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Medicine Podiatric > wk 2- neuro > Flashcards

wk 2- neuro Flashcards

1
Q

issues of neuropathy (sensory/motor)

A

loss of sensation
- repetitive trauma
-unaware of injuries
- loss of proprioceptive feedback - impacting muscle tone and posture, gait and foot structure

motor deficits
- reduce muscle tone, strength
- gait changes / loading issues

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2
Q

diagnostic approach

A
  1. locate lesion
  2. find pathophysiology causing lesion
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3
Q

nervous system made up of what systems

A
  1. CNS: brain and spinal cord
  2. PNS: Afferent (sensory), efferent (motor)
  3. somatic: voluntary nervous system
  4. autonomic nervous system: involuntary (regulates bodies organs
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4
Q

what controls movements and what makes up the motor pathway

A

motor cortex which involves upper and lower motor neurons when descending down the body

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5
Q

what controls regulatory actions

A

basal ganglia and cerebellum

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6
Q

the motor cortex controls what?

A

the contralateral side of the body

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7
Q

Upper motor neuron tracts where

A

cerebral cortex to anterior/ventral horn (spinal cord)

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8
Q

lower motor neuron tracts where

A

anterior/ventral horn (spinal cord) to peripheral nerve that synapses at neuromuscular junction

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9
Q

symptoms of an UMN lesion

A
  • increased tone
  • hyper reflexia
  • babinski sign present
  • no muscle twitching/spasicity

occurs when theres a lesion above anterior/ventral horn

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10
Q

examples of UMN lesion pathology

A

stroke
cerebral palsy
multiple sclerosis

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11
Q

symptoms of LMN lesion

A

-decreased tone
-hypo reflexia / absent
- no babinski sign
- muscle twitching/spasicity

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12
Q

exmaples of LMN lesion pathology

A

poliomyelitis
nerve entrapment

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13
Q

sensory pathways

A

3 main pathways

  1. Dorsal column-medial leminscal pathway: fine touch and vibration, crosses over in the
    brainstem
  2. Spinothalamic pathway: coarse touch & pressure,
    pain and temperature; cross over in spinal cord 2-3
    levels above entry
  3. Spinocerebellar pathways: convey information re
    muscle stretch to ipsilateral cerebellum
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13
Q

autonomic system is made up of

A
  1. parasympathic system- rest and digest
  2. sympathetic system- fight or flight
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13
Q

dermatomes/myotomes in the lower leg

A

L3- knee extensors
L4- ankle dorsiflexors
L5- long toe dorsiflexors
S1- ankle plantarflexors
S2- knee flexors

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14
Q

imaging/investigations for nerves

A

CT and MRI
nerve conduction tests
serum and CSF testing

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15
Q

seizure is

A

sudden, abnormal electrical discharge in the brain

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16
Q

epilepsy is

A

tendency to experience recurrent seziures

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17
Q

seizure classification

A
  1. simple partial/focal- no LOC
  2. complex partial/focal- Reduced consciousness
  3. generalised- LOC
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18
Q

stroke and clinical features

A

block of blood flow to the brain

F- face or mouth drooped?
A- can they lift arms up?
S- slurred speech? can they undertsand you
T- time is critical call 000 if any signs

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19
Q

cerebral palsy

A

impaired voluntary movement due to brain prenatal development malformations or peri/postnatal brain injury

manifests by age 2
non progressive

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20
Q

different presentations of CP

A
  • spastic syndromes- causes weakness/stiffness in legs, resistance to passive movement. (70%)

-athetoid / dyskinetic syndromes- slow, writhing, worm like movements

  • ataxic syndromes- weak, tremor, wide base
  • combination of these is also common
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21
Q

other clinical features of CP

A

-misalignment of eyes
-normal intelligence in hemiplagia/paraplegia
-foot deformities: equinas, planovalgus, equinovarus

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22
Q

diagnosis of CP

A

neuro imaging (MRI)
blood tests- screen for metabolic disease

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23
Q

CP management

A
  1. stretching for ROM, strengthening muscles and facilitating correct movement patterns
  2. braces and orthoses
  3. spasticity medication - baclofen
  4. botulinum injections - prevent uneven muscle pulls/fixed contractures
  5. surgery tendon release/transfer to improve joint range/alignment
24
Q

parkinsons

A

progressive, degenerative neurological disorder causing
parkinsonism (tremors, rigidity, postural instability, slow movement)

25
Q

patho of parkinsons

A

degeneration or injury to dopaminergic circuits in the basal ganglia,
impacting direct and indirect pathways of motor function

