Physiology practical second year 2 Flashcards
What are the fine sensations? Give their afferent.
fine touch and pressure
Vibration
stereognosis
Position
All A beta except position which is A alpha
Dorsal column is for?
fine sensation
Gracile and cuneate tracts are in the _____ column
Dorsal
Spinothalamic tract (lateral and ventral) has what afferent?
The ventral spinothalamic is for?
The lateral spinothalamic is for?
Alpha S and C
Crude touch and pressure
tickling and itching
pain and temperature
crude touch is tested by?
It tests the _____ path?
cotton
ventral spinothalamic tract
Fine touch is teste by?
receptors are?
afferent
it tests pathway
Blunt object and compass for 2 point discrimination
meissner’s and merkel’s
A beta
Dorsal column
Tactile localization how its done
test for
patient close eyes. place object and he tells where
intact sensory pathways and cortical
Tactile discrimination how its done
tests is for
most accurate test
Ability to feel 2 touched points simultaneously as separate two points with closed eyes, using a caliper and weber’s compass
Most accurate are tongue, finger tips and least accurate is back
factors affecting 2 point discrimination
Number of receptors
small receptive field
less convergence
large area of cortical representation
Pressure sensation and weight and discrimination test how its done
what are the receptor
What pathway does it test
place different weight in hand and ask patient to differentiate
Pacinian corpuscles
Dorsal column
Vibration test how its done
Receptor
Afferent
Pathway it test
tuning fork with low frequency. fork is placed on bony prominence. proceed from upper part of the body downwards. Ask patient when vibration stop
Meissner’s corpuscle and pacinian corpuscle
Alpha beta
Dorsal column
Mention clinical importance of vibration sense?
impaired vibration sense is early diagnostic sign in degeneration of posterior column
localize lesions of spinal cord
pernicious anemia (b12 def)
Tabes dorsalis
Spinal cord hemi section
patient feels tuning fork as cold object
Stereognosis test
afferent
pathway
patient closed eyes given a familiar object
AB
Dorsal column
test intact sensory pathways, cortical sensory areas, early sign of cortical damage.
Graphesthesia test
Importance
patient has something written drawn with marker on his skin and identify it
assessment of cortical sensory function
Proprioceptive sensation examination test
receptors
Afferent
Pathway
Show patient with eyes open the position of his big toe. Move his big toe and ask him if he feels it moving and which direction
Pacinian corpuscles, muscle spindles and golgi tendon
A alpha
Dorsal column
Importance of proprioceptive sensation
Define romberg sign
Asses the integrity of dorsal column
Patient cant maintain erect position with closed eyes suggest impaired proprioception
Define sensory ataxia, What is its cause?
Incoordination of voluntary muscle movements without paralysis. with stamping gait
loss of proprioception
temperarture sensation test
receptor
Afferent
Pathway
Importance
2 test tubes contain warm and cold water. touch different parts of the body and ask subject to tell temp difference
C fibers and A sigma fibers
lateral spinothalamic tract
more sensitive measure of subtle dysfunction
Pain sensation test
Afferent
Pathway
Importance
sharp pin. prick skin
A sigma for acute pain
lateral spinothalamic tract
impaired pain sensation in peripheral neuropathy
Define abnormal sensation that could be found during neurological assessment
Hyperalgesia exaggerated pain sensation
-primary hyper-algesia in inflamed skin because it lowers pain threshold
-Secondary hyper-algesia is found in normal skin sensitization of central neurons of pain
Hypoalgesia: reduced pain sensation
Analgesia: inability to feel pain sensation
What is glove and stock hypothesia?
caused by vitamin b12 deficiency or diabetic neuritis
numbness tingling burning
Bulk of muscles test
Measure muscle bulk with tape, compare
both sides
Compare thenar and hypothenar eminence
with your owns
If there is wasting Unilateral or bilateral,
More distal or proximal, Symmetrical or
asymmetrical
Forms of hypertonia:
Clasp -Knife spasticity: initial in resistance then sudden release (UMNL)
-Activation of stretch reflex with stretch
-Further stretch activate inverse stretch
Lead Pipe rigidity: continuous ↑ in resistance throughout movement. (parkinsonism)
o Excessive impulses along corticospinal tract to alpha and gamma
Cog wheel rigidity: intermittent resistance to passive movement (parkinsonism)
Muscle Power Examination
ACTIVE movement of the muscle against resistance Abnormalities:
Weakness (Paresis): Incomplete LMNL or UMNL.
