Final Flashcards
Scleratogenous pain is derived from ___. Primarily from the ___ joint.
connective tissue
facet joint
How does pt. describe scleratogenous pain?
Dull, achy, no descript
*pain @ site of origin may be sharp, pt. may have difficulty describing sensation.
Does scleratogenous pain follow dermatome/ peripheral N. pattern?
no
Scleratogenous pain in the C spine doesnt cross the ___ joint. In the L-spine, it doesnt cross the ___.
GH
Knee
Dermatagenous pain is derived from the ___ ___.in a ___ pattern
Nerve root
Dermatomal
Dermatogenous pain is ___ in nature. How does pt. describe pain?
radicular
Sharp or shooting, but not always.
*pt can usually pinpoint this pain
Radiculopathy is derived from a __ __ and follows a ___ pattern.
nerve root
dermatomal
Myotagenous pain comes from ___. What is the difference between myofascial pain syndrome and fibromyalgia pain?
muscles
Myofascial –> local and referring
Fibromyalgia –> Local without referral
Viscerogenic pain may be __ at the site of origin, but the referred pain is usually described how?
sharp
dull achy, non-descript
Teitze’s is normally seen in ___ > __ y/o. Whee is pain?
Women
50
Upper chest 2nd/3rd ICS
*Unilateral
How will pleurisy manifest?
Sharp pain in the chest related to coughing , sneezing and positional in nature.
Most noted with side bending to the same side or lying on the involved sided.
Will often have a history of coexisting or recent history of respiratory infection.
How will pukmonary embolism manifest?
Middle Aged Male Sudden Chest pain after pain in the calf Low grade fever maybe Pleuritic Pain Pain is severe and similar to a Myocardial Infarction Very High Mortality Rate 600,000 cases each year in US 1/3 end in death
Angina Pectoralis is noted after ___ and rest will __ symptoms. Pain usually lasts around __ mins. Secondary to ___
exertion
decrease
30
atherosclerosis
What causes S1?
Closure of Mitral and Tricuspid (AV) valves
-normally lower pitched and longer than S2
S2 is best heard over ___ and is closure of __ and __ valves
Aorta
Pulmonic
aortic
When is S3 normal? What is it called in an adult?
Children and adolescent
Gallop
S4 is heard when? When may it be present?
Before s1
Infants and children
Pain on empty stomach indicates ___
ulcer
Pain with a full stomach indicates ___
reflux
What will be elevated with cholecystitis?
Alkaline phosphate
*use ultrasound to Dx
MC urethral stones are what?
Calcium Oxalate
What does Sinuvertebral N. innervate?
Outer 1/2 of IVD
PLL
Dura Mater
Spinal Canal Vessels
What is a bulge/ protrusion?
Bulges outward through a tear in the AF, but does not escape from the outer AF or the PLL.
Bulges against the PLL and dura generally producing dull, poorly localized pain in the lower back and SI region.
Pain is worse in the morning due to inhibition
Generally no leg symptoms
Pain is worse with sitting, because the noiceptors within the AF are irritated by the protrusion.
What is an extrusion>
Nuclear material remains attached but escapes the AF or PLL.
Extrusion is generally posterolateral in nature into the IVF.
Patient will have the same presentation as with a protrusion, though leg pain will generally be present and the pain levels maybe greater.
What is a sequestration?
The migrating disc material escapes the disc all together and becomes a free floating fragment.
This fragment has potential to migrate up and down the central canal.
What are 3 causes of Foraminal encroachment?
SOL
Spinal malposition
Swelling/ inflammation
What is claudication?
Reproducible ischemic muscle pain –> cramp feeling in leg
Neurogenic Claudication pain is usually ___ and occurs where?
bilateral
lower back an extermity
MC injured nerve?
Radial
Lesion of Radial N causes __ __
Wrist drop
AKA radial palsy –> can;t extend wrist or abduct thumb
-loss of sensation esp. dorsum of hand
What causes radial tunnel syndrome?
