The Nervous System Flashcards
1
Q
A-alpha neural info:
A
Tbc
2
Q
A-delta neural info:
A
Afferent Temperature and touch
3
Q
Meissner’s corpuscle
A
- function: Exact location/texture
- location: Non Hairy
4
Q
Hair end organ
A
- function: Continuous touch
- location: Skin
5
Q
Ruffini’s end-organs
A
- function: Continuous state deformation
- location: Deep skin & joint capsule
6
Q
Pacicnian corpuscles
A
- function: Rapid movement/vibration
- location: Skin and deep fascia
7
Q
Muscle spindle (annulospinal ending)
A
- function: Dynamic and static posture changes
- location: Muscle
8
Q
Muscle spindle (flower spray ending)
A
- function: static posture changes
- location: Muscle
9
Q
Golgi tendon organ
A
- function: tension in muscle unit
- location: tendon
10
Q
1) Nerve cell components
2) peripheral nerve fiber components
3) peripheral nerve
A
1) cell body, dentrite, axon
2) axon, myelin, ranvier node, nucleus, cytoplasm, neurofibrils
3) epineurium, perineurium, endoneurium, blood vessels, sensory & motor nerve fibers bundles
11
Q
Describe the area of skin innervated by the follow dermatome:
- C5
A
Shoulder, the front of the arm, the forearm as far as the base of the thumb
12
Q
Describe the area of skin innervated by the follow dermatome:
- C7
A
Back of the arm and forearm to the index finger,middle & ring fingers
13
Q
Describe the area of skin innervated by the follow dermatome:
- L3
A
Upper bottomless, inner and front of thigh, as far as the med malleolus
14
Q
Describe the area of skin innervated by the follow dermatome:
- L4
A
Ant and med aspect of the leg, the medial side dorsum of the foot, hallux
15
Q
Describe the area of skin innervated by the follow dermatome:
- S2
A
Back of the thigh, leg, sole and the plantar aspect of the heel
16
Q
Describe the area of skin innervated by the follow dermatome:
- S4
A
Saddle area, anus, perineum,scrotum, penis, inner upper thigh
17
Q
Describe the area of skin innervated by the follow dermatome:
- T1
A
Inner side of the forearm as far as the wrist
18
Q
What embryological segments are the following tissues derived?
A- capsule of the shoulder joint
B- gall bladder
C- supraspinatus
D- Triceps
A
A: C5
B: C4-T7
C: C5
D: C7
19
Q
What embryological segments are the following tissues derived?
E: AC joint
F: Diaphragm
G: Heart
H: Hip joint capsule
A
E: C4
F: C3-4
G: C8-T4
H: L2-L3
20
Q
What embryological segments are the following tissues derived?
I: Quadriceps
J: Gastrocnemius
K: L1 vertebrae
A
I: L3-4
J: S1
K: T12-L1
21
Q
Name two tests for each of the following areas to assess the mobility of the dura mater.
- Lumbar levels
- Thoracic levels
A
Lumbar levels:
- SLR, PKB, Slump
Thoracic:
- Slump, scapular approximation, T1 dural stretch
22
Q
What fingers would be affected by pressure on the C7 nerve root?
A
2,3,4
23
Q
Classify the following tissues as inert or contractile:
- Muscle, ligament, tendon, capsule, fascia, bursa, attachments to periosteum, Dura mater, nerve root
A
Connective:
- mm, lig, tendon, attachment to periosteum
Inert:
- capsule, fascia, bursa, dura, nerve
24
Q
What does the following Hx suggest?
- pain staying in the back as it moves to the leg?
A
- Discogenic symptoms progressing to radicular (mechanical or inflammatory)
- referred (embryological) from structures on the lumbar segment (ie. Facet)
25
What does the following Hx suggest:
Unilateral leg pain on standing for 10 minutes?
- Discogenic protrusion resulting from "creep" of the disc connective tissue impacting on the radical of the nerve on one side.
26
What does the following Hx suggest?
Unilateral leg pain on walking for 10 minutes:
- Suspect unilateral lateral stenosis of the IVF if relieved quickly with lumbar flexion or side flexion,
- Be suspicious of intermittent claudication in the lower extremity (femoral artery) pain relieved with rest, to effect noted with lumbar movement, pain returns with walking
27
What does the following Hx suggest?
Hip pain at the age of 15:
- Slipped femoral epiphysis
28
What does the following Hx suggest?
Knee pain at age of 15. On exam, full ROM, all resisted tests normal:
- Slipped femoral epiphysis
29
What does the following Hx suggest?
Hip pain at the age of 5:
- Leg Perthes Disease
30
What does the following Hx suggest?
