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Clinical Measurements > Neurophysiological Disorders > Flashcards

Neurophysiological Disorders Flashcards

1
Q

Structural problems in the CNS

A

Injury
Carcinoma
Ischaemia
Haemorrhage

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2
Q

What is first line diagnosis for structural problems in the CNS?

A

CT/MRI

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3
Q

Chemical problems in the CNS

A
  • ionic concentrations
  • neurotransmitter production
  • neurotransmitter release
  • neurotransmitter reception
  • neurotransmitter re-uptake
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4
Q

Which is harder to diagnose - structural or chemical CNS problems?

A

Chemical

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5
Q

“Wiring” problems in the CNS

A
  • may cause epilepsy
  • imaging does not help
  • need to find precise 3D location
  • problems at synapses
  • can cause positive feedback/constant firing
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6
Q

Multiple Sclerosis

A
  • affects the CNS (brain and spinal cord)
  • myelin sheath damage
  • inflammation and scarring of myelin sheath
  • myelin attacked by the immune system
  • myelin replaced by scarred and sclerotic tissue
  • nerve transmission impaired
  • some nerves permanently damaged
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7
Q

What is the myelin sheath?

A
  • single cell layer membrane which wraps around the axon

- insulator

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8
Q

Types of MS

A
  • relapsing-remitting
  • primary-progressive
  • secondary-progressive
  • progressive-relapsing
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9
Q

Motor Neurone Disease

A
  • a group of diseases of upper and lower motor neurones
  • typical onset in 50s to 70s
  • slightly higher incidence in men
  • causes peripheral weakness
  • can affect speech, swallowing and ocular muscles
  • autonomic nervous system spared
  • no effect on senses
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10
Q

ALS

A
  • amyotrophic lateral sclerosis
  • progressive disorder of nervous system
  • upper AND lower motor neuron degeneration at once
  • muscle weakness
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11
Q

ALS Lower motor neurone symptoms

A
  • weakness
  • muscle twitching (fasciculations)
  • atrophy
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12
Q

ALS Upper motor neurone symptoms

A
  • stiffness
  • cramping
  • weakness
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13
Q

What is it called if only lower motor neurone extending from spinal cord to muscle is compromised?

A
  • motor neuron disease
    OR
  • spinal/progressive muscular atrophy
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14
Q

Progressive bulbar palsy

A
  • lower motor neuron extending from brainstem to muscles of speech and swallowing are compromised
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15
Q

Upper motor neuron involvement only

A

Primary Lateral Sclerosis

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16
Q

Guillian-Barre Syndrome

A
  • neuropathy
  • inflammatory disorder of peripheral nerves
  • rapid onset of weakness
  • often paralysis of legs, arms, breathing muscles and face
  • most recover but length of illness is unpredictable
  • often months of hospital care required
  • like MS, myelin sheath damaged but in PNS not CNS, possibly by the immune system
17
Q

Carpal tunnel syndrome

A
  • neuropathy
  • much more common
  • median nerve
  • over-usage
  • non invasive treatment = stop activity, splint to hold hand backwards and relieve compression, steroid injections
  • invasive treatment = surgery
  • numbness/pins and needles/ pain
18
Q

Myasthenia Gravis

A
  • neuromuscular transmission problem
  • not many others
  • autoimmune
  • receptors get attacked by immune system so less effective
  • some types only affect orbicularis oculi (double vision, trouble focusing)
  • some types only affect masseter (chewing fatigue)
  • treatments = disease modifying drugs, anti-Ach-esterase to prevent recycling of Ach
19
Q

Muscular Dystrophy

A
  • affecting muscle fibres themselves
  • muscle wasting
  • 9 types
  • genetic, degenerative diseases affecting voluntary muscles
  • males from early age = Duchenne Muscular Dystrophy
20
Q

Duchenne Muscular Dystrophy

A
  • absence of dystrophin (protein keeping muscle cells intact)
  • onset: 2-6 years (early childhood)
  • generalised weakness, muscle wasting, first hip muscles/ pelvic area/ thighs/ shoulders/ calves often enlarged
  • progresses to affect ALL voluntary muscles, heart and breathing muscles
  • survival is rare beyond early 30s
  • less severe variant is Becker muscular dystrophy
  • X linked recessive
  • primary affects boys who inherit through mothers
  • woman can be carriers but no symptoms
21
Q

Other types of Muscular Dystrophy

A
  • limb-girdle
  • facioscapulohumeral
  • myotonic
  • ophthalmoplegic
  • distal
22
Q

EMG Amplifier

A
  • typically recorded using a differential amplifier with 2 active electrodes and a common reference electrode
23
Q

Types of electrodes

A
  • surface electrodes (non invasive)
  • concentric needle electrode (cannula forms 1 electrode and core forms the other, invasive, picks up activity from individual motor units)
  • single fibre electrode (very fine wire exposed through side of cannula, 25 microns, picking up single muscle fibre activity)
  • earth strap (reference electrode, reference can also be surface, velcro strip with mesh inside, dip in saline)
24
Q

Surface EMG

A
  • limited to superficial muscles
  • cannot completely isolate muscles
  • attenuated according to thickness of fat and other tissues
  • most useful info. from surface EMG is temporal
  • common application is gait analysis
25
Q

Surface EMG Uses

A
  • unacceptable as clinical tool in diagnosis of neuromuscular disease, low back pain
  • acceptable for kinesiological analysis of movement disorders for differentiating types of tremors, myoclonus, dystonia, evaluating gait and posture disturbance, psychophysical measures of reaction and movement time
26
Q

Multi Channel Surface EMG

A
  • 128 channels
  • action potentials propagate down nerve so can track them
  • lots of measurements made at once so can use it to identify problem in larger area where you don’t know where the problem is
27
Q

Concentric needle EMG

A
  • stick into muscle
  • in specific muscle
  • well trained clinicians
  • picking up different action potentials in muscle fibres at different times depending on distance from terminal
  • can make a number of measurements from this = number of phases, turns, amplitude, duration
28
Q

Single fibre EMG

A
  • 2 or more muscle fibres within the same motor unit
  • need to adjust position of needle to get right location
  • IPI = interpotential interval = separation
  • healthy individual = intervals not changing in distance
  • not healthy = jitter and blocking
  • blocking when nothing appears = could be myasthenia gravis for example
  • raised jitter/frequency = early sign of neuromuscular transmission disturbance
29
Q

Surface EMG with nerve stimulation

A
  • recording electrodes (want to position one in center and one further away as other difference in potential will just cancel out)
  • earth strap
  • stimulating electrodes (
  • routine test
  • carpal tunnel/ulnar nerve
30
Q

F response

A
  • late response

Clinical Measurements (11 decks)

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