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IPAP > Neuro Block 1 > Flashcards

Neuro Block 1 Flashcards

1
Q

Define Dysarthric

Define Photophobia

A

D/o or articulation, stammering or stuttering due to a nerve defect

Eye discomfort from brith lights

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2
Q

Define Phonophobia

What is the criteria for alcohol abuse?

A

Fear of own voice or sounds

1-2 drinks at a time
1-2 drinks a month
Never more the 5 drinks at a time

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3
Q

Define Diplopia

Define Dysphagia

A

Double vision

Difficulty swallowing

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4
Q

Define Paresthesia

Define Radiculopathy

Define Dyskinesia

A

Burning, tingling, prickling

Nerves not working (neuropathy) at or near the root

Involuntary movements

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5
Q

What are the red flags of neuro that can’t be missed?

A

Worst HA of life/thunder clap (hemorrhage/aneurysm)
Sudden blindness (Amaurosis fugax/hypoperfusion of retina)
Back pain worse at night (CA)
Bowel/bladder incontinence (Cauda equine)
SI w/ plans

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6
Q

Define Level of Consciousness

How is Orientation tested for

A

Awareness of self and environment and rages from awake to comatose

PT states name, location, time of day (day of week and date)

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7
Q

What part of a PTs orientation is FIRST to deteriorate

How is speech assessed?

A

Time, date, week

Articulation, rate, rhythm and prosody- change in pitch/accentuation of syllables and words

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8
Q

How is language assessed?

What is a typical testing sequence for assessing speech and language

A

Content of PTs verbal and written output, response to commands and ability to read

Name parts of clothing, watch and pen
Repeat “no ifs, ands, or buts”
Follow 3 step verbal command
Write sentence
Read and respond to written command
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9
Q

How are abnormalities of insight or judgement detected during an interview?

What is an example question?

A

PT describes how they’d respond to situations that have a variety of outcomes

“What would you do if you found a wallet on the ground?”

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10
Q

Types of memory categories and how the info is extracted

A

Fund of info- history/current events
Insight/judgement- found wallet
Abstract thought- describe similarities
Calculation- subtract by 7s

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11
Q

Define the mini-mental status exam?

What type of score is concerning?

A

Formal eval tool w/ max of 30pts total

<24/30= suggestive of cognitive d/o

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12
Q

How reliable is a MMSE?

What is it one of the best tests for?

A

85% and 85% for dementia Dx that is moderate to severe in educated PTs

Mental status of PT, especially as a baseline for future scores

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13
Q

When conducting HEENT exam, testing for other modalities such as corneal reflex and motor part of CN5 is needed when?

What are the 5 movements tested when assessing CN7?

A

Hx suggests need

Eye brow elevation
Forehead wrinkling
Eye closure
Smiling
Cheek puff
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14
Q

Paralysis of the lower half of the face suggests ?

Paralysis of the entire half of the face suggests?

A

UMN lesion

LMN lesion

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15
Q

What size tuning fork is used to assess CN8?

When/why is the Rinne and Weber tests conducted?

A

512Hz

Abnormality is detected by Hx or exam

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16
Q

What are the three parts of a motor exam?

The decrease of one of these is indicative of ?

A

Strength, Tone, Appearance

Dec tone- LMN or peripheral nerve d/o

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17
Q

Pronator drift test is extremely useful for screening for ?

A finding of side, up, searching of withering during this test is indicative of ?

A

Upper limb weakness- flexion of elbows/fingers, pronation of forearm, especially asymmetrical

Loss of position sense

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18
Q

Define Jendrassik maneuver

What types of movements does this maneuver include?

A

PT contracts other/distant muscle groups to enhance reflexes during DTR assessment

Inc upper limb reflexes by clenching jaw
Inc Achilles reflex by flexing fingers and pulling them apart

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19
Q

Motor, reflex and sensation of C5

What nerves control the biceps AND brachioradialis reflex?

A

Deltoid, Bicep tendon, Outter upper arm

C5 and C6

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20
Q

Motor reflex and sensation of C6

Motor, reflex and sensation of C7

A

Wrist extension, Brachioradialis reflex, lateral forearm (“6-shooter”)

Wrist flexion, tricep tendon, middle finger

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21
Q

Motor, reflex and sensation of C8

What nerves don’t have reflexes associated with them?

A

Intrinsic hand muscles, no reflex, medial forearm

C8, L5

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22
Q

Motor, reflex and sensation of L4

Motor, reflex and sensation of L5

A

Tibialis anterior for foot inversion, patellar tendon, medial foot sensation

Extensor digital rum longus, no reflex, middle toes sensation

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23
Q

What nerves in never ate ankle dorsiflexion

Why is this one important to know?