26
Q

risk factors for parkinsons

A

family history
male
head injury
pesticides exposure
rural living

27
Q

clinical features of parkinsons

A
  • resting tremor
  • rigidty
  • slow movement
  • postural instability
  • can be with dementia, autonomic or neuropsychiatric symptoms
28
Q

friedreich’s ataxia

A

progressive loss of voluntary muscle coordination, obstructive cardiac hypertrophy, and development of DM

29
Q

friedrecichs ataxia clinical features

A

-delayed motor milestones
-tendency to stagger / fall
-distal muscle weakness greatest in peroneal
-cavus foot type with contracture of digits
-wide base gait

30
Q

difference between incomplete and complete injuries to the spinal cord

A

incomplete- partial preserving of function below level and bowel and bladder

complete- complete loss below including bowel and bladder dysfunction

31
Q

spinal cord ASiA classification

A

grade A- complete loss of sensory and motor below level of injury
Grade B- incomplete sensory loss, complete motor loss below level
Grade C- incomplete motor, muscle strength less than 3/5
Grade D- incomplete motor, muscle strength 3/5 or more
Grade E- normal sensory and motor

32
Q

Spina bifida

A

Congenital brith defect that occurs when the neural tube that forms the spinal cord does not close properly during foetal development

33
Q

Types of Spina bifida

A
  1. Occulta
  2. Meningocele
  3. Myelomeningocele
34
Q

Cauda equina

A

Acute onset of lower limb neurological symptoms (radicular pain, weakness, sensory changes) and urinary and bowel dysfunction

Emergency can lead to permanent changes

35
Q

Radiculopathy

A

Nerve root compression

36
Q

Symptoms of Radiculopathy

A

Pain
Numbness

Flaccid motor weakness- emergency if this symptom occurs to avoid permanent disability

37
Q

MS affects what nerve fibres

A

Central nerve fibres

38
Q

GBS affects what nerve fibres

A

Peripheral nerve fibres

39
Q

MS

A

Thought to be linked to an immunological process

Disseminated patches of demyelination in the brain and spinal cord

-common in women around 20-40y

40
Q

Clinical features of MS

A
  • paraesthesia
    -weakness
    -clumsiness
    -visual disturbances
41
Q

MS diagnosis

A

MRI of brain and spinal cord
CSF analysis

42
Q

MS management

A

Medicine
1. immunotherapy early during onset
2. cortciosteroids for relapses
3. neurpathic pain medicines for symptoms (antidepressants/anticonvulsants)

43
Q

GBS

A

rapidly progressive but self limiting inflammatory polyneuropathy

involves the demyleination of peripheral nerves resulting in weakness and sensory loss in LMN

44
Q

GBS clinical features

A

ascending, symmetrical weakness and paralysis (starts with lumbs then goes to arms) with associated parasthesia

45
Q

GBS management

A
  1. hospital
    -IV fluids
    -respiratory support
    -physical therapy

IV immunoglobin can shorten hospital stay

46
Q

chronic peripheral polyneuropathy

A

symmetrical, bilateral parathesia in glove and stocking dsitrubition with feet affected first

burning sensation in feet, often at night

47
Q

diagnosis of chronic peripherl polyneuropathy

A

loss of sensation distally
reduced vibration and propriception

48
Q

hereditary peripheral neuropathy

A

CMT

49
Q

CMT

A

autosomal dominant condition, that is slowly progressive sensory and motor peripheral neuropathy

doesnt affect lifespan

50
Q

clinical features of CMT

A

-pas cavus
-hammer toes
-gait disturbances, foot drop
-equinovarus deformity
-muscle weakness
-stork leg appearance- due to distal wasting
-glove and stocking
-loss of reflexes

51
Q

management of CMT

A
  1. braces/orthoses for foot drop
52
Q

Peroneal nerve palsy

A

compression of the nerve against lateral fibula neck

common in thin patients who cross legs

53
Q

clinical featues of peronela nerve palsy

A

weakness in dorsiflexion and eversion causing foot drop
sensory changes in lower limb that it innervates

54
Q

myasthenia gravis

A

acquired autoimmune disorder

chronic, progressive weakness of of voluntary skeletal muscles

55
Q

Motor neuron disease

A

incurable
neurodegenerative disease of motor neurons (UMN, LMN)

death usually within 3 years of diagnosis

56
Q

clinical features of MND

A

limb weakness
progresses to trips falls

57
Q

muscular dystrophy

A

two types
duchenne muscular dystrophy and
becker muscular dystrophy

X-linked recessive disorders
progressive proximal muscle weakness caused by muscle fibre degeneration

DMD is worse

58
Q

MD management

A
  1. active/passive exercises
  2. braces/orthoses
  3. daily prednisone, extends period of mobilisaiton, improves lungs and heart function, improves survival with DMD
59
Q
A

Medicine Podiatric (13 decks)

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