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Practical Year 2 > Physiology practical second year 2 > Flashcards

Physiology practical second year 2 Flashcards

1
Q

What are the fine sensations? Give their afferent.

A

fine touch and pressure
Vibration
stereognosis
Position

All A beta except position which is A alpha

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2
Q

Dorsal column is for?

A

fine sensation

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3
Q

Gracile and cuneate tracts are in the _____ column

A

Dorsal

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4
Q

Spinothalamic tract (lateral and ventral) has what afferent?

The ventral spinothalamic is for?
The lateral spinothalamic is for?

A

Alpha S and C

Crude touch and pressure
tickling and itching

pain and temperature

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5
Q

crude touch is tested by?
It tests the _____ path?

A

cotton

ventral spinothalamic tract

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6
Q

Fine touch is teste by?
receptors are?
afferent
it tests pathway

A

Blunt object and compass for 2 point discrimination

meissner’s and merkel’s

A beta

Dorsal column

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7
Q

Tactile localization how its done
test for

A

patient close eyes. place object and he tells where
intact sensory pathways and cortical

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8
Q

Tactile discrimination how its done
tests is for
most accurate test

A

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

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9
Q

factors affecting 2 point discrimination

A

Number of receptors
small receptive field
less convergence
large area of cortical representation

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10
Q

Pressure sensation and weight and discrimination test how its done
what are the receptor
What pathway does it test

A

place different weight in hand and ask patient to differentiate

Pacinian corpuscles

Dorsal column

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11
Q

Vibration test how its done

Receptor

Afferent

Pathway it test

A

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

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12
Q

Mention clinical importance of vibration sense?

A

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

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13
Q

Stereognosis test

afferent

pathway

A

patient closed eyes given a familiar object

AB

Dorsal column

test intact sensory pathways, cortical sensory areas, early sign of cortical damage.

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14
Q

Graphesthesia test

Importance

A

patient has something written drawn with marker on his skin and identify it

assessment of cortical sensory function

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15
Q

Proprioceptive sensation examination test

receptors

Afferent

Pathway

A

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

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16
Q

Importance of proprioceptive sensation

Define romberg sign

A

Asses the integrity of dorsal column

Patient cant maintain erect position with closed eyes suggest impaired proprioception

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17
Q

Define sensory ataxia, What is its cause?

A

Incoordination of voluntary muscle movements without paralysis. with stamping gait

loss of proprioception

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18
Q

temperarture sensation test

receptor

Afferent

Pathway

Importance

A

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

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19
Q

Pain sensation test

Afferent

Pathway

Importance

A

sharp pin. prick skin

A sigma for acute pain

lateral spinothalamic tract

impaired pain sensation in peripheral neuropathy

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20
Q

Define abnormal sensation that could be found during neurological assessment

A

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

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21
Q

What is glove and stock hypothesia?

A

caused by vitamin b12 deficiency or diabetic neuritis

numbness tingling burning

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22
Q

Bulk of muscles test

A

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

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23
Q

Forms of hypertonia:

A

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)

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24
Q

Muscle Power Examination

A

 ACTIVE movement of the muscle against resistance Abnormalities:

 Weakness (Paresis): Incomplete LMNL or UMNL.

 Loss of movement (Paralysis): Complete LMNL or UMNL

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25
Q

A- Superficial reflexes

A

a-Corneal & light reflexes
b- Palatal reflex
c-Abdominal reflexes:
d-Plantar reflex:

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26
Q

Palatal reflex
Afferent
Center
Efferent
Response

A

touching the mucous membrane covering soft plate

afferent: IX and Efferent: X

Response: elevation of tonge

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27
Q

Plantar reflex

A

polysynaptic superficial spinal reflex

Center: sacral 1-2

Response: plantar flexion of all toes

Abnormal response: Babinski sign

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28
Q

Babinski sign what is it? and causes of Babinski sign.

A

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

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29
Q

Center of reflexes
Ankle jerk
Knee jerk
Biceps jerk
Triceps jerk

A

Ankle jerk: sacral 1-2
knee jerk: lumbar 3-4
Biceps jerk: Cervical 5-6
Triceps jerk: Cervical 6-7

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30
Q

Areflexia and atonia and example

A

interruption of reflex arc

Tabes dorsalis
Peripheral neuritis

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31
Q

Hyperreflexia, hypertonia and examples

A

Interruption of inhibitory impulses

UML
Anxiety
Hyperthyroidism

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32
Q

Hyporeflexia, hypotonia and examples

A

Interruption of faciliatory impulses

Neocerebellar syndrome
Sleep
Myxedema

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33
Q

Spasticity happens in ___. It is characterized

A

UMNL
Hypertonia in antigravity muscle
caused by increase gamma motor neuron discharge.

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34
Q

Dysdiadokokinesia is from

A

uncoordinated of movement (Can’t touch nose with finger tip)

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35
Q

Arm pulling test responses

A

Normal response: brakes appropriate time

Abnormal: rebound phenomenon (due to neocerebellar syndroma)

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36
Q

Ataxia is

A

incoordination of movements due to errors in rate range and direction of movement

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37
Q

abnormal coordination of movement seen in heel-knee test, arm pulling test, finger-nose is due to

A

Neocerebellar syndrome

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38
Q

Ataxia manefistations

A

head is tilled to lesion side, drunken gait
Slurred speech
past-pointing
rebound
Adiadochokinesia: inability to perform opposite alternate movements quick

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39
Q

Spastic gait occurs in

A

unilateral UMNL
from increase gamma discharge (hypertonia)

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40
Q

Scissor gait occurs in

A

Bilateral UMNL

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41
Q

High steppage occur in

A

sensory ataxia
tabes doralils
With romberg’s sign

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42
Q

Staggering (drunking) gait

A

In Neocerebellar lesion

43
Q

Shuffling waddling occurs in

A

parkinsonism
LMN

44
Q

UMNL possible causes, effect on muscle bulk, muscle tone and deep reflexes

A

Cause: cerebrovascular strokes causing damage in internal capsule
Muscle tone: hypertonia, clasp knife type
Muscle bulk: No significant muscle wastingg

45
Q

LMNL possible causes, effect on muscle bulk, muscle tone and deep reflexes

A

lesion of AHC, damage of motor nerve
Hypotonia: flaccid paralysis
marked muscle waisting

46
Q

corneal reflex afferent and efferent
what does it test for

A

Afferent: opthalmic n
Efferent: Bilateral facial N
Opthalmic nerve integrity

47
Q

Pupillary light reflex what it is

receptor

afferent

efferent

A

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

48
Q

Argyll-Robertson pupil

cause and manifestation

A

cause: neurosyphilis causing lesion in pretectal nucleus

Manifestation: no pupillary constriction on light reflex or near reflex

49
Q

explain the near response reflex

A

eyes converse inwards, miosis, and increase lens power

50
Q

pathway of Near response

A

receptor: photoreceptors
Afferent: visual pathway
Center: mid-brain
Efferent: moves medial rectus and autonomic on ciliary ms

51
Q

Myopia (near sightedness) is caused by

fixed by what

A

eyeball longer and light converges before retina
fixed by concave lens

52
Q

Hypermetropia (far sightedness) is caused by
fixed by

A

shorter eyeball light falls beyond retina
fixed by convex lens

53
Q

Prespyopia is caused by
fixed by

A

decrease elasticity of lens so it becomes flat
Corrected with convex lens

54
Q

Astigmatism is caused by
corrected with

A

Inequality of corneal curvature, light can’t focus on retina
Cylindrical lens

55
Q

Test dot and circle experiment (explain it)

A

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.

56
Q

Test for color vision using ishihara chart test

A

used to asses color blindness
color blindness (achromatopsia) is more common in males

57
Q

What is scotoma? How is it tested for

A

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.

58
Q

unilateral lesion of optic nerve causes what

A

blindness of same side eye and loss of light reflex

59
Q

Lesion at center of optic chiasma can happen why and causes what

A

from pituitary tumor

Bitemporal hemianopia

60
Q

Lesion at optic tract or LGB causes

A

contralateral homonymous hemianopia

61
Q

Lesion of optic radiation

A

Contralateral homonymous hemianopia

62
Q

describe weber test
what happens if its normal? abnormal?

A

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

63
Q

describe Rinne test
Normal finding
abnormal finding

A

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

64
Q

what has the highest pH from the digestive secretion?

A

Pancreatic juice

65
Q

Name the cells that secrete acid by gastric and cells the are responsible for secretion of intrinsic factor?

A

Parietal cells of stomach

66
Q

Gastric ulcer peak age, location, mechanism, incidence, pain related to eating, patient weight, vomiting and cancer risk

A

45-55
stomach
reduction of defensive factors
increase with age
increase 1h after food
loss of weight
vomiting more common
high risk

67
Q

Duodenal ulcer age, location, peak age, mechanism, pain related to eating, patient weight, vomiting, risk of carcinoma and incidence

A

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

68
Q

Define MEN-1 associated Zollinger-Ellison syndrome variants.

A

a disorder that is characterized by the development of parathyroid hyperplasia (resulting in hyperparathyroidism), pancreatic endocrine tumors , pituitary, adenomas, and adrenal adenoma.

