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-nm Npte > Neuro Diff Diag 1/14 > Flashcards

Neuro Diff Diag 1/14 Flashcards

1
Q

description of Neuropathic (Neurogenic) pain

A

Sharp, shooting, burning, tingling, electric.
Burning, shooting, constant
Evoked with “non-noxious” stimulus eg. light touch, cold

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2
Q

central or peripheral NS disorder?

TBI, CVA, SCI

A

central

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3
Q

central or peripheral NS disorder?
Trigeminal neuralgia
Peripheral neuropathy (diabetes)
Trauma

A

peripheral

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4
Q

central or peripheral NS disorder?

MS, Parkinson’s

A

central

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5
Q

central or peripheral NS disorder?

Carpal tunnel, tarsal tunnel, thoracic outlet

A

peripheral

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6
Q

central or peripheral NS disorder?
Herpes Zoster
Guillain-Barre syndrome

A

peripheral

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7
Q

central or peripheral NS disorder? patient symptoms-
bilateral Carpal tunnel syndrome, tarsal tunnel syndrome,
asterixis “liver flap”
ammonia abnormality

A

peripheral

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8
Q

what is asterixis? causes?

A

UMN symptoms
hyperextend wrist > tremor of the hand
resemble a bird flapping its wings
causes: liver cirrhosis, encephalopathy, hepatic encephalopathy, liver failure, esophageal varices

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9
Q

central or peripheral NS disorder? patient symptoms-
start as weakness and tingling in the feet and legs that spread to the upper body. distal to proximal
Paralysis can occur, problem once affects phrenic nerve
starts from infection

A

peripheral

Guillain-Barre syndrome

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10
Q

how are SCI neurological level named?

  • sensory
  • motor
A

Neurological level named for lowest functional level (normal sensory/motor)
• Normal sensory
• MMT 3/5 (fair) and the immediately proximal level is at 5/5 (normal)
• Can vary between left/right sides of body

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11
Q

what Asia scale? complete or incomplete?
no motor
no sensory in S4-5

A

Asia A

complete SCI

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12
Q

what Asia scale? complete or incomplete?
sensory spared
no motor function below neurological level to S4-S5

A

Asia B

sensory incomplete

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13
Q

what Asia scale? complete or incomplete?

motor function below neurological level most key muscles have motor score <3/5

A

Asia C

motor incomplete

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14
Q

what Asia scale? complete or incomplete?

motor function below neurological level most key muscles have motor score 3-5/5

A

Asia D

motor incomplete

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15
Q

what Asia scale? complete or incomplete?

sensory and motor normal

A

Asia E

Normal

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16
Q

what does ASIA stand for?

A

american spinal injury association

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17
Q

what pathology? mechanism?
- onset 3-6 days s/p severe SCI, trauma
• sympathetic loss
• hypotension
• Immediate, TEMPORARY loss of power, sensation,
and reflexes below the lesion (and possibly above)
• Temporarily unresponsive to stimuli, flaccid paralysis
• Bowel/bladder flaccidity, loss of bulbocavernosus reflex (S2-4)

A

spinal shock syndrome

- due to inflammatory process, edema fills spinal canal

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18
Q

what SCI level may have autonomic dysreflexia? types of stimulus to trigger?

A

T6 or higher

restrictive clothing, tangled catheter, full bladder, fecal impaction, pressure area, ingrown toenail

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19
Q

symptoms of autonomic dysreflexia? first steps when you see patient with the symptoms?

A

symptoms: above SCI injury - vasodilation, flushed face, pounding headache, increased BP, decreased HR, increased sweating distended neck veins
below level of SCI - vasoconstriction, pale, cool, no sweating
next step - sit up patient (decrease blood to head avoid hemorrhagic stroke), quick check for noxious stimulus, activate EMS

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20
Q

what is orthostatic hypertension? what next to do?

A

drop 20mmHg SBP or 10mmHg DBP moving supine to sit/stand or on tilt table

  • next step lay supine or trendelenburg to get blood flow back to head
  • use tilt table to build up threshold
  • “head is pale, raise the tail”
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21
Q

SCI sensory locations for

C2 to T2?

A 
C2- occipital protuberance
C3- supraclavicular fossa
C4- tip AC joint
C5- lateral side elbow
C6 thumb
C7 middle finger
C8 pinky
T1 medial elbow
T2 apex axilla
22
Q

SCI sensory locations for

T3 to T12?

A 
T3- 3rd intercostal space
T4- 4th IS @ nipple line
T5- 5th IS
T6- 6th IS @ xiphisternum
T7- 7th IS
T8- 8th IS
T9- 9th IS
T10- 10th IS @ umbilicus
T11- 11th IS
T12- midpoint inguinal ligament
23
Q

SCI sensory locations for

L1 to L5?