A

L4 and L5 via peroneal nerve

Crosses head of fibula below the knee and if injured, causes Foot Drop- inability to dorsiflex the foot

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24
Q

Motor, reflex, and sensation of S1

Define the Plantar Reflex

A

Peroneus longus and brevis muscles, Achilles’ tendon reflex, lateral foot sensation

Normal= plantar flexion of toes
Babinski= extensor plantar response from UMN lesion above S1
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25
Q

What cutaneous reflexes are tested for?

A

Plantar, Superficial Abdomen, Cremaster (L1, L2), Anal (S2-S4)

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26
Q

What are the 4 primitive reflexes

What causes these to appear in adults?

A

Suck, Root, Grasp, Palmomental- contraction of mental is from ipsilateral scratch across palm

Dz of frontal lobe pathways

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27
Q

Define Dysdiadochokensis

What causes this in adults and kids?

A

Inability to perform rapid alternating movements

MS in adults
Cerebellar tumors in kids

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28
Q

What is the most important part of the neurological exam?

Why work ups would LPs be obtained?

A

Walking

Infection, hemorrhage, dementia, CA, MS or ICP

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29
Q

What are the indications to order an LP?

What therapeutic effect does this procedure offer?

A

Dx infections of meningitis, encephalitis, or sarcoidosis

Reduces CSF pressure

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30
Q

What studies are ordered prior to an LP?

When are the true contraindications for LPs?

A

Neuroimaging for AMS, papilledema, focal neuro deficit, new onset seizure

Only true contra- Infection at puncture site
WBC count <20K
Lack of consent from PT

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31
Q

What medication causes LPs to be c/i?

What other anti-platelet drugs need to be d/c’d prior to an LP

A

Warfarin, stop 4-5 days prior or reverse w/ FFP; INR needs to be in range at time of puncture

14 days prior for Ticlopidine 
7 days prior for Clopidogrel
10 days prior for ASA
4 days prior for Naproxen
24hrs for ibuprofen
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32
Q

What is it called when CSF is yellow and indicative for a brain bleed?

What site is an LP done at?

A

Xanthochromia

L3-L4

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33
Q

What is the principle complication of LP?

What population is this s/e common in?

How is this s/e treated?

A

Positional HA from dec CSF pressure

Inc in Female and Younger PTs

PO analgesics, Caffeine, epidural blood patch

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34
Q

Define an EEG

What are the indications for ordering one?

A

Non-invasive record of brain activity for suspected seizure/sleep d/os and brain death w/ no contraindications

Seizure, death, Metabolic encephalopathy, Brain lesions, Dementia, Creutzfeldt Jakob, HS Encephalitis, Psychogenic Coma

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35
Q

What is an EMG

What is a NCV

A

Electromyography
Records intrinsic activity in muscles

Nerve Conduction Study
Stimulates a nerve and records the response

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36
Q

Why are EMGs or NCVs used?

Who can interpret them?

A

Evaluation of neuromuscular d/o, peripheral neuropathy or entrapment

Neurologist
Physical medicine/rehab providers

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37
Q

What are skull x-rays used for?

What are they usually followed up with?

A

Evaluate direct trauma (Child abuse), metastasis, calcification or sinus Dzs

CT and/or MRI

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38
Q

What causes the dark/light areas of the CT scan results?

What determines the resolution?

A

Greater attenuation, high density= white
Soft tissue, poor attenuation= black

Radiation dose, detector size, collimating, field of view and matrix size

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39
Q

CT scans can get images as thin as ? With ? Resolution at ? Speed

What can be added to CT’s for enhanced results?

A

0.5-1mm w/ 0.4mm in plane resolution at 0.3 seconds per rotation

IV iodinated contrast- shows vascular defects and issues w/ BBB

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40
Q

In a normal CNS, only ? And ? Are enhanced w/ contrast

CTis the primat SOC for evaluating ? Issues

A

Vessels, and structures lacking BBB: Pituitary, Choroid Plexus, Dura

AMS, focal neuro, acute trauma to brain/spine, subarachnoid hemorrhage, conductive hearing loss

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41
Q

What two studies are used together to evaluate the base of the skull, orbit and Ossetia structures?

What study is used for spinal and intracranial fistula studies?

A

CT and MR

CT

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42
Q

What imaging modality is used to asses the spinal subarachnoid space in failed back surgery syndromes?

