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NMS > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

What are multimodal sensations?

A

Combination of both superficial and deep sensations that are subject to integration with higher cortical functions and memory

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2
Q

Where is the association cortex for somatosensory, visual and auditory functions?

A

Inferior parietal lobe

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3
Q

The inferior parietal lobe is the association cortex for what 3 multimodal sensations?

A

Somatosensory, visual, and auditory

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4
Q

Stereognosis test

A

Patient identifies object in hand

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5
Q

Barognosis test

A

Patient assess relative weight of similar shape and size object in hands

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6
Q

Topognosis

A

Touch patient on their skin and ask them to point to the spot you just touched

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7
Q

Graphognosis

A

Write a letter or number on patients chest, back or palm and have them identify it

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8
Q

2 point discrimination and normal measurements

A

Determine at what distance a patient can determine 2-point discrimination

Finger tips: 2-4mm
Dorsum of finger: 4-6mm
Palm: 8-12mm
Dorsum of hand: 20-30mm

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9
Q

Somatognosis?

A

Patients ability to know a body part is their own

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10
Q

Nosognosis:

A

Ability of patient to know that he is ill

Ex: hemiplegia, patient believes they are healthy

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11
Q

Aka for graphognosis

A

Graphesthesia

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12
Q

Problems with sterognosis, barognosis, topognosis, graphognosis, 2 point discrimination, somatognosis or nosognosis would indicate an issue where?

A

Association cortex in the inferior parietal lobe

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13
Q

Somatic sensation is conscious perception of what 5 things?

A 
Touch
Pain
Temperature
Vibration
Proprioception
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14
Q

What are the two main somatosensory systems?

A

Posterior column pathways

Anterolateral pathway

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15
Q

What sensations does the posterior column pathway mediate?

A

Proprioception
Vibration
Fine, discriminative touch

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16
Q

What sensations do the anterolateral pathways mediate

A

Pain
Temperature
Crude touch

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17
Q

What sensations does the lateral spinothalamic pathway mediate?

A

Superficial pain
Temperature

(Pinch your lateral neck it hurts)

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18
Q

What sensations does the anterior spinothalamic tract mediate?

A

Crude touch

Could be very crude and touch your anterior

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19
Q

Pathway of posterior columns

A

Stimuli carrie

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20
Q

Posterior columns pathway: stimuli is carried by _____ ____ neurons and enter the ____ ______ via the ____ _____ ____. From here it ____ the spinal cord ______ in _____ _____.

A 
Primary sensory
Spinal cord
Dorsal root ganglion
Ascends
Ipsilaterally
Posterior columns
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21
Q

After ascending the spinal cord ipsilaterally in posterior columns it synapses in ____ ____ nuclei with secondary axons that then _____ and _____ in the ____ ______. From here it synapses in the _____ and is distributed to ____ ____ _____

A

Posterior column nuclei
Synapse and ascend in the medial lemniscus
Thalamus and is distributed to primary somatosensory cortex

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22
Q

What kind of findings are seen in posterior column pathway lesions

A

Ipsilateral

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23
Q

Pain, temperature and crude touch are carried by ___ _____ neurons and enter the spinal cord via ___ ___ ____. From here they synapse with ___ ____ neurons immediately in ___ _____ of the spinal column. From here they _______ and ascend in the ____ _____. Then it synapses in the ____ and is distributed to ____ ____ cortex

A

Primary sensory
Dorsal root ganglion
Secondary sensory neurons in gray matter
Deccussate and ascend in the spinothalamic tract
Synapse in thalamus and distribute to somatosensory cortex

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24
Q

Sensation with posterior column lesion

A

Tingling, numb

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25
Q

Sensation with anterolateral lesions

A

Sharp, burning, or searing pain

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26
Q

Sensory loss can be caused by lesions where

A 
Peripheral nerves
Nerve roots
Posterior columns
Anterolateral pathways
Thalamus
Primary somatosensory cortex
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27
Q

Sensations in spinothalamic tract

A

Light touch
Sharp
Temperature

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28
Q

Sensations in dorsal columns

A

Vibration
2 point discrimination
Proprioception

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29
Q

Superficial sensory examination aka?

