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Year 2 > NEURO: Part 9 > Flashcards

NEURO: Part 9 Flashcards

1
Q

WHat nerves contributes to the median nerve

A

C5-7, C8 + T1

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2
Q

What muscles of the forearm are innervated by the median nerve

A
  1. Palmaris longus
  2. Flexor capri radialis
  3. Flexor digitorum superficialis
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3
Q

What does the anterior interosseous branch of the median nerve supply

A
  1. Flexor policis longus
  2. Lateral half of flexor digitorum profundus
  3. Pronator quadratus
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4
Q

What does the palmer cutaenrous branch of the median nerve supply

A

Sensory innervation to thenar eminence of palm

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5
Q

Median nerve innervation of the hand

A
  1. Flexor digitorum superficialis
  2. Flexor digitorum profundus
  3. Flexor pollicis longus

Recurrent branch:

  1. opponens pollicis
  2. Abductor pollicis brevis
  3. Flexor pollicis permis
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6
Q

What do the cutaneous branch of the median nerve supply

A
  1. Lateral 3 and a half
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7
Q

What is Anterior interosseous syndrome

A

—- Reminder —–
1. Flexor policis longus
2. Lateral half of flexor digitorum profundus
3. Pronator quadratus
—————————-
Loss of pronation of forearm
Loss of flexion of radial half of digits and thumb

NO SENSORY LOSS

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8
Q

What causes anterior interosseous syndrome

A

Tight Cast

Forearm bone fracture

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9
Q

Result of damaging the wrist

A

MOTOR DEFICIT:

  1. Weakness in flexion of the radial half of digits and thumb
  2. Loss of abduction and opposition of the thumb

APE HAND DEFORMITY seen (hyperextension of index and thumb)

Benediction sign seen

SENSORY:
Loss of sensation in lateral 3 1/2 digits including nail beds

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10
Q

What is the benediction sign

A

Patients can flex all fingers EXCEPT the index finger

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11
Q

Innervation of the lubricals

A

Lateral two = lumbrical

Medial two = ulnar

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12
Q

What doe the ulnar nerve supply when it branch sin the forearm

A
  1. Medial half of flexor digitorum profundus
  2. Flexor carpi lunaris
  3. Medial half sensory sensation to digits (1 and a half)
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13
Q

What does the ulnar supply in the hand when it branches

A
    1. Abductor digiti minimi
  2. Flexor digiti minimi
  3. Opponens digiti minimi
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14
Q

Roots of the ulnar nerve

A

C7-T1

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15
Q

What causes damage commonly to the ulnar nerve at there elbow

A
  1. Cubital tunnel syndrome

2. Fracture of medial epicondyle

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16
Q

Clinical presentation of ulnar damage at the elbow

A

MOTOR DEFICIT:
1. Weakness in flexion of hand AT THE WRIST
2. Loss of flexion in ulnar half of digits
3. CLAW HAND deformity when hand is at rest
4. Weakness of adduction o the thumb
5. Interossei muscle wasting means patient can’t do good luck sign
——SENSORY——–
Loss of sensation and paraesthesiae in ulnar half of palm and back of hand

Medial 1 and 1/2 digits on both palmar and dorsal aspects of the hand

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17
Q

How do we assess weakness of adduction o the thumb

A

Look for FROMENT’s Sign

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18
Q

What is Froment’s sign

A

Difficult maintaining a hold on an object (digits minimi oppenens is not working so will try compensate by flexing policies longs more)

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19
Q

What usually causes damage to ulnar nerve at the wrist

A
  1. WOUNDS
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20
Q

Clinical presentation of ulnar damage at the wrist

A
  • —-MOTOR_—–
    1. Loss of flexion in ulnar half of the digits
    1. CLAW HAND deformity when hand is at rest (more prominent than in elbow)

——SENSORY——-
Loss of sensation and paraesthesiae in ulnar half of palm, medial 1 1/2 digits and the DORSAL is spared

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21
Q

Why is CLAW HAND DEFORMITY more prominent in wrist injuries to the ulnar

A

Ulnar half of flexor digitorum profundus is not affected so they pull interphalangeal joints of 4th and 5th digit into flexion whilst the lateral three digits are straight

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22
Q

Why is the dorsal part of the hand spared in wrist damage to ulnar nerve

A

Because the posterior cutaneous branch of the ulnar nerve is given off higher up the forearm

