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Year 2 - Nervous > Nerve diseases > Flashcards

Nerve diseases Flashcards

1
Q

What is peripheral neuropathy + name types of peripheral neuropathy

A

Damage of peripheral nerves

Can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy)

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2
Q

Causes of peripheral neuropathy (8)

A 
Heriditary
Diabetes
Alcoholism
Infectious diseases - lyme, HIV
Certain medications - esp chemo
Tumour compression
Paraneoplastic - body's immune response as a result of the cancer
Autoimmune diseases - Guillain barre syndrome, chronic inflammatory demyelinating polyneuropathy
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3
Q

Pathophysiology of Guillain barre syndrome (acute inflammatory demyelinating polyneuropathy)
-proposed mechanism

A

Acute inflammatory demyelinating polyneuropathy (i.e. a peripheral neuropathy affecting many nerves)

Thought to maybe be an AUTOIMMUNE ATTACK OF MYELIN sheath of peripheral sensory and motor nerves –> decreased propagation of electrical impulses –> motor weakness/flaccid paralysis

When immune reaction stops, repair and remyelination promptly begin, which correlate with a quick recovery from the flaccid paralysis

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4
Q

Risk factor of Guillain barre syndrome

A

Preceding viral/bacterial infection, esp gastroenteritis or URTI

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5
Q

Clinical features of Guillain barre syndrome

  • which symptoms are seen first
  • sensory (1)
  • motor (8)

(hint: bilateral, FLACCID, ascending weakness of limbs peaking in <4 weeks)

A

Paraesthesia - PRECEDES WEAKNESS

Back and leg pain - PRECEDES WEAKNESS

Muscle weakness

  • usually hands/feet first BEFORE spreading to arms/legs
  • facial weakness
  • oropharyngeal weakness –> dysphagia
  • extraocular muscle weakness –> diplopia
  • ptosis
  • dysarthria
  • dyspnoea/resp distress

Absent reflexes/hyporeflexia

FLACCID PARALYSIS (late symptom)

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6
Q

Investigations of Guillain barre syndrome + their findings (2)

A

Nerve conduction studies - shows slowing of conduction velocities

LP - shows increased CSF protein but NORMAL CELL COUNT

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7
Q

Where do symptoms of peripheral neuropathies usually start

A

Distally in feet and hands and spread up legs/arms

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8
Q

UMN lesion signs (4) + 2 not seen

A 
Weakness
NO WASTING
Increased tone (spasticity)
Brisk/exaggerated reflexes 
NO FASICULATIONS
Babinski +ve (extensor plantar)
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9
Q

LMN lesion signs (6)

A 
Weakness
Wasting
Decreased tone (flaccidity)
Decreased reflexes 
Fasciculations
Babinski -ve (flexor plantar)
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10
Q

Symptoms (3) /signs (10) of motor neurone disease (amyotrophic lateral sclerosis)

A

BOTH UMN (4) + LMN SIGNS (6)

Symptoms:
Dyspnoea
Dysphagia
Dysarthria

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11
Q

Motor neurone disease is a disorder of what horn

A

Anterior (Ventral) horn

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12
Q

Muscle weakness usually begins in the (1) in motor neurone disease but sometimes may begin in other places - name these (2)

A

Limb weakness

May also begin in bulbar muscles (Swallowing + speech) or resp muscles

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13
Q

What initial presentation of motor neurone disease is more aggressive - limb weakness or bulbar weakness

A

Bulbar weakness

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14
Q

Investigations/diagnosis (2) of motor neurone disease

A

Clinical diagnosis is 1st line - a thorough history and examination

Electromyography (EMG) - shows diffuse, ongoing, chronic denervation

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15
Q

Treatment of motor neurone disease

  • supportive
  • medical
A

Supportive/palliative care

  • mechanical ventilation
  • physio
  • speech and language therapy
  • feeding tube

Riluzole - prolongs survival as it’s a glutamate antagonist (degeneration in ALS is caused by excitatory glutamate neurotransmitter so if you block that then can slow degeneration)

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16
Q

How does riluzole help in motor neurone disease

A

prolongs survival as it’s a glutamate antagonist (degeneration in ALS is caused by excitatory glutamate neurotransmitter so if you block that then can slow degeneration)

17
Q

What type of lesion is a nerve root disease (Radiculopathy)

A

LMN lesion

18
Q

Motor (6) /sensory (1) /autonomic (2) signs of nerve root disease (think what lesion nerve root means)

A 
LMN signs (6)
-Myotomal wasting + weakness of the nerve root damaged

Sensory signs:
-dermatomal sensory loss (Area of skin innervated by that nerve loses sensation)

Autonomic signs:
-may get bladder/bowel dysfunction

19
Q

Investigation of nerve diseases (e.g. radiculopathies, peripheral nerve lesion, peripheral neuropathies) (5)

A 
LP + CSF analysis
Nerve conduction studies
Nerve biopsy
Routine bloods
Genetic analysis
20
Q

Individual peripheral nerve lesion causes (2)

A

Lesion is either:

  • compressive neuropathy
  • Vasculitic neuropathy (blood supply to the peripheral nerve damaged)
21
Q

Signs of individual peripheral nerve lesion (3)

A

Wasting
Weakness
of innervated muscle

Specific sensory loss

22
Q

What is generalised peripheral neuropathy

A

Damage to peripheral nerves affecting motor and sensory and maybe autonomic function

23
Q

Most common cause of chronic peripheral neuropathy

A

Diabetes

24
Q

Symptoms/signs of peripheral neuropathies (think Guillain barre)

  • sensory (4)
  • motor (3)
  • autonomic (4)
A 
Sensory:
Paraesthesia
Numbness
Burning/stabbing pain
Sensory ataxia - loss of balance and co-ordination when eyes closed

Motor:
muscle weakness, especially in feet
Muscle fasiculations
Muscle wasting

Autonomic (DEPENDS ON WHERE THE AUTONOMIC FIBRES THAT ARE DAMAGED SUPPLY):
Nausea/vomiting
Constipation or diarrhoea
Urinary retention
Bowel incontinence
25
Q

Define radiculopathy

A

DISEASE OF SPINAL NERVE ROOTS

= compression of nerve roots leading to DERMATOMAL + MYOTOMAL DEFICITS

26
Q

Symptoms/signs of a nerve root lesion, e.g. L4 nerve root lesion (4) [think LMN signs)

A

Pain down ipsilateral leg
Numbness in L4 dermatome
Weakness in ankle dorsiflexion
Reduced knee jerk

27
Q

Cauda equina syndrome is a disease of which nerve roots

A

L2-Cc1

28
Q

Symptoms/signs of caudal equina syndrome (think clinical triad)

A

Bilateral sciatica – pain down both legs
Saddle anaesthesia – numbness around bottom
Urinary dysfunction

29
Q

Investigation of cauda equina syndrome

A

MRI

30
Q

Treatment of cauda equina syndrome

A

Emergency lumbar discectomy

31
Q

What is more affected - sensory or motor function - in diabetic retinopathy

A

Sensory

32
Q

Symptoms/signs seen in Guillain barre not seen in myasthenia gravis (3)

A

Absent reflexes/hyporeflexia
Sensory loss/paraesthesia
Muscle wasting

33
Q

Signs seen in myasthenia gravis that are not seen in motor neurone disease (4)

A

Ptosis
Diplopia
Opthalmoplegia - paralysis of extraocular muscles
Muscle fatiguability throughout the day

Year 2 - Nervous (39 decks)

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