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Physio II > Neuro-peripheral > Flashcards

Neuro-peripheral Flashcards

1
Q

controls the 1. Muscles of facial expression

A

VII- facial
You’re lucky if you get a facial

if you’re lucky you are smiling

all come out of the parotid

Temporal
Zygomatic
Buccal
Mandibular
Cervical
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2
Q

what CN involves the muscles of mastication

A

V- Trigeminal

snesory

if you TRI to kiss me i will feel it

V1-tip of the nose
V2
V3

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3
Q

the first brachial arch is innervated by the

A

trigeminal -5

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4
Q

the second brachial arch ins innervation by the

A

facial -7

remember nerves are in place before development and then carried with development

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5
Q

MCC of facial pain

A

Trigeminal nerve issue

dental, triggers include hot, cold, sweet foods

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6
Q

what is the term used to describe pain in the trigeminal nerve

A

Lancinating pain like zaps

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7
Q

dx associated with CNV pain

A

trigeminal neuralgia

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8
Q

tic douloureux”

A

trigeminal neuralgia

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9
Q

what divisions are most commonly hit by trigeminal neuralgia

A

V2 and V3

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10
Q

if you have neuralgic looking pain that is bilateral or in a young person what ddx do you want to consider

A

MS

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11
Q

nueralgic pain is usually described as iv. Pain at ____ points,_____ sensory deficit

A

iv. Pain at trigger points, without sensory deficit

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12
Q

tx for neuralgic pain

A

Neuropathic pain - AVOID narcotics
Antiepileptic agents have proven effective

a. Carbamazepine, phenytoin (Dilantin), gabapentin

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13
Q

what do you want to be careful of with antieplileptic prescribed for nerualgia?

A

need to titrate in order to avoid a seizure

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14
Q

what is the surgical intervention for neuralgic facial pain

A

a. Usually attempts to relieve decompression by tortuous vasculature in the posterior fossa or along path of CN V

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15
Q

why do we see hyperacusis with damage to the to the facial nerve

A

chorda typmani is a branch of the facial nerve If paralyzed, the TM moves more and it sounds louder

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16
Q

shingles like eruption in pharynx, ear canal distinguish what should we suspect

A

i. Ramsay Hunt

can cause facial paralysis and hearing loss in the affected ear.

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17
Q

geniculate ganglion vs CN VII

A

geniculate ganglion an L-shaped collection of fibers and sensory neurons of the facial nerve located in the facial canal of the head.

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18
Q

Bell’s palsy affects what CN

A

VII

this is why we see v. Hyperacusis

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19
Q

recover with bell’s palsy

A
  1. 60% recover c/o treatment
  2. Only 10% with permanent disfigurement or disability
  3. Assess severity in early disease
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20
Q

indicators of poor prognosis with bell’s palsy

A

Poor prognosis associated with age, hyperacusis (b/c its more into the CNS), severe early pain

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21
Q

two major classifications of neuropathies

A

mono =compression/trauma thing

poly= metabolic, toxic or hereditary cause

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22
Q

why do we typically see stocking-glove distribution with neuropathies

A

longest nerves are affected first

iv. Begin distally, usually (stocking-glove distribution) and move proximally

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23
Q

MC mono neuropathies

A

MC:
ulnar (elbow or lateral part of hand),
median (carpal tunnel), peroneal/common fibular (in the leg near tib/fib)

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24
Q

what predisposes you to mononeuropathies

A

pregnancy
DM
arthritis
tumors

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25
Q

positive and negative sxs associated with poly neuropathies

A

Positive (paresthesias = pins and needles)

negative (numbness) symptoms

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26
Q

preserved muscle bulk is a sign of uMN or LMN

A

UMN

LMN seen wiht atrophy

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27
Q

what type of muscle tone would we expect to see in UMN dz

A

spasctic knife opening

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28
Q

spontaneous movement seen with UMN or LMN dz

A

LMN

fasciculations

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29
Q

reflexes are increased in UMN or LMN

A

UMN

kickin can of preserved muscle bulk that you have to open wiht a knife and fan our like a bb

30
Q

bibinski’s sign is present UMN or LMN

A

UMN

31
Q

what is an example of UMN dz

A

CVA or MS

32
Q

ii. Position in space and vibration tell us about

A

posterior columns)

33
Q

Pain and temperature

A

spinothalamic tract

34
Q

Discriminative sensations

A

involve cortical input

35
Q

Most prevalent inherited ataxia

A

a. Friedreich’s Ataxia

36
Q

first disturbance in friedreich’s ataxia

A

iv. Gait is first disturbance

37
Q

onset of friedreich’s ataxia

A

ii. Presents in childhood (5-15), early adulthood

38
Q

babinski positive of negative in friedreich’s ataxia

A

Babinski –> UMN

39
Q

what is most commonly the cause behind trigeminal neuralgia

A

90% of the time caused by compression of CN by the superior cerebral artery

especially in older pt with less compliant artery

40
Q

ddx of bells palsy

A

CVA/TIA, Lyme, herpes Zoster

41
Q

classification of peripheral neuropathies

A

a. Axonal
b. Paranodal/segmental demyelination
c. Mononeuropathies by compression

42
Q

the diminished ability to perceive pain, temperature, touch, or vibration.

A

hypoesthesia

43
Q

decreased sensitivity to painful stimuli.

A

hypalgesia

44
Q

ability of the patient to identify numbers or letters drawn in the palm of the hand.

A

●Graphesthesia

45
Q

ability to recognize common objects such as keys, coins or paper clips by touching or handling them with one’s eyes closed.

●

A

Stereognosis

46
Q

evaluated by simultaneously touching two separate points on either side of the body.

A

Extinction

47
Q

why do we see a positive romberg test

A

when the patient has lost proprioception from feet

48
Q

Mononeuropathies

A

pathology affecting an individual peripheral nerve

49
Q

Radiculopathies refers to

A

Radiculopathies refer to pathology affecting the nerve root,

50
Q

anterolateral spinothalamic tract AP are perceived as

A

pain

51
Q

AP carried over the dorsal column medial lemniscal system are perceived as

A

touch or pressure

52
Q

describe the neural transmition of touch of pressure

A

occurs through the medial lemniscal pathway

posterior columns receive signal on first order neuron that is translated to the medulla which then synapses with a second motor neuron and crosses over where it is transmitted to the thalamus synapses to a 3rd order neuron and then reach the sensory cortex of the brain (parietla lobe)

you can also have the transmission of pain going directly from the posterior horn to the anterior horn
–> reflexes

53
Q

describe the neural pathway of pain

A

synapse is made in the posterior horn

54
Q

vascular ischemic theory of diabetic neuropathy

A
  1. Hyperglycemic damage of capillaries that feed nerve cells so they can’t deliver proper blood flow (not enough blood to feed the axon)
55
Q

iii. Laminin theory behind Diabetic neuropathy

A

lack of normal laminin in basement memebrane, effects growth of nerve fiber and capillaries

56
Q

iv. Autoimmune theory behind diabetic neuropathy

A
  1. Immunogenic disruption of endotheliumí nerve damage
57
Q

v. Altered neurotrophic effect

A
  1. Altered production/transport of NGF (nerve growth factor) that results in damage to the nerve
58
Q

ii. Follows infection (Campylobacter), vaccine, surgery

seen commonly with Gi symptoms

and involves respiratory complaints 40% of the time

A

Guillain barre LMN

59
Q

lab diagnostics for guillain abrre

A

protein in the CSF (you also see this with MS)

60
Q

carpal tunnel is most bothersome at what part of the day

A

night

61
Q

tx for carpal tunnel

A

Modify 2. Splint 3. Drugssss

iii. NSAIDs - pain relief in 20-30 mins; anti-inflammatory effects in 7-10 days – Keep the inflammation down w/ ices

62
Q

etiologies of UMN lesions

A

stroke
multiple sclerosis
cerberal palsy
brain or spinal cord damage

63
Q

etiologies of LMN lesions

A 
guillan barre syndrome
botulism
poliomuelitis
cauda equina syndrome 
bells palsy
64
Q

spastic paralysis is more associated with umn or lmn lesions

A

UMN

65
Q

fasciculation are associated with UMN or LMN

A

End stage LMN

66
Q

iv. Discriminative sensations involve what type of input from the brain

A

cortical

67
Q

if you can’t stimulate the ventral horn with sensory input you get

A

hyporeflexia

ventral horn is another name for the anterior horn

68
Q

What can lack of Position and vibration sensation indicate?

A

posterior columns lesions, Fingers and toes first

69
Q

What can lack of light touch sensation indicate?

A

posterior and spinothalamic

70
Q

What can lack of discrimination sensation indicate?

A

involve cortical input

71
Q

Describe the presentation of Diabetic Neuropathy

A

1] Sensory before motor,

2] Dulled perception of vibration, pain and temperature

3] Denervation of small muscles results in toe clawing,

4] Decreased pain, high pressures leads to ulcers

5] Also effects autonomic nerves

72
Q

Antibodies to Cj cross react with nerve fibers

A

Describe pathophysiology of Guillain Barre Syndrome due to Campyloabacter

Physio II (18 decks)

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