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23
Q

How is Ulnar nerve palsy treated

A

Night splint and rest

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24
Q

Roots of the radial nerve

A

C5 - T1

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25
What does the radial nerve supply in the arm
1. Brachialis 2. Brachioradialis 3. Extensory carpi radialis longus 4. Suppinators SENSORY: Supplies skin at back of the arm
26
What does the radial nerve supply in the forearm
Forms the posterior interosseous nerve: 1. Extensor digitorum 2. Extensor digit minimi 3. Extensor carpi lunaris 4. Abductor pollicis longus 5. Extensor pollicis brevis 6. Extensor pollicis longus 7. Extensor indicis
27
Common causes of injury to the radial nerve at the axilla
1. Saturday NIGHT PALSY | 2. Crutch palsy
28
What is Saturday night palsy
Caused by: Another individual sleeping on one's arm overnight Falling asleep with one' arm hanging over arm rest chair compressing nerve Squash
29
Common injury to the radial nerve at the mid-arm
1. MID-SHAFT humeral fracture
30
Clinical presentation of radial nerve damage at th mid-arm
1. Weakness of supination and loss of hand extension and fingers (test by flexing elbows and arm pronated) 2. Presence of WRIST DROP due to inability to extend hand and fingers -------Sensory--------- Loss of sensation in posterior forearm Radial dorsal of the hand Dorsal radial 3 and a half digits
31
Causes of damage to the brachial plexus
1. Trauma 2. Radiotherapy 3. Prolongues wearing of heavy rucksack 4. Neuralgic amyotrophy 5. Thoracic outlet compression
32
Clinical presentation of brachial plexus
1. Pain/paraesthesiae and weakness in affected arm in variable distribution
33
Clinical presentation of phrenic palsy
ORTHOPNOEA | Raised hemidiaphragm on CXR
34
What causes phrenic palsy
1. Lung cancer 2. Myeloma 3. Thymoma 4. Cervical spondylosis 5. Phrenic nucleus lesion in MS 6. Thoracic surgery 7. HIV 8. Muscular dystrophy
35
Roots of lateral cutaneous nerve of the thigh
L2 and L3
36
Clinical presentation of lateral cutaneous nerve palsy
Anterior-lateral burning of thigh from entrapment under inguinal ligament
37
What causes sciatic nerve palsy
1. Pelvic tumours | 2. Fractures to pelvis or femur
38
Clinical presentation of sciatic nerve palsy
FOOT DROP Loss of sensation to lateral skin below knee
39
Where does the common perineal nerve originate from
Sciatic nerve just above the knee
40
Why does common perineal nerve get injured
Winds round fibular head so sitting cross-legged will do it
41
Clinical presentation of common perineal nerve palsy
FOOT DROP WEAK ANKLE DORSIFLEXION/EVERSION SENSORY LOSS OF dorsal of foot
42
What does the common perineal nerve supply
Muscles in anterior and lateral compartments of the leg
43
What doe the tibial branch of the sciatic supply
Posterior compartment and sole of the foot (plantar)
44
Clinical presentation of tibial palsy
Inability to stand on tiptoes, invert foot or flex toes SENSORY LOSS OF SOLES
45
What are polyneuropathies
1. SYMMETRICAL Disorders of peripheral or cranial nerves
46
Where does polyneuropathy usually begin
Hands and feet Spreads to arms and legs
47
What three ways can we classify polyneuropathies
1. Distal axonopathy 2. Myelinopathy (loss of Schwann cells - Guillain-Barre syndrome) 3. Neuropathy (caused by disease) Course: Acute or chronic Function: Sensory, mixed or motor Pathology: Demyelination etc
48
What usually causes distal axonopathies
Metabolic diseases: Diabetes Kidney failure Connective tissue disease
49
What polyneuropathies cause motor problems
1. Guillain-Barre syndrome 2. Lead poisoning 3. Charcot-Marie-Tooth syndrome
50
What polyneuropathies cause sensory problems
1. Diabetes mellitus 2. Renal failure 3. Leprosy METABOILC
51
Overview of causes of polyneuropathies
- Metabolic: Diabetes mellitus, renal failure, hypothyroidism, hypoglycaemia - Vasculitides: Polyarteritis nodosa, rheumatoid arthritis, wegener’s granulamatosis - Malignancy: Paraneoplastic syndromes, polycythaemia rubra vera - Inflammatory: Guillain-Barre syndrome, sarcoidosis - Infections: Leprosy, HIV, syphilis, lyme disease - Nutritional: Decreased; vit B12,B1,E,B6 & folate - Inherited syndromes: Charcot-marie-tooth, porphyria - Drugs/toxins: Lead, arsenic, alcohol, vincristine, cisplatin, metronidazole
52
How is polyneuropathy diagnosed