Loss of movement (Paralysis): Complete LMNL or UMNL
A- Superficial reflexes
a-Corneal & light reflexes
b- Palatal reflex
c-Abdominal reflexes:
d-Plantar reflex:
Palatal reflex
Afferent
Center
Efferent
Response
touching the mucous membrane covering soft plate
afferent: IX and Efferent: X
Response: elevation of tonge
Plantar reflex
polysynaptic superficial spinal reflex
Center: sacral 1-2
Response: plantar flexion of all toes
Abnormal response: Babinski sign
Babinski sign what is it? and causes of Babinski sign.
Dorsiflexion of big toe and fanning of small toes
extra pyramidal tract lesion
normal in infants
pathologically in UMNL, deep anesthesia, coma and recovery stage of spinal shock
Center of reflexes
Ankle jerk
Knee jerk
Biceps jerk
Triceps jerk
Ankle jerk: sacral 1-2
knee jerk: lumbar 3-4
Biceps jerk: Cervical 5-6
Triceps jerk: Cervical 6-7
Areflexia and atonia and example
interruption of reflex arc
Tabes dorsalis
Peripheral neuritis
Hyperreflexia, hypertonia and examples
Interruption of inhibitory impulses
UML
Anxiety
Hyperthyroidism
Hyporeflexia, hypotonia and examples
Interruption of faciliatory impulses
Neocerebellar syndrome
Sleep
Myxedema
Spasticity happens in ___. It is characterized
UMNL
Hypertonia in antigravity muscle
caused by increase gamma motor neuron discharge.
Dysdiadokokinesia is from
uncoordinated of movement (Can’t touch nose with finger tip)
Arm pulling test responses
Normal response: brakes appropriate time
Abnormal: rebound phenomenon (due to neocerebellar syndroma)
Ataxia is
incoordination of movements due to errors in rate range and direction of movement
abnormal coordination of movement seen in heel-knee test, arm pulling test, finger-nose is due to
Neocerebellar syndrome
Ataxia manefistations
head is tilled to lesion side, drunken gait
Slurred speech
past-pointing
rebound
Adiadochokinesia: inability to perform opposite alternate movements quick
Spastic gait occurs in
unilateral UMNL
from increase gamma discharge (hypertonia)
Scissor gait occurs in
Bilateral UMNL
High steppage occur in
sensory ataxia
tabes doralils
With romberg’s sign
Staggering (drunking) gait
In Neocerebellar lesion
Shuffling waddling occurs in
parkinsonism
LMN
UMNL possible causes, effect on muscle bulk, muscle tone and deep reflexes
Cause: cerebrovascular strokes causing damage in internal capsule
Muscle tone: hypertonia, clasp knife type
Muscle bulk: No significant muscle wastingg
LMNL possible causes, effect on muscle bulk, muscle tone and deep reflexes
lesion of AHC, damage of motor nerve
Hypotonia: flaccid paralysis
marked muscle waisting
corneal reflex afferent and efferent
what does it test for
Afferent: opthalmic n
Efferent: Bilateral facial N
Opthalmic nerve integrity
Pupillary light reflex what it is
receptor
afferent
efferent
Light torch held to into one eye to the other. Should have direct light reflex if stimulated
receptor: photo receptors
Afferent: optic n to optic chaism
center: midbrain and pretectal nucleus
efferent: pretectal nucleus, EWN
Argyll-Robertson pupil
cause and manifestation
cause: neurosyphilis causing lesion in pretectal nucleus
Manifestation: no pupillary constriction on light reflex or near reflex
explain the near response reflex
eyes converse inwards, miosis, and increase lens power
pathway of Near response
receptor: photoreceptors
Afferent: visual pathway
Center: mid-brain
Efferent: moves medial rectus and autonomic on ciliary ms
Myopia (near sightedness) is caused by
fixed by what
eyeball longer and light converges before retina
fixed by concave lens
Hypermetropia (far sightedness) is caused by
fixed by
shorter eyeball light falls beyond retina
fixed by convex lens
Prespyopia is caused by
fixed by
decrease elasticity of lens so it becomes flat
Corrected with convex lens
Astigmatism is caused by
corrected with
Inequality of corneal curvature, light can’t focus on retina
Cylindrical lens
Test dot and circle experiment (explain it)
used to test blind spot
the subject will look at the x on the with left eye closed. The dot next to it in the periphery of vision disappears.
