PCP - Semester Two Flashcards
(91 cards)
1
Q
Name for true muscle weakness?
Two other types of non-neuromuscular weakness?
A
Motor weakness
- Emotional Or physical fatigue
- Joint pain or stiffness
2
Q
Two main groups of causes of muscle weakness?
A
Primary problem with muscles
Neurological conditions.
3
Q
What is a well-known cause of generalised muscle weakness affecting the neuromuscular junction?
A
Myasthenia gravis
4
Q
Common causes of muscle weakness?
A
Immunological Malignancy Vascular events Drugs Metabolic disorders
5
Q
How do you breakdown site of muscle weakness
A
General or localised
Localised: symmetric (proximal or distal) or asymmetric.
6
Q
Another name for true muscle weakness?
A
Motor Weakness
7
Q
Name two other common types of non neuromuscular weakness?
A
Physical or emotional Fatigue
Joint pain or stiffness
8
Q
Two main Categories of causes of muscle weakness?
A
Primary problem involving muscles OR Neurological conditions (affecting the NM junction, Peripheral nerves, spinal nerve roots, anterior horn cells or corticospinal tracts
9
Q
How do we classify muscle weakness?
A
General
Focal > Asymmetrical or symmetrical (distal or proximal)
10
Q
Common cause of generalised muscle weakness affecting the NM junction?
A
Myasthenia gravis
11
Q
Proximal weakness caused by what kind of disorders and which muscle groups?
A
Primary muscle disorders affecting axial muscle groups
12
Q
Distal weakness caused by what kind of disorders and at which muscle groups?
A
Peripheral neuropathy and motor neuron disease
Hands and Feet
13
Q
Common causes of muscle weakness?
A
Immunological malignancies vascular events Drugs Metabolic disorders
14
Q
Common causes of CNS sensory disturbances
A
Cerebrovascular disease MS Tumours Parkinsons Huntingtons
15
Q
Common causes of peripheral NS sensory disturbances?
A
Diabetes
Alcohol excess
Nerve entrapment
16
Q
Four common patterns of sensory loss?
A
Hand or glove = peripheral neuropathy
Dermatomal pattern
Area supplied by a particular nerve eg Median Bar
Hemisensory loss (strokes or other cerebral events)
17
Q
Two main types of sensation tested in clinical situation?
A
Primary sensation or Cortical sensory function
18
Q
Order of Motor Exam modalities
A
Tone, Power, Reflexes, Sensation, Coordiantion/Clonus
Tall, People, Rule, South China
19
Q
Which direction do you move to determine border of a sensory abnormatlity?
A
From abnormal to normal area
20
Q
Five areas of basic eye exam?
A
Acuity, Field testing, Eye Movements, Pupils and Fundus examination.
All, fish, move, pretty, funny
21
Q
Which cranial nerves are important to function of eyes?
A
CN 2 (optic) - optic tracts from retina to visual cortex CN 3 (occularmotor) - all eye muscles except LR and SO, levator palpebrae superioris and parasym to pupil (constriction -sphincter) CN 4 (Trochlear) - SO muscles CN 5 (Trigeminal) - Normal Sensation to Cornea CN 6 (Abducens) - LR CN 7 (Facial) - Closing of eyelid - Orbicularis oculi
22
Q
What nerve division control pupil dilation? Where does the nerve come from?
A
Sympathetic - Superior Cervical Ganglion - dilator pupillae
23
Q
Which muscles control eye movements?
A
LR6 - SO4 R3
Lateral Rectus (CN 6 - Abducens) Superior Oblique (Trochlear CN4) The rest Occulomotor aka CN3
24
Q
Three ways to test visual acuity?
A
Unaided
Pinhole
Glasses
25
Four things you should check in the pupils?
```
SSDC
Shape
Symmetry
Direct Response
Consensual Response
```
26
Severity of muscle weakness?
Function loss in affected area.
| Move against gravity? Or paralysed?
27
Time course muscle weakness?
Sudden - vascular
Slower onset - tumour
Fluctuate? worse after activity?
28
Relieving factors Muscle weakness?
