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NS_BTRAN > Unit2_SpinalCord+Ojemann Lectures > Flashcards

Unit2_SpinalCord+Ojemann Lectures Flashcards

1
Q

Immediate muscle weakness and hypotonia, hyporeflexia or areflexia (“Spinal Shock”)
Followed by spasticity and HYPERreflexia in days to weeks (including extensor plantar response: Babinski’s sign)
SPASTIC PARESIS

UMN or LMN?

A

UMN

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2
Q

Muscle weakness, hypotonia, hyporeflexia, areflexia are all immediate and long-lasting
FLACCID PARESIS
FASCICULATIONS
ATROPHY

UMN or LMN?

A

LMN

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3
Q

UMN or LMN?

SPASTIC PARESIS

A

UMN

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4
Q

UMN or LMN?

HYPERreflexia in days to weeks (including extensor plantar response: Babinski’s sign)

A

UMN

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5
Q

UMN or LMN?

Immediate muscle weakness and hypotonia, hyporeflexia or areflexia (“Spinal Shock”)

A

UMN

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6
Q

UMN or LMN?

Muscle weakness, hypotonia, hyporeflexia, areflexia are all immediate and long-lasting

A

LMN

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7
Q

UMN or LMN?

~w/ FASCICULATIONS

A

LMN

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8
Q

UMN or LMN?

~w/ ATROPHY

A

LMN

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9
Q

UMN or LMN?

~w/ FLACCID PARESIS

A

LMN

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10
Q

Hypoesthesia: ?

A

decreased sensation

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11
Q

Hyperesthesia: ?

A

excessive sensation

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12
Q

Anesthesia: ?

A

Loss of sensation

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13
Q

Paresthesia: ?

Dysesthesia: ?

A

Paresthesia: numbness, tingling, burning sensation

Dysesthesia same, but usually when this is more unpleasant

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14
Q

Paresis: ?

A

decreased strength

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15
Q

Plegia: ?

A

complete loss of strength

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16
Q

C5 is the _____ reflex

A

biceps

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17
Q

C6 is the _____ reflex

A

triceps

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18
Q

C7 is the _____ reflex

A

Biceps & Brchioradialis

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19
Q

What is the Motor function of C5?

A

Delts, INFRAspinatus, Biceps

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20
Q

What is the Motor function of C6?

A

Wrist Extensors, Biceps

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21
Q

What is the Motor function of C7?

A

Triceps

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22
Q

What is the sensory territory of C5?

A

shoulder, upper lateral arm

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23
Q

What is the sensory territory of C6?

A

1st & 2nd digits of hand

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24
Q

What is the sensory territory of C7?

A

3rd digit

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25
Q

What is the Motor function of L4?

A

Psoas, Quads

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26
Q

What is the Motor function of L5?

A
  • Foot dorsiflexion
  • big toe extension
  • foot eversion & inversion.
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27
Q

What is the Motor function of S1?

A

Foot plantarflexion

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28
Q

What is the sensory territory of L4?

A

Knee, medial leg

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29
Q

What is the sensory territory of L5?

A

Dorsum of foot, great toe

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30
Q

What is the sensory territory of S1?

A

Lat foot, small tow, sole of foot

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31
Q

What is the L4 reflex?

A

Patellar

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32
Q

What is the L5 reflex?

A

NONE!

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33
Q

What is the S1 reflex?

A

Achilles

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34
Q

The _________ reflex elicited by drawing a line away from the umbilicus along the diagonals of the 4 abdominal quadrants. A normal reflex draws the umbilicus toward the direction of the line that is drawn.

A

abdominal

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35
Q

The _________ reflex elicited by drawing a line along the medial thigh and watching the movement of the scrotum in the male. A normal reflex results in elevation of the ipsilateral testis.

A

cremasteric

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36
Q

The ________ reflex elicited by gently stroking the perianal skin with a safety pin. It results in puckering of the rectal orifice owing to contraction of the corrugator-cutis-ani muscle.

A

anal wink

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37
Q

Clinical assessment of Reflexes:

0 = ?
1+ = ?
2+ = ?
3+ = ?
4+ = ?
5+ = ?
A 
0 = Reflex is absent
1+ = trace
2+ = normal 
3+ = brisk 
4+ = nonsustained clonus (i.e., repetitive vibratory movements)
5+ = sustained clonus
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38
Q

Plantar Response is described as what? (3)

A
  • Flexor
  • Extensor (Babinski Sign)
  • Ambivalent
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39
Q

Clinical Assesment of Strength:

0/5: ?

