Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Orthopaedics > Muscle Weakness > Flashcards

Muscle Weakness Flashcards

1
Q

muscle weakness (power)

A 
5= normal
4= slight weakness
3= active against gravity but not resistance
2= active but not against gravity or resistance
1= small trace contraction
0 = complete paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

where can muscle weakness arise from?

A

upper motor neurone
NMJ
lower motor neurone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

muscle tone

A

upper motor neuron
tone is increased (spastic paralysis)

lower motor neurone
decreased tone (flaccid)

NMJ tone is decreased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

muscle bulk

A

upper- normal
NMJ- normal
lower- severe atrophy (disuse)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

reflexes

A

upper- hyper-reflexia
NMJ- preserved
lower- hypoactive / absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

fasiculations

A

small muscle twitches

*only in lower motor neuone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

upper motor neurone lesion extra

A

babinski *lateral aspect (plantarflexion is normal) (dorsiflexion is the babinski +ve)

pronator drift
outstretch with palms faced upwards
forearm pronator
suddenly drift to pronator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

causes of muscle weakness

  1. brain
  2. spinal cord
  3. anterior horn
  4. peripheries
  5. NMJ
A

brain: stroke, space occupying lesions

spinal cord: trauma, disk herniation, spinal stenosis, spinal epidural abscess, hematoma, syringomyelia, MS

anterior horn cells
amyotrophic lateral
poliomyelitis

peripheries:
diabetic neuropathy

NMJ:
myasthenia gravis
Lambert eaton
dermatomyostiis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

brain symptoms

A

stroke- sudden onset, hemiparesis and hemisensory loss, aphasia, neglect, visual field defect

basilar artery- locked in syndrome. quadripareiss, intact consciousnesss, eye movement

space occupying lesions:
gradual onset weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

spinal cord lesions symptoms

A

weakness in the extremities without cortical signs

penetrating trauma- hemisection of the spinal cord (brown squared) ipsilateral hemiparesis , loss of proprioception but CONTRALATERAL loss of pain and temp

at spinal level of lesions there is loss of all sensation and flaccid paralysis of the msucle

intervertebral disc herniation: weakness and pain (sciatic)

compression of caudal equine and spinal cord + bladder and bowel dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

spinal cord artery occlusion

A

usually affects anterior 2/3 of spinal cord

sudden onset bilateral flaccid paralysis that evolves into spastic paralysis

weakness
bilateral loss of pain and temp
*preseved dorsal column to proproception and vibration is spared

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

syringomyelia

A

cavity or syrinx grows from centre of spinal cord outwards destroying grey and white matter. effects cervical spinal cord and extends into brain stem

bilateral loss of pain and temp
cape like distribution
shoulders and upper arms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

MS

A

chronic inflammatory demyelinating
effects white
optic neuritis
upper motor damage

RAPD
diplopia

ataxia, vertigo, chronic constipation, bladder dysfunction (overactive detrusor muscle)

Lhermitte’s sign- electric shock like down back with neck flexion

uhtoffs phenomenon
worsening of symptoms when body temperature increases

disseminated in time and place
relapsing-remitting

diagnosis: brain and spinal cord MRI. periventricular (around the ventricles)

lumbar puncture- oligoclonal bands (discrete sets of antibodies IgG)

evoked potential conduction velocity- slowing of electrical events

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

treatment of MS

A

disease modifying meds
IFN-B, glatriamer acetate, natalizumab

symptomatic therapy
spasticity: tx baclofen
(muscle relaxant)

urge urinary incontinence: amitriptyline

urinary retention: bethanechol

neuropathic pain
anticonvulsants
carbamezapine, gabapentin, pregabalin.
antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

amyotrophic lateral sclerosis

A

affects anterior horn and cortical motor neurons
purely motor
steven hawkin had this

diplopia
difficult with speech and swallowing
focal limb weakness

muscle relaxants
percutaneous gastronomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

polyneuropathies

moloneuropathies

A

polyneuropathies
DANG MY THERAPIST

D- diabetic neuropathy
A- alcoholic neuropathy
Nutritional (vit B1, B6, B12)
Gullian Barre syndrome
Medications
Toxins (lead, arsenic poisoning)
Hereditary (Charcot Marie Tooth)
renal failure (uraemic neuropathy)
Amyloidosis
Prophyrias
Infection- leprosy, syphilis, HIV
systemic disorders (hypothyroidism)
Tumors
17
Q

diabetic neuropathy

A

sensory - loss of sensation and paraesthesis (stocking and glove neuropathy)

motor weakness- cranial nere palsy

autonomic
arrhythmias, orthostatic hypotension, erectile disfunction, gastroporesis

