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C&M Neuroanatomy > Clinical lectures Week 9 > Flashcards

Clinical lectures Week 9 Flashcards

1
Q

How do motor neuron problems first present?

A

with a weakness of something

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2
Q

What are the 6 pathologies that can cause muscle weakness?

A
  1. UMN - stroke, tumour
  2. LMN - MND, root damage, peripheral neuropathy, single nerve damage
  3. Neuromuscular junction - myasthenia
  4. Muscle fibre - myopathy
  5. Non-specific - systemic illness
  6. Functional - poor effort, pain, hysteria
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3
Q

In UMN weakness, what happens to:

  1. Tone
  2. Reflexes
  3. Plantars
A
  1. Tone increased –> muscles more stiff
  2. Reflexes increase / brisk
  3. Plantars increase
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4
Q

In LMN weakness, what happens to:

  1. Tone
  2. Reflexes
  3. Plantars
A
  1. Decrease - muscles more flaccid
  2. Reflexes decrease (will be absent or depressed)
  3. Plantars decrease
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5
Q

What are some causes of UMN disorders?

A

stroke, infection, tumour, degeneration

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6
Q

What are the clinical findings in UMN disorders?

A

weakness
mild atrophy of muscles
brisk reflexes
upgoing plantars

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7
Q

What are the clinical findings in LMN disorders?

A

weakness
mild atrophy of muscles
depressed or absent reflexes
down going plantars

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8
Q

What are the two types of LMN lesions?

A
  1. Axonal loss (if its affecting axons)

2. Demyelination (if its affecting myelin sheath)

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9
Q

What are the clinical features of myopathy? (disease of muscle)

A
  • progressive weakness (rapid or slow), usually proximal normal sensation
  • normal reflexes
  • normal tone
  • moderate wasting
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10
Q

What are the causes of myopathy?

A
  • congenital
  • inherited
  • metabolic
  • toxic
  • mitochondrial
  • acquired
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11
Q

What is myasthesia gravis a disorder of?

A

neuromuscular junction

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12
Q

What are the clinical features of myasthesia gravis?

A
  • weakness
  • fatigability
  • worse as the days go bye –> symptoms are transient
  • normal sensation as its an NMJ disorder
  • can see problems with speech and swallowing
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13
Q

What are repetitive nerve stimulation studies?

A

we stimulate motor nerves to see the action potentials and see if they look similar

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14
Q

How can nerve pathologies be divided?

A

into focal and generalised

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15
Q

Give an example of a focal nerve pathology

A

Carpal Tunnel syndrome:

  • focal median neuropathy at the wrist
  • median nerve is compressed at the wrist, resulting in numbness or pain
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16
Q

What are the symptoms of peripheral neuropathy?

A
  • numbness (especially in arms and legs)
  • stabbing pain
  • burning pain
  • sensitivity to touch
  • co ordination difficulties
  • muscle weakness
  • bladder/bowel problems
17
Q

What is the most common cause of polyneuropathy?

A

diabetes

18
Q

What is radiculopathy?

A
  • pinching of nerve at spinal cord level

- will feel sensory and motor symptoms at distributions of specific nerve roots

19
Q

What is motor neuron disease?

A
  • disease of motor neurones (UMN & LMN)
  • idiopathic, progressive motor deficit
  • median survival 3-5 years
20
Q

What are the clinical features of MND?

A
  • painless
  • progressive bulbar palsy - weakness in the tongue, face and palate
  • dysphasia, dysarthria, nasal regurgitation and aspiration
  • progressive muscle weakness
21
Q

What is electromyography?

A

fine needle is inserted into a bicep muscle and we record from motor units in the muscle –> this activity is known as motor unit action potentials and is seen when a patient starts contracting
-for LMN function analysis

22
Q

What is a motor unit?

A

the number of muscle fibres which are supplied by a single motor neurone

23
Q

What will you see on an electromyography in a patient with denervated muscle?

A
  • reduced interference pattern

- high amplification but more gaps between MUAP

24
Q

What will you see on an electromyography in a patient with myopathy?

A
  • full interference pattern

- MUAP are small (low amplification)

25
Q

What is the presentation of an intracranial tumour?

A
  • raised ICP
  • epilepsy
  • neurological dysfunction
  • incidental
26
Q

What is the presentation of raised intracranial pressure?

A
  • headaches (early morning)
  • vomiting
  • blurred vision
27
Q

What are the causes of raised ICP?

A
  • tumour mass
  • surrounding oedema
  • obstructive hydrocephalus
28
Q

What is MRS?

A
  • Magnetic resonance spectrometry

- can be used to look at tumours and see what chemical signals might give you an idea of the type of tumour

29
Q

What are the main categories of brain tumours?

A
  1. Glial tumours
    - high grade glioma
    - low grade glioma
  2. Benign tumours
    - meningiomas
    - pituitary adenomas
    - schwannomas
  3. Paediatric
    - medulloblastoma
    - germ cell
    - ependymoma
30
Q

What does the tumour grade tell us?

A

How aggressive the tumour is –> mitotic rates, proliferative, differentiation

31
Q

How do brain tumours present?

A
  • pressure symptoms (headache, N&V, confusion, reduced concious level)
  • seizures
  • focal symptoms due to location e.g weakness, dysphasia
32
Q

What is expressive aphasia?

A

can understand but can’t speak

lesion in brocas area

33
Q

What is receptive aphasia?

A

can’t understand language spoken to you

34
Q

What are the side effects of taking steroids in high doses?

A 
insomnia
weight gain
high BP
hyperglycaemia
irritability
osteoporosis
35
Q

What are the acute, intermediate and late effects of cranial radiotherapy?

A
  1. Acute effects
    - cerebral oedema causing raised ICP
    - hair loss
    - scalp/ear erythema
  2. Intermediate effects
    - severe tiredness and exacerbation of exisitive neurological symptoms
  3. Late effects
    - damage to sensitive structures e.g lens (cataracts), pituitary (hypopituitarism) and cerebral hemispheres (memory loss)
36
Q

What is the commonest brain tumour?

A

brain metastases

37
Q

What are the 5 types of tumour of the nervous tissue?

A
  1. Glial (glioma)
  2. Meningeal (meningioma)
  3. Neuronal (gangliocytoma)
  4. Primitive (PNET)
  5. Nerve sheath (schwannoma)
38
Q

What are the 3 types of gliomas?

A
  1. Astrocytoma
  2. Oligodendroglioma
  3. Ependymoma
39
Q

What are the WHO grades of brain tumours

A

I: Benign, no recurrence, no/very slow progression

II: low grade, progressive

III: high grade, rapid progression

IV: aggressive

C&M Neuroanatomy (44 decks)

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