Hip weaknees noted early as the child's normal walking milestone is significantly delayed:
- Suspect neurologically based development or orthopaedic disease. Referral to paediatric specialist is required
31
What does the following Hx suggest?
L3 pain with a painful cough
- Acute L3 disc prolapse impacting structures like the nerve root and and the disc
32
List 4 possibilities of warmth surrounding a joint?
- RA
- OA
- Haemarthrosis (bleed into joint space)
- Infection
33
What is a capsular pattern?
Limitation of passive movements in a specified proportion to each other
34
What is the capsular pattern of the shoulder
ER> abduction, IR
35
What is the capsular pattern of the ulno-humeral joint?
Flexion>extension
36
What nerve root could be involved if elbow flexion is weak?
- C5 + C6
37
What nerve is involved in each case if weak elbow flexion is accompanied by:
- weak abduction at the shoulder
- weak extension at the wrist
- weak abduction at the shoulder: C5
| - weak extension at the wrist: C6
38
Pressure on which nerve roots would produce the following signs?
- Weakness of supraspinatus:
- Weakness of triceps:
- Weakness of infraspinatus:
- Weakness of biceps:
- Weakness of supraspinatus: C5
- Weakness of triceps: C7
- Weakness of infraspinatus: C5
- Weakness of biceps: C5-6
39
Pressure on which nerve roots would produce the following signs?
- Pins and needles in the thumb and index fingers
- pins and needles in the long, ring and index fingers
- Absence of triceps reflex
- Weakness of small muscles of the hand
- Pins and needles in the thumb and index fingers: C6
- pins and needles in the long, ring and index fingers: C7
- Absence of triceps reflex: C7
- weakness of small muscles of the hand: C8
40
Is calcification of the supraspinatus tendon painful?
No, not necessarily if there is no inflammation. Calcification does not hurt on its own.
41
Name three types of arthritis at the shoulder joint?
- RA
- OA
- traumatic immobilization arthritis
42
Is the disc innervated? If so how much?
Yes, peripheral 1/3
43
Can a single disc protrusion cause an L4-L5 palsy?
Yes. A L4 lateral protrusion will impact the L4 root. If this has a posterior component it will impact the L5 nerve root as it continues in the central canal on its was to exit L5 IVF
44
Will a nerve trunk/root produce pain if subjected to pressure?
Nerve trunks typically will not cause pain. (Tingling/weakness/paresthesia). Surrounding structures may become inflamed around the trunk and therefore cause pain
45
What might be the reason for an X-ray failing to detect Spondylolethesis?
- May be missed if taken in non-weight bearing.
| - Look for a step deformity in standing
46
What level does a painful SLR indicated immobility at?
- L4-5
47
What roots can be tested with prone knee bend
L2-3
48
List one possibility of?
- painless weakness of deltoid:
- weakness of deltoid, bicep, supraspinatus and infra:
- painless weakness of supraspinatus:
- painful and weak supraspinatus:
- painless and weak supraspinatus and infraspinatus
- Axillary nerve palsy
- C5
- rupture of supraspinatus
- 2nd degree strain
- Suprascapular nerve palsy
49
List one possibility of:
- painless weak SA:
- painless weak trap:
- Painless weak infraspinatus
- painless weak triceps and wrist flexors
- painless weak biceps and wrist extensors
- long thoracic nerve palsy
- Spinal accessory nerve + C4
- Rupture
- C7 compression
- C6 compression
50
Differentiate low and high irritability:
High:
- low activity causes high degree of pain
Low:
- high activity causes a low degree of pain
51
Describe what a patient with radicular pain would feel?
- Sharp distinct linear pain. Deep and unrelenting pain following an embryological segment
52
Is radicular pain always direct mechanical pressure?
No, because the inflammatory component can irritate the nerve root
53
List 4 clinical possibilities for dizziness
- Vertebral artery pathology: trauma, injury, stenosis, plaque
- Labyrinthe and vestibular apparatus
- Upper cervical joint proprioception dysfunction
- brain/ cerebellar pathology
54
What are the vertebral basilar insufficiency symptoms
5D's
| - dizzy, drop attack, dysphasia, dysarthria,diplopia
55
Name 4 cord signs
- Hyperreflexia
- babinski (extension- up turning toes)
- wide base gait
- bowel/ bladder signs
56
What does babinski, Oppenheimer, and Hoffman test suggests
The pressence of these reflexes suggests a loss of inhibition from CNS (UMN)
57
What is the Oppenheimer test?
Down going toes when the noxious stimulus is applied to the tibial crest
58
What is the Hoffman's reflex?
