PNS Flashcards
(80 cards)
1
Q
spinothalamic tract contains fibers that conducts what? do fibers decussate?
A
pain, temperature, and crude touch
yes - go contralateral
2
Q
posterior column contains fibers that conducts what? do fibers decussate?
A
position, vibration, and fine touch
no - stays ipsilateral
3
Q
corticospinal tract contains fibers that conducts what? do fibers decussate?
A
motor
yes - go contralateral at pyramid
4
Q
2 division of motor pathway
A
- upper motor neurons - cortex to anterior horn
2. lower motor neurons - anterior horn to mm
5
Q
most common complaints patients come in with
A
- pain
- weakness
- paresthesia (numbness/tingling)
6
Q
most common causes of PNS problems
A
- ischemia
- bleeding
- masses (impingement)
- peripheral nervous disorders (MS, Guillian Barre)
- neuromuscula disorder (myasthenia gravis)
- muscular disorders (dystrophies)
7
Q
sensations described by patients
A
- dysesthesia
2. paresthesia
8
Q
dysesthesia
A
all types of abnormal sensation including pain regardless of a stimulant being present or not
9
Q
paresthesia
A
mostly tingling, pins and needles w/o pain and w/o apparent stimulus
10
Q
sensations found on exam
A
- hypoesthesia
- hyperesthesia
- hyperalgesia
- allodynia
11
Q
hypoesthesia
A
reduced sensation to a particular test
12
Q
hyperesthesia
A
pain in response to mostly touch
13
Q
hyperalgesia
A
severe pain in response to mildly painful stimulus (sharp)
14
Q
allodynia
A
non-painful stimulus perceived as painful on the skin
15
Q
5 types of sensation tested in peripheral sensory exam
A
- pain - pin or sharp end of broken Q-tip
- temperature - metal hammer handle is cool
- light touch - Q-tip
- proprioception
- vibration - tuning fork
16
Q
discriminative sensation exam
A
- stereognosis - identify an object by feel
- 2-point discrimination
- number identification
- extinction - touch b/l, feel both?
17
Q
motor exams include?
A
- inspection - atrophy
- palpation - tone
- strength testing - major mm groups
- reflexes
18
Q
reflexes
A
- brainstem - corneal, gag, pupillary
- superficial - abdominal, Babinski, anal
- DTR
- clonus - seen in UMN lesions
19
Q
what should be done if need to enhance visible motor movement of a tendon reflex?
A
use reinforcement techniques
20
Q
anal wink used to check what disorders?
A
S2-4, cauda equina
21
Q
Babinski used to check what disorders?
A
- L5-S1
2. can be pos in CNS disorders
22
Q
what happens with DTR in CNS disorders? PNS disorders?
A
- CNS disorders - DTRs increased
2. PNS disorders - DTRs decreased
23
Q
DTR
A
- brachioradialis
- biceps
- triceps
- patellar
- achilles
24
Q
brachioradialis DTR tests what nerves? and where to place hammer?
A
- C5, C6
2. point end on proximal mm belly or flat end on distal tendon
25
biceps DTR tests what nerves? and where to place hammer?
1. C5, C6
| 2. point end onto thumb lying over tendon
26
triceps DTR tests what nerves? and where to place hammer?
1. C6, C7
| 2. flat or point end on triceps tendon above olecranon
27
patellar DTR tests what nerves? and where to place hammer?
1. L2, 3, 4
| 2. flat end on patellar tendon below patella above tibia
28
achilles DTR tests what nerves? and where to place hammer?
1. S1
| 2. flat end on achilles tendon above calcaneus
29
normal DTR is written as?
2/4
30
what is reinforcement technique?
engage b/l mm groups above the level being tests to block any run away motor neuron signals going up to enhance reflex signal
31
UMN lesion will have what symptoms?
1. spasticity
2. loss of dexterity
3. up going Babinski
4. loss of superficial reflexes
5. weakness w/o atrophy of mm
6. hyperreflexia DTR
32
disorders due to UMN lesions
1. stroke
2. MS
3. cerebal palsy
4. traumatic brain injury
5. ALS
33
LMN lesions will have what symptoms?