A

Exteroceptive/cutaneous examination

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30
Q

What is part of the superficial sensory examination

A

Light touch
Pain
Temperature

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31
Q

What is tested in light touch examination

A

Anterior spinothalamic tract
Tactile disc of merkle

Testing dermatomes

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32
Q

What is a dermotome

A

Area of skin innervation by a single spinal nerve

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33
Q

What does the sharp touch examination test

A

Lateral spinothalamic tract

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34
Q

What does temperature examination test

A

Lateral spinothalamic tract

Unnecessary if pain is fine—why it is rarely performed
-better at localizing area of dysfunction

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35
Q

Allogynia

A

Painful sensations provoked by normally non-painful stimuli

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36
Q

Anesthesia/analgesia

A

Absence of all sensation/pain

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37
Q

Dysethesia

A

Unpleasant, abnormal, or painful sensation

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38
Q

HYPESTHESIA/hypoesthesia

A

Decreased sensation

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39
Q

Hyperesthesia

A

Increased sensation

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40
Q

Paresthesia

A

Abnormal sensation

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41
Q

Myelo-

A

Spinal cord

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42
Q

Radiculo-

A

Nerve root

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43
Q

Neuro-

A

Nerve

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44
Q

General presentation of myelopathy

A

Pain: neck, arm, lower back, leg
Usually bilateral
Sensation: abnormal pattern

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45
Q

General presentation of radiculopathy

A

NR
Pain: dermatomal
Usually unilateral
Sensation: dermatomal

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46
Q

General presentation of neuropathy

A

Pain: follows nerve distribution
Usually unilateral
Sensation: peripheral nerve distribution

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47
Q

Common causes of compression

A 
Disc hernation
DJD
Trauma
Inflammatory changes
Tumors
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48
Q

Posterior cord lesion causes and characteristics

A

Vibration and position sense loss at injury site and distal

Due to:
Trauma
Compression from tumors
MS
B12 deficiency and tables dorsalis
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49
Q

Most common cause of radiculopathy

A

Disc derangement

Pressure from IVF narrowing

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50
Q

Compression of a dorsal nerve root

A

Radiculopathy

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51
Q

Characteristics of radiculopathy

A
  • Numbness and tingling
  • Loss of vibration and position sense
  • Hyporeflexia with NO muscle atrophy (NO input of stretch but muscle shortens/lengthening normal)
  • sensory loss dermatomally
  • LMNL characteristics of reduced strength, reflexes, sensation
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52
Q

What may cause numbness and tingling, loss of vibration or position sense, hyporeflexia, sensory loss in dermatomes, LMNL characteristics of reduced strength, reflexes and sensation?

A

Compression of dorsal nerve root—Radiculopathy

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53
Q

Mononeuropathy characteristics

A

Unilateral loss in distribution of peripheral nerve
Sensory lost first (vibration often earliest affected)
DTR depressed

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54
Q

MC causes of mononeuropathy

A

Trauma

Autoimmune

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55
Q

Polyneuropathy characteristics

A

Bilateral loss in glove and stocking distribution

  • sensory lost first (vibration) & LONGEST nerves affected first
  • DTR depressed
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56
Q

MC causes of polyneuropathy

A
  • DM
  • malnutrition of alcoholism
  • Lyme disease/inflammatory/autoimmune conditions
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57
Q

What tissues are devoid of nociceptos

A

Articulate cartilage
Inner annulus and nucleus of intervertebral disc
Synovial membranes

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58
Q

What are mechanical noxious stimuli

A

Acute trauma
Repetitive microtrauma
Subluxation complex

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59
Q

Thermal noxious stimuli

A

Exposure to excessive heat/cold

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60
Q

Chemical noxious stimuli

A
  • histamine
  • prostaglandins
  • plasma kinins
  • potassium
  • serotonin
  • substance P—released directly from damaged tissue
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61
Q

Type A Delta fibers characteristics and what they relay?

A

Lightly myelinated

Relay a sharp, stinging sensation

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62
Q

Type C pain transmission and characteristics

A

Unmyelinated

Aching, burning type of pain

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63
Q

Common causes of neuropathic pain

A

Diabetes
Postherpetic neuralgia
Phantom limb
Trigeminal neuralgia

64
Q

Recurrent meningeal nerve aka?

A

Sinuvertebral nerve

65
Q

What does the sinuvertebral nerve/recurrent meningeal nerve innervate?