Flick of the finger tip of the 3rd finger produces opposition of the thumb and index finger
59
Differentiate between cauda equina and cord signs
Remember the pathology is affecting the roots and the category is classified as a LMN pathology and not the UMN (SC).
- Lumbo-sacral root signs (LMN) = hyporeflexia & can be multisegmental (likely bilateral), sensation (light touch) (bilateral and multisegmental) loss in a dermatomal distribution, key muscle loss ( multisegmental and bilateral).
- Bowel and bladder signs: hypotonic (dribbling). Low tone and no capacity to fill, the sphincter is hypotonic and will not hold back the flow compared to a hypertonic UMN SC lesion bladder which has urgency with sudden evacuation
60
Approximately where does the SC end?
T12-L1,2
- large posterior herniations at L3-L4-L5 will not compress the SC but will impact the cauda equina.
61
List the key muscles for L2-S2
ie. "Myotomes"
- L1-2: Hip flexion
- L3: Knee extension
- L4: DF
- L5: great toe extension/ hip abduction
- S1: PF/eversion/ knee flexion
- S2: hip extension/ knee flexion
62
List 3 UMN signs of the lower quadrant
- Plantar response (babinski)
- Oppenheimer
- Clonus
63
Name the 3 neural mobility tests for the lower quadrant
- Slump
- SLR
- PKB
64
Where do you find the femoral pulse?
- Inferior to the inguinal ligament at the midpoint
65
The iliac crests are usually in line with L ____ interspace?
L4-5
66
What can be assessed in the popliteal fossa
- Tibial nerve
- Popliteal artery
- Popliteus mm
67
Name 2 tests for the ACL
- Lachman's
| - Anterior drawer
68
Name 6 structures running between the Achilles tendon and the medial malleolus
Tom dick and not harry "stiles"
- Tibialis Posterior
- Flexor digitorum longus
- Posterior tibial artery
- Tibial nerve
- Flexor Hallucis longus
- Long saphenous vein
69
List C1-T1 key muscles
```
C1-2: Short neck flexors
C3-4: shoulder elevation
C5: Shoulder abduction
C6: Elbow flexion, wrist extn
C7: Elbow Extension, wrist flex
C8: thumb extension
T1: intrinsics, 5th abduction
```
70
List the neural mobility tests of the upper quadrant
- ULTT: radial, ulnar, median X 2
- slump
- passive neck flexion
- Scapular retraction (T1)
71
What must be assessed prior to vertebral artery Ax?
- neurological exam: 5D's, 3N's, URTI, headache Q's
- AROM
- Craniovertebral stability: Spurlings, sharp purser (AA), ant sheer, distraction,
-
72
List symptoms of vertebral artery dysfunction
- Diplopia
- Dysarthria
- Dysphasia
- Drop attack
- Dizziness
- vertigo
- Nystagmus
- Ataxia
- Peri-oral numbness
- B&B dysfunction
73
List symptoms of SC lesions
- Hypertonicity
- Quadrilateral paraesthesia
- Ataxia
-
74
List one muscle in which a true myotome exists
- Multifidus
- Rotators
- Suboccipitals
75
Failure to fuse during the 2nd decade results in which condition found in the upper cervical spine?
- Os odontoidium
76
List 3 congenital anomalies in the upper limb?
- Bifid clavicle
- cervical fusion
- Scalene anticus
77
List 3 congenital abnormalities of the lower limb
- Anteversion of the hip > 15 degrees
- Patella Baha
- Extra growth of the navicular
78
Name a difference b/w peripheral nerves and nerve roots as it relates to blood supply
- Nerve roots have more limited blood supply
| - Nerve roots are more at risk of ischemia
79
speed conduction of a nerve depends on 2 factors
- Diameter of the nerve fiber
| - myelination
80
Name 2 mechanoreceptors
Look up
81
Where is the proposed location of the "gate controlled theory"
- Substantial Gelatinosa (lamina 5 of dorsal horn)
82
Clue to differentiate Mechanical vs. Inflammatory pain
Mechanical pain is: intermittent
| - AM stiffness
83
What is root pain / neuropathic pain?
- laminating pain
- remember compression of an uninsured nerve is paresthesia and not pain
- intra/peri- neural edema may produce nerve root ischemia, which cause radicular symptoms = lancinating/ shooting pain
84
5 ways that pain can be categorized
- Nociceptive
- Neuropathic
- centrally evoked (anxiety)
- psychological facts
- social/ environmental factors
85
When listing structures and related pathology...what 7 things should we keep in mind?
- anatomical components
- how does the structure react when injured (mm vs. Nerve)
- what might refer to that spot?
- how do you assess those structures, what are the signs?
- what is a +ve tests
- what Hx precipitates such an event
- age predictors?