A

(0/5)

no contraction

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40
Q

Clinical Assesment of Strength:

1/5: ?

A

(1/5)

muscle flicker, but no movement

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41
Q

Clinical Assesment of Strength:

2/5: ?

A

(2/5)

movement possible, but not against gravity (test the joint in its horizontal plane)

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42
Q

Clinical Assesment of Strength:

3/5: ?

A

(3/5)

movement possible against gravity, but not against resistance by the examiner

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43
Q

Clinical Assesment of Strength:

4/5: ?

A

(4/5)

movement possible against some resistance by the examiner (sometimes subdivided further into 4–/5, 4/5, and 4+/5)

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44
Q

Clinical Assesment of Strength:

5/5: ?

A

(5/5)

normal strength

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45
Q

List some other additional sensory testing:

A

two-point discrimination

Double simultaneous stimulation (looking for extinction)

Testing higher order (cortical) sensory processing:

      - Graphesthesia
      - Stereognosis-  ability to recognize based on: texture, size, temperature.
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46
Q

What is Cauda Equina Syndrome (ROOTS L1-S5)?

A 
○ EARLY root pain radiating to legs
○ Leg weakness and decreased DTRs (LMN sign)
○ Patchy, ASYMMETRIC “saddle”
○ LATE bladder dysfunction
○ LATE bowel and sexual dysfunction
47
Q

What is Conus Medullaris Syndrome (ROOTS L1-S5)?

S3-S5, tip of cord

A 
○ Supplies bladder, rectum, and genitalia
○ LATE pain in thighs and buttocks
○ Pelvic floor muscle weakness
○ SYMMETRIC “saddle” anesthesia numbness
○ EARLY bladder dysfunction
○ EARLY bowel and sexual dysfunction
48
Q

Thoracic dermatomes:

nipple line = ?
xypoid = ?
umbilicus = ?

A

nipple line=T4
xypoid=T6
umbilicus = T10

49
Q

What is Radiculopathy:

A

Pain = shooting, burning, tingling, numbness
○ Radiates to dermatome or myotome.
○ Localization: determine which root of abnormal muscles and dermatomes have in common.

50
Q

What shows up in the P.Exam of Radiculopathy?

A

LMN signs!

51
Q

What are the common causes of Radiculopathy?

A

Common causes: compression by degenerative joint disease or herniated disc near intervertebral foramen

52
Q

The Sx of Radiculopathy are Exacerbated by?

and relieved by?

A

○ Exacerbation by exam: neck flexion/extension/rotation, shoulder movements, cough, etc.

○ Relieving factors: rest, immobilization, graded therapy, NSAIDS +/- muscle relaxant.

53
Q

pain syndrome arising from spinal cord is called __________ symptoms.

A

Lhermitte’s symptom:

54
Q

In Lhermitte’s symptom, neck flexion results in what?

What what is it due to?

A

Neck flexion results in “electric shock” sensation down back and/or into arms

○ Due to posterior column disease
•

55
Q

Spinal shock: ?

A

Spinal Shock = loss of all neurological activity below level of injury, including loss of motor, sensory, reflex, and autonomic function.

56
Q

The loss of all neurological activity below level of injury, including loss of motor, sensory, reflex, and ANS function is known as what?

A

Spinal Shock.

Loss is BELOW level of injury!

57
Q

hyperreflexia in upper extremity is known as ______ sign?

A

Hoffman’s sign

58
Q

tapping medial aspect of adductor tendons near knee elicits scissoring of both legs is known as the ___________ response.

A

Cross ADDucter response.

59
Q

What is Neurogenic Shock?

A
  • Disruption of descending SNS outflow.

- No SNS response and unopposed Vagal tone.

60
Q

What is Vagal tone?

A
  • activity of the vagus nerve; which originates in the medulla oblongata of the brainstem.
  • PNS branch of the ANS; homeostatically regulates the resting state of the majority of the body’s internal organ.
  • vagal activity is continuous, chronic, and passive.
61
Q

disease affecting nerve roots =?

A

Radiculopathy

62
Q

Radiculopathy is do to?