4 indications for CT ordering

A

CY myelography

Stroke/hemorrhage, Tumor, Trauma, Dementia

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43
Q

What lab results are indicative of contrast nephropathy

Who is more likely to have an allergic reaction to CT contrast?

What previous allergy is not used as an indicator?

A

SrCr rise of 0.5mg/dL w/in 48hrs of administration

Hx, Atopy (hay fever, asthma)

Shellfish

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44
Q

If an iodinated contrast must be used in a PT w/ allergies, what is given prophylactic

How much radiation exposure is there in a CT brain scan

A

Glucocorticoids, Antihistamines

2-5 mSv

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45
Q

Any PT getting a CT needs a SrCr measurement if what criteria are present?

A SrCr result can be used as long as it’s within how many weeks?

A 
\+60y/o
CKDz, Hx, Transplant
DM
HTN
Paraproteinemia
Collagen vascular Dz

6wks

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46
Q

What are the pros of using an MRI

A 
Better for detecting stroke bleeds
Acoustic neuroma/pituitary tumor
More sensitive for atrophy of dementia
Demyelination d/o
Edema/infection
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47
Q

What are the complications and c/i with MRI?

A 
Loud/claustrophobia
Artifacts from movement
Not for unstable PTs
No metal implants- accelerated to 150mph
Nephrotoxicity
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48
Q

What med can be given to PTs prior to MRIs to relax them?

GFR must be obtained in PTs prior to MRI with what Hx?

A

Valium

\+60
Renal Dz
HTN
DM
Hepatic Dz
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49
Q

What are Magnetic Resonance Angiography used for?

A

Image of blood flow

Detects vascular stenosis/occlusion especially in carotid artery bifurcation and Circle of Willis aneurysms

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50
Q

What are PET scans used for?

A

Perfusion and metabolic activity as a functional imaging study and shows decreased results in dementias

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51
Q

What are myelography used for?

What are the c/is ?

A

Contrast LP injected into subarachnoid space for evaluating cord compression, AVMs, abscesses and tumors

Tumor/infection at injection site
Bleeding d/o
Inc ICP
Allergy to dye/contrast

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52
Q

What are Carotid US’ used for?

What are the 3 functions of the NS?

A

Measures blood velocity through carotid artery to bifurcation

Sensory, Integrative, Motor

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53
Q

CNS develops from the ?

PNS develops from the ?

A

Neural tube- brain and cord

Neural crest- all neural structures outside of the cord

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54
Q

When does the NS begin to develop?

What developmental events occur?

A

3rd week as the ectoderm/neural plate thickening

Plate folds in forming longitudinal/neural groove

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55
Q

What are the raised edges of the neural plate called?

What is formed when the edges increase in height?

A

Neural folds

Neural tube

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56
Q

What are the 3 layers of the neural plate?

A

Outer- marginal, white matter
Middle- mantle, gray matter
Inner- ependymal, lining and ventricles of brain

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57
Q

Define the Neural Crest and what it develops into

A

Mass of tissue between neural tube and skin ectoderm

Dorsal root/CN ganglia, spinal nerves, CNs, ANS ganglia, adrenal medulla and meninges

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58
Q

When does the neural tube close?

A

26-28 days after conception (6wks of gestation)

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59
Q

Define Ancencephaly

A

1:100-, 4x F>M

Failure of neuropore to close, cranial bones fail to develop and brain degenerates

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60
Q

Define Spina Bifida

A

Failure of posterior neuropore to form, most commonly in sacrolumbar region
SB Occulta at L5-S1 occurs in 10% of population

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61
Q

What two results of the neuropore failure to close a different gestational development times?

How are low and high risks for these issues decreased?

A

Anencephaly, Spina Bifida

Low- 0.4mg/day started 1mon prior to conception
High- 4mg/day 3mon prior to conception

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62
Q

What are the 4 major parts of the brain

What are the 3 parts of the brain stem

A

Stem, Cerebellum, Diencephalon, Cerebrum

Oblongata, Pons, Midbrain

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63
Q

What part of the brain is AKA the “little brain”

What is the largest part of the brain and what supports it?

A

Cerebellum

Cerebrum, deincephalon and brain stem

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64
Q

What does the diencephalon comprise of?

What is the only connection between the L and R hemispheres of the brain?

A

Thalamus, Hypothalamus, Epithalamus (pineal gland) and Subthalamus

Corpus Callosum

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65
Q

Diencephalon means ?

Cerebrum means ?

A

Through, Brain

Brain

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66
Q

What functions does the areas of the Cerebral Cortex control and what happens if they’re damaged?

