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Neurology Year 3 > Physiology x > Flashcards

Physiology x Flashcards

1
Q

How to assess for acessory nerve function

A

Should inspect the shoulders for loss of muscle bulk, ask the patient to shrug their shoulders against resistance, and turn their head against resistance

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2
Q

When is the ankle reflec delayed?

A

It is typically delayed in L5 and S1 disk prolapses.

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3
Q

What nerve roots does the ankle reflex test?

A

The ankle reflex is elicited by tapping the Achilles tendon with a tendon hammer. It tests the S1 and S2 nerve roots

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4
Q

The anterior interosseous nerve (volar interosseous nerve)

A

A branch of the median nerve that supplies the deep muscles on the front of the forearm, except the ulnar half of the flexor digitorum profundus.

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5
Q

Brachial artery journey

A

The brachial artery begins at the lower border of teres major as a continuation of the axillary artery. It terminates in the cubital fossa at the level of the neck of the radius by dividing into the radial and ulnar arteries

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6
Q

How is the brachial artery seperated from the median cubital vein?

A

In the cubital fossa it is separated from the median cubital vein by the bicipital aponeurosis.

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7
Q

Mamilliary body

A

Function is recollective memory. Memory information begins within the hippocampus. Theta waves activate CA3 neurons in the hippocampus. Information about memory transmits through the fornix to the mammillary bodies.

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8
Q

Anyglada function

A

The main job of the amygdala is to regulate emotions, such as fear and aggression. The amygdala is also involved in tying emotional meaning to our memories. reward processing, and decision-making.

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9
Q

What are the cavernous sinuses?

A

The cavernous sinuses are paired and are situated on the body of the sphenoid bone. It runs from the superior orbital fissure to the petrous temporal bone

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10
Q

Where is the common pernoeal nerve derived from?

A

Derived from the dorsal divisions of the sacral plexus (L4, L5, S1 and S2).

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11
Q

Common peroneal nerve functions

A

This nerve supplies the skin and fascia of the anterolateral surface of the leg and the dorsum of the foot. It also innervates the muscles of the anterior and peroneal compartments of the leg, extensor digitorum brevis as well as the knee, ankle and foot joints.

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12
Q

Branches of the common peroneal nerve in the thigh

A 
Nerve to the short head of biceps
Articular branch (knee)
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13
Q

Branches of the common peroneal nerve in the popliteal fossa

A

Lateral cutaneous nerve of the calf

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14
Q

Branches of the common peroneal nerve at the neck of fibula

A

Superficial and deep peroneal nerves

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15
Q

The cranial venous sinuses

A

The cranial venous sinuses are located within the dura mater. They have no valves which is important in the potential for spreading sepsis. They eventually drain into the internal jugular vein.

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16
Q

Occulomotor nerve palsy features

A

Ptosis
Eye down and out
Unable to move the eye superiorly, inferiorly, medially
Pupil fixed and dilated

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17
Q

Trochlear nerve palsy features

A 
Vertical diplopia (diplopia on descending the stairs)
Unable to look down and in
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18
Q

Abducens nerve palsy features

A

Convergence of eyes in primary position
Lateral diplopia towards side of lesion
Eye deviates medially

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19
Q

Location of jugular and stylomastoid foramen

A

Temporal bone

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20
Q

Location of foramen magnum

A

Occipital bone

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21
Q

Location of Foramen ovale, spinosum, rotundum & lacerum

A

Sphenoid bone

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22
Q

Damage to what nerve causes a Trendelenberg gait?

A

Damage to the superior gluteal nerve will result in the patient developing a Trendelenberg gait

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23
Q

Superior gluteal nerve (L5, S1)

A

Gluteus medius
Gluteus minimis
Tensor fascia lata

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24
Q

Inferior gluteal nerve

A

Gluteus maximus

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25
Q

Ventromedial nucleus

A

Satiety centre. Lesions → hyperphagia

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26
Q

Paraventricular nucleus

A

Produces oxytocin + ADH. Lesions → diabetes insipidus

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27
Q

Supraoptic nucleus

A

Produces antidiuretic hormone (ADH). Lesions → diabetes insipidus

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28
Q

Suprachiasmatic nuclues

A

Regulars circadian rhythm

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29
Q

Septal nucleus

A

Regulates sexual desire

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30
Q

Posterior nucleus of hypothalamus

A

Heating (conservation and increased production) - damage results in poikilothermia
Stimulates sympathetic nervous system