1. flaccid paralysis
2. mm atrophy/wasting
3. hyporeflexia DTR
4. superficial reflexes fine
34
disorders due to LMN lesions
1. polio
2. guillian-Barre
3. ALS
35
disorders due to anterior horn lesions? symptoms?
1. ALS; polio
2. symptoms:
- fasciculations and weakness in segmental pattern
- sensation intact
- weak DTR
36
disorders due to spinal nerve roots compression? symptoms?
1. herniated disc
2. symptoms:
- dermatomal sensory changes
- weakness --> atrophy
- weak DTR
37
peripheral mononeuropathy disorders? symptoms?
1. carpel tunnel; Bell's Palsy
2. symptoms:
- weakness and sensory loss in that peripheral nerve distribution
- weak DTR
38
peripheal polyneurophaty disorders? symptoms?
1. diabetes; ETOH neuropathy
2. symptoms:
- distal weakness and stocking-glove distribution sensory loss
- weak DTR
39
neuromuscular junction disorder? symptoms?
1. myasthenia gravis
2. symptoms:
- muscular fatigability
- sensation intact
- DTR intact
40
mm disorders? symptoms?
1. muscular dystrophy
2. symptoms:
- weakness primarily in proximal mm
- sensation intact
- DTR intact or possibly decreased
41
cutaneous nerves of the anterior arm and hand
1. upper arm - brachial cutaneous nerve (medial and lateral)
| 2. lower arm - ante-brachial cutaneous nerve
42
cutaneous nerves of posterior arm and hand
1. upper arm - brachial cutaneous merve
2. lower arm - ante-brachial cutaneous nerve
3. hand - ulnar and radial n.
43
upper brachial plexus injury due to? damage to? common disorder?
1. stretching of neck away from shoulder due to birth trauma or falling on shoulder
2. damage to C5 + C6 nerve root motor and sensory
3. waiters tip position
44
lower brachial plexus injury due to? damage to? common disorder?
1. arm being pulled superiolry from catching something overhead or birth trauma
2. C8 + T1 motor palsy/weakness
3. thoracic outlet syndrome
45
thoracic outlet syndrome cause
compression of brachial plexus:
- b/w anterior scalene and medial scalene or cervical rib
- b/w clavicle and 1st rib
- b/w ribs and pectoralis minor mm
46
thoracic outlet syndrome results
weakness and numbness of the hands and arms due to compressed neurovascular supply
47
thoracic outlet syndrome tests
1. Roo's test
| 2. Adosn's test
48
long thoracic nerve injury caused by
- compression b/w clavicle and 1st rib
| - axillary surgery
49
long thoracic nerve injury results
- damage to C5-7 region
| - weak serratus anterior m --> winging of scapula
50
media nerve injury caused by
1. crush injury
2. pronator syndrome
3. carpal tunnel syndrome
4. wrist slashing
5. palm injury/laceration (recurrent branch of the median nerve)
51
median nerve injury results
1. damage to C6-T1 region
- weak foramen pronation, wrist and digit flexion, thumb abduction and opposition; dropping things
- atrophy of thenar mm
- paresthesias or loss of sensation to lateral palm, thumb, index and middle finger
2. ape hand deformity
52
pronator syndrome
media nerve pinched b/w the 2 heads of pronator teres
53
test for pronator syndrome
- examiner resists the patient's effort to pronate
| - tingling along forearm and lateral hand = pos for median nerve impingement by pronator teres
54
anterior interosseus neuropathy caused by
- pronator teres impingement of anterior interosseus n. (from median n.)
