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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
Q

What does the radial nerve supply in the arm

A
  1. Brachialis
  2. Brachioradialis
  3. Extensory carpi radialis longus
  4. Suppinators

SENSORY: Supplies skin at back of the arm

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26
Q

What does the radial nerve supply in the forearm

A

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
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27
Q

Common causes of injury to the radial nerve at the axilla

A
  1. Saturday NIGHT PALSY

2. Crutch palsy

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28
Q

What is Saturday night palsy

A

Caused by:
Another individual sleeping on one’s arm overnight
Falling asleep with one’ arm hanging over arm rest chair compressing nerve
Squash

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29
Q

Common injury to the radial nerve at the mid-arm

A
  1. MID-SHAFT humeral fracture
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30
Q

Clinical presentation of radial nerve damage at th mid-arm

A
  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
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31
Q

Causes of damage to the brachial plexus

A
  1. Trauma
  2. Radiotherapy
  3. Prolongues wearing of heavy rucksack
  4. Neuralgic amyotrophy
  5. Thoracic outlet compression
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32
Q

Clinical presentation of brachial plexus

A
  1. Pain/paraesthesiae and weakness in affected arm in variable distribution
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33
Q

Clinical presentation of phrenic palsy

A

ORTHOPNOEA

Raised hemidiaphragm on CXR

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34
Q

What causes phrenic palsy

A
  1. Lung cancer
  2. Myeloma
  3. Thymoma
  4. Cervical spondylosis
  5. Phrenic nucleus lesion in MS
  6. Thoracic surgery
  7. HIV
  8. Muscular dystrophy
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35
Q

Roots of lateral cutaneous nerve of the thigh

A

L2 and L3

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36
Q

Clinical presentation of lateral cutaneous nerve palsy

A

Anterior-lateral burning of thigh from entrapment under inguinal ligament

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37
Q

What causes sciatic nerve palsy

A
  1. Pelvic tumours

2. Fractures to pelvis or femur

38
Q

Clinical presentation of sciatic nerve palsy

A

FOOT DROP

Loss of sensation to lateral skin below knee

39
Q

Where does the common perineal nerve originate from

A

Sciatic nerve just above the knee

40
Q

Why does common perineal nerve get injured

A

Winds round fibular head so sitting cross-legged will do it

41
Q

Clinical presentation of common perineal nerve palsy

A

FOOT DROP
WEAK ANKLE DORSIFLEXION/EVERSION
SENSORY LOSS OF dorsal of foot

42
Q

What does the common perineal nerve supply

A

Muscles in anterior and lateral compartments of the leg

43
Q

What doe the tibial branch of the sciatic supply

A

Posterior compartment and sole of the foot (plantar)

44
Q

Clinical presentation of tibial palsy

A

Inability to stand on tiptoes, invert foot or flex toes

SENSORY LOSS OF SOLES

45
Q

What are polyneuropathies

A
  1. SYMMETRICAL Disorders of peripheral or cranial nerves
46
Q

Where does polyneuropathy usually begin

A

Hands and feet

Spreads to arms and legs

47
Q

What three ways can we classify polyneuropathies

A
  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
Q

What usually causes distal axonopathies

A

Metabolic diseases:
Diabetes
Kidney failure
Connective tissue disease

49
Q

What polyneuropathies cause motor problems

A
  1. Guillain-Barre syndrome
  2. Lead poisoning
  3. Charcot-Marie-Tooth syndrome
50
Q

What polyneuropathies cause sensory problems

A
  1. Diabetes mellitus
  2. Renal failure
  3. Leprosy

METABOILC

51
Q

Overview of causes of polyneuropathies

A
  • 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
Q

How is polyneuropathy diagnosed

A
  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
Q

What condition is probable upon examining a palpable thickened nerve

A

LEPROSY or CHARCOT-MARIE-TOOTh

54
Q

Sensory clinical presentation of polyneuropathies

A
  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
Q

Motor clinical presentations of polyneuropathies

A
  1. Weak hands
  2. Difficulty walking
  3. Difficulty breathing
  4. LMN lesion apparent (foot or wrist drops and hyporeflexia)
56
Q

What causes brainstem compression

A
  1. tumour
  2. MS
  3. Trauma
  4. Aneurysm
  5. Vertebral artery dissection resulting in infarction
  6. Infection: cerebellar abscess from ear
57
Q

