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year 2 > diff dx neuro - basics > Flashcards

diff dx neuro - basics Flashcards

1
Q

in a neurological exam…
what is a negative sign
what is a positive sign

A

negative sign - reveals a disorder by the absence of what should be present
eg; non-reactive pupils, atrophy, absent reflex

positive sign- reveals a disorder by a finding that should not be present
eg; babinski, spasticity, rigidity

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2
Q

grades for DTR

0-4+

A 
0= absent
1+ = diminished
2+ = normal
3+ = increased
4+ hyperactive
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3
Q

how does root compression affect DTR grade?

how does CNS issue affect DTR grade?

A

root compression => lower grade

CNS issue => spasticity = higher grade

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4
Q 
sensory classifications (what do they lose)
 peripheral involvement (4)
 cortical involvement (5)
A

peripheral sensations inclue…

  1. light touch
  2. pain & temp
  3. proprioception
  4. vibration

cortical sensations are things that are interpreted…

  1. 2 point discrimination
  2. stereognosis
  3. graphesthesia
  4. bi-lat simultaneous extinction
  5. localization
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5
Q 
abnormal reflexes & tone
 clasp knife
 lead pipe
 clonus
 babinski
 grasp reflex
A 
clasp knife- spasticity = corticospinal
lead pipe - rigidity = basal ganglia (PD)
clonus = corticospinal tract
babinski - corticospinal tract
grasp reflex - frontal lobe
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6
Q

motor system & motor control

A

sherrington reflex model

sensory input => motor output

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7
Q

heirarchial model

A

control is top down

motor programs drive movement, feedback oriented

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8
Q

motor programming theories

A

motor engrams exist and become hardwired

eg handwriting is the same on paper and on a board

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9
Q

systems model

A

bernstein

movements come from integration from all systems, CNS, PNS, musculoskeletal & the environment

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10
Q

apraxia (def)

A

loss of ability to execute movement

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11
Q

motor homunculus (3)

A
  1. the primary motor cortex has lowest threshold of activation
  2. 1:1 correspondence btwn cells and AHC
  3. the more you stimulate, the more complex the movement
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12
Q

corticospinal tracts
names
where they originate (which cortex)
which lobe?

A
  1. corticobulbar & corticospinal

2. 40-50% of fibers originate in primary motor cortex, located in parietal lobe

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13
Q 
CVA
 most common site
 appearance (at rest)
 muscle tone
 voluntary movement
 coordination
 reflexes
 babinski
A 
most common site- internal capsule
appearance (at rest) - normal
muscle tone - flacid then spastic
voluntary movement- severe weakness, the pathological synergies
coordination - poor
reflexes- absent then hyperreflexive
babinski - absent then heyperreflexive
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14
Q 
basal ganglia
 process
 appearance (at rest)
 muscle tone
 voluntary movement
 coordination
 reflexes
 babinski
A

process- loss of balance between cholinergic and dopaminergic
appearance (at rest)- rigidity, tremor at rest
muscle tone - rigid
voluntary movement - bradykinesia
coordination - slow
reflexes - normal
babinski - absent

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15
Q 
cerebellar dysfunction
 process
 appearance (at rest)
 muscle tone
 voluntary movement
 coordination
 reflexes
 babinski
A

process- deficit in coordination, balance and/or hypotonia (depending where lesion is)
appearance (at rest) - normal
muscle tone - normal or decreased
voluntary movement - normal or decreased
coordination - poor with intention tremor
reflexes - swinging or pendular reflex
babinski - absent

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16
Q 
LMN
 process
 appearance (at rest) (3)
 muscle tone
 voluntary movement
 coordination
 reflexes
 babinski
A

process- all motor functions lost when pathway is damaged or destroyed
appearance (at rest) - atrophy, fasciculations & fibrillations on EMG
muscle tone- decreased
voluntary movement - decreased proportional to extent of lesion
coordination - weak or totally paralyzed
reflexes - absent
babinski - absent

17
Q

what is a ridiculopathy?

A

injury to nerve root

18
Q

motor symptoms of a peripheral neuropathy (5)

A
  1. weakness
  2. absent DTRs
  3. atrophy
  4. fibrillations - random discharge of muscle fibers (see on EMG)
  5. fasciculations - random discharges of MU
19
Q

5 sensory symptoms of peripheral neuropathy

A
  1. numbness, decreased sensation (hypoesthesia)
  2. pins & needles - parasthesia
  3. burning - dysethia
  4. hyperesthesia
  5. severe deficits can -> sensory ataxia because of loss of proprioception
20
Q

what paresthesia and dysesthia tell us about fiber involvement

A

parasthesia = tingling, pins & needles
large fiber involvement

dysesthia = pain
small fiber involvement

21
Q

4 sympathetic symptoms of peripheral neuropathy

A
  1. altered sweating, blood flow & temp
  2. trophic changes (texture, color, smoothness)
  3. hair loss, edema, hyperesthesia
  4. cardiac, GU, GI symptoms
22
Q

how do sympathetic neuropathic symptoms usually present?

A

localized to 1 limb

23
Q

reflex sympathetic dystrophy
a.k.a.
eitology (5)
treatment (3)

A

a.k.a. complex regional pain syndrome (type I)

eitology:

  1. tight splint or cast
  2. localized trauma or surgery
  3. improper use of a sling
  4. not elevating limb to reduce edema
  5. disuse

trx

  1. use limb** => desensitize
  2. reduce edema
  3. progressive, intense, multidisciplinary therapy
24
Q

neurogenic vs. vascular condition (3 each)

A

neurogenic:

  1. dry skin (because sweat glands are peripheral nerves)
  2. localized trophic changes
  3. edema can cause nerve compression

vascular:

  1. majority of limb presents with hair loss, shiny skin or cold
  2. blue skin (venous insufficiency)
  3. pale skin (arterial insufficiency)
25
Q

what does blue skin mean?

what does pale skin mean?

A

blue skin => venous insufficiency

pale skin => arterial insufficiency

26
Q

levels of peripheral nerve involvement (3)

A
  1. neurapraxia - local conduction block
    recovery starts w/i 1 minute of removal of compression
  2. axonotomesis - damage to axon with wallerian degeneration
    can occur after 6hrs of intense compression
  3. neurotmesis - damage to axon and one or more protective sheaths
    more derangement => more scar tissue
27
Q

what is wallerian degeneration?

A

break down of myelin sheath (which is many layers of schwan cells)

28
Q

5 categories of PNL & causes

A 
1. mononeuropathy 
 from compression, traction or vascular
2. mononeuropathy multiplex = multiple mononeuropathies = discrete lesions of several individual nerves 
 usually vascular
3. polyneuropathies
 motor, sensory, sensorimotor or autonomic
4. plexopathy - lesion at plexus
 trauma or tumor
5. ridiculopathy - at root
 disc or tumor (dosal root = herpes)
29
Q

classic characteristics of polyneuropathies (2)

A
  1. symmetrical sensory loss (stocking & glove presentation)
  2. affects LE before UE (then progresses)
    sensory loss in distal LE -> peripheral -> UE
30
Q

progression of multiple mononeuropathies

A

starts with 1 nerve, then => 2, then 3…

usually vascular

31
Q

metabolic neuropathies (3)

A
  1. alcoholic
  2. diabetes
  3. uremic (people on HD)
32
Q

examples of degenerative peripheral neuropathy (2)

A
  1. AIDS

2. herpes

year 2 (24 decks)

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