Test for color vision using ishihara chart test
used to asses color blindness
color blindness (achromatopsia) is more common in males
What is scotoma? How is it tested for
Scotoma is loss of small area in visual field
It is tested with the confrontational method. Patient and doctor sit at exact same eye level 2 feet apart. the doctor moves the finger into periphery and patient must see it at the same time as doctor.
unilateral lesion of optic nerve causes what
blindness of same side eye and loss of light reflex
Lesion at center of optic chiasma can happen why and causes what
from pituitary tumor
Bitemporal hemianopia
Lesion at optic tract or LGB causes
contralateral homonymous hemianopia
Lesion of optic radiation
Contralateral homonymous hemianopia
describe weber test
what happens if its normal? abnormal?
tuning fork is placed on top of skull
Normal: sound is heard equally both sides
conduction deafness: sound is heard better in diseased ear, due to absence of environmental noise on diseased side.
nerve deafness:
Sound is heard better in normal ear
describe Rinne test
Normal finding
abnormal finding
Procedure: Base of a vibrating tuning fork is placed on mastoid process until bone conduction is over. Then the tuning fork is held in air next to ear
Normal finding: sound is heard in air after bone conduction is over
conduction deafness: sound in not heard in air in diseased ear after bone conduction is over.
nerve deafness: both bone and air conduction are impaired sound is heard in air after bone conduction is over as long as nerve deafness is partial
what has the highest pH from the digestive secretion?
Pancreatic juice
Name the cells that secrete acid by gastric and cells the are responsible for secretion of intrinsic factor?
Parietal cells of stomach
Gastric ulcer peak age, location, mechanism, incidence, pain related to eating, patient weight, vomiting and cancer risk
45-55
stomach
reduction of defensive factors
increase with age
increase 1h after food
loss of weight
vomiting more common
high risk
Duodenal ulcer age, location, peak age, mechanism, pain related to eating, patient weight, vomiting, risk of carcinoma and incidence
35-45
Duodenum
Enhanced acid production
4 times more common than gastric ulcer, increases with age
decrease after food intake
gain weight
melena more common
low
Define MEN-1 associated Zollinger-Ellison syndrome variants.
a disorder that is characterized by the development of parathyroid hyperplasia (resulting in hyperparathyroidism), pancreatic endocrine tumors , pituitary, adenomas, and adrenal adenoma.
Differential Diagnosis: Diabetes Insipidus
In males: gynecomastia
In females: galactorrhea
Bitemporal hemianopia
Hypogonadism
Panhypopituitarism
Polyuria is due to:
Hyperglycemia, glucosuria
Hyperprolactinemia:
Cause:
Adenoma of anterior pituitary.
Manifestations:
In females : Infertility, Amenorrhea, ↓ libido, Galactorrhea (milk secretion).
Treatment:
dopamine agonist: bromocriptine.
Panhypopituitarism (Sheehan’s syndrome):
Cause:
in females after severe post-partum hemorrhage.
Manifestations:
- ↓ GH function: premature senility → Premature graying of scalp hairs + loss of body hairs.
↓ Of body weight, Dry & wrinkled skin, Shrunken hands & Feet.
- ↓ thyroid function: anemia.
- ↓ Adrenal cortex function: hypoglycemia, hypotension
- ↓ Gonadotrophic hormones: amenorrhea in females, and sterility in males.