18
Q

gullian-barre

A

autoimmune demyelinating diosrer
acute inflammatory diarrhoea

caused by campylobacter jeuni

acute inflammatory demyelinating polyneuropathy

two-four weeks post infection. rapid progressive symmetric ascending weakness in distal lower extremities.

flaccid paralysis. decreased or absent tendon reflex.
fluctatoni in BP, cardiac arrhythmias

*sensory is rare

Ix: 
CSF analysis (albuminocytological dissociation)

tx: immunoglobulins

19
Q

charcot-marie tooth

A

progressive hereditary motor and sensory polyneuropathy

distal lower extremity weakness
foot drop (common perineal nerve)
high arching of foot (pes caves)
scoliosis

sensory: pain, sensory loss

diagnosis:
electrodiagnostic testing
genetic testing

management:
physiotherapy
rehabilitation
chemotherapetuic- vincristine, isonizid, paclitexl, colchicine.

20
Q

mono-neuropathies

A

facial nerve palsy

carpal tunnel syndrome

21
Q

facial nerve palsy

A

ipsilateral complete paralysis
eye - paralysis of orbiculares oculars (cannot close eyes)
ears- sensitive (hyperacusis)
tongue- abnormal taste (dysgeusia)

Bell's palsy
lyme disease
Ramsay hunt syndrome (herpes zoster) (painful eruption in external auditory canal)
sarcoidosis
gullian barre syndrome
acoustic neuroma
22
Q

bells palsy treatment

A

10 days prednisolone
in some cases HSV is involved so sometimes give acyclovir
cover with eye patch to prevent cornea from getting dry

23
Q

carpal tunnel syndrome

A

*mononeuropathy

entrapment of median nerve
receptive use of wrist
numbness and tingling on lateral 3 1/2 fingers

O/E
tinnels test
phalanx test (raised forearms)

treat:
immobilise the wrist (splint)
injection of glucocorticoids
surgical decompression (carpal tunnel release)

24
Q

NMJ disorders

A

myasthenia gravis

Lambert eaton myasthenic syndrome

25
Q

myasthenia gravis

A

autoantibodies that binds to the nicotinic acetylcholine receptors on skeletal msucle

diplopia
ptosis
difficulty swallowing
nasal voice
proximal limbs affected
fatiguability- worsens the more using the muscle

autoantibodies from the thymus?

26
Q

myasthenia gravis investigations

A

edrophonium- inhibits acetylcholinesterase. this will temporarily improve symptoms / improve weakness in <1 in

serological testing for antibodies
(anti acetylcholine receptor)
anti MuSK

27
Q

repetitive nerve stimulation and imaging

A

stimulated multiple times
compound muscle action potentials

normal muscle- CMP always remains the same amplitutde

in MG- the muscles are fatiguable so the CMP begi to decrease

CT and MRI (look for thyme pathology)

28
Q

myasthenia gravis management

A

pyridostigmine (acetylcholine esterase inhibitors)

corticosteroids
azathoprine
cyclosporine

29
Q

myasthenic crisis

A

severe weakness in bulbar and respiratory muscles
precipitating trigger

secure airway
measure vital capacity
elective intubation
immunoglobulins / plasma exchange
stop pyridostigmine (increases airway secretions= aspiration)
stop the trigger
30
Q

cholinergic crisis

A

excessive acetylcholine from excessive pyridostigmine so the receptors shut down and stop working causing the same respiratory crisis

there will be cholinergic symptoms (they bind to nicotinic and muscarinic)

SLUDGE
salivation
lacrimation
urination
diarrhoea
GI cramps
emesis

give ATROPINE (anti muscarinic meds)

31
Q

Lambert eaton syndrome

A

voltage gated ca2+ channels so less acetylcholine is released

proximal muscle weakness that improves with muscle use
reflexes low or absent
associated with malignancy

investigate:
serology
electrodiagnositc testing (CMP increases)
CT TAP

32
Q

myopathies

muscles

A

inflammatory myopathies
dermatomyositis and polymyositis

endocrine disorder- hypothyroidism

diagnosis: CK level (raised), EMG (abnormal)

Orthopaedics (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions