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SUMPHYS2 > NEURO-Perip/Crania DZ > Flashcards

NEURO-Perip/Crania DZ Flashcards

1
Q

This nerve is Sensory and Motor w/ mastication of the face..

A

CN V (V1-opthmalic, V2maxilla, V3 mandibular)

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2
Q

During 5 weeks embyro what occurs?

A

Brachial Arches are innervated prior to limb buds forming
Arch 1- trigeminal nerve, mandible, maxilla teeth
Arch 2- facial nerve, muscle of facial expresion

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3
Q

What are MCC of facial pain?

A

Hot
Sweet or Spicy foods
Dental infx

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4
Q

Mrs. Shock has electric shock pain on R V2 and V3 lasting seconds. Excruciating along maxilla and mandible
What is dx and other findings?

A

Trigeminal neuralgia- compression by a vessel (superio cerbellar aa) at entrance by brain stem
Lacinating- electric shock pain, “Tic douloreux”

CP- MC >65yo
SX-UL, HA, TMJ, trigger pts

DDX-think MS IF young and BIL

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5
Q

How do you treat trigeminal neuralgias?

A 
PAIN
Antiepileptics: slow/low goal 1200. LIFELONG but tirate down to none. Risk seizures
Gabapentin-GREAT, but dosage
carbamazepine (Tegretol)
phenytoin (Dilantin)

**AVOID NARCOTICS/OPIODS

Surgery- rare, danger d/t posterior cranial fossa

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6
Q

What are CP of CN VII dysfunction?

A

Weakness with frown, eyebrows, smile
Asymmetric Face
Inc muscle involved, the longer the problem

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7
Q

If the chorda tympani part of CNVII is dysfunctional, what is outcome

A
  1. loss of taste ANT 2/3 and palate
  2. dec excretion of salivary, lacrimal glands
  3. HYPERACUSIS- Sounds abnormally loud d/t middle ear innervation from infratemporal fossa
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8
Q

Mrs. Ramsay has vesicular rash around ear, auditory issue, and facial neuropathy. What is DX?

A

RAMSAY HUNT
EMERGENT
Geniculate ganglion dys
Loss of taste may occurs

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9
Q

What are DDX of facial weakness?

A

Cerebral Vascular accident- stroke
TIA- transient ischemica accident
Lyme DZ
HZV

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10
Q

What is Idiopathic facial neuropathy attributed to inflammatory reaction of the facial nerve?

A

Bells Palsy- post viral prodrome, tumor, p/o middle ear surgery
CP- acute onset, ipslateral weakness, pain near ear, stiff face, lack of taste, hyperacusis
Droop eyelid- dry cornea

PE- CN, Peripheral neural, VA

TX- Self limiting, 60% recover, 10% permanent
steroids (yet suppress immune)
AVOID Acyclovir
eye patch prn

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11
Q

Who is at risk of Bell palsy?

A

DM
Pregnant
Infections and traumas

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12
Q

What are Bell’s palsy pt able to do?

A

Wrinkle forehead*

IF not most think GLOBAL problem not just CN 7

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13
Q

What are the classification of ulnar nerve injury when you hit your medical epicondyle

A

● Mononeuropathies by
○ sensory and motor affected
○ compression d/t trauma ​
○ MC: ulnar, median, peroneal

○ Predisposition: pregnancy, DM, arthritis, tumors

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14
Q

Mrs. Neuro has pins and needles in her feet w/ H/o DM? What classification is this nerve damage

A

POLYNEUROPATHIES
○ Toxic, ​metabolic in nature
○ Intermittent symptoms → normal exam early
○ Positive sx- paresthesias, Pins and needles
○ negative sx- numbness, ​reduction​ of sensation
○ SYMMETRIC

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15
Q

What are the patterns of Neuropathies

A

■ Neuropathies come with both POLY/MONO
■ progress to Positive- early and negative - later
■ Distally 1st- stocking-glove
■ Feet_ankles, hands_ wrists
■ length susceptible to neurologic problems- Vagus nerve - could affect visceral structures
○ Sensory before motor

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16
Q

Mrs Neuro has normal muscle size, but spastic MSK tone, w/ no spontaneous movements and INC reflexes.
ST- Babinski- present
Where is the lesion?

A

UPPER MOTOR
central so lacks specific direction
MSK lots of signal- TIGHT, TOO STRONG, UNContolled in cortex lesion
Nerves too much signal- DTR INC OR NORMAL,

Ex. MS/CVA

17
Q

Mr. Neuro has atrophy muscle, flaccid, fasciculations, DEC reflexes.
ST-BAbinski- Absent
Where is the lesion?