A 
L1 thigh between T12 and L2
L2 mid anterior thigh
L3 medial knee, femoral condyle
L4 medal malleolus
L5 dorsum foot 3rd MTP
24
Q

SCI sensory locations for

S1 to S5?

A

S1- lateral heel
S2- popliteal fossa
S3 ischial tubersoity
S4-5 perianal area

25
Q

what is brown sequard syndrome injury?

what is affected - motor, pain/temp, discriminatory sensation

A

hemisection spinal cord

  • ipsilateral below lesion - motor (corticospinal), fine touch/proprioception/vibration (DCML) - decussate at medulla
  • contralateral below lesion - pain and temp (spinothalamic)
26
Q

prognosis brown sequard

A

good

27
Q

prognosis central cord

A

average

28
Q

prognosis anterior cord

A

poor

29
Q

cause of brown sequard?

A

penetrating trauma - gunshot, stab wound

30
Q

cause of central cord?

A

forced hyperextension eg. MVA

31
Q

cause anterior cord

A

forced flexion or vascular trauma

32
Q

central cord affects what?

A

sensory and motor loss
cervical (more central than sacral) UE > LE
difficulty with hand function

33
Q

anterior cord affects what?

A
  • incomplete SCI, anterior 2/3 of SC
  • complete all loss of motor (corticospinal) below level of lesion
  • all pain, temp below injury (spinothalamic)
  • maintain proprioception and vibration (DCML spared)
34
Q

micturition control what spinal level?

A

bladder control S2-4

35
Q

lesion above L1/conus medullaris leads to what kind of bladder? how is it managed?

A

spastic/hyperreflexic bladder
- Reflex arc intact,
reflexively empties with adequate filling pressure
- no voluntary control
-manage w intermittent catheterization initially, suprapubic tapping without dyssynergia

36
Q

lesion below L1/conus medullaris leads to what kind of bladder?

A

flaccid/areflexic bladder

  • unable coordinate between detrusor and sphincters
  • managed with catheter or Valsalva maneuver training
37
Q

lesion above S2 leads to what kind of bowel? how is it managed?

A

Spastic/reflexic bowel

• Reflex defecation when rectum fills or Digital stimulation

38
Q

lesion below S2 leads to what kind of bowel? how is it managed?

A

Flaccid/areflexive bowel
• Manual evacuation
• gentle Valsalva maneuver

39
Q 
SCI level C1-3
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A

no movement or sensation below neck

  • ventilator dependent
  • ADL dependent
  • elimination dependent
  • mobility - voice or sip n puff controlled electric WC
40
Q 
SCI level C1-3
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A

no movement or sensation below neck

  • ventilator dependent
  • ADL dependent
  • elimination dependent
  • mobility - voice, tongue, or sip n puff controlled electric WC
41
Q 
SCI level C4
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A

movement + sensation head and neck

  • partial diaphragm function, weak respiration
  • ADL dep
  • Elim dep
  • head, chin-operated electric WC
42
Q 
SCI level C5
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • control head, neck, shoulders
  • flex elbows
  • ADL with assist, ModI
  • dependent for transfers
  • Elim dep
  • AD: electric WC w joystick, electronic tilt/recline, driving possible with modifications
43
Q 
SCI level C6
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • use shoulder, extend wrist
  • ADL indep, or with assist - Some set-up required, but mostly independent
  • self-transfer
  • Elim with assist
  • AD: manual wheelchair possible with modifications, transfers with slide board
  • driving with adaptive equipment
44
Q 
SCI level C7-C8
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • extend elbow, flex wrist, use some fingers
  • ADL indep
  • Elim indep
  • AD: manual WC, manual pressure relief
45
Q 
SCI level T1-5
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • full hand and finger control use thoracic muscles
  • ADL indep or modI
  • Elim indep
  • AD: manual WC
46
Q 
SCI level T6-10
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • controls abdominal muscles, good balance
  • ADL indep
  • Elim indep
  • AD:manual WC
47
Q

what level SCI can person self transfer to WC?

A

C6

has shoulder and wrist extension

48
Q 
SCI level T11-L5
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • flex and abduct hips
  • flex and extend knees
  • ADL indep
  • Elim indep
  • AD: ambulate w leg brace, short brace, or cane
49
Q 
SCI level S1-5
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • full control legs
  • progressive bowel, bladder and sexual function
  • ADL indep
  • Elim indep
  • AD: ambulate w leg brace, short brace, or cane
50
Q 
SCI level L1-3
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • hip flexion
  • knee extension
  • ADL indep
  • Elim indep
  • ambulate with HKAFO or KAFO (AFO possible)
51
Q 
SCI level L4-S1
what sensation/motor functional abilities? 
- ADL? 
- Elimination indep/dep?
- what type of Mobility?
A
  • flex and extend knees
  • ankle PF, DF
  • ADL indep
  • Elim indep
  • AD: Full ambulation, possibly needing AFO or assistive device

-nm Npte (28 decks)

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