A

Outer third of annulus fibrosis posteriorly
PLL
Dura

66
Q

What is the significance of the sinuvertebral nerve related to neuropathic pain

A

Nocioceptive nerve endings within annulus fibrosis of disc. Annular tears can cause low back pain, and in buttocks, SI, and lower region

67
Q

Nerve root irritation cause

A

No direct compression of NR

Inflammatory response of disc injury that causes pain

68
Q

Cause of NR compression

A

Direct compression of NR

69
Q

Presentation of NR irritation

A

Dermatomal pattern
Hyperesthesia
Increased sympathetics—> vasoconstriction (hypothermia)
Sensory, motor, DTR often normal

70
Q

Presentation of NR compression

A

Pain, numbness in dermatomal pattern
Hypoesthesia
Decreased sympathetics—> vasodilation (hyperthermia)
-sensory, motor and DTR have decreased findings

71
Q

Particular dermatomal or paraspinal level of ______ often correlates with area of what?

A

Hyperalgesia

Primary spinal subluxation

72
Q

Cool info: sharpless demonstrated that minuscule amounts of pressure on a NR equivalent to a feather falling on your hand can cause up to a 50% decrease in electrical transmission down the course of the nerve

A

Wow!

73
Q

If compression at c5 IVF….what disc/NR?

A

C6 NR

C5 disc

74
Q

If compression at C5 disc…IVF/NR?

A

C5 IVF

C6 NR

75
Q

If T7 IVF compressed what NR and disc involved?

A

T7 NR

T7 disc

76
Q

If L5 IVF compressed what disc/NR involved?

A

L4 disc

L5 NR

77
Q

If L4 disc herniated what IVF/NR involved?

A

L5 NR/IVF

78
Q

Motor pathway?

A

Cortex…..
Brainstem……cerebral peduncle….pyramids (points of crossing)
Spinal cord……lateral corticospinal tract, anterior horn, alpha motor neuron
Peripheral NS…..target muscle

79
Q

From the motor cortex, the motor pathway descends through the ______ _____ and then through the _____ where they ______. From here they enter the spinal cord and ______ in the ____ ______ _____ and synapse in the ____ ____ with __ ______ neurons. From here the neurons target the ________

A

Cerebral peduncles
Pyramids where they decussate
Descend in the lateral corticospinal tract
Synapse in the anterior horn with alpha motor neurons
Target the muscle

80
Q

Motor pathway lesions would show what kind of findings?

A 
Ipsilateral UMN
Contralateral LMN (spinal cord)
81
Q

0/5 grade of muscle

A

Complete paralysis

82
Q

1/5 muscle testing

A

A twitch of muscle
0-10% of movement
Doctor can feel action but no movement

83
Q

2/5 muscle testing

A

Active movement available with no gravity

11-25% of normal movement

84
Q

3/5 muscle test

A

Active movement against gravity

26-50% of normal movement

85
Q

4/5 muscle testing

A

Movement against gravity and mild resistance
51-75% normal movement
-resistance of two fingers

86
Q

5/5 muscle testing

A

76-100% normal movement

87
Q

Increased muscle tone indicates what?

A

UMNL

88
Q

Decreased muscle tone indicates what?

A

LMNL

89
Q

Hypertonic

A

Increased muscle tone

TWO TYPES

90
Q

What are the two types of hypertonia?

A

Spasticity

Rigidity

91
Q

Spasticity

A

Hypertonia most near middle of ROM
Apparent with fast passive ROM
VELOCITY DEPENDENT (seen with rapid movements)
Lesions of pyramidal tract (corticospinal)
—-seen with stroke, spinal cord compression, motor neuron disease
More tone in initial part of movement aka “clasped knife phenomenon”

92
Q

What type of hypertonia is more apparent with fast passive ROM and is velocity dependent?

A

Spasticity

93
Q

Lesions of where lead to spasticity?

A

Pyramidal tract—aka corticospinal tract

94
Q

Lesions in the pyramidal tract—corticospinal tract cause what?

A

Spasticity

95
Q

What may cause a lesion of the corticospinal tract that may lead to spasticity?

A

Stroke
Spinal cord compression
Motor neuron disease

96
Q

Clasped knife phenomenon? Associated with?

A

More tone in initial part of movement

Spasticity

97
Q

Characteristics of rigidity

A 
Increased tone throughout passive ROM
Same resistance in all directions
Independent of speed of movements
Seen in extrapyramidal lesions (Parkinson’s)
2 subtypes: cog wheel, lead pipe
98
Q

What type of hypertonia is seen with increased tone through passive ROM and is independent of speed of movement?