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31
Q

Lateral nucleus of hypothalamus

A

Stimulation → increased appetite

Lesions → anorexia

32
Q

Anterior nucleus of hypothalamus

A

Cooling by stimulation of parasympathetic nervous system

33
Q

Long thoracic nerve injury

A

Winging of Scapula occurs in long thoracic nerve injury (most common) or from spinal accessory nerve injury (which denervates the trapezius) or a dorsal scapular nerve injury

34
Q

Lumbar punctuure procedure

A

The supraspinous ligament which connects the tips of spinous processes and the interspinous ligaments between adjacent borders of spinous processes

Then the needle passes through the ligamentum flavum, which may cause a give as it is penetrated

A second give represents penetration of the needle through the dura mater into the subarachnoid space. Clear CSF should be obtained at this point

35
Q

Median nerve motor supply in hand

A

Motor supply (LOAF)

Lateral 2 lumbricals
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis

36
Q

Median merve sensory supply in hand

A

Over thumb and lateral 2 ½ fingers

37
Q

Median nerve damage at wrist

A

carpal tunnel syndrome
paralysis and wasting of thenar eminence muscles and opponens pollicis (ape hand deformity)
sensory loss to palmar aspect of lateral (radial) 2 ½ fingers

38
Q

The four infoldings of the dura mater

A

Falx cerebri: separates the cerebral hemispheres
Tentorium cerebelli: separates the occipital lobes from cerebellum
Falx cerebelli, vertical infolding: separates the cerebellar hemispheres
Diaphragma sellae: covers the pituitary gland and sella turcica

39
Q

Musculocutaneous nerve innervations

A

Coracobrachialis
Biceps brachii
Brachialis

40
Q

Knee reflex nerve roots

A

L3-L4

41
Q

Biceps reflex nerve root

A

C5-C6

42
Q

Triceps reflex nerve root

A

C7-C8

43
Q

Lateral geniculate nucleus

A

visual signals

44
Q

Medial geniculate nucleus

A

Auditory signals

45
Q

Lateral portion of the ventral posterior nucleus of thalamus

A

Body sensation (touch, pain, proprioception, pressure, vibration)

46
Q

Medial portion of the ventral posterior nucleus (VML) of thalamus

A

Facial sensation

47
Q

What are the different nuclei of the thalamus?

A

Lateral geniculate nucleus
Medial geniculate nucleus
Medial portion of the ventral posterior nucleus (VML)
Ventral anterior/lateral nuclei
Lateral portion of the ventral posterior nucleus

48
Q

Features or Wernicke’s encephalopathy

A 
nystagmus (the most common ocular sign)
ophthalmoplegia
ataxia
confusion, altered GCS
peripheral sensory neuropathy
49
Q

Wallerian degenaeration

A

Is the process that occurs when a nerve is cut or crushed.

  • It occurs when the part of the axon separated from the neuron’s cell nucleus degenerates.
  • It usually begins 24 hours following neuronal injury and the distal axon remains excitable up until this time.
50
Q

Triptans

A

Triptans are specific 5-HT1B and 5-HT1D agonists used in the acute treatment of migraine. They are generally used first-line in combination therapy with an NSAID or paracetamol

51
Q

Triptans side effects

A

triptan sensations’ - tingling, heat, tightness (e.g. throat and chest), heaviness, pressure

52
Q

Triptans contraindications

A

patients with a history of, or significant risk factors for, ischaemic heart disease or cerebrovascular disease

53
Q

Clinical presentation of neurogenic Thoracic outlet syndrome

A

painless muscle wasting of hand muscles, with patients complaining of hand weakness e.g. grasping
sensory symptoms such as numbness and tingling may be present
if autonomic nerves are involved, the patient may experience cold hands, blanching or swelling

54
Q

Clinical presentation of vascular Thoracic outlet syndrome

A

subclavian vein compression leads to painful diffuse arm swelling with distended veins
subclavian artery compression leads to painful arm claudication and in severe cases, ulceration and gangrene

55
Q

Subacute combined degeneration of spinal cord

A

due to vitamin B12 deficiency
dorsal columns + lateral corticospinal tracts are affected
joint position and vibration sense lost first then distal paraesthesia
upper motor neuron signs typically develop in the legs, classically extensor plantars, brisk knee reflexes, absent ankle jerks
if untreated stiffness and weakness persist