A

Motor- spastic paresis
Frontal eye field- deviation of eyes to ipsilateral side
Brocas- aphasia
Prefrontal cortex- problem solving/concentration, incontinence
Destruction of orbital portion- inappropriate behavior, words, actions

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67
Q

The frontal lobe is responsible for what roles?

The temporal lobe is responsible for what roles?

A

Behavior, Emotion, Problem solving, Personality, Reasoning, Primary Motor region, Loss of orientation

Language, Hearing, Short term memory, Olfaction

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68
Q

The parietal lobe is responsible for what roles?

The occipital lobe is responsible for what roles?

A

Astereognosis
Hemispatial neglect
Inability to copy figures

Visual processing
Shape/color identification

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69
Q

Left sided dominance is better at ? and responsible for ?

Non-dominant is usually right and responsible for ?

A

Vocal naming
Language, speech, calculation

3D/spacial perception, facial recognition, non-verbal ideation, pointing to a stimulus

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70
Q

Cerebral dominance is determined by the ? test and checks for ?

A

Wada Test

Aphasia

71
Q

Ach is released by ? neurons

What are the catecholamines and what do they do?

A

Mostly PNS, some CNS

Dopamine- emotion, addiction, pleasure, dec in Parkinsons, Inc in Schizo
NorEpi- most common transmitter of post-ganglionic neurons, hypothesized mood s/o

72
Q

What enzyme breaks catecholamines down?

What are the 3 opioid peptides?

A

MAOs

Endorphins- B-endorphin 40x more powerful than morphine in hypothalamus
Enkephalines- most distributed, mostly in globus pallidus and reduces pain
Dymophins- same as enkephalines

73
Q

What are the non-opioid neuropeptides?

A

Sub-P: pain transmitter in dorsal ganglion, mostly in substantia nigra

Somatostatin- somatotrophin inhibiting factor, regulates release of GH and TSH
Red in Alzeih.
Inc in Huntingtons

74
Q

What are the two inhibitory AA transmitters

A

GABA- major inhibitory NT of the brain, activated by Benzos that enhance GABA activity

Glycine- major inhibitory NT of the spinal cord

75
Q

What are the two excitatory AA transmitters?

A

Glutamate- major excitation NT of the brain; transmitter of fibers entering the spinal cord/brain, corticobulbar/spinal tracts

Aspartate- transmitter of the climbing fibers of the cerebellum, role in long term memory and can be a neurotoxin

76
Q

Most common cause of exotoxicity?

A

O2 deprivation to the brain from ischemic strokes, stimulates nerves to death

77
Q

Why is Parkinson’s an issue

A

Degeneration of dopamine neurons in pars compacta of the substantia nigra

78
Q

Why is Huntingtons an issue

A

Loss of Ach and GABA neurons in striatum and substantia nigra

79
Q

Why is Alzeihmers an issue?

A

Degeneration of cortial and cholinergic neurons in basla nucleus of Meynert and associated w/ +60% loss of choline-transferase in the cerebral cortex

80
Q

Why is Myasthenia Gravis an issue?

What are 5 Sxs localized to the cerebral functions?

A

Abs to nicotinic Ach receptors destroys receptors and causes paralysis

Aphasia, Apraxia, Neglect/Extinction, Frontal lobe dysfunction, Affect

81
Q

Define Aphasia

What are the 2 forms

A

Inability to speak, deficit of naming (anomia) is single most common finding

Brocas- motor/expressive from frontal lobe (doing)
Wernickes- temporal lobe (sensing)

82
Q

Damage to Broca’s speech area results in ?

A

Non-Fluent Aphasia- inability to articulate/form words

Know what they want to say but can’t and speak intelligibly

Depressed, tearful, frustrated

Insight to condition is preserved

83
Q

Damage to Wernicke’s Area results in ?

A

Fluent Aphasia- faulty understanding of spoken words.

Word salad- string of good words w/ no combined meaning
Word deafness/blindness or both

84
Q

Almost all PTs with speech aphasia will have ?

Brocas aphasis is located ?
Wernickes aphasia is located in ?

A

Agraphia or aphasic in ability to write

B- R hemiparesis
W- R upper visual field defect

85
Q

Define Apraxia

A

Inability to carry out purposeful movements in absence of paralysis

A focal disturbance of planning/doing

86
Q

Define Neglect

What is it AKA

A

Cortical D/o: R frontal/parietal lobe
Damage to non-dominant hemisphere

Directed inattention or lack of attention to one hemisphere

87
Q

What are the S/Sxs of Neglect

A

Completely unaware of anything on one side of body up to denying existence of affected side (fail to shave/shower side of body)

88
Q

How is Neglect tested for in clinic?

