Review (part 2) Flashcards
The ASIA (ISNCSCI) impairment score has 5 levels (A, B, C, D, and E). What is an A score? E score?
A = Complete injury
E = return of normal and sensory function
What motor abilities will a patient with a C1-4 injury have? What are the realistic activity of daily living (ADL) rehab goals?
Patients have limitied movement of head and neck meaning they are dependent on caregivers for everything
What motor abilities will a patient with a C5 injury have? What are the realistic activity of daily living (ADL) rehab goals?
Has elbow flexors (C5)
Goals include independent eating after cuff set up and assisting with upper body dressing/bathing (need help with lower body dressing/bathing)
What motor abilities will a patient with a C6 injury have? What are the realistic activity of daily living (ADL) rehab goals?
elbow flexors (C5) and wrist extensors (C6)
independent eating, upper body dressing/bathing (need help with lower body derssing/bathing)
What motor abilities will a patient with a C7 injury have? What are the realistic activity of daily living (ADL) rehab goals?
elbow flexors (C5), wrist extensors (C6), elbow extensors (C7)
independent upper body dressing/bathing and inependent/some help with lower body dressing/bathing
What motor abilities will a patient with a T1-S5 injury have? What are the realistic activity of daily living (ADL) rehab goals?
complete use of upper extremities
independent in all ADLs
With regards to a C1-3, C4, C5, C6, and C7-8 spinal injury, which patients will have a greater amount of mobility and independence?
greatest to least
C7-8 > C6 > C5 > C4 > C1-3
What is neurogenic shock? Describe how the symptoms occur
Definition:
Triad of hypotension, bradycardia and hypothermia due to disruption of ANS.
Lack of sympathetic input to vasculature, arteries dilate, blood pools in venous compartment.
Lack of sympathetic input to heart (T1-T4) results in unopposed vagal tone, causing bradycardia and reduced myocardial contractility.
What is spinal shock? Describe how the symptoms occur
loss of sensory, motor, and reflex function of the spinal cord below the lesion
What is autonomic dysreflexia (AD)? Who is at high risk for AD?
Disconnection of the sympathetic nervous system to the brain above the lesion can result in episodes of HTN (below the lesion), bradycardia, pounding headache (vasodilation of vessels above the lesion - especially in the brain), sweating above the lesion, and anxiety in response to a noxious stimulus
Patients with a lesion T6 or above are at high risk
What is cauda equina syndrome? Is this an UMN or LMN syndrome? What are the GI/GU symptoms? Is pain present?
injury to the “horse tail”
LMN
areflexic bowel, bladder, and lower extremities
pain is present
What is conus medullaris syndrome? Is this an UMN or LMN syndrome? What are the GI/GU symptoms? Is pain present?
injury to the cone at the end of the spinal cord
can be UMN, LMN, or mixed
variable degrees of bowel, bladder effects.
No pain but saddle anesthesia is common
Do patients with UMN damage to S2, 3, 4 have bowel reflexes?
yes
Do patients with LMN damage to S2, 3, 4 have bowel reflexes?
no
Is ALS a motor or sensory or mixed disease? Does it involve UMN or LMN? What is the tissue involvement (cell body-motor neuron/myelin/axon/NMJ/muscle)?
motor
UMN and LMN (will have both clinical symptoms)
What are the characteristics of Guillan-Barre? What is the tissue involvement (cell body-motor neuron/myelin/axon/NMJ/muscle)?
ascending paralysis
myelin
What can cause acquired neuropathy? What is an example of hereditary neuropathy? What is the tissue involvement (cell body-motor neuron/myelin/axon/NMJ/muscle)?
Diebetes and EtOH
Charcot-Marie-Tooth type 1A
axon
What are clinical characteristics of Myesthenia Gravis? What is the tissue involvement (cell body-motor neuron/myelin/axon/NMJ/muscle)?
ocular symptoms (lots of NMJs there) - Ptosis, diplopia
fatigue increases with prolonged used
NMJ
What is muscular dystrophy? What is the tissue involvement (cell body-motor neuron/myelin/axon/NMJ/muscle)? What is the special test to identify this disease?
muscle weakness due to wasting
muscle
Gower’s sign
Is glutamate an excitatory or inhibitory neurotransmitter? What is its precursor?
excitatory
glutamine
What are the 3 ionotropic glutamate receptors? What ions do they conduct?
NMDA = Na+ and Ca2+
AMPA = Na+
Kainate = Na+
What is so special about NMDA receptor channels?
it is blocked by Mg2+ until sufficient depolarization is reached
What are the 2 metabotropic receptors? One is found on the presynaptic cleft and the other on the post synaptic cleft. Which one is excitatory? inhibitory? What G protein do they use?
presynaptic = inhibitory; Gi
Post synaptic = excitatory; Gs
Is GABA an excitatory or inhibitory neurotransmitter? What is its precursor?
inhibitory
Glutamate
What are the 2 GABA receptors? Are they ionotropic or metabotropic? What do they conduct?
GABA-A = ionotropic; conducts Cl-
GABA-B = metabotropic; decrease Ca2+ conductance and increase K+
Is glycine excitatory or inhibitory? What is its precursor? What does its ionotropic channel conduct?
inhibitory
Serine
Cl- conductance
Is acetylcholine excitatory or inhibitory? What is its precursor?
excitatory
choline + acetyl-CoA
Where in the neuron is ACh made?
terminal end of axon (presynaptic bulb)
What are the two types of ACh receptors? are they ionotropic or metabotropic?
nicotinic = ionotropic
muscarinic = metabotropic
Is dopamine excitatory or inhibitory? What is its precursor?
excitatory
tyrosine
Is dopamine released at varicosities?
yes
Dopamine has 2 receptors. One is on the varicosity (presynaptic) and the other is postsynaptic. what do they do? Are they ionotropic or metabotropic?
presynaptic (varcosity) = inhibitory; metobotropic
postsynaptic = excitatory; metabotropic
Is norepinephrine excitatory or inhibitory? What is its precursor?
excitatory
tyrosine
what are the receptors for norepinephrine? are they metabotropic or ionotropic?
alpha and beta receptors
metabotropic
How are monoamines (dopamine, norepinephrine) degraded?
they are reabsorbed via specific transporters
Is serotonin excitatory or inhibitory? What is its precursor?
excitatory
tryptophan
What are group of serotonin receptors called?
5-HT receptors
What are the receptors for neuropeptides called? What do they conduct?
mu-opioid receptors
increase K+ conductance and decrease Ca2+ conductance
What is serotonin syndrome?
increased HR
sweating
dilated pupils
hyperactive bowel sounds
hyperthermia
How do you treat serotonin syndrome?
benzodiazepines
Name 5 opioids that are strong agonists
morphine
methadone
fentanyl
oxycodone
heroin
Name 2 partial agonist opioids
tramadol
tapentadol
Name 1 mixed agonist-antagonist
buprenorphine
name 2 opioids with high affinity but no efficacy
naloxone
naltrexone
What is MAC? how does it relate to potency?
minimum alveolar concentration
potency = 1/MAC
