LMN/UMN

Question 1

site of lesion for UMN lesion

Answer 1

cerebral hemispheres, brainstem, cerebellum, spinal cord

Question 2

site of lesion for LMN lesion

Answer 2

anterior horn cell, nerve roots, peripheral nerves, NM junction, muscles

Question 3

muscle weakness in UMN lesion

Answer 3

quadriplegia, hemiplegia, diplegia, paraplegia

Question 4

muscle weakness in LMN lesion

Answer 4

proximal (myopathy) distal (neuropathy)

Question 5

muscle tone in UMN lesion

Answer 5

spasticity, rigidity

Question 6

muscle tone in LMN lesion

Answer 6

hypotonia, flaccidity

Question 7

fasciculation in UMN lesion

Answer 7

absent

Question 8

fasiculations in LMN lesion

Answer 8

present (particularly tongue)

Question 9

tendon reflexes in UMN lesion

Answer 9

hyperreflexia

Question 10

tendon reflexes in LMN lesion

Answer 10

hypo/areflexia

Question 11

abdominal reflexes in UMN lesion

Answer 11

absent (depending on involved spinal level)

Question 12

abdominal reflexes in LMN lesion

Answer 12

present

Question 13

sensory loss in UMN lesion

Answer 13

cortical sensations

Question 14

sensory loss in LMN lesion

Answer 14

peripheral sensations

Question 15

electromyography in UMN lesion

Answer 15

normal nerve conduction decreased interference pattern and firing rate

Question 16

electromyography in LMN lesion

Answer 16

abnormal nerve conduction
large motor units
fasciculations and fibrilations

Question 17

which CN are not part of PNS

Answer 17

CN 1 and 2 optic and olfactory

Question 18

muscle bulk in LMN lesions

Answer 18

Neurogenic atrophy: rapid, focal, significant muscle wasting consistent with degree of axonal/myelin damage

Question 19

voluntary movements in LMN lesion

Answer 19

weak/absent

Question 20

strength in LMN lesions

Answer 20

depends on nerve involvement

Mononeuropathy: muscles impacted from one nerve
Radiculopathy: muscles from a specific myotome (example?)
Polyneuropathy: Initially distal extremity muscles and progress to proximal muscles

Question 21

mononeuropathy

Answer 21

involvement of single nerve (cubital tunnel)

Question 22

mononeuropathy multiplex

Answer 22

involvement of 2 or more nerves (bilateral carpal tunnel)

Question 23

radiculopathy

Answer 23

involvement of nerve roots

Question 24

plexopathy

Answer 24

involvement of brachial or lumbosacral plexus

Question 25

polyneuropathy

Answer 25

involvement of 2 or more nerves Generally, a result of a disease process affecting entire body Associated with Diabetes Mellitus (diabetic neuropathy) Associated with nutritional deficiency Associated with chronic kidney disease (CKD)

Question 26

neuropraxia

Answer 26

: demyelination of the nerve when the axon remains intact; weakness without atrophy expected; regeneration/remyelination probable MS is an example of

Question 27

axonotmesis

Answer 27

injury to the axon while the outer coverings of the nerve remain intact; Wallerian degeneration before regeneration occurs; weakness expected with atrophy

Question 28

neurotmesis

Answer 28

axon is severed, and the connective tissue coverings are disrupted; regeneration possible but not as effective; not likely to experience neurological recovery and need compensatory training for permanent loss

Question 29

PNI peripheral nerve injury

Answer 29

Traumatic injury to peripheral nerves is caused by contusion/compression, tension, ischemia, laceration, electrical source

Question 30

types of PN and LMN conditions

Answer 30

GBS post-polio syndrome chronic inflammatory demyelinating polyneuropathy (CIDP) critical illness polyneuropathy and myopathy (CIP/CIM)

Question 31

diagnostics of LMN and PNI

Answer 31

Neuro exam -> Clinical symptoms Nerve conduction velocity test Electromyography (EMG) Spinal fluid analysis (looking for elevated proteins, normal cell count) Blood and urine tests (R/O other disorders that can cause neuropathy, looking for unusual proteins) MRI and CT Scans

Question 32

CIDP overview

Answer 32

damage to the myelin sheath, immune system attack progressive weakness, impaired sensation of U/LE diminished DTRs fatigue unusual feelings in the body proximal and distal symmetrical and asymmetrical no bulbar involvement relapsing remitting

Question 33

CIDP etiology and treatment

Answer 33

Etiology: CIDP can happen at any age; may be triggered by a viral infection; more common in young adult men closely related to Guillain-Barré syndrome; considered the long-term stage Treatment: corticosteroids, high dose IVIG, plasmapheresis rehab/physical therapy

Question 34

critical illness polyneuropathy and myopathy

Answer 34

Acute or subacute axonal length-dependent neuropathy that occurs in critically ill patients, not as a direct consequence of their underlying illness Increases ICU morbidity via the inability/difficulty in weaning these patients off mechanical ventilation Increase long-term disability Decreased exercise capacity and tolerance Symmetrical paralysis Associated with ARDS, sepsis, organ failure

Question 35

The PADIS guidelines the ICU bundle

Answer 35

A - assess, prevent and manage pain B - both SAT and SBT C - choice of analgesia and sedation D - delirium: assess, prevent and manage E - early mobility and exercise F - family engagement and empowerment