A

Rigidity

99
Q

A lesion where may lead to rigidity?

A

Extrapyramidal lesions

100
Q

Lesions in extrapyramidal tract may cause what type of hypertonia?

A

Rigidity

101
Q

What are the two subtypes of rigidity?

A

Cog wheel and lead pipe rigidity

102
Q

What may cause a lesion in extrapyramidal tract that leads to rigidity?

A

Parkinson’s

103
Q

Hypotonia? Indicative of?

A

Decreased muscle tone

Issues at level of reflex arc aka LMNL

104
Q

What may cause neural shock

A

Severe upper motor neuron damage in brain or spinal cord

Cerebral shock and spinal shock

105
Q

What is unique of neural shock in regards to it’s presentation?

A

Peripheral symptoms first noted even though its an UMNL

106
Q

Deficit in regards to reflexes

A

Loss of normal neurological function

Reduced muscle tone, stretch, reflexes, strength, volume

LMNL

107
Q

Release in regard to reflexes

A

Exaggerations or perversions of normal function due to loss of cortical inhibition

**inhibition normally there so that you don’t have crazy reflexes and kick people

Hyperreflexia, hypertonia, and pathologic reflexes

108
Q

Lesions where in reflex deficit?

A

LMNL

109
Q

Lesions where in release reflex

A

UMNL

110
Q

Findings in deficit reflexes

A

Reduced muscle tone, strength, reflexes, strength, volume

111
Q

Findings in release reflexes

A

Hyper-reflexia, hypertonia, pathologic reflexes

112
Q

0-1 reflex grade indicative of what?

A

LMNL

113
Q

3-4 grade reflex indicative of what?

A

UMNL

114
Q

Grading reflexes aka?

A

Wexler scale

115
Q

Jendrassik Maneuver

A

Distractions given such as clenching fist, wiggling toes, etc.

Done when reflexes appear to be diminished or absent with no other neurologic findings

116
Q

Clonus

A

Involuntary rhythmic contractions when sudden passive stretch of muscle occurs

117
Q

Clonus often seen with what other findings

A

Spasticity and hyperactive DTRs in corticospinal tract disease

118
Q

Pathway of superficial reflexes

A

Sensory signal reaches spinal cord, ascend, reach brain, motor limb descends cord to reach neurons

119
Q

What can cause a + superficial reflex?

A

Severe LMNL or destruction of sensory pathways from skin that’s stimulated
Spinal cord damage (UMNL)

120
Q

LMNL cause _____ DTRs, _______ superficial reflexes

UMNL cause _____ DTRs, and ______ superficial reflexes

A

Decreased, absent

Increased, absent

121
Q

What are the 10 superficial reflexes

A 
Gag reflex
Corneal blink reflex
Epigastric
Upper abdominal
Middle abdominal 
Lower abdominal
Cremasteric reflex
Gluteal reflex
Plantar reflex
Anal
122
Q

Innervation of cremasteric reflex

A

L1-L2

Ilioinguinal, genitofemoral nerves

123
Q

Female version of cremasteric reflex

A

Geigel reflex

124
Q

Normal finding in plantar reflex

A

Plantar flexion of toes and foot

125
Q

+ finding of plantar reflex

A

Dorsiflexion of great toes and flaring of the other toes

126
Q

Anal reflex innervation

A

S2-S5

Hemorrhoidal

127
Q

What controls/inhibits pathologic reflexes

A

Motor cortex

Pyramidal tracts

128
Q

Timeline of findings in UMNL?

A
  1. Increased DTR
  2. Absent superficial
  3. Pathological reflex
129
Q

When are pathological reflexes considered normal?

A

Infants-6mo

2 years for babinski

130
Q

What is one of the most significant indications of disease of corticospinal system at any level from motor cortex through descending pathways?

A

Babinski sign?

131
Q

What innervations are tested with pupillary light reflex?

A

Afferent: CN2

Efferent CN3

132
Q

Accommodation reflex tests what?

A

CN 3

133
Q

Ciliospinal reflex tests what?

A

Afferent: cervical pain fibers c8-t2 and CN5
Efferent: cervical sympathetics

134
Q

What is normal finding in ciliospinal reflex?

A

1-2mm dilation

135
Q

Oculocardiac reflex tests? Normal finding?

