding into sensory and motor cortexes
• Cingulate gyrus: pericallosum and calloso-marginal arteries Irritability and aggressive behavior due to deterioration of limbic system
• Affects contralateral side

94

PCA infarction

Occipital lobe: loss of vision, recognition of faces, ability to remember someone's face
• Also feeds inferior and medial temporal lobe: deficits in memory formation, recall, and vision

95

Transient Ischemia Attack

Neurological deficit

96

major categories of stroke

neurological deficit, headache, possibly seizures

97

what are the two categories of stroke

hemorrhagic
ischemic

98

georges test

test for vertebral artery insufficiency
Starts with the history: most important part of test
• Proceeds to bilateral blood pressure
• Then auscultation for bruits
• Then Maigne's test

99

what fibers initiate visual reflexes

extrageniculate fibers
Goes to pretectal area of midbrain
• Direct light reflex
• Indirect light reflex
• Auditory reflex: when a sound is heard, your head and eye moves toward the sound
• Coordination of gaze and accommodation

100

occipital lobe areas do

Area 17 the primary visual cortex: sees what is actually in front of you
Area 18 secondary visual cortex (Visual association cortex)
For recognition
Area 19 for memory: to recall the appearance of an object or person not currently in view

101

myopia

near sighted 20/80

102

hyperopia

far sighted 20/15

103

presbyopia

old age vision

104

Inflammation and demyelination of the retina (M.S.)

Patient under 45 y.o.
Eye pain with movement: due to traction of optic nerve
Monocular central scotoma: central blind spot
Decreased visual acuity (blurry): due to all light focusing on macula
Decreased color vision: due to greatest concentration of cones in macula (center of eye)
Tunnel vision
Fundoscopic exam may show papillitis or optic disc pallor
Inflammation may be only in the optic nerve (retrobulbuar neuritis-optic nerve affected) tunnel vision (macula sparing): red vision loss

105

Optic retrobulbar neuritis

Onset and preogression can be fast or slow
Recovery is usually 6-8 weeks (near 100%)
Multiple attacks can lead to permanent deficit

106

brain stem is made up of

midbrain
pons
medulla

107

3 sensory columns

Medially is the visceral sensory column
General somatosensory nucleus (Trigeminal)
Most lateral is the special sensory column

108

GVA

sensory from viscera

109

SVA

taste and smell I, VII, IX, X

110

General somatosensory nucleus (Trigeminal)

Sensation from head via V, VII, IX, and X

111

Most lateral is the special sensory column

II for sight, VIII for hearing and equilibrium

112

GSE

adjacent to the midline (CN III, IV, VI, XII)

113

visceral motor nuclei have how many columns

2

114

GVE

parasympathetics 3, 7, 9, 10
VII and IX: sensory for taste and motor for making saliva
III pupil dilation

115

SVE

voluntary motor control of visceral muscles
V, VII, IX, X, XI innervate muscles of branchiomeric origin

116

embryologically where do muscles of mastication arise

mesoderm

117

only CN to not pass through thalamus

CN 1 opthalmic

118

anosmia

loss of smell

119

hyperosmis

increased sense of smell

120

parosmia

abnormal sense of smell

121

temporal lobe issue with smell

cause smell things that are not there

122

olfactory nerve lesion caused by

Cocaine and other inhalants
Tumor of frontal lobe or pituitary gland
Viral infection
Trauma at cribiform plate

123

what cause cataracts

denaturing of the proteins in the lens due partly to exposure to UV light
• Get big blind spots .
• Remove lens and place artificial lens

124

Nyctalopia

night blindness
Rhodopsin breaks in half when light strikes eyes
• Energy release from break allows you to see
• Need Vitamin A to rebuild Rhodopsin

125

optic nerve exam

inspect
funduscopic exam
visual acuity
reflex
visual field

126

largest N

trigeminal

127

what type of nerve is trigeminal

SVE
GSA

128

sensory lesion of trigeminal N

paresthesia, anesthesia, diminished absent reflexes

• Located in brainstem lead to ipsilateral loss

129

motor lesion of trigeminal N

muscle weakness, atrophy

• Muscles of mastication: chewing

130

trigeminal neuralgia

sharp, stabbing, electric pain
rare
women 30-50
attacks last about 1 min happen 100x day
Seems random but may have triggers: cold exposure, touch, pressure, eating, swallowing
Patients will consider / commit suicide

131

herpes zoster virus most commonly affects

trigeminal N

132

facial CN VII is what type

Mixed nerve (SVE, GSA, SVA): voluntary control of visceral control (facial expression), sensory to head behind the ear, taste anterior 2/3 of tongue (sweet, salty, sour) and smell
Parasympathetic (GVE): lacrimal gland and saliva, and mucous in nose