A

Double stimulation test- won’t feel L side when both sides are touched at same time
Draw test- everything is pushed to R side or only R sided features are drawn

89
Q

Define Basal Ganglia

What are the parts of this structure

A

3 nuclei deep in each hemisphere

Globus Pallidus, Putanem, Caudate nucleus= Lentiform= Corpus Striatum

90
Q

What is the function of the Basal Ganglia

What happens if this area is damaged?

A

Coordinates motor activity from input from cerebral cortex, thalamus and substantia nigra

Uncontrollable tremors, stiffness and involuntary muscle movements (Parkinson, Huntington)

91
Q

What is the function of the thalamus?

What crude perception occurs here?

What two nuclei are located here?

A

Relays almost all sensory input to cerebral cortex; sensory relay and memory pathway

Touch, Pressure, Pain and Temp

Movement planning and control

92
Q

What does the hypothalamus do?

How is the pituitary gland connected to the hypothalamus?

A

Over control of ANS, controls pituitary function
Temp, Sleep, Appetite, Sex

Infundibulum

93
Q

Through the ANS, what functions does the hypothalamus control?

What hormones does the hypothalamus produce?

A

BP, HR, RR, Temp, Inc Hunger, Thirst, E+/Water balance, Cercadian Rhythm

Oxytocin and ADH

94
Q

Lesions on the hypothalamus will present as issues with ?

How is the hypothalamus a messenger for the pineal gland?

A

Appetite, Emotions, Temp and autonomic/endocrine behaviors

Connection w/ pineal gland

95
Q

Epithalamus consists of the ? gland which controls ?

What structure encircles the upper part of the brain stem and corpus collosum?

A

Pineal gland- regulation, secretion of melatonin, serotonin and NorEpi

Limbic system

96
Q

Limbic system is made up of ?

What does it control?

A

Amygdala, Cingulate Gyrus, Midbrain Raphe, Locus Ceruleus, Hippo Campus

Affective/Emotional brain- emotion, eating and reproduction

97
Q

Seizures arising from the amygdala are perceived/felt as ?

Where is the amygdala

A

Fear

Deep in temporal lobes

98
Q

What is the Amygdalas function

An enlarged amygdala is found in ? d/o

A

Chief role- Memory of emotional experiences
Central- behavior response to fear

Autism

99
Q

What does the Hippocampus do?

What part of the brain is it closely connected with?

A

Integrator of incoming novel/unpleasant stimuli

Connects w/ temporal lob

100
Q

What unique ability does the hippocampus have?

What is the make up of the “little brain”

A

Predicts next event based on what has already happened

Cerebellum- 10% of volume, 50% of CNS neurons
2 hemispheres/10 lobes

101
Q

What is the blood supply to the cerebellum?

Cerebellum occupies the ?

A

Sup Cerebral Artery,
Ant Inf Cerebral Artery, Post Inf Cerebral Artery

Posterior Fossa, AKA posterior circulation

102
Q

What are the 3 fold functions of the cerebellum

A

Sensory perception, coordination, motor control

No paralysis
Feedback d/o- posture, equilibrium, motor learning
Ataxia- posterior fossa localizing condition; inability to have posture

103
Q

What chemical inhibits the activity of the cerebellum?

What are the 3 parts of the brain stem and rules that apply here

A

Alcohol

Midbrain, Pons, Medulla
Ant- motor
Post- sensory

104
Q

Tracts responsible for movement all pass through ?

What two centers are found here?

A

Midbrain
Pyramidal- voluntary
Extra pyrimidal- involuntary

Reticular Activating System and respiration/consciousness center

105
Q

Where does the spinal column start and end?

What are the two types of matter found?

A

Medulla to L1-2

Gray- nerve cell bodies
White- mylenated nerves

106
Q

? and ? roots travel the longest to fan out at ? to form the Cauda Equina

Motor pathways of the UMN begin ? and travel down the spine to synapse with ?

A

Lumbar and Sacral
L1-2

Cortex and brain stem

Anterior horn cells

107
Q

LMN begin in the ? w/ the axons traveling directly to ?

These carry info to the ?

A

Anterior horn

Muscle fibers

Neuromusclar junction

108
Q

Each spinal nerve is formed with the union of ?