- trauma; tennis elbow strap too tight
55
anterior interosseus neuropathy results:
weak flexor digitorum profundus and flexor pollicis longus
56
anterior interosseus neuropathy test
pinch grip OK sign
- inability to pinch the fingers together tip to tip
- check mm strength
57
tests for carpal tunnel syndrome
1. tinnels sign
2. phalens test
3. reverse phalens (prayer test)
58
ulnar nerve injury caused by
1. fracture of the humerus near medial epicondyle
2. cubital tunnel syndrome (trauma or entrapment of ulnar nerve as it passes behind medial epicondyle)
3. laceration near wrist
4. entrapment at Guyon's canal
59
ulnar nerve injury results
1/ damage in C6-8 region
- paresthesias or loss of sensation of the medial part of the palm and 4th + 5th digits
- weak wrist flexion and adduction (weak flexor carpi ulnaris)
- weak finger abduction and adduction (weak interossei)
- loss of thumb adduction (lost adductor pollicis)
- loss of MCP flexion in 4th + 5th digits (lost lumbricals)
2. claw hand
60
claw hand
- extended 4th + 5th MCP joints (lost 3rd and 4th lumbricals)
- flexed 4th + 5th PIP (functional flexor digit superficials)
- weak flexion of 4th + 5th DIP joints (weak flexor digit profundus)
61
radial nerve injury caused by
- fracture of the humerus near radial groove
| - saturday night palsy - compression by bleeping with arm under head
62
radial nerve injury results
1. damage in C7-T1 region
2. sensory loss to back of the hand
3. wrist drop - weak brachioradialis, supinator, wrist and digit extensors
63
cubital tunnel syndrome tests
tinels sign at elbow
64
cutaneous nerves of anterior leg
1. lateral femoral
2. anterior femoral
3. common fibular
4. saphenous
5. superficial peroneal
65
cutaneous nerves of posterior leg
1. lateral femoral
2. branches of post femoral
3. saphenous n
4. lateral sural
5. medial plantar
6. lateral plantar
66
sciatic nerve injury caused by
1. disc compression on L4 and L5 nerve roots
2. piriformis syndrome
3. posterior hip dislocation
4. misplaced intramuscular injection
5. gunshot or stab wounds to the medial buttock
6. surgery
67
sciatic nerve injury results
1. sciatic
| 2. steppage gait - weakness of paralysis of hamstring mm and thing extensors and all mm below knee
68
superior gluteal nerve injury results
trendelenburg gait - weak hip abductors and external rotators (gluteus medius)
69
lateral femoral cutaneous nerve injury caused by
compression at iliac crests (belts, seats, large bellies)
70
lateral femoral cutaneous nerve injury results
numbness over lateral thigh
71
common fibular/peroneal nerve injury caused by
1. impingement by piriformis
2. proximal fibular fracture
3. stretched from a varus stress (with lateral collateral ligament)
4. compressed by casting
5. surgery
72
common fibular/peroneal nerve results
1. paralysis of dorsiflexors and everters
2. loss of sensation of anterolat leg and dorsum of foot
3. foot drop - pt displays high stepping gait and foot slap
73
superficial fibular/peroneal nerve injury caued by
1. proximal fibular fracture
2. stretched with varus stress
3. compressed by casting
4. surgery
74
superficial fibular/peroneal nerve injury results
1. paralysis of foot everters; NO FOOT DROP
| 2. loss of sensation of anterolateral leg and dorsum of foot
75
deep fibular/peroneal nerve injury caused by
1. anterior compartment syndrome
2. anterior tarsal tunnel syndrome
3. pes cavus (high arch) - less space under retinaculum
4. tight shoelaces
5. trauma
76
deep fibular/peroneal nerve injury results
1. weak dorsiflexors
| 2. FOOT DROP
77
medial plantar nerve injury (runners) causes
1. entrapment in the longitudinal arch
| 2. joggers foot - valgus hindfoot and pes planus
78
medial plantar nerve injury results
aching pain in arch and burning/paresthesia in the medial plantar surface
79
diabetic peripheral neuropathy
- damage to peripheral nerves
- paresthesias and pain of feet > hands
- loss of vibratory, pain, temp, light touch sensations
- loss of proprioception
- decreased reflexes
- weakness and atrophy of interossei mm (later stages)
80
myasthenia gravis
- autoimmune disorder of NMJ with Abs against postsynaptic acetycholine receptor and disturbed T cell function
- common presenting complaint/signs:
fatigue or proximal mm weakness
ptosis
diplopia
dysphagia
dysarthria
dyspnea and respiratory mm weakness
- no sensory loss or altered reflexes
