NMS

Question 1

Briefly explain how the fluid health of an Intervertebral Disc is maintained.

Answer 1

aggrecan, a proteoglycan that aggregates by binding to hyaluronan.

Attached to each aggrecan molecule are glycosaminoglycan (GAG) chains of chondroitin sulfate and keratan sulfate.

Aggrecan is highly negatively charged, allowing the nucleus pulposus to swell by imbibing water.

Question 2

Briefly explain the role of the Rotator Cuff in maintaining supra-humeral joint space.

Answer 2

The rotator cuff compresses the glenohumeral joint, a term known as concavity compression

Humeral head translates up, lessening the efficiency of the deltoid muscle.

Glenoid fossa is deeper in superior and inferior directions

The rotator cuff’s contributions to concavity compression and stability vary according to their stiffness and the direction of the force they apply upon the joint.

Question 3

Explain how a fixed flexion deformity may occur in an osteoarthritic hip.

Answer 3

Due to cartilage loss the muscles that flex the hip will contract and tighten up for stability,

the collagen matrix becomes more disorganized and there is a decrease in proteoglycan content within cartilage.

Question 4

What is polyneuropathy?

Answer 4

Polyneuropathy (poly- + neuro- + -pathy) is damage or disease affecting peripheral nerves (peripheral neuropathy) in roughly the same areas on both sides of the body, featuring weakness, numbness, and burning pain.[3] It usually begins in the hands and feet and may progress to the arms and legs and sometimes to other parts of the body where it may affect the autonomic nervous system. It may be acute or chronic. A number of different disorders may cause polyneuropathy, including diabetes and some types of Guillain–Barré syndrome

Question 5

What can cause cauda equina damage?

Answer 5

The cause is usually a disc herniation in the lower region of the back.[1] Other causes include spinal stenosis, cancer, trauma,

Question 6

TWO likely neurological symptoms of central cauda equina damage (nature/ location)

Answer 6

Saddle anesthesia, i.e., anesthesia or paraesthesia involving S3 to S5 dermatomes,[

Achilles (ankle) reflex absent on both sides

Question 7

The results (but not how to do it) of ONE sensory test (signs) that would differentiate central cauda equina damage from polyneuropathy (peripheral neuropathy)

Answer 7

involving S3 to S5 dermatomes saddle anathesia pinprick test

Question 8

The results (but not how to do it) of ONE motor test (signs) that would differentiate central cauda equina damage from polyneuropathy (peripheral neuropathy)”

Answer 8

A bulbocavernous reflex (BCR) test helps to determine whether or not this reflex is intact and functioning. It involves inserting a gloved finger into the rectum and tugging on a Foley catheter or squeezing the glans penis.

Question 9

What would be the likely differences between the following presentations?

a. Patient A has spinal cord damage at the C5/6 spinal level from spinal damage sustained yesterday in a multiple-car accident on the motorway
b. Patient B has spinal nerve damage from meningioma at the C5/6 spinal level

Answer 9

Spinal meningoma comes on much more slowly.

The tumor may be palpable

Question 10

How would you use neurological examination of motor function to differentiate between:

a. Peripheral nervous system damage
b. Central nervous system damage

Answer 10

a:Reflexes would be increased in PNS damage or diminished reflexes

b:Rigidity
Cogwheeling (abnormal tone suggestive of Parkinson’s disease)