A

Dorsal- convey sensory axons afferent signals towards spinal cord
Ventral roots- motor axons efferent/away from CNS to skeletal muscles and visceral/glands

109
Q

What are the 3 de/ascending fibers that connect the CNS with the PNS

A

Corticospinal tract- voluntary motor activity

Spinothalmic tract- pain and temp

Dorsal columns- vibration, position, light touch

110
Q

Corticospinal pathway is AKA ? and controls ?

Where does it originate?

A

Motor pathways
Voluntary movements, integration of complicated movements

Cortex

111
Q

Corticospinal tract descending is AKA ?

Where does it cross?

Where does it terminate

A

Pyramidal tract

Medulla

Anterior horn cells

112
Q

What are the two ways sensory impulses ascent the spinal tract?

What are the crossing and end points for these paths?

A

Dorsal column- ascend up same side as fibers entering the cord and cross midline at the medulla

Spinothalamic- crosses midline immediately and ascends to thalamus on the opposite side

113
Q

What type of PE findings would be seen in PTs w/ a lesion on their spinothalamic column?

What is the simplest unit of sensory and motor function and what is the sequence of events??

A

Loss of pain, temp, sensory on contralateral side below site of lesion

Monosynaptic reflex arc- tapping tendon, sensory fibers in partially stretched muscle, sensory impulse, peripheral nerve, spinal cord, anterior horn, NM junction, contraction
10:00-10:30 lect 3

114
Q

Summary pathway of motor, dorsal and spinothalamic tracts and what is seen if there is a lesion there?

A

Motor- crosses at medulla, goes down lateral corticospinal tract; ipsilateral Sxs

Dorsal- vibration, position, light tough go up and crosses at medulla; ipsilateral Sxs

ST- pain/temp immediately cross and go up; contralateral Sxs

115
Q

Arterial blood supply to the brain comes from what two supplies

Each supplier then provides blood for what lobes?

A

Internal carotid- anterior/middle cerebral- frontal, parietal, lateral temporal= “devastating” strokes

Vertebral arteries- posterior basilar, occipital, medial temporal lobe, cerebellum- TIAs= drop attacks

116
Q

What are the consequences of a block in the anterior and middle cerebral artery and basilar artery?

A

Anterior- lower limb area of motor cortex

Middle- face and upper limb, language hemisphere

Basilar- L/R PCA, occlusion leads to drop attacks, complete occlusion at junction= blindness

117
Q

What is the posterior circulation of the brain stem?

What layer of the meninges extends through the entire CNS?

A

SCA, PICA, AICA, Basilar artery

Dura (Out to in= Dura, Arachnoid, Pia)

118
Q

Where is CSF created and absorbed?

Define Cranium Bifidum

A

Choroid plexus
Subarachnoid space

Defect in occipital lobe, provides area for meninges, cerebellar tissue and 4th ventricle to herniate through

119
Q

ANS fibers exit the spinal cord at ? level

Where to PNS fibers exit?

A

T1-L2

CN 3, 7, 9, 10
S2-4

120
Q

What is the master control of the ANS?

What is the function of the PNS

A

Hypothalamus

Carry impulses to/from cord through 31 pairs of nerves
8C, 12T, 5L, 5S, 1C

121
Q

Define Sensory Dermatomes

Why are these helpful?

A

Band of skin innervated by sensory root of a single spinal nerve

Used in localizing neurolgical lesions

122
Q

What are the basic parts of a neuron?

What are the functions of these parts?

A

Cell body
Fibers- axon and dendrites

Dendrites- short/branched receiving portion
Axon- propagates impulses to other cells, can be 3ft long

123
Q

There is virtually always _ axons(s) per neuron

Axons arise from __ on cell bodies

A

One

Hillock

124
Q

What is the first part of an axon called?

Where do APs arise from?

A

Initial segment

Trigger zone- junction of hillock and initial segment

125
Q

Define Synapse

A

Junction between two neuron or between neuron and effector

126
Q

What are the 4 events that occur at a chemical synapse

A

1- impulse arrives
2- depolarization opens Ca channels and causes outflow
3- Inc Ca causes exocytosis of NT into cleft
4- NT travel and bind w/ post-synaptic neuron
5- Na travels and creates post-synaptic potential
6- nerve impulse triggered

127
Q

What type of myelin sheath is on PNS and CNS?

Impulse velocity depends on ?

A 
PNS= Schwann cells
CNS= oligodendrocytes

Diameter

128
Q

Voltage gated channels are only present at ?

What do these structures allow?

A

Nodes of Ranvier

Increased transmission speed w/ less energy

129
Q

What are the 7 questions asked during a PT approach with a neuro issue?