133

lesion of the facial N result in

Facial muscle weakness
• Upper motor neuron lesion spares forehead (forehead gets innervation from both nerves, both cerebral hemispheres), but face gets droopy on one side
• Lower motor neuron lesion is above and below the eye
bells palsy
Ramsy-Hunts syndrome:

134

Bells palsy

Facial nerve paralysis
o Often accompany by pain around the ear
o Often with drooling, speech impediment (can't make Band P sounds)
o Eyelid may not close
o Onset is sudden
o 80% recovers in 2-6 weeks
o If recovery is delayed beyond 12 weeksr there is usually some degree of permanence because nerves begin to take over other muscle fibersr
o resembles a grimace that makes unaffected side appear paralyzed
(may be treated with BoTox)

135

Ramsy-Hunts syndrome

Herpes paralysis and swelling behind the ear
Affects cornea
Characteristic tree-like pattern in cornea indicative of inflammation
One of more common causes of Bell's palsy during pregnancy

136

Vestibulocochlearr Cochleovestibularr Accousticr Statoaccoustic nerve VIII is what kind of nerve

SSA

137

low frequency sounds travel

the farthest

138

what are the types of deafness

conductive
perceptual

139

perceptual deafness

a.ka.a. sensorineural: means the cochlea is malfunctioning or the nerve to the temporal lobe is destroyed
Inner ear infectionr Meniere's diseaser noise induced deafness

140

conductive deafness

mechanical deficit in getting sound to the cochlea
Obstructionr eardrum damager otosclerosisr external or middle ear
Dampens sound getting in
Wipes out one area of cochlear membrane usually at the first turn
Loud noises gets concentrated at the first turn so you lose hearing infection
tends to be higher range frequency

141

cochlear lesions

Tinnitus: ringingr buzzingr roaring in the ear is a cochlear problem
• Auditory scotomas: loss of hearing at certain frequencies (often noise induced)
• Auditory hallucinations: temporal lobe lesionr formed soundsr hearing voices
• Schwannoma a.k.a. acoustic neuroma

142

Schwannoma a.k.a. acoustic neuroma

Unilateral haering loss
o Tinnitus
o Facial pain and sensory loss from Trigeminal involvement (often starts with loss of corneal reflex)
o May involve facial nerve if quite large
o May even effect IXr Xr and cause hydrocephalous
o Benign tumor

143

vestibular nerve lesion

Dizziness: feeling of unsteadiness with ataxia
• Impulsion: feeling of forward motion
• Vertigo: abnormal feeling of motion
Subjective vertigo: patient feels he is moving while still
Objective vertigo: patient feels the room moving while he is still
• Any of these may cause motion sickness
• Vision, proprioception and vestibular system work together to allow you to stand in space

144

peripheral vestibulocochlear lesion

patients will have a 2-5 second lag between motion and nystagmus then it goes away in 30 seconds or so

145

Meniere's syndrome

Inner ear disorder
o Too much fluid production increases pressure but normal drainage
o Over stimulates inner ear

146

central vestibuocochlear lesion

no lag time between motion and onset and no habituation to stimulus

147

glossopharyngeal exits the skull

jugular foramen

148

Lesions of IX, X and XI

go together
at jugular foramen

149

vagus N responsible to

all viscera down to transverse colon

150

unilateral vagal lesion

hoarseness, dyspnea, dysphagia uvular deviation away from affected side

151

bilateral vagal lesion

arrhythmia, laryngeal paralysis, stomach dilation, death

152

irritative vagal lesion

increased parasympathetic tone =Bradycardia, stomach dilation, esophageal and pyloric sphincter spasm

153

spinal accessory nerve is

SVE

154

where does CN XI arise from

ant horn C1-5

155

LMNL CN XI

ipsilateral weakness of shoulder shrug and contralateral head rotation

156

UMNL CN XI

deficit turning head to contralateral side (SCM innervated ipsilaterally)
o The muscles will be stuck in contralateral head rotation and shoulder shrug but muscle test will be weak

157

hypoglossal nerve is

GSE
motor to tongue

158

Superior rectus

upward gaze

159

inferior rectus

downward gaze

160

medial rectus

eye adduction

161

lateral rectus

eye abduction

162

supirior oblique

down and in

163

inferior oblique

up and in

164

Strabismus

lazy eye

165

exotropia

bad eye goes outward, lateral deviation, wall-eye

166

esotropia

bad eye goes inward, medial deviation, cross-eye

167

hypertropia

bad eye goes upward

168

hypotropia

bad eye drops downward

169

oculomotor palsy wont include

SO and LR

170

Anisocoria:

diff size pupils

171

miosis

constricted pupil, usually due to pharmaceuticals