69
Q

Differential Diagnosis: Diabetes Insipidus

A

In males: gynecomastia

In females: galactorrhea

Bitemporal hemianopia

Hypogonadism

Panhypopituitarism

70
Q

Polyuria is due to:

A

Hyperglycemia, glucosuria

71
Q

Hyperprolactinemia:
Cause:

A

Adenoma of anterior pituitary.
Manifestations:

In females : Infertility, Amenorrhea, ↓ libido, Galactorrhea (milk secretion).

Treatment:

 dopamine agonist: bromocriptine.

72
Q

Panhypopituitarism (Sheehan’s syndrome):

A

Cause:

 in females after severe post-partum hemorrhage.

Manifestations:

  1. ↓ GH function: premature senility → Premature graying of scalp hairs + loss of body hairs.

↓ Of body weight, Dry & wrinkled skin, Shrunken hands & Feet.

  1. ↓ thyroid function: anemia.
  2. ↓ Adrenal cortex function: hypoglycemia, hypotension
  3. ↓ Gonadotrophic hormones: amenorrhea in females, and sterility in males.
73
Q

Tetany:

A

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.

74
Q

(Conn’s syndrome)

A

its 1ry hyperaldosteronism

cause Aldosterone secreting tumors of adrenal cortex

75
Q

2nd hyperaldosteronism
cause:

Manifestations:

A

2nd to heart failure, liver cirrhosis, or nephrosis →↑ level of RAAS →↑ aldosterone

  1. Hypokalemia: lead to Nephropathy, polyuria, Muscle weakness
  2. Hypertension: due to Na+ & H2O retention
  3. No edema (Escape phenomenon) In 1ry hyperaldosteronism: due to ↑ ANP secretion. Edema in 2ry hyperaldosteronism
76
Q

Cushing’s syndrome types and manifestations

A
  1. Primary: (ACTH independent): Adrenal tumors mainly secrete cortisol
  2. 2nd : (ACTH dependent): 2nd to pituitary hyper secretion of ACTH → cause skin pigmentation
    (MSH activity)

Hair distribution: ↑ facial hair (hirsutism) & acne due to ↑Androgens

77
Q

Undescended testis is called

A

cryptorchidism

78
Q

how to treat cryptorchidism

A

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

79
Q

① True precocious puberty: Precocious gametogenesis and steroidogenesis.

Causes:

A

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.

80
Q

Precocious pseudo puberty:

  • Early development of 2nd sexual characteristics without gametogenesis (spermatogenesis or oogenesis) causes
A

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

81
Q

Solution to LES

A

Has rat tail appearance

check with endoscope to exclude cancer
Laparoscopic surgical myotomy
Botox if surgery not available

82
Q

Achalasia is

A

dysphagia with solid and liquid
\

83
Q

Dysphagia is

A

with solid food only, associated with structural anomalies

84
Q

GERD manifestation

A

Heart burn and epigastric pain
Obesity puts pressure on sphincter

Esophogaeus can narrow

85
Q

GERD manifestation

A

Heart burn and epigastric pain
Obesity puts pressure on sphincter

Esophogaeus can narrow
Ulcer of esophagus

86
Q

Things that increase gastrin secretion

A

Hpylori infection
Stress
Smoking

87
Q

BMR formula

A

(O2 consumption/hr)x4.8
Body S.A

88
Q

If HbA1c is elevated that indicates

A

Insulin resistance

89
Q

2dry amenohrrae is related to

A

weight gain

90
Q

GFR formula

A

U inulin x V
_____________
P inulin

91
Q

RPF (effective)

A

U PAHA x V
______________
P Paha

92
Q

RPF actual

A

RPF
____________
percentage

93
Q

RBF

A

RPF actual
_______________
(1-hematocrit)

94
Q

filtered load is

A

GFR X P

95
Q

Excreted load is

A

Urine flow x Urine (x)

96
Q

Clearance is

A

U x V
_________
P

97
Q

TmG is

A

the maximum amount of glucose can be reabsorbed by renal tubules per minute

98
Q

Renal threshold is

A

plasma level which glucose first appears in urine

99
Q

Splay is due to

A

each nephron having a different TmG

100
Q

Renal reabsorption of glucose mechanism

A

secondary active transport to Na. Glucose and Na bind to common carrier SGLT-2. As Na moves down concentration gradient, glucose follows it.

101
Q

Name each thing

A

1 TmG
2 renal threshold
3 splay

102
Q

Name this and give the reason it occurs

A

Von Graefe’s sign, slow down ward movement of upper eyelid

caused by hyper reflexibility from hyperthyroidism

103
Q

this is?

A

The Chvostek sign, contraction of ipsilateral facial muscles. Caused by hyperexcitability do to hypocalcemia

104
Q

this is?

A

Trousseau’s sign spasm of hand muscles thumb is abducted and wrist is flexed. in response of elevation of arterial blood pressure

Practical Year 2 (9 decks)

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