A 
System
Distribution
Nature of sensory involvement
UMN involvement
Temporal evolution
Evidence of hereditary
Associated medical condition
130
Q

Define Mononeuropathy: Unilateral Peripheral Neuropathy

A

From trauma/compression
Rads: electroDx to assess demyelination/axonal degeneration
If caught early, transient

131
Q

Legal limit for driving DUI is ? level of alcohol?

What level is lethal?

A

80mg

350-900mg

132
Q

Alcohol intoxication is manefested by ? and indicated a blood alcohol elvel of ?

A

Ataxia, Dysarthria, N/V

> 150mg

133
Q

Define Chronic Alcohol Brain Syndrome

What other issue can this be associated w/ ?

A

Encephalopathy that has erratic behavior, memory issues and emotional instability

Wernicke-Korsakoff syndrome

134
Q

What is the most common complication of DM?

DM is also the most common cause of ? in developed countries

A

Diabetic neuropathy

Peripheral neuropathy

135
Q

What is the most common form of diabetic peripheral neuropathy

What is the first sensory involvement seen?

A

Distal Symmetric Polyneuropathy

Stocking-glove pattern

136
Q

What test is done for distal symmetric polyneuropathy

A biopsy can be done to look for ?

A

Filament test

Axonal degeneration

137
Q

What is the other form of diabetic neuropathy

How is diabetic neuropathy treated?

A

Autonomic neuropathy- OHOTN
Sweating disturbance

Strict glycemic control
Pain control- TCA, Gaba, S/NRI, Capsaicin

138
Q

What two meds can offer pain relief from diabetic neuropathy in the first 72hrs?

What med is used if the first one fails to provide relief?

A

Nortriptyline, Desipramine

Gabapentin/Pregabalin

139
Q

What annual exam do diabetics need to have on their feet?

A

Monofilament test and Dilated eye exam

140
Q

Presentation of HIV neuropathy can be affected by ?

Late stages of this form needs to be distinguished from ?

A

Highly Active Anti-Retroviral therapy

Toxic form related to nucleoside analogue Tx

141
Q

What is a late stage of HIV Neuroapthy that would involve ortho?

How is this issue treated?

A

Cauda equina from Cytomegalovirus

Ganciclovir

142
Q

What causes Lyme Dz and what carries it?

What makes this presentation unique from Bells Palsy?

A

Borrelia Burgdoferi from Ixodes Deer tick

Bilateral in half of cases

143
Q

S/Sxs Lyme Neuropathy

How is it Tx

A

Migratory joint pain

Doxy 100mg
ABX if severe

144
Q

What causes Leprous Neuritis

Where does it come from and how is it transferred?

A

Chronic infection from acid fast bacilli Mycobacterium Leprae

SE Asia, Africa, South America
Respiratory, dirt, insects

145
Q

What are the S/Sxs of Leprous Neuritis

What are the two presentations

A

Affects cooler areas of skin as anesthesia and motor abnormalities
Macular/nodular skin lesion that is pale or erythematous

Lepromatous- symmetric nerve involvement, more extensive
Tuberculoid- asymmetric, confined to skin/peripheral nerves

146
Q

How is Leprous Neuritis Dx confirmed?

How are the two forms treated?

A

Biopsy and acid-fast stain

Lepromatous- Rifampin, Clofazimine and Dapsone

Tubercloid- Rifampin and Dapsone

147
Q

Autonomic Neuropathy is AKA ?

Where does it effect?

A

Dysautonomia

Peripheral autonomic nerves

148
Q

What usually precedes Autonomic Neuropathy

What are the S/Sxs

A

Viral Prodrome

Post HOTN, Anhidrosis, Hypothermia, Dry mouth/eyes

149
Q

Define Pure Motor Neuropathy

What does it present with?

A

Affects any level of motor neuron

Weak, denervation, atrophy, fasciculations

150
Q

Define Pure Sensory Neuroapthy

Why is this form dangerous

A

Common
Large/small afferent fibers

Poor prognosis and no recovery

151
Q

Define Plexopathy

How does the Cold cause neuropathy

How is it treated

A

Brachial or Lumbosacral plexus as motor and sensory deficits; usually from trauma

Cutaneous vasomotor instability causing axon degeneration of myelinated fibers

Tx Sxs

152
Q

Define Trophic Changes

How does it present

A

Observable changes in body structures from denervation

Skin break down and poor healing

153
Q

How long for peripheral neuroapthy to regenerate?

