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CMC 2 > Wk 2 Peripheral Nerve Lecture > Flashcards

Wk 2 Peripheral Nerve Lecture Flashcards

1
Q

What is the inheritance pattern of SMA?

A

Autosomal recessive -> loss of SMN protein

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2
Q

Neurological ROS

A
  • Headache
  • Dizziness
  • Difficulty with coordination
  • Tremors
  • Weakness
  • Numbness
  • Problems with balance
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3
Q

Paresis

A

impaired strength or weakness

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4
Q

Paralysis or plegia

A

absent strength
(hemiplegia, paraplegia, tetraplegia)

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5
Q

Paralysis or plegia

A

absent strength
(hemiplegia, paraplegia, tetraplegia)

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6
Q

Radiculopathy

A

dysfunction of a spinal nerve root (often due to compression)

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7
Q

Neuropathy

A

dysfunction of a nerve

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8
Q

Allodynia

A

pain due to a stimulus that normally does not provoke pain.

Light touch/feather could provoke pain

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9
Q

What 4 things do we examine during a motor exam?

A
  1. Inspection: normal muscle bulk vs atrophy (reduced bulk) or hypertrophy (increased bulk)
  2. Tone:
  3. Pronator drift: a sensitive screen for mild weakness
  4. Muscle strength
    – Isolate individual movements
    – Know spinal root innervation of muscles tested (myotomes) * + Radial/Ulnar/Median nerve exams
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10
Q

Pronator drift test

A

(+) = abnormal, see drift
(-) = absent, no drift
-testing upper motor neuron: strength and motor control
-pronation is more primitive

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11
Q

Motor exam strength grading (MRC)

A
  • 5 : Normal: movement against full resistance
  • 4 : movement against gravity and some resistance
  • 3 : movement against gravity alone
  • 2 : movement across joint with gravity removed
  • 1 : Visible muscle contraction, no movement at the joint
  • 0 : No muscular contraction at all
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12
Q

nerve level motor exam arm testing

A

C5: Shoulder abduction
C6: Elbow flexion/Wrist Extension
C7: Elbow extension/Wrist flexion
C8: Thumb extension
T1: Finger Abduction & Adduction

  • T1/Ulnar nerve – Finger abduction
  • T1/Median nerve – Thumb opposition
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13
Q

Motor testing in the legs

A
  • L1,L2 –hip flexion (iliopsoas)
  • L2,L3 –thigh adduction (adductors)
  • L3,L4 –knee extension (quadriceps)
  • L4,L5 – ankle dorsiflexion (tibialis anterior)
  • S1 – knee flexion (hamstrings)
  • S1,S2–ankleplantarflexion(gastrocnemius/soleus)
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14
Q

What 4 components are tested in the sensory exam?

A
  1. proprioception
  2. vibration
  3. light touch
  4. pain and temp
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15
Q

Meaningful patterns in sensory exam

A
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16
Q

What is the Romberg sign?

A

Tests proprioception
* Patient stands with feet together
with eyes open
* Have patient close eyes x 10
seconds
– ‘absent’ = normal
* Patient does not lose balance when eyes closed (micro-adjustments okay)
– ‘present” = abnormal:
* Patient loses balance; takes a step or has to open their eyes

17
Q

What are 5 causes of distal sensory polyneuropathy?

A
  1. Metabolic: – Type 2 DM and prediabetes > type 1 DM,
    hyperlipidemia, B12 deficiency
  2. Idiopathic:
    – 40% of those presenting with distal sensory polyneuropathy. Often, found to have metabolic syndrome.
  3. Toxic:
    – Alcohol, chemotherapy, lead, mercury,
    arsenic and thallium, vitamin B6 toxicity
  4. Infectious:
    – Lyme, herpes, hepatitis, HIV and syphilis
  5. Immune:
    – Sarcoid, Sjogren’s, Guillain-Barre syndrome, vasculitis, amyloidosis/MGUS (monoclonal gammopathy of uncertain significance)
18
Q

What is the significance of an abnormal vibration exam?

A

abnorm = never felt vibration or lose sensation earlier than tester does
Dorsal column dysfunction

19
Q

What is the scale for reflex grading?

A
  • Descriptive: “absent” “present” “brisk” * Scale:
    – 0 absent
    – 1+ trace, or only seen with reinforcement
    – 2+ normal
    – 3+
    – 4+ very brisk (jumpy) associated clonus
    *Note: 1+ and 3+ are normal in many situations
    BUT asymmetric reflexes, and 4+ is always abnormal.
    “0” is presumably abnormal but may be due to ‘technical’ difficulties or age
20
Q

What’s included in the reflex exam?

A
  • C5 - biceps brachii reflex
  • C6 - brachioradialis reflex
  • C7 - triceps reflex
  • L4 - patellar reflex
  • S1 - Achilles reflex
  • Babinski
21
Q

What is the Babinski sign?

A

Plantar reflex
* Normal Response: Down going toes
– Say: “Absent Babinski”, “flexor plantar response”
or “down-going toes” NOT “negative Babinski”

  • Abnormal Response: Upgoing toes +/-
    fanning of the toes
    – Say: “Babinski sign present,” “Extensor plantar
    response” or “up-going toes”
  • Babinski sign: disinhibition of spinal cord circuits due to loss of corticospinal track modulation (upper motor neuron sign)
  • When is this normal to have?… – Neonates/infants
22
Q

When would we see hyperreflexia?

A

Dysfxn/damage to descending corticospinal tract
-caused by damage to CNS by many pathologies

23
Q

What causes hyporeflexia?

A

Interruption of efferent or afferent arcs due to:
– Peripheral neuropathy
* Guillain Barre syndrome (AIDP); other peripheral neuropathies
– Myopathy- muscular dystrophy or inflammatory myopathy
– Hypothyroidism
– Electrolyte imbalance (elevated magnesium or calcium)
– Anterior horn cell disease
* Spinal muscular atrophy; others – Botulism, Polio

24
Q

What are fasciculations?

A

muscle twitches
=lower motor neuron sign

25
Q

Signs of ALS?

A

Lower and upper motor neuron signs (one of the few pathologies w/ both)
-weakness, muscle atrophy
-lower fasciculations
-upper spasticity

26
Q

How to document a norm peripheral nerve exam

A

CMC 2 (10 decks)

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