1. Electrophoresis of serum proteins 2. NCS 3. Urinalysis 4. Serum Creatinine Kinase 5. Antibody testing 6. Nerve biopsy 7. HISTORY taking for course, symptoms etc before the event (ARthalgia from connective tissue, weight loss in cancer and vomiting in Guillain-Barre syndrome) EXAMINE OTHER SYSTEMS
53
What condition is probable upon examining a palpable thickened nerve
LEPROSY or CHARCOT-MARIE-TOOTh
54
Sensory clinical presentation of polyneuropathies
1. NUMBERNESS, pins and needles 2. Affects extremities (glove and stocking distribution) 3. Difficulties handling objects like buttons 4. Signs of trauma but unaware of it 5. Diabetic and alcoholic neuropathies are PAINFUL
55
Motor clinical presentations of polyneuropathies
1. Weak hands 2. Difficulty walking 3. Difficulty breathing 4. LMN lesion apparent (foot or wrist drops and hyporeflexia)
56
What causes brainstem compression
1. tumour 2. MS 3. Trauma 4. Aneurysm 5. Vertebral artery dissection resulting in infarction 6. Infection: cerebellar abscess from ear
57
Clinical presentation of oculomotor palsy
1. Ptosis (dropping eyelids - levator palpebrae superioris) 2. Fixed dilated pupil 3. Eye down and out 4. DIPLOPIA as rectus muscles
58
What is nucleus does parasympathetic outflow from the oculomotor nerve to the pupillary sphincter called
EDINGER-WESTPHAL nucleus
59
What causes oculomotor palsy
1. Raised ICP 2. Diabetes 3. Hypertension 4. Giant cell arteritis
60
Clinical presentation of Trochlear palsy
1. Innervates superior oblique muscle Patient will tilt head to correct extortion - causes diplopia
61
Clinical presentation of Abducens palsy
INNERVATES lateral rectus muscle thus eyes will be adducted Cross-eyed
62
Causes of abducens palsy
1. MS 2. Wenicke's encephalopathy 3. Pontine stroke - fixed small pupils + quadriparesis
63
What is CN 3,4,6 palsy
1. Non functioning eye
64
Causes of 3,4,6 palsy
1. Stroke 2. Tumours 3. Wernicke's encephalopathy
65
Clinical presentation of Trigeminal palsy
1. Jaw deviates to side of lesion | 2. Loss of corneal reflex
66
Causes of trigeminal palsy
1. Trigeminal neuralgia (PAIN not sensory loss) 2. Herpes Zoster 3. Nasopharyngeal cancer
67
Clinical presentation of facial palsy
Facial droop + weakness
68
Causes of facial palsy
1. Bells palsy = dribbling outside of the mouth 2. Fractures of petrous bones 3. Middle ear infections 4. Inflammation of parotid gland - which facial nerve pass through
69
Signs of vestibularcochlear palsy
1. Hearing impairment | 2. Vertigo and lack of balance
70
Causes of CN8 palsy
NERVE RUNS CLOSE TO THE BONE 1. Affected by tumours in internal acoustic meatus 2. Skull fracture 3. Drug effects 4. ear infection
71
CN9 and CN 10 palsy clinical presentation
1. Gag reflex issues 2. Swallowing issues 3. Vocal issues
72
What causes glossopharyngeal and vagus palsy
1. JUGULAR FORAMEN LESION
73
What is an autonomic neuropathy
1. Sympathetic and parasympathetic neuropathies
74
Causes of autonomic neuropathy
1. Diabetes mellitus 2. HIV 3. SLE 4. Sjogren's syndrome and Guillain-Barre
75
Clinical presentation of sympathetic neuropathy
1. Postural hypotension - faints on standing 2. Ejaculatory failure 3. Reduced sweating
76
Clinical presentation of parasympathetic neuropathy
1. Erectile dysfunction 2. Constipation 3. Nocturnal diarrhoea 4. Urine retention
77
Polyneuropathy diagnsoes
1. FBC 2. Urinalysis 3. CXR 4. Lumbar puncture for specific neuropathies
78
FBC result for polyneuropathies
1. ANA, ANCA and anti-CCP
79
How is Polyneuropathy treated
1. TREAT CAUSE 2. Foot care and shoe choices important in sensory 3. Splint joint to prevent contractors (shortening and hardening of muscles and tendons) in prolonges paralysis 4. Vasculitic causes - steroids and immunosuppressants 5. ORAL AIMTRIPTYLINE or ORAL NOTRIPTYLINE
80
Where is pain felt in L2
1. Across upper thigh
81
Where is weakness felt in L2
Hip flexion and adduction
82
L3 lesion pain
Lower thigh
83
Weakness in L3
Hip adduction and knee extension
84
L4 lesion pain
Across knee to medial malleolus
85
Weakness in L4
2. Knee extension Foot inversion Dorsiflexion
86
Reflex affect din L3-L4
KNEE JERK
87
Pain in L5
Lateral shin to dosrum of foot and great toe
88
Weakness in L5 lesion
Hip extension Abduction of hip Knee flexion foot and great toe dorsiflexion
89
Reflex affected in L5
Great toe jerk
90
S1 pain
Posterior calf to lateral foot and little toes
91
Weakness in S1 lesion
Knee flexion Foot and toe plantar flexion Foot eversion
92
Reflex los in S1
Ankle jerk

Year 2 (155 decks)

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