When does healing process begin

A

2mon to more than a year

Removal of toxin
Return to normal metabolic rate

154
Q

What is the most common type of hereditary neuropathy?

A

Charcot Marie Tooth Dz, autosomal dominant presents as foot/gait abnormality

Distal weakness starting in legs and spreads to hands and forearms
Inverted champagne bottle legs
Type 1- most common, demyelination
Type 2- axonal loss

155
Q

How is Charcot Marie Tooth Dz treated?

A

PT/OT- ankle-foot orthotics

Rare to lose ability to ambulate

156
Q

How does HSAN present

A

Distal sensory loos w/ burning/aching pain
Dermal ulcerations
Foot/hand deformities
Bladder dysfunction and reduced foot sweating

157
Q

What kind of gene mutation causes Familial Amyloid Polyneuropathy

How does it present

A

Tranthyretin gene

Painful paresthesis and early ANS involvement
Cardiomyopathy leads to HF

158
Q

How is Familial Amyloid Polyneuropathy treated?

A

Liver transplant

159
Q

Define Refsum’s Dz

What is the classic tetrad for this Dz

A

Earliest Sxs= night blindness
Progressive sensorimotor demyelingating neuropathy

Peripheral neuropathy
Retinitis pegmentosa
Cerebellar ataxia
Inc CSF protein level

160
Q

How is Refsum’s Dz Dx?

How is it treated

A

Phytanic acid in urine and serum

Avoid phytanic acid, plasmaphoresis

161
Q

What is the most common variant of Guillain Barr Syndrome

What microbe infection is this Dz associated with?

A

Acute Inflammatory Demylination Poly.

Campylobacter Jejuni

162
Q

How does GBSyndrome present

What will lab results show of an LP?

A

Weak legs that ascends
Max paralysis in 2wks
Areflexia

High protein, normal cell count

163
Q

How is GBSyndrome Tx

Since it’s a self limiting d/o, what is the most common residual issue?

A

IV Immunoglobulin
Plasmaphoreisis,
ICU admit

Fatigue

164
Q

What drugs are used for CIPD

How does Multiple Myeloma present on x-ray and EDx studies

A

Azathioprine, Methotrexate, Cyclosporin, Cyclophosphamide

Lytic/osteoprotsis lesions
Consistent w/ axonal degeneration

165
Q

How does vascultitic neuropathy present

When is a high degree of suspicion needed

A

Multifocal asymmetric motore snesory neuropathy from ishemic lesion on nerve trunks/roots

Subacute/chronically evolving mononeuropathy multiplex occurs w/ constitutional sxs

166
Q

What are the hallmarks of Myasthenia Gravis

What types of lab results will show?

A

First- diplopia, ptosis
Weak respiratory muscles
Worse Sxs at end of day
Improve w/ rest

ACh receptor Abs in blood
Impaired EMG/NCV transmission

167
Q

What can a CT scan of myasthenia gravis Pts show?

How is it tested for to Dx?

A

Thymoma- thymic medullary cells that synthesize anti-Ach receptor Abs

Ice-Pack test
Tensilon Test- give Edrophonium 2mg given to Pts w/ negative Ab and EDx testing
Tensilon pos if weakness improves

168
Q

How is Myasthenia Gravis treated?

A 
Anticholinesterase drugs- 
Pyridostigmine
Generalized MG= thymemctomy
Corticosteroids-
Prednisone
Plasmapheresis
169
Q

What is Myasthenic Syndrom (Lambert-Eaton) associated w/?

A

Small cell carcinoma

P/Q type Ca channel Abs causing weakness in proximal limb muscles

170
Q

How does Myasthenic Syndrome differ from MG?

How is it treated?
What med gives poor results?

A

Power increases w/ sustained contraction

Prednisone
Anticholinesterase drugs

171
Q

Consider Botulism poisoning in kids under 1yr if the present with ? Sxs?

D/os associated with Aminoglycoside use is common with what two offending agents?

A

Constipation, Poor feeding, Failure to thrive w/ progressive weakness

Gentamicin
Streptomycin

172
Q

How does Tetanus exert it’s effect?

What are the presenting Sxs?

A

Irreversibly binds to receptors in brain/spine blocking GABA release

Trismus
Risus Sardonicus- facial muscle contortion
Opisthotonis- hyperextended posturing

173
Q

How is tetanus treated?

How do nerve agents exert their effect?

A

Human tetanus immune globulin 500units
Metronidazole- preferred ABX
Benzos

Cholinesterase inhibition, prevent ACh from being destroyed causing over stimulation

IPAP (212 decks)

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