A

○ Due to posterior/lateral displacement of nucleus pulposus outside → impinges on nerve root and stenosis/occludes the neural foramen → symptoms relative to that root.
○ Pain = shooting, burning, tingling, numbness.

Radiates to dermatome or myotome

63
Q

On exam, is Radiculopathy ~w/ UMN or LMN?

A

LMN!

64
Q

On exam, what are the two signs that are ~w/ Radiculopathy?

A

○ Spurling’s sign

○ Lasegue’s sign:

65
Q

What is a straight leg raising test;

Sciatic nerve test - if sciatic nerve roots are under compression → shooting shock like sensation down legs called?

A

Lasegue’s sign

66
Q

foraminal compression test.

Turn head towards a narrowed neural foramen → tight foramen can cause acute pinching of nerve root → pain radiates out with nerve root into arms.

This is called what sign?

A

Spurling’s sign

67
Q

In Radiculopathy, what are exacerbating factors?

A

neck flexion/extension/rotation, shoulder movements, cough, etc.

Figure this out via P.Exam

68
Q

In Radiculopathy, what are relieving factors?

A

rest, immobilization, graded therapy, NSAIDS +/- muscle relaxants

69
Q

disease affecting spinal cord = ?

A

Myelopathy

70
Q

Myelopathy:?

A

disease affecting spinal cord

71
Q

Central displacement of nucleus pulposus of intervertebral disc out of annulus→ impinge spinal cord is the cause of what?

A

Myelopathy

72
Q

What is the cause of Myelopathy?

A

Central displacement of nucleus pulposus of intervertebral disc out of annulus→ impinge spinal cord.

73
Q

Lhermitte’s symptom ~w/ ?

A

“electric shock” down the back and/or into arms

74
Q

What is Lhermitte’s symptom?

A

pain syndrome arising due to disease of spinal cord (posterior column)

75
Q

pain syndrome arising due to disease of spinal cord is called what?

A

Lhermitte’s symptom

76
Q

Neck flexion results in “electric shock” sensation down back and/or arms is ~w/ ?

A

Lhermitte’s symptom

77
Q

Polyradiculopathy:?

A

impingement of collection of nerve roots within cauda equina (in lumbosacral spine below conus) → can cause problems with bowel/bladder function.

78
Q

What is impingement of collection of nerve roots within cauda equina (in lumbosacral spine below conus) → can cause problems with bowel/bladder function called?

A

Polyradiculopathy

79
Q

What is a physiologic disruption of all spinal cord function called?

A

Spinal shock

80
Q

Spinal shock: ?

A

Spinal shock: physiologic disruption of all spinal cord function

81
Q

What does a Bulbocavernosus reflex indicate?

A

Bulbocavernosus reflex indicates when spinal shock has resolved.

*If B.C. reflex is present and patient still is not moving/no sensation → anatomic transection of fibers.

82
Q

What is a disruption of descending sympathetic outflow called?

A

Neurogenic shock

83
Q

Neurogenic shock: ?

A

Neurogenic shock: disruption of descending sympathetic outflow.

○ No sympathetic response and unopposed vagal tone.
○ Cardiovascular instability
○ Treated with dopamine drip.

84
Q

__________ lesions arise from outside cord.

A

Extramedullary

85
Q

__________lesions: arise within cord

A

Intramedullary

86
Q

The following describes what kind of lesion.

○ Early pain and UMN signs
○ Pain and temperature sensation evolves in ascending fashion (affects sacral, lumbar, then thoracic, etc.)

A

Extramedullary lesions: arise from outside cord

87
Q

The following describes what kind of lesion.

○ Cause early bladder dysfunction with only late development of pain.
○ Loss of pain and temperature progresses in descending fashion (Cervical → thoracic early, then lumbar → sacral later)

A

Intramedullary lesions: arise within cord

88
Q

________ sign = extension of big toe, fanning of other toes → HYPERREFLEXIA

A

Babinski

89
Q

Babinski sign = extension of big toe, fanning of other toes → _____________

A

HYPERREFLEXIA

90
Q

What response involves tapping medial aspect of adductor tendons near knee elicits scissoring of both legs.

A

Crossed adductor response: tapping medial aspect of adductor tendons near knee elicits scissoring of both legs

91
Q

What are the 10 spinal cord lesions?