Does sitting, standing, sleeping help? Heat packs?
29
Aggravating Factors of Muscle weakness?
Triggering the episodes of weakness?
30
Associated Features of Muscle weakness
Medication - statins can cause myocytis
| pain? Associated with sensory changes? Fever? Headache, back pain, breathing problems? pins and needles or memory.
31
What do you need to rule out before you know it is true muscle weakness?
Doesn't want to move because of General Apathy/Fatigue or Joint pain.
32
What does the Stem plegia mean?
Complete loss of strength aka Paralysis
33
What does the stem paresis mean?
incomplete loss of strength
34
What does the stem Hemi mean?
Half
35
What does the stem Mono mean?
One of them, aka one limb
36
What does the stem Para mean?
Both lower limbs
37
What does Quad mean?
All four limbs?
38
What is Para-aesthesia
Abnormal sensation perceived without a stimulus eg pins and needles
39
What is Hyper-aesthesia
Abnormal increase in sensitivity to a stimulus
40
What is Dysaesthesia
All positive Sensory changes including Para and Hyper aesthesia.
41
Hyper-algesia
Heightened response to noxious stimulus
42
Allodynia
Normal stimulus felt as pain eg clothes brushing body felt as pain
43
Phrases used by patients around positive symptoms?
tingling, pins and needles, pricking, burning, tightness and electric shock or a sharp stabbing (pain)
44
A numbness, coldness or loss of feeling is described as a what symptom?
Negative sensory symptom
45
Diminished ability to perceive pain, temp or touch?
Hypo-aesthesia
46
Complete inability to percieve pain, temp or touch?
Anaesthesia
47
Analgesia?
Complete insensitivity to pain (can still feel temp and touch)
48
Determining Site of the Sensory Dysfunction?
Ask them to point? Half body? whole limb? Sym or asym?
49
Determining Quality of the Sensory Dysfunction?
Is it a postive or negative? characterise extent
50
Determining Time course of the Sensory Dysfunction
Suddenly, over days or worse at night or during day
51
Sensory Dysfunction Assoc Features?
EtOH, Medications, Diabetes (other Hx and Fx), other neuro symptoms eg muscle weakness or gait disturbances, injuries to effected area (eg burns or ulcers).
52
Dermatome at anterior surface of knee
L3
53
Dermatome behind the knee
S2
54
Dermatome at medial malleous
L4
55
Dermatome L2 test?
Upper Thigh lateral aspect
56
Dermatome L1 test?
Just bellow undie line
57
Lateral aspect of the calf Dermatome?
L5
58
Heel?
S1
59
Important Cardinal Features in an eye exam?
Time course: sudden (med ER) or gradual, degenerative?
| , Site: unilateral, bilateral which visual fields, neglect?
60
TOC is a common symptom. It affects what percentage of the population at some stage?
50%
61
```
What is not a bengin cause of syncope?
Cardiac syncope
Vasovagal syncope
Postural hypotension
Situational syncope
```
Cardiac Syncope
62
```
What is not a feature of syncope?
Sudden LOC
Amnesia
Sudden loss of postural tone
Spontaneous recovery
Complete recovery
```
Amnesia
63
```
Which of the following is not a key element of syncope?
Seizures
Global fall in blood flow
Reduction in O2 supply to brain
Inactivity of cerebral cortex
```
Seizures
64
```
What is not a cause of cardiac syncope?
MI
Aortic Stenosis
Vertigo
Bradycardia
Tachycardia
```
Vertigo
65
What is the key difference in cerebral cortex activity between syncope and seizures?
The cerebral cortex is inactive in syncope and overactive in seizures.
66
What is the key difference in blood flow between syncope and seizures?
Decreased global blood flow in syncope and increased in seizures
67
During seizures electrical neuronal activity in the brain is:
- Normal throughout
- sudden and uncontrolled
- Slowly rising to a crescendo
- Sudden but in a distinct pattern.
Sudden and uncontrolled
68
Tut 28: Possible causes of knee pain?
