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CNS > Where in the PNS > Flashcards

Where in the PNS Flashcards

1
Q

What does the Cauda Equina enTAIL lmaozedong

Whats Sciatic Nerve

A

L1-L5
S1-S5

L4-S3

Sciatic Plexus is L4-S4

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2
Q

Give the components of PNS after spinal cord exit

A

Roots - Plexus - Nerve

  • NMJ
  • Muscle
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3
Q

How to distinct between Nerve and NMJ-Muscle problem

A

If Nerve - Sensory impairments;
If Nerve - complete NO REFLEX

  • Weak Reflex nia - BOTH NMJ-Muscle
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4
Q

NMJ vs Muscle lesion
- Presentation - Compare and Contrast

Note:

Fasciculations arise as a result of spontaneous depolarization of a lower motor neuron

A

Muscle Weakness
- WASTING, sometimes Pseudohypertrophy

NMJ

  • NO wasting, NO fasciculations
  • Ocular weakness in Myasthenia Gravis
  • FATIGUE
  • Both have Proximal Weakness, Weak Reflex, No sensory loss
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5
Q

Name a congenital Myopathy and describe pathogenesis and effects;

A

Duchenne Musculat Dystrophy

    • XLR
  • mutated dystrophin
  • needed for membrane stability - sarcolemma;
    • Ca2+ enters, muscle die, hypertrophy
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6
Q

Myasthenia Gravis

  • pathogenesis
  • all symptoms
  • drugs
A

AchRAb against AchR - competitive inhibition
- Ach is exhausted + normal breakdown by AchE

Myasthenia gravis also affects eyes (special case);
- Fatigability is a symptom;
- Muscle wasting, pseudohypertrophy
(notes said no wasting, PH for NMJ but lecturer said yes)
– maybe for MG can

neostigmine and pyridostigmine - AE: diarrhoea
- AchE inhibitors

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7
Q

Peripheral Neuropathy

  • presentation principal
  • name some causes
A

Longer nerves more vulnerable to systemic insults

  • all nerves beyond a certain point will be affected;
  • Weakness distribution is called “glove and stocking”
  • Fasciculations, No reflexes, Wasting, Hypotonia
  • SENSORY LOSS;
  • Diabetes
  • Guillain Barre Syndrome
    • think Campylobacter Jejuni, CMV
    • Type II HS;
  • B12 deficiency
    • think Posterior Cord Syndrome
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8
Q

Nystagmus
Diplopia

  • suspect where?
  • Note Monocular is when close other eye still see it;
    otherwise is Binocular Diplopia; Monocular is eye problem;
A

Nystagmus
- eyes make repetitive, uncontrolled movements
- think Cerebellum; Vestibulocerebellar
can have others - thiamine deficiency, Chiari Malformation
- BS also can; Multiple Sclerosis also can

Diplopia

  • Double vision
  • can be alot
  • think CN346 eye problems; extraocular muscles hence CN nerves, or NMJ for Myasthenia Gravis
  • BS can, Cerebellum can also cos of Vestibulocerebellar (googled);
    • Myasthenia Gravis (for NMJ), ANTIPSYCHOTICS
    • GBS, Multiple Sclerosis - Neuropathies
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9
Q

Cannot name pen or watch

Right hand weakness

A

Left hemisphere lesion
Broca’s Area - Left Frontal Cortex - speech production

  • Wernicke’s at temporal/parietal (Left)
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10
Q

Weakness of climbing stairs

Double Vision

A

Assuming no sensory complain
- Think NMJ+Muscle

Double vision
- NMJ, Myasthenia Gravis possible

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11
Q

Numbness and weakness in hands and feet, Absent reflexes;

A

Sensory involvement

- Peripheral Neuropathy

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12
Q

Peripheral Neuropathy causes

  • Categories by Systemic, Drugs
A

Systemic Diseases

  • Diabetes
  • B12 deficiency
  • GBS Type II HS

DRUGS

  • FQ, Metronidazole
  • Isoniazid, Ethambutol
    • Isoniazid treat w B6 Pyridoxine
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13
Q

Differentiate presentation of peripheral neuropathy and myopathy

Further differentiate between NMJ and Muscle problem

A

PN presents as
- sensation loss at Glove and Stocking distribution

Myopathy presents as
- proximal weakness, no sensory

  • BOTH NMJ and MUSCLE
  • no sensory loss, reflex weak/NORMAL
  • muscle problem leads to wasting

NMJ no wasting but have fatigability and in Myasthenia Gravis ocular weakness

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14
Q

Mononeuropathy time!