56
Q

Syringomyelia features

A

~~~
Flacid paresis (typically affecting the intrinsic hand muscles)
2. Loss of pain and temperature sensation

57
Q

Anterior spinal artery occlusion

A
  1. Bilateral spastic paresis

2. Bilateral loss of pain and temperature sensation

58
Q

Friedrich’s ataxia

A
  1. Bilateral spastic paresis
  2. Bilateral loss of proprioception and vibration sensation
  3. Bilateral limb ataxia

In addition cerebellar ataxia → other features e.g. intention tremor

59
Q

Features of sciatic nerve lesion

A

motor: paralysis of knee flexion and all movements below knee
sensory: loss below knee
reflexes: ankle + plantar lost, knee jerk intact

60
Q

Pathway of pupillary light reflex

A

afferent: retina → optic nerve → lateral geniculate body → midbrain
efferent: Edinger-Westphal nucleus (midbrain) → oculomotor nerve

61
Q

A relative afferent pupillary defect

A

Is found by the ‘swinging light test’. It is caused by a lesion anterior to the optic chiasm i.e. optic nerve or retina

When the test is performed in an eye with an afferent pupillary defect, light directed in the affected eye will cause only mild constriction of both pupils while light in the unaffected eye will cause a normal constriction of both pupils (due to an intact efferent path, and an intact consensual pupillary reflex).

62
Q

Progressive supranuclear palsy features

A

postural instability and falls
patients tend to have a stiff, broad-based gait
impairment of vertical gaze (down gaze worse than up gaze - patients may complain of difficultly reading or descending stairs)
parkinsonism
bradykinesia is prominent
cognitive impairment
primarily frontal lobe dysfunction

63
Q

Internuclear ophthalmoplegia features

A

Features
impaired adduction of the eye on the same side as the lesion
horizontal nystagmus of the abducting eye on the contralateral side

64
Q

Internuclear ophthalmoplegia cause

A

due to a lesion in the medial longitudinal fasciculus (MLF)
controls horizontal eye movements by interconnecting the IIIrd, IVth and VIth cranial nuclei
located in the paramedian area of the midbrain and pons

65
Q

Miller Fisher syndrome

A

variant of Guillain-Barre syndrome
associated with ophthalmoplegia, areflexia and ataxia. The eye muscles are typically affected first
usually presents as a descending paralysis rather than ascending as seen in other forms of Guillain-Barre syndrome
anti-GQ1b antibodies are present in 90% of cases

66
Q

Ethosuximide

A

Ethosuximide is an antiepileptic that is particularly indicated in patients with absence seizures

67
Q

Ethosuximide mechanism of action

A

blocks T-type calcium channels in thalamic neurons

68
Q

Enpty sella features

A

headaches
hypertension
rhinorrhoea

69
Q

Empty sella

A

pituitary gland is flattened and on the posterior aspect of the sella turcica
cause unknown
more common in multiparous obese women

70
Q

Chorioretinitis causes

A 
syphilis
cytomegalovirus
toxoplasmosis
sarcoidosis
tuberculosis
71
Q

Cerebellar syndrome/diseases causes

A 
Friedreich's ataxia, ataxic telangiectasia
neoplastic: cerebellar haemangioma
stroke
alcohol
multiple sclerosis
hypothyroidism
drugs: phenytoin, lead poisoning
paraneoplastic e.g. secondary to lung cancer
72
Q

Cerebellar syndrome/disease features

A

D - Dysdiadochokinesia, Dysmetria (past-pointing), patients may appear ‘Drunk’
A - Ataxia (limb, truncal)
N - Nystamus (horizontal = ipsilateral hemisphere)
I - Intention tremour
S - Slurred staccato speech, Scanning dysarthria
H - Hypotonia

73
Q

Frontal lobes lesions

A 
expressive (Broca's) aphasia
disinhibition
perseveration
anosmia
inability to generate a list
74
Q

Temporal lobe lesions

A

Wernicke’s aphasia
superior homonymous quadrantanopia
auditory agnosia
prosopagnosia (difficulty recognising faces

75
Q

Parietal lobe lesions

A 
sensory inattention
apraxias
astereognosis (tactile agnosia)
inferior homonymous quadrantanopia
Gerstmann's syndrome (lesion of dominant parietal): alexia, acalculia, finger agnosia and right-left disorientation

Neurology Year 3 (22 decks)

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