A

LOWER MOTOR
damage lower cuts off at access to limb
Muscle no signal from local- WEAK- slow process, BIL
Nerves no signal locally- NO DTR

Ex. Neuropathy

18
Q

What are parkinson like movements?

A 
Tremor, fasciculation, twitch, cogwheel
UMN- basal ganglia affected lacking abiliyt to control movements
Depression
Flat affect
Cognitively still there
19
Q

What is ROAD test?

A 
D/c criteria
Ataxia
Coordination- cerebellar, RAM, point, gait, Stance
Watch feet as they turn
Pill rolling
Reduce movements
20
Q

What travels from spine to thalmus-cortex to produce sensation for pain and temperature?

A

Spinothalmic tracts
afferent-towards
Light touch
crosses low posterior horn CNS

21
Q

What detects finger and toe 1st during DM vibration neuro testing?

A

Posterior column tract
crosses high medulla
Proprioception

22
Q

When we place a object in the hand of patient? What tract are we testing?

A

Cortiospinal tract
cortex to spinal- cause a reaction, response
Efferent

Discriminative, myotomes, RROM

23
Q

What are ideal strategies for neuro testing?

A 
Be confident
Do test once
Compare distal to proximal 1st
Compare BiL
Eyes closed
Sharp vs. dull
24
Q

What is an autosomal recessive genetic dz that affects corticospinal UMN first, which is d/t Loss of cells in dorsal root ganglion​?

A

FRIEDREICH ATAXIA- loss of posterior column
M=F
MC ataxia inherit dz

CP Gait affected 1st-cerebellar
Hands clumsy
Leg weak
Babinski UMN normal
Loss of Reflexes progress overtime
25
Q

Mrs. Franklin is starting to have pin and needles in feet

AIc 8.5. What other findings?

A

Diabetic Neuropathy- sytemic metabolic dz neuropathy
● MC Peripheral neuropathy
● Distal symmetric MC
● Stocking glove pattern – axonal
● sensory b4 motor- longer nerves loss of ankle reflexes
● DEC vibration sense
● Toe clawing, hammer toes
● DEC pain sensation, foot ulcers
● Autonomic nerves- digest, sex, urination
● Burning pain-LC
● Pos. sx parathesia-LC

26
Q

What is important for all DM to have a foot exam at every visit?

A

● Excess intracellular glucose disrupts normal axonal physiology, causes breakdown. Water inflam damage nerves. Na/K pump

○ Vascular-ischemic theory: Hyperglycemic damage of capillaries

○ Laminin theory: Lack of normal laminin, affects growth

○ Autoimmune theory: Immunogenic disruption of endothelium

○ Altered neurotrophic effect theory: Altered production/transport of NGF ​(nerve growth factor)

NERVES don’t regenerate

27
Q

Mrs. Barre started to notice leg weakness after having watery stool after eating at chipotle.

A

GUILLIAN BARRE SYNDROME
Acute Idiopathic Polyneuropathy
● infection Campylobacter, vaccine, surgery
○ Antibodies to Cj​ (Campylobacter)​ cross react with nerve fibers

28
Q

Mrs. Barre leg weakness is linked with what other findings

A

● DEC Sensory than motor
● +/- pain
● 40% URI c/c

● Physical Exam:
○ LE weakness – symmetric
○ Minimal objective sensory changes, no sensory level
○ DTR Absent, slow, Hypotonia
■ NO Babinski lower motor neuron defect

○ LAB: Protein on CSF

29
Q

What is initial treatment in Pt with Gullian Barre?

A

PREPARE for ventilation

○ **Spontaneous onset and recovery is hallmark of this disease

30
Q

Mrs. Key has pain, burning on palmar aspect of digits 1-4. PMH- RA and pregnant. What is DX

A

Median Nerve compression- entrapment by transverse carpal lig. MONONEUROPATHY
Carpal Tunnel Syndrom

CP- tingling finger 1-3 palmer, radiation of pain high to shoulder
thenar atrophy

31
Q

What are special test for CTS?

A 
PE- Dermatomes Myotomes above and below c/c
Tinels
Phalens
2-pt discrim
PROM flex
Night pain
NERVE conduction not NEEDED
32
Q

Mrs. Key wants to get back to work. What are the initial steps?

A 
#1 Modify activity
#2 Splint at night-neutral BIL- d/t likey onset
#3- NSAIDS- 2-3wks
Last- steroid inj

SUMPHYS2 (27 decks)

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