Median Nerve time

  • innervation motor, sensory
  • lesion
A

Median Nerve - C5-T1

ALL wrist flexors, pronator teres
(except flexor carpi ulnaris)
Thenar eminence - OAF;
Lumbricals (2)

Sensory 3.5 fingers + fingertips;

Lesion - hand of benediction
- cannot make a fist
- loss of extension of IP
- loss of flexion of IP
Sensory Loss

Lesion - carpal tunnel syndrome

  • Thenar wasting - LMN lesion
  • cutaneous sparing of sensation - cutaneous sensory nerve
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15
Q

Ulnar Nerve time

  • innervation motor, sensory
  • lesion
A

Ulnar Nerve - C8 T1

  • Hypothenar Eminence
  • 2 Lumbricals
  • Interossei
  • ADDUCTOR pollicis

Sensory to 1.5 fingers on both sides

Lesion - Ulnar Claw

  • cannot extend IP joints cos of Lumbricals
  • MCP joint extended cos of Interossei cannot flex
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16
Q

Radial Nerve time

  • innervation motor, sensory
  • lesion
A

Radial Nerve - C5-T1

  • Triceps Brachii
  • Brachoradialis, Supinator, Wrist extensors
  • Snuffbox sensation

Lesion - Wrist drops

17
Q

Femoral N

Obturator N

A

L2 3 4

Femoral - anterior compartment of thigh
- Quads

Obturator - medial compartment of thigh
- adductors

18
Q

Sciatic N

Lesion at Pelvis
Lesion at Head of fibula

A

L4-S3

Sciatic nerve innervates Hamstring for hip extension, knee flexion
Gives tibial nerve; and Common peroneal nerve;
Tibial: Posterior leg, plantar foot
CPN: Anterior and Lateral leg;

Pelvis:

Weak hip extension
Weak knee flexion
Weak dorsiflexion - foot drop AND Weak plantarflexion

Fibula; Common Peroneal Nerve gone
Foot drop but Strong plantar flexion
Strong hip extension
Strong inversion - tibialis posterior Tibial N ok
- inversion is sole face in;
19
Q

Leg compartments

A

Anterior + Lateral by Common Peroneal Nerve
- Dorsifexion and eversion
Posterior by Tibial Nerve
- Plantar flex

20
Q

Sensation nerves

Dermatome description

A

Thigh mostly femoral; medial is obturator

LEG and feet by Sciatic; medial is femoral Saphenous

L1 L2 L3 thigh;
L4 L5 S1 Leg
S2 rise up;

21
Q

Brachial Cords to Nerves

A

Posterior - Axillary and Radial
Lateral - MLC
Medial - Ulnar

Medial Nerve - both Lateral and Medial cord

22
Q

What does upper plexus supply

Lower plexus?

A

C5 C6
- MLC - BBC
+ ROTATOR CUFF

C8 T1

  • Ulnar, Median, Radial
    • More so muscles of HANDS;
23
Q

Erb’s Palsy

A

C5-C6 gone

MLC - C567
Axillary - C5 C6
Suprascapular - Rotator Cuff - C5 C6

  • Winging of scapula
  • Radial nerve for wrist and finger extension gone too;
    • Fingers and Wrist flexed - “waiter’s tip”
  • Shoulder rotated forward - i think cos pec major pull;
    • Note rotator cuff is for external rotation of shoulder
24
Q

C8 T1
Klumpke’s Palsy
- nerves affected and presentations

A

Median
Ulnar
Horner syndrome from T1 sympathetic outflow
- Ptosis, Miosis, Sweating problems

25
Q

Lumbar Plexus
Sacral Plexus

Sciatic Nerve
Gluteal Nerve

A

T12-L4
L4-S4

SN: L4-S3
Gluteal Nerve: L5-S2

CNS (20 decks)

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