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peripheral nn disord

peripheral nervous disorders

are the vental or dorsal root fibers more affected in an aging persons PNS? ventral root
T/F Neuropathy is always indicative of a disease process. FALSE it can be a part of normal aging
What vascular events occur with aging and what is the result? athlerosclerosis of blood vessels to nerve resulting in the loss of nerve fibers and peripheral neuropathies.
myelin deterioration occurs with aging secondary due to what and results in what? secondary to decreased protein production and results in diminshed vibratory sense
Why is there ANS dysfunction doe to aging (3 reasons) 1) loss of cell bodies in sympathetic ganglia, 2) loss of unmyelinated fibers in peripheral nerves, 3) decrease of sympathetic control of dermal vasculature
How soon are age related changes seen in the motor endplate (i.e. decade of life)? 3rd decade
What is altered within the motor endplate due to age? sensory receptors, axonal myelination, loss of motor units
What is "aging neuropathy?" the clinical signs of peripheral neuropathy are present but there is no evidence of a neurological disease or disease process
What are some causes of aging neuropathy? loss of motor and sensory cell bodies. dying back condition, comorbidities, nutritional deficiencies, fx, and swelling
How is recovery affected in the aging system? Wallarian degeneration is delayed, reduced density of regenerating axons, and reduced collateral sprouting
What is the response of the peripheral nerve secondary to compression or disease? segmental demyelination
What is the response of the peripheral nerve secondary to physical injury and disease/ directly affects the axon? degeneration (anterograde or Wallarian degeneration)
What are the 3 Seddon Classifications of nerve injury? neuropraxia, axonotmesis, neurotmesis
Neuropraxia results in ___ (axon and/or myelin) which causes ___ speed of an action potential at the point of the lesion. segmental demyelination/ slow or block
Is there atrophy of the nerve in a neurapraxia? no
What could cause neuropraxia? mild ischemia
Axonotmesis is the result of of what (axon and/or myelin)? axon damage but the myelin is still intact
What could cause axonotmesis? infarction and necrosis
Axonotmesis can have regeneration as long as ___. the cell body remains intact if compression is relieved
Neurotmesis is the result of of what (axon and/or myelin)? complete severance of axon and disruption of connective tissue
How fast does a nerve reginerate? 1mm/day
What is mononeurpathy vs. polyneuropathy? mono: one nerve affected, poly: multiple nerves affected
What is radiculopathy vs. polyradiculitis? rad: nerve root affected, polyrad: multiple roots inflamed
T/F A peripheral nerve lesion is when the peripheral nerve is affected and everything above the lesion innervated reamins intact. TRUE
What is affected in a dermatomal pattern? nerve roots or cell bodies
T/F a peripheral nerve degeneration typically affects the shorter nerves nefore the longer nerves FALSE it affects the longest fibers first (LE before UE)
What is paresis vs paralysis? paresis: severe weakness, paralysis: no motor function
What is the most common hereditary neuropathy? Charcot-Marie-Tooth
What systems does CMT affect? sensory and motor
Is CMT usually symmetrical or asymmetrical? symmetrical
What are some clinical signs of CMT? distal symmetrical muscle weakness, atrophy, diminished DTRs (LEs), oes cavus, hammer toes, weak DF and evertors, later involvement of hand intrinsics/ forearm muscles.
What is a clinical difference in CMT1 but minimal in CMT2? sensory signs will be present in both but sensory loss is generally only in type1
T/F Diabetic neuropathy occus in setting of diabetes mellitus with other causes for peripheral neuropathy FALSE without other causes for peripheral neuropahy
How does diabetic polyneuropathy present? distally and symmetrical
What is the cause of diabetic polyneuropathy? chronic metabolic imbalances that affect nerve and schwann cells (high sugar levels are toxic to vascular supply and toxic to the nerve)
What are the classificaiton of a diabetic neuropathy? (5) rapidly reversible, generalized symmetric polyneuropathy, chronic sensorimotor, autonomic neuropathy, focal
What is problematic in rapid reversible diabetic neuropathy? What population does this normally involve? blood sugar needs to be controlled, seen in newly diagnosed diabetics or individuals with poorly controlled diabetes
What are the acute sensory signs of generalized symmetric polyneuropathies? rapid onset of severe burning, sudden deep and sharp pain, "eletric shock" and hypersensitivety of the feet