Compression prior to entering the supinator by Fibrous band off anterior radial head, sharp medial edge of ECR Brevis, or Arcade of Froshe (thickened head of superficial head of supinator)
Cubital Tunnel syndrome: Compression of ___ nerve. Weakness of __ grip. Affects __ the most.
ulnar
power
men
Pisiform/ Hamate Syndrome: __ nerve compression within ____. Will have __ grip weakness.
ulnar
tunnel of Guyon
power
What causes claw hand?
Lesion of ulnar N
What causes ape hand deformity?
Median N. lesion
Carpal Tunnel Syndrome: Clumsiness with __ grip.
precision
Pronator teres syndrome: __ neuropathy due to __ of pronator teres muscle or entrapment. Also caused by excessive pronation/ supination
median
edema/ hypertrophy
*Phalen may be negative, but reverse phalens may be positive
Piriformis syndrome is entrapment of __ nerve as it passes under ___ muscle. What are some causes?
sciatic piriformis -females 6:1 -trauma to gluteal or SI region -Flexion contracture of hip --> Pelvic obliquity -Buttock pain but no lbp
what causes foot drop?
Deep peroneal N. entrapment
-different from L5 radilopathy
Tarsal Tunnel Syndrome: __ nerve entrapment between __ __ and __ __.
Tibial
flexor Retinaculum
Medial Malleolus
What are the Sensory tracts?
DCML
Spinothalamic
Anterior Spinothalamic senses…
touch and deep pressure
Lateral Spinothalamic Senses…
Pain and temp.
What is the motor tract?
Corticospinal (UMN Pathway)
What tract does Coordination?
Spinocerebellar
What do dorsal columns carry?
Vibration (pallesthesia)
joint position sense
pressure
light touch
How to evaluate Spinothalamic System
Sharp vs. Dull
Pin prick
Tracts of Upper motor neuron and AKA. Where does it synapse?
Corticospinal
corticobulbar
AKA pyramidal system
Synapses in Anterior Horn cell
Lower motor neuron originates in ___ and AKA is ___. Pathways of (3). Terminates in ___.
AHC
Nerve root, plexus, peripheal nerves
Final Common Pathway
NMJ
Cerebellum function
Fine motor control
Postural reflexes (via CN VIII)
Determines muscle range, velocity, strength
Procedural Memory
Basal Ganglia Function
Modulates and adjusts tone of motor system
*NOT a part of upper or lower motor neuron
3 types of ataxia and where problem is
Motor –> Cerebellar
Sensory –> Dorsal Columns
Vestibular –> CN VIII (vestibular portion)
How will pt. present with motor ataxia?
Unstable with eyes open or closed
worse when lying down
Gait is wide, staggering, reeling (like theyre drunk)
Tend to lean or stagger to side of lesion
How will pt. present with Vestibular ataxia?
- problem with vestibular nuclei, CN VIII, or labyrinth of inner ear
- gravity dependent –> standing or sitting
- lack of coordinated limb movements (not seen when supine, seen with standing/ walking)
- Unilateral Nystagmus
- Vertigo
How will pt. with Sensory Ataxia present?
Impaired joint position sense/ diinished vibration sense
numbness and tingling
slappage* and wide based gate
+ Romberg’s
Syringomyelia is an idiopathic disease of the ___ and ___ associated with ___. MC onset range is __-__ y/o. Causes __ and __ pain.
brain stem spinal cord cavitation 30-50 headache shoulder
Syringomyelia presents with early loss of __ and __ in a __-like distribution. ___ is also often seen and __ syndrome can develop as a result.
pain temperature shawl* Scoliosis Horners*
What causes Tabes Dorsalis? What does it damage? What does pt. lose?
Tertiary Syphilis
Dorsal roots and post. columns
Loss of proprioception and vibratory sensation
*Sensory ataxia
Hypotonia due to cerebellar dysfunction can cause what?