Tetany:
Sign:
carpal spasm (accoucheur hand).
Cause:
hypoparathyroidism : due to accidental removal following thyroidectomy
Vitamin D deficiency, Alkalosis, Renal failure
Management:
slow IV calcium gluconate, Vitamin D injection, Treatment of the cause.
(Conn’s syndrome)
its 1ry hyperaldosteronism
cause Aldosterone secreting tumors of adrenal cortex
2nd hyperaldosteronism
cause:
Manifestations:
2nd to heart failure, liver cirrhosis, or nephrosis →↑ level of RAAS →↑ aldosterone
- Hypokalemia: lead to Nephropathy, polyuria, Muscle weakness
- Hypertension: due to Na+ & H2O retention
- No edema (Escape phenomenon) In 1ry hyperaldosteronism: due to ↑ ANP secretion. Edema in 2ry hyperaldosteronism
Cushing’s syndrome types and manifestations
- Primary: (ACTH independent): Adrenal tumors mainly secrete cortisol
- 2nd : (ACTH dependent): 2nd to pituitary hyper secretion of ACTH → cause skin pigmentation
(MSH activity)
Hair distribution: ↑ facial hair (hirsutism) & acne due to ↑Androgens
Undescended testis is called
cryptorchidism
how to treat cryptorchidism
New born: Wait till the end of 1st year because of high possibility of descent during the first year
Adult: surgical removal
if not removed, irreversible damage to spermatogonia epithelium since sperm need 32 degrees
normal secondary sexual characteristic
① True precocious puberty: Precocious gametogenesis and steroidogenesis.
Causes:
a) Cerebral disorders involving posterior hypothalamus; as tumors, infections
b) Pineal tumors due to interruption of neural pathways that inhibit GnRH pulse
c) Gonadotropin-independent precocity.
Precocious pseudo puberty:
- Early development of 2nd sexual characteristics without gametogenesis (spermatogenesis or oogenesis) causes
abnormal exposure of immature males to androgen, or immature females to estrogen caused from tumors on androgen/estrogen secreting glands or on leydig/granulosa cell
Solution to LES
Has rat tail appearance
check with endoscope to exclude cancer
Laparoscopic surgical myotomy
Botox if surgery not available
Achalasia is
dysphagia with solid and liquid
\
Dysphagia is
with solid food only, associated with structural anomalies
GERD manifestation
Heart burn and epigastric pain
Obesity puts pressure on sphincter
Esophogaeus can narrow
GERD manifestation
Heart burn and epigastric pain
Obesity puts pressure on sphincter
Esophogaeus can narrow
Ulcer of esophagus
Things that increase gastrin secretion
Hpylori infection
Stress
Smoking
BMR formula
(O2 consumption/hr)x4.8
Body S.A
If HbA1c is elevated that indicates
Insulin resistance
2dry amenohrrae is related to
weight gain
GFR formula
U inulin x V
_____________
P inulin
RPF (effective)
U PAHA x V
______________
P Paha
RPF actual
RPF
____________
percentage
RBF
RPF actual
_______________
(1-hematocrit)
filtered load is
GFR X P
Excreted load is
Urine flow x Urine (x)
Clearance is
U x V
_________
P
TmG is
the maximum amount of glucose can be reabsorbed by renal tubules per minute
Renal threshold is
plasma level which glucose first appears in urine
Splay is due to
each nephron having a different TmG
Renal reabsorption of glucose mechanism
secondary active transport to Na. Glucose and Na bind to common carrier SGLT-2. As Na moves down concentration gradient, glucose follows it.
Name each thing
1 TmG
2 renal threshold
3 splay
Name this and give the reason it occurs
Von Graefe’s sign, slow down ward movement of upper eyelid
caused by hyper reflexibility from hyperthyroidism
this is?
The Chvostek sign, contraction of ipsilateral facial muscles. Caused by hyperexcitability do to hypocalcemia
this is?
Trousseau’s sign spasm of hand muscles thumb is abducted and wrist is flexed. in response of elevation of arterial blood pressure