A
  1. Complete cord transection
  2. Central lesions
  3. Posterior column syndrome
  4. Combined anterior horn cell-pyramidal tract syndrome
  5. Brown-Sequard (hemi-section)
  6. Posteriolateral column syndrome
  7. Anterior Horn Cell syndrome
  8. Anterior Spinal Artery Occlusion
  9. Pyramidal Tract Syndrome
  10. Myelopathy w/ Radicuopathy
92
Q

What are the features of Conus medullaris syndrome: S3-S5, tip of cord?

A 
○ Supplies bladder, rectum, and genitalia
○ LATE pain in thighs and buttocks
○ Pelvic floor muscle weakness
○ SYMMETRIC “saddle” anesthesia numbness
○ EARLY bladder dysfunction
○ EARLY bowel and sexual dysfunction
93
Q

What are the features of Cauda equina: ROOTS L1-S5 syndrome?

A 
○ EARLY root pain radiating to legs
○ Leg weakness and decreased DTRs (LMN sign)
○ Patchy, ASYMMETRIC “saddle”
○ LATE bladder dysfunction
○ LATE bowel and sexual dysfunction
94
Q

What is involved in the neural control of micturition?

A

○ Detrusor (smooth) muscle

○ Involuntary (smooth) sphincter

○ Skeletal muscle of pelvic floor

95
Q

In the neural control of micturition, the Detrusor (smooth) muscle is activated by what?

A

○ Detrusor (smooth) muscle: activated by preganglionic parasympathetic outflow from S2-S4

96
Q

In the neural control of micturition, the Involuntary (smooth) sphincter is controlled by what?

A

○ Involuntary (smooth) sphincter: controlled by sympathetic outflow, T10-L2

97
Q

In the neural control of micturition, the Skeletal muscle of pelvic floor is controlled by what?

A

Skeletal muscle of pelvic floor: innervated by alpha motor neurons, S2-S4

98
Q

What is involved in the higher order control of micturition?

A

○ Forebrain (medial frontal)

○ Pontine micturition center

99
Q

In the higher order control of micturition, the forebrain (medial frontal) does what?

A

Forebrain (medial frontal):

voluntary inhibition of pontine center AND relaxation of voluntary sphincter

100
Q

In the higher order control of micturition, the Pontine micturition center does what?

A

Pontine micturition center:

coordination of sympathetic and parasympathetic centers in spinal cord

101
Q

When the bladder does not contract → overflow incontinence; this is called what?

A

Flaccid Bladder

102
Q

What is injured in Flaccid Bladder?

A

Parasympathetic lower motor neuron injury, axon compression/disruption

103
Q

Descending pathways cut or injured (BILATERALLY) → UMN injury; will result in what bladder issue?

A

Spastic Bladder

initial flaccidity of bladder, then spasticity

104
Q

Urinary frequency and urgency ~w/ what bladder issue?

A

Spastic Bladder

105
Q

Problems with coordination between sympathetic outflow (inhibited during voiding) and parasympathetic outflow (activated during voiding) is what bladder issue?

A

Spastic Bladder

106
Q

Injury above S2-S4 (PNS of detrusor m.) –> what?

UMN or LMN

A

UMN

107
Q
  • ___ dermatome = nipple line
  • ___ dermatome = xiphoid process
  • ___ dermatome = umbilicus
A
  • T4 dermatome = nipple line
  • T6 dermatome = xiphoid process
  • T10 dermatome = umbilicus
108
Q
  • T4 dermatome = ______________
  • T6 dermatome = ______________
  • T10 dermatome = ______________
A
  • T4 dermatome = nipple line
  • T6 dermatome = xiphoid process
  • T10 dermatome = umbilicus
109
Q

In the Neuro Exam, how do you test for the following?

Discriminative Touch →

A

Discriminative Touch → q tip testing light touch

110
Q

In the Neuro Exam, how do you test for the following?

Vibration →

A

Vibration → use tuning fork to test vibration sense

111
Q

In the Neuro Exam, how do you test for the following?

Joint position →

A

Joint position → toe down towards the floor or up to ceiling

112
Q

In the Neuro Exam, how do you test for the following?

2-point discrimination →

A

2-point discrimination → paperclip, feel 1 point or two?

113
Q

In the Neuro Exam, how do you test for the following?

Pain and temperature →

A

Pain and temperature → safety pins (sterilized) and cold handle of reflex hammer

NS_BTRAN (21 decks)

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