Loss of resistance offered by muscles to palpation or passive ROM
-floppy, loose-jointed, rag doll appearance, inebriated appearance
4 things Cerebellar dysfunction can cause
Intention tremors
Dysmetria
Dysdiadochokinesia
Dysarthria
4 things Basal ganglia dysfunction can cause
Resting tremors (*the ONLY BG tremor) (parkinsons)
-present at rest, usually decreases with action
-In hands --> pill rolling tremor
Chorieform Movements
Athetoid Movements
Rigidity
-Cogwheel--> Parkinson's
-Lead pipeWhat are choreiform movements?
Rapid, abrupt, highly complex jerky movements that appear well coordinated but are involuntary
What are Athetoid Movements?
Involuntary, ceaseless, irregular, slow continuos writhing wormlike motions (MC in hands and fingers)
What is Cogwheel rigidity?
Has underlying tremor, seen in parkinson’s
What is lead pipe rigidity?
Smooth, no underlying tremor
5 causes of generalized weakness
Depression Infection hormonal Chronic Fatigue Metabolic
How will cervical myelopathy present?
Neck pain, lower extremity abnormal sensations, balance problems, numbness in hands and fingertips, difficulty with fine movements, possible hyper-reflexia
Parkinsons 2 AKAs
Paralysis Antigans
Shaking Paralysis
How will MS present?
**Younger patient Hx of dizziness, numbness, tigling, weakness that resolved in a few days relapses mc 2-3 months after childbirth **possible urinary dysfunction -possible diplopia
What causes MS?
Patchy demyelinization with reactive gliosis
- spinal cord
- optic N
- White matter of brain (including cerebellum)
- Thought to be autoimmune
What will lab work on a pt. with MS be like?
Mild lymphocytosis
Increased protein in CSF
How Will Guillan barre present?
- Bilateral leg weakness
- Possible distal paresthesia
- *Possible post immunization or viral infection
- lost DTR
- Motor weakness
- possible autonomic involvement –> BP fluctuation, sweating, sphincter dysfunction
How will ALS present?
- Complaint of muscle weakness and cramping in hand
- S&S progressively increase –> difficulty chewing, swallowing, coughing, breathing
- 30-60 y/o
- ***Sensory exam is normal
What causes ALS?
degeneration of AHC, motor nuclei of lower CNs, Corticospinal and bulbar tracts
- Death within 2- 2 1/2 years
- No treatment
How will Myesthenia Gravis present?
- Young female
- Compaint of Double vision, dysphagia, arm weakness w/ repetitive use, weak jaw mm from chewing
- Ptosis
- **NO sensory findings
What causes myasthenia gravis?
neuromuscular transmission is blocked by auto antibodies that bind to ACH receptors aking the receptors unavailable
Nuchal Rigidity with fever indicates…
Meningitis
Nuchal rigidity without fever indicates…
Subarachnoid Hemorrhage
What is classic migrane?
Migrane with aura usually female *increasing blidn spot and flashing lights which lasts 30 mins can last 1-3 days photo and phonophobia possible nause and vomiting -considered neurologic
What is a migrane without an aura?
Common migrane
Similar to classic, but no aura
Severe, but pt. can continue ADLs
No neuro findings
Tension HA description
Frequent occurrence
Worse in afternoon/ early evening
Suboccipital/ Supraorbital
OTC NSAIDs provide relief
Cervicogenic HA description
Referral from soft tissue structures of C spine
No neuro findings
Can overlap with other HAs
How does a cluster HA present?
Middle aged male painful, orbital in location lasts for ~30 mins Cluster for days to weeks, then appears weeks to months late *Hx of smoking or alcohol abuse
How does Neurologic HA present?
Sudden onset Progressive Dizziness/ nausea **CN findings possible -Immediate referral
What are the 5 Ds and 3 Ns of Neurogenic HA?
Diplopia Dizziness Drop Attacks Dysarthria Dysphagia Ataxia Nausea Numbness Nystagmus
**If suspected Cerebral vascular compromise, MUST refer to ER and DO NOT adjust
