PNS- 10 ?s Flashcards
NS disorders are responsible for what percent of years lived with disability
28%
What is the most important part of neurologic pathology
knowing the LOCATION
Where could lesions be in the CNS
Cx, basal ganglion, brain stem, cerebellum, spinal cord
where could lesions be in the PNS
CN, motor efferents, sensory afferents, NMJ, muscle itself
What are the overall exams for CNS
mental status and cognition, coordination, CN
what are the overall exams for PNS
motor: strength and motion
sensation
reflexes
What are the components of a neuro exam
mental status, CN, motor, sensory, reflexes
The posterior root of spinal cord carry what type infor
anterior?
posterior- sensory
anterior- motor
what type of info is in a peripheral nerve
both sensory and motor
What are the 2 nervous system distribution
dermatomes
cutaneous peripheral
What are the most common complains of peripheral nerve disorder
pain weakness and paresthesias
what are associated symptoms of peripheral nerve disorders
swelling, rash, spasm deformities, mental status
what is important in PMH for peripheral nerve disorder
autoimmune, dystrophies, diabetes, DJD
What are the most common causes of peripheral nerve disorder
ischemia (arterial stenosis)
bleeding (TIA, CVA)
masses (impingement)
peripheral nervous disorders (MS, Guillian Barre)
Neuromuscular disorders (Myasthenia gravis)
muscular disorders (dystrophies)
what are findings on the sensory exam for peripheral nervous problems
hypesthesia or hypoesthesia
hyperesthesia
hyperalgesia
allodynia
what is allodynia
non-painful stimulus perceived as painful on the skin, sometimes severe
how do patients with peripheral nervous disorders describe their sensations
dysesthesia
paresthesia
What are examples of proximal weakness
combing hair
getting out of chair
worse with repeated effort (myasthenia gravis)
what are examples of distal weakness
open a jar, writing, tripping
What are the 5 types sensation
pain, temp, light touch, proprioception, vibration
What is stereognosis
identifying object by feel
What is the scale for mm strength
0- no mvmnt 1- m twitch no joint 2- mvmnt w/o gravity 3- full strength against gravity 4- partial strength against resistance 5- full strength against R
What are the brainstem reflexes
corneal, gag, pupillary
what are the superficial reflexes
abdominal, plantar, anal
When is clonus seen in reflexes
UMN lesions
The abdominal wink reflexes involve what nn
T8-T10
T10-12
what are levels involved in anal wink
S2-4
what are the levels involved in plantar(babinski)
L5-S1
what is a normal babinski response
downgoing, the toes curl
describe lesion signs for DTR CNS vs PNS
CNS- increased DTR
PNS- decreased DTR
What are the levels in brachioradialis DTR
C56
what are the levels in biceps DTR
C56
what are the levels in triceps DTR
C67
what are the levels in patellar DTR
L2-4
what are the levels in achilles DTR
S1
What is the scale for DTR
0-absent 1- diminished 2- normal average 3- mildly over-active 4- highly over-active
what is the max amount of strikes for DTR
3
What can cause UMN lesions
MS
cerebral palsy
traumatic brain injury
ALS
What are causes of LMN lesions
Polio
Guillain-Barre
ALS
What do you see in LMN lesions
paralysis from muscle atrophy wasting pronounced falccid, hypotonic DTR low or absent superficial reflexes fine
What are the most common causes of peripheral nervous disorders
polio, ALS, herniated disc, carpel tunnel syndrome, bell’s palsy, diabetes, alcoholic neuropathy, myesthenia gravis, muscular dystrophy
Where does ALS, polio affect nervous system
in the ventral horn
where does herniated discs hurt nervous system
along spinal nerve
where does bells palsy and diabetes and ETOH affect nervous system
distal peripheral nerve
where does myasthenia gravis affect nervous system
motor component of nerve in muscle
What is peripheral mononeuropathy
weakness, sensory loss in peripheral n distribution- carpal tunnel and bells palsy
what is peripheral polyneuropathy
distal weakness and stocking-glove distribution sensory loss
caused by DM, alcoholic neuropathy
Weakness in proximal mm, intact sensation and slight decreased DTR might be what
muscular dystrophy
What are common ways to cause upper brachial plexus injury
birth trauma- pulling head
falling on shoulder
the waiters tip is seen in what type injury
upper brachial plexus- radial
What are the tests for thoracic outlet syndrome
Roos and Adsons
What nn levels are involved in thoracic nerve injury
C5-7
What is pronator syndrome
injury to median n- compression
Ape hand deformity is seen in what
median n injury
also thenar eminence atrophy
how do you test for pronator syndrome
resist pronation
What are causes of anterior interosseus neuropathy
pronator teres impingement of anterior interosseus N
trauma caused by tennis elbow strap too tight
what is the test for anterior interosseus neuropathy
pinch grip “ok”
What are the tests for carpal tunnel syndrome
tinels, phalens, reverse phalens
What can cause ulnar n injruy
fracture humerus near medial epicondyle
cubital tunnel syndrome
laceration near wrist
entrapment at Guyon’s canal
What are signs or ulnar n injury
weak wrist flexion, ADduction, weak finger ABduction, ADduction
loss tumb Adduction
loss MCP flexion 4th5th digits
claw hand
what are causes of radial n injury
fracture of humerus near radial groove
satruday night palsy
what are signs of radial n injury
sensory loss back of hand
wrist drop- weak brachioradialis, supinator, wrist and digit extensors
What is a steppage gait and what causes it
weakness or paralysis of hamstring mm and thigh extensors and mm below knee from sciatica
What n injury causes trendelenburg gait
superior gluteal n injury
What causes lateral femoral cutaneous nerve injury
compression at iliac crests
numbness over lateral thigh
What are signs of peroneal n injury
paralysis dorsiflexors, evertes
loss sensation anterolateral leg and dorsum foot, foot drop
What are signs of superficial fibular n injury
paralysis foot everters, no foot drop
loss sensation anterolateral leg and dorsum foot
What are signs of deep fibular n injury
weak dorsiflexors
foot drop
what cause medial plantar n injury
cause entrapment longitudinal arch, joggers foot
what are signs of medial plantar n injury
aching pain in arch and burring/paresthesia in medial plantar surface
the most common polyneuropathy
DM
What sensation goes away first in DM
vibration
What are signs of myasthenia gravis
fatigue, proximal m weakness droopy eyelids double vision trouble swallowing trouble speaking dyspnea, respiratory m weakness no sensory loss or altered reflexes