A

Afferent: CN 5
Efferent: CN 10
Decreased heart rate and BP noticed where thumb is pressed on eyeball

136
Q

Carotid sinus reflex tests, normal?

A

Afferent: CN 9
Efferent: CN 10
Decreased heart rate and fall in BP when press carotid sinus

137
Q

Bulbocavernosus reflex tests? Normal?

A

S3-s4

Contraction of bulbocavernosis muscle and urethral constriction and anal sphincter contraction when stroke, pinch, or prick the dorsum of the glans of the penis?

138
Q

Reflex dysfunction of the muscle

A

Stretch reflexes are depressed in parallel to loss of strength

139
Q

Reflex dysfunction of neuromuscular junction

A

Stretch reflexes are depressed in parallel to loss of strength

140
Q

Reflex dysfunction of peripheral nerve

A

Stretch reflexes are depressed usually out of proportion to weakness

Bc afferent arc is involved early in neuropathy

141
Q

Reflex dysfunction in nerve root

A

Stretch reflexes depressed in proportion to contribution that root makes to the reflex

  • superficial reflexes are rarely depressed since many overlap
  • extensive damage can depress reflex in proportion to amount of sensory loss in dermatomes tested or motor loss in involved muscles
142
Q

Reflex dysfunction and spinal cord and brainstem

A

Stretch reflexes are hypoactive at the level of lesion and hyperactive below lesion

Superficial reflexes are hypoactive at and below level of lesion and normal above

143
Q

Reflex dysfunction in cerebellum

A

Lesions don’t have large affect on stretch reflexes

144
Q

Reflex dysfunction and basal ganglia

A

No consistent DTR or superficial reflex changes

May see “primitive reflexes” associated with diffuse cerebral dysfunction (Dementia)

145
Q

Reflex dysfunction and cerebral cortex

A

Unilateral disease affecting motor cortex will give UMN pattern of weakness: hyperactive muscle stretch reflexes and depressed or absent abdominal and cremasteric reflexes on contralateral side

-babinski response possible

-bilateral damage to motor cortex inhibitory control causes emotional expression reflexes to be defective
——-cry or laugh with little cause and don’t understand why they are laughing/crying
————-responses are released in “pseudobulbar” pattern

146
Q

Presentation of transverse cord lesion

A

Partial/complete interruptions to all motor/sensory paths
Diminished sensation in all dermatomes below lesion
Weakness/reflex loss pattern helpful to determine location of lesion

Causes: trauma, tumor, MS, transverse myelitis

147
Q

What may cause transverse cord lesion

A

Trauma
Tumor
MS
Transverse myelitis

148
Q

Presentation with hemicord lesion aka?

A

Brown-square syndrome

Ipsilateral UMN weakness due to lateral corticospinal tract damage
Ipsilateral vibration and joint position (dorsal column)
Contralateral loss of pain and temperature (ant/lat spinothalamic)

Causes: penetrating injuries, MS, lateral compression from tumors

149
Q

What may cause brown-sequard syndrome?

A

Penetrating injuries
MS
Lateral compression from tumors

150
Q

Presentation of central cord lesion-small

A
  • sensory fibers crossing from spinothalamic tract injuries
  • pain and temperature loss
  • cape distribution in Cervicals
151
Q

Presentation of central cord lesions-large

A

Anterior horn cells damaged leading to lower motor findings at level of lesion
Corticospinal tract damaged leaded to UMN signs
Posterior columns: vibration/position affected

Below lesion:
Vibration, position, pain, temp, motor losses with small area of sacral sparing

Causes: syringomyelia, contusion, intrinsic cord tumors

152
Q

What may cause a large central cord lesion

A

Syringomyelia
Contusions
Intrinsic cord tumors

153
Q

Presentation of posterior cord lesion

A

Vibration and position sense loss at site and distal

154
Q

Causes of posterior cord lesion

A

Trauma
Compression from tumor
MS
B12 deficiency and tabes dorsalis

155
Q

Presentation of anterior cord lesion

A

Pain and temp loss distal to side (anterolateral)
Lower motor weakness at lesion (anterior horn cells)
UMN findings if lesion is large to impact corticospinal tract

Incontinence common as descending tracts controlling sphincter are primarily ventral cord

Cause: trauma, MS, anterior spinal artery infarct

156
Q

What may cause an anterior cord lesion?

A

Trauma, MS, anterior spinal artery infarct

NMS (12 decks)

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