```
injury to ligaments or menisci
loss of cartilage from osteoarthritis
inflammation bcz of rheumatoid or posoriatic arthritis
inflam of surrounding tendons and bursae
Reffered pain from hip or back
```
69
Different sites of knee pain? And what they suggest? Radiation?
Anterior knee pain: osteoarthritis or patella problem
Lateral or medial: ligament sprain or meniscal tear.
Posterior knee: hamstring strain, bursitis or baker's cyst or DVT.
Check that the knee is the only joint affected
70
Time course and what it suggests? Knee pain
Acute: trauma or haemorrhage inot joint
Slow onset: consistent with arthritis, bursitis or tendonitis.
Is it worse in morning or after exercise?
71
Context of Knee pain?
Ask about the postiono f the knee when injured, direction of force
72
Ag or Rel factors of knee pain?
Certain movements making it worse? Tried any pain relief?
73
Common Associated features of knee pain?
swelling, noises, popping sounds (esp acute injury).
| Loss of Function: stiffness, locking, giving way.
74
Severity of Knee Pain?
Rate the pain, What can't they do (esp chronic eg stairs)
75
Features of a Focal Seizure?
- Abnormal activity starts focally and spreads across the brain
- Or it stays focally
- Symptoms depend on the function of the affected brain area
- altered state of consciousness after the seizure has started.
76
Which of the following are the two key features of the definition of epilepsy: Seizures that are:
- Once off
- Recurrent
- Occur with a known cause
- Unprovoked
- Unprovoked and recurrent
77
Which of these conditions is not associated with causing seizures?
- Metabolic disorders
- Infectious diseases
- genetic disorders
- Mild hypothermia
- focal brain lesions due to stroke, tumour or head injury
- Mild hypothermia
78
What are some words used to describe a TLOC by patients?
Spell, Collapse, Blackout and Funny turn
79
If the patient has not actually lost consciouness, which of the following is not related-type problem?
- Light-headedness
- Dizziness
- Vertigo
- Loss of balance
- Narcolepsy
- Muscle weakness
- Psychiatric disturbances
Narcolepsy
80
What two Cardinal Features are especially relevant for syncope and seizures?
Prodrome aka Context
| Period after the event
81
What three word classification can be used as an alternative information collection approach for syncope and seizures?
Before, During and After
82
What is the typical cardiac syncope prodrome?
Typically no pro-drome, patient will not remember falling over/losing consciousness.
83
What is not a characteristic of the tonic phase of a seizure?
- Stiffening of limbs
- Extension of back and limbs
- Loss of postural tone
- Eyes deviate upwards
- May cry out involuntarily
Loss of Postural Tone
84
Which of the following two characteristics apply to syncope but not to the clonic phase of seizures?
- Generalized flexion contraction of muscles
- Contractions alternate with relaxation
- LOC usually less than 30 seconds
- Convulsive movments can occur (usually only a few jerks)
- LOC usually 1-2 minutes.
LOC usually lasts less than 30 seconds
| Convulsive movements can occur but usually only a few jerks.
85
Which two apply to both cardiac syncope and seizures?
- Usually doesn't occur when sitting or lying
- Can occur while sitting or lying
- Can occur during sleep
- Self limiting
- Lying flat assists recovery
- Can occur while sitting or lying
| - Self Limiting
86
What are two common associated features are commonly found with syncope?
Pallor and Sweating
87
Which two are descriptive of seizures?
- Injury not common
- injury may occur
- injury common
- protective reflexes are preserved
- Muscle aches after the event
- Muscle aches after the event
| - injury common
88
What could a "spell" be if there wasn't a true LOC?
Vertigo
Disequilibrium
Pre-syncope
Non-specific dizziness
89
Causes of Cardiac Syncope?
MI, Aortic Stenosis, Brady/Tacycardia, Arythmias
90
Other causes of Seizures besdies epilepsy?
Recreational Drugs, Fever, Tumours, MI and strokes.
91
Associated Features that diffentiate seizure from other TLOC?
Tongue biting, Head turning, Cyanosis, Cry or moan, Frothing at mouth, incontinence often occurs, usually not sweaty.