How will a pt with generalized symmetric polyneuropathies motor and sensory signs present? motor is normal and sensory could have a mild loss of with allodynia (pt has painful response to non-painful stimulus)
Can a person with generalized symmetric polyneuropathy recover? if achieves a stable blood glucose the recovery can occur within a year
What is the most common type of diabetes neuropathy? chronic sensorimotor
What is problematic in chronic sensorimotor DM? blood supply
What are the clinical features (motor and sensory) of chronic sensorimotor DM? sensory loss, small fiber involvement (burning, paresthesia), and large fiber involvement (painless paresthesia, imapired proprioception, touch and pressure, loss of ankle DTRs), mild motor
The pt may be experiencing sweating, orthostatic hypotension, and resting tachycardia in which classification of DM? chronic sensorimotor
How does alcoholic neuropathy present? typically peripheral involvement with distal, symmetrical distribution loss.
What are possible causes of alcoholic neuropathy? toxic effects of alcohol, nutritional deficiencies (thiamine, B vitamins, etc.), accumulation of ethanol
T/F In alcoholic neuropathy all 4 extremities are involved and the UE and more effected than the LE. FALSE the LE> UE
T/F a pt experiencing chronic renal failure will commonly complain a lot of restless leg and in general the LE are mor affected than the UE. TRUE
The pain present in chronic renal failure is due to what? excess nitrogen and waste product
Does chronic renal failure more commonly affect the CNS and/or PNS? both
What disease is the most common to cause acute motor and sensory deficits? Guillain-Barre
What are possible triggers of Guillain-Barre? virus, bacterial, surgery, vaccinations (2/3 report recent infection)
What are the peaks in frequency of GBS? teens to 20s and 50-80s
Are there variants of GBS? yes
How is the progression of GBS and how does recovery occur in GBS? after progession stops there is a static phase (2-4 wks) and then recovery occurs proximal to distal in fashion (months - yrs)
What are possible treatment options for GBS? plasmapheresis and high-does IV immunoglobulins (corticosteroids have not been effective)
What can the PT do for a pt in the initial and early treatment stages of GBS? prevent secondary complications, monitor exercise, positioning, splinting, and muscle pain relief, head-hips realtionship
What percent of polio survivors develop postpolio syndrome? 25-50%
What does polio attack in the body? anterior horn cells of the spinal cord (motor neuron dysfunction)
What are symptoms of polio? muscle strength decline, myalgia, joint pain, muscle atrophy, excessive fatigue, decreased indurance, night pain
What is the prognosis of postpolio syndrome? it is a slowly preogressive disorder with stable periods for 3-10 yrs.
What are PT interventions and are the well tolerated by the pt? pt education for joint integrity, maneuvers, and orthotic prescription (not well tolerated)
What autoimmune disorder effects the NMJ and motor end plate? Myasthenia Gravis
What age and gender is typically more affected by MG? females 20-30s and males 50-60s, females > males
What are additional risk factors of MG? thymic disorders (tumor), throid disorders (hyper, thyrotoxicosis), diabetes, RA, lupus, hormone flucturations
What occurs at the cellular level in MG? decreasde number of ACh receptors and the receptors present are not enough
What are the cardinal features of MG? skeletal muscle weakness and fatigability
T/F MG presents as motor weakness and a change in DTRs FALSE MG only presents as muscle weakness
T/F MG is more notable in dital muscles FALSE proximal
T/F cranial muscles are commonly affected first in MG TRUE (ptosis, diplopia, facial expression and mastication)
What are the three ways to diagnose MG? immunology, phamacological, and electrophysical testing
What are treatments to MG? AChE inhibitor, immunosuppressive drugs, thymectomy, plasmapheresis/IV globulin therapy
What are PT considerations for pts with MG? proximal stabilization for distal use, avoid secondary complications, respiration, energy conservation, strength training
What can cause paraneoplastic neuropathies? cancer treatments and neoplasms
What are 3 changes to the PNS with aging? 1) thicking of perineurium and epineurium 2) fibrous and inc collagen of endoneurium 3) decreased cross sectional area
Why is there a decreased cross sectional area of an aging person's nerves? (hint what is reduced in number) reduced myelinated and unmyelinated fibers
Created by: Leeli.PT



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