Clinical presentation of oculomotor palsy

A
  1. Ptosis (dropping eyelids - levator palpebrae superioris)
  2. Fixed dilated pupil
  3. Eye down and out
  4. DIPLOPIA as rectus muscles
58
Q

What is nucleus does parasympathetic outflow from the oculomotor nerve to the pupillary sphincter called

A

EDINGER-WESTPHAL nucleus

59
Q

What causes oculomotor palsy

A
  1. Raised ICP
  2. Diabetes
  3. Hypertension
  4. Giant cell arteritis
60
Q

Clinical presentation of Trochlear palsy

A
  1. Innervates superior oblique muscle

Patient will tilt head to correct extortion - causes diplopia

61
Q

Clinical presentation of Abducens palsy

A

INNERVATES lateral rectus muscle thus eyes will be adducted

Cross-eyed

62
Q

Causes of abducens palsy

A
  1. MS
  2. Wenicke’s encephalopathy
  3. Pontine stroke - fixed small pupils + quadriparesis
63
Q

What is CN 3,4,6 palsy

A
  1. Non functioning eye
64
Q

Causes of 3,4,6 palsy

A
  1. Stroke
  2. Tumours
  3. Wernicke’s encephalopathy
65
Q

Clinical presentation of Trigeminal palsy

A
  1. Jaw deviates to side of lesion

2. Loss of corneal reflex

66
Q

Causes of trigeminal palsy

A
  1. Trigeminal neuralgia (PAIN not sensory loss)
  2. Herpes Zoster
  3. Nasopharyngeal cancer
67
Q

Clinical presentation of facial palsy

A

Facial droop + weakness

68
Q

Causes of facial palsy

A
  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
Q

Signs of vestibularcochlear palsy

A
  1. Hearing impairment

2. Vertigo and lack of balance

70
Q

Causes of CN8 palsy

A

NERVE RUNS CLOSE TO THE BONE

  1. Affected by tumours in internal acoustic meatus
  2. Skull fracture
  3. Drug effects
  4. ear infection
71
Q

CN9 and CN 10 palsy clinical presentation

A
  1. Gag reflex issues
  2. Swallowing issues
  3. Vocal issues
72
Q

What causes glossopharyngeal and vagus palsy

A
  1. JUGULAR FORAMEN LESION
73
Q

What is an autonomic neuropathy

A
  1. Sympathetic and parasympathetic neuropathies
74
Q

Causes of autonomic neuropathy

A
  1. Diabetes mellitus
  2. HIV
  3. SLE
  4. Sjogren’s syndrome and Guillain-Barre
75
Q

Clinical presentation of sympathetic neuropathy

A
  1. Postural hypotension - faints on standing
  2. Ejaculatory failure
  3. Reduced sweating
76
Q

Clinical presentation of parasympathetic neuropathy

A
  1. Erectile dysfunction
  2. Constipation
  3. Nocturnal diarrhoea
  4. Urine retention
77
Q

Polyneuropathy diagnsoes

A
  1. FBC
  2. Urinalysis
  3. CXR
  4. Lumbar puncture for specific neuropathies
78
Q

FBC result for polyneuropathies

A
  1. ANA, ANCA and anti-CCP
79
Q

How is Polyneuropathy treated

A
  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
Q

Where is pain felt in L2

A
  1. Across upper thigh
81
Q

Where is weakness felt in L2

A

Hip flexion and adduction

82
Q

L3 lesion pain

A

Lower thigh

83
Q

Weakness in L3

A

Hip adduction and knee extension

84
Q

L4 lesion pain

A

Across knee to medial malleolus

85
Q

Weakness in L4

A
  1. Knee extension
    Foot inversion
    Dorsiflexion
86
Q

Reflex affect din L3-L4

A

KNEE JERK

87
Q

Pain in L5

A

Lateral shin to dosrum of foot and great toe

88
Q

Weakness in L5 lesion

A

Hip extension
Abduction of hip
Knee flexion
foot and great toe dorsiflexion

89
Q

Reflex affected in L5

A

Great toe jerk

90
Q

S1 pain

A

Posterior calf to lateral foot and little toes

91
Q

Weakness in S1 lesion

A

Knee flexion
Foot and toe plantar flexion
Foot eversion

92
Q

Reflex los in S1

A

Ankle jerk

Year 2 (155 decks)

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