CMT & Sciatica - Medicine Exam 1 Rated A+, Exams of Nursing

Download CMT & Sciatica - Medicine Exam 1 Rated A+ and more Exams Nursing in PDF only on Docsity! CMT & Sciatica - Medicine Exam 1 Rated A+ -clawing of the toes (extensor substitution) -hindfoot varus -"peek-a-boo" heel sign - ANSWER-What is the appearance of a CMT foot? -consider the deforming forces -improve pronation forces -improve dorsiflexion (drop-foot deformity) - ANSWER-What is the objective of a tendon transfer in a CMT patient? -create a stable, pain-free, functional limb -fixed deformities need to be corrected -prevent recurrence of the deformity -address the deforming force - ANSWER-What are principals of surgical correction in a CMT patient? -decreased number of myelinated fibers in the peripheral nerves -enlarged endoneurium -some posterior column degeneration - ANSWER-What is the histopathology of CMT? (nerve biopsy) -Foot orthoses (lateral FF elevated, 1st ray able to bear weight on ground to keep STJ in NP) -shoe modifications -braces/AFO -physical therapy - ANSWER-What are some non-surgical treatment options for flexible CMT? -genetic testing -EMG/NCV -nerve biopsies - ANSWER-What are potential lab studies for CMT? -hindfoot varus -FF equinus -plantarflexion of 1st MT (FF valgus) -plantarflexion of FF/midfoot on RF -pseudoequinus - ANSWER-What are some features of a CMT foot (deformities) -inspection of back/posture (look for spinal curvatures) -ROM (possible arthritis, ankylosing spondylitis) -straight leg raise test (Lasegue test) - ANSWER-What is involved in the PE of a individual suspected of having sciatica? -NSAIDs -Muscle relaxants - ANSWER-What are the medication treatments for sciatica? -peroneus longus -deep posterior muscle group (tibialis posterior) -Achilles tendon - ANSWER-What are the main deforming forces on the CMT cavus foot -physical therapy/chiropractic adjustments -spinal injections -yoga, acupuncture, trigger point injections - ANSWER-What are other treatments for sciatica? -skeletal realignment of deformity -improve muscle function w/realignment -stepwise reconstruction - ANSWER-What are the goals of osseous surgery for CMT? -spinal radiographs -MRI/CT imaging of spine -NCV/EMG to evaluate velocity/magnitude of impulses - ANSWER-What diagnostic tests would you order to evaluate for sciatica/nerve root compressions? -steppage gait (dorsiflexion weakness, fixed equinus, proprioception difficulties) -lateral ankle instability - ANSWER-What should you look for in a gait analysis of suspected CMT -strength of ankle and great toe dorsiflexion will be diminished -numbness lateral leg, medial foot and 1st interdigital space - ANSWER-What is seen on a L5 lesion? -tendon rebalancing/transfers -plantar fascia release/Steindler stripping -jones tenosuspension -TAL - ANSWER-What are examples of soft tissue procedures done for CMT? -Tibialis posterior - ANSWER-The BLANK exaggerates RF varus -weakness with ankle plantarflexion (advanced) -weak ankle PF reflex -decreased sensation lateral foot and posterior/lateral calf - ANSWER-What is seen with a S1 lesion? 1st to 2nd decade of life (early childhood) - ANSWER-What is the peak onset for type 1 CMT? Autosomal dominant - ANSWER-What is the most common inheritance pattern for CMT? L4 - ANSWER-BLANK nerve root supplies the skin on the gluteal region, middle anterolateral and lower anterior aspect of the thigh, medial aspect of the leg, medial aspect of foot, and medial aspect of hallux L4 nerve root compression - ANSWER-BLANK - symptoms usually affect thigh, weakness straightening leg, decreased knee-jerk reflex L4-S2 - ANSWER-The common peroneal nerve is formed by BLANK L4-S3 - ANSWER-The tibial nerve is formed by BLANK L4-S3 branches of lumbosacral plexus - ANSWER-The sciatic nerve is formed by BLANK L5 - ANSWER-BLANK nerve root supplies the skin on the gluteal region, lower anterolateral aspect of the thigh, lateral aspect of the leg, middle and dorsum and plantar aspects of foot L5 nerve root compression - ANSWER-BLANK - symptoms extend to great toe/ankle, numbness on top of foot (1st web space particularly), decreased ankle joint strength (foot drop) Laminectomy Microdiscectomy - ANSWER-What are the surgical options for sciatica? Leaning forward - ANSWER-What position will cause the sciatica symptoms with spinal stenosis? loss of proprioception, vibratory sense and 2 point discrimination - ANSWER-What is expected to see for the sensory examination of a CMT patient? Loss of sensory and motor nerve response amplitudes - ANSWER-Type 2 CMT is manifested by BLANK Main deforming force in CMT cavus foot - ANSWER-Tibialis posterior is the BLANK Muscular wasting and neuropathy symptoms - ANSWER-CMT is a hereditary and progressive condition that is characterized by BLANK Neurological - ANSWER-CMT is the most common BLANK cause of cavovarus feet Neurological cause - ANSWER-If a patient has hallux malleolus, what should you assume? Numbness, muscle weakness, diminished/lost reflexes - ANSWER-What are the sensory & motor dysfunctions associated with sciatica? Onion-bulb - ANSWER-Schwann cells proliferate and form concentric arrays of re- myelination which causes a thick layer of abnormal myelin around the peripheral axons giving a BLANK appearance (associated with Type 1 CMT) patients >10 y/o - ANSWER-Best result of a tendon transfer is when they are performed on BLANK Peroneus longus - ANSWER-The tibialis anterior can be overpowered by BLANK peroneus longus tendon - ANSWER-BLANK is relatively spared during the CMT process until very late in the disease. A transfer of this will reduce the plantarflexion of the 1st ray, and improve the eversion strength of the foot. Plantarflexed 1st ray, FF pronation, RF inversion - ANSWER-When the peroneus longus overpowers the tibialis anterior this can cause BLANK Plantarflexion and supination - ANSWER-What are the two main forces the Achilles tendon places on the foot progressive disorder - ANSWER-Why is non-surgical treatment often unsuccessful in CMT? Radiculopathy - ANSWER-BLANK is caused by a herniated/slipped disc that is pressing on the nerve root. Most common at L5, S1 levels and most common cause of sciatica RF deformity - ANSWER-If the heel does NOT correct to neutral and remains in varus in a Coleman block test this indicates BLANK S1 - ANSWER-BLANK nerve root supplies the skin on the gluteal region, posterolateral aspect of thigh, posterolateral aspect of leg, lateral aspect of foot and all of digiti minimi S1 nerve root compression - ANSWER-BLANK - numbness on outer part of foot, weakness with standing on tiptoes, decreased ankle joint reflex, sciatica symptoms S2 - ANSWER-BLANK nerve root supplies the skin on the gluteal region, posteromedial aspect of thigh, posteromedial aspect of leg, and plantar aspect of heel Slow development of motor skills, loss of walking ability as adult, severe sensory problems - ANSWER-What are the characteristics of type 3 CMT? Soft tissue procedure - ANSWER-Should a soft tissue or osseous procedure be done first for a patient with CMT? Spinal stenosis - ANSWER-BLANK is a nerve root entrapment from narrowed spinal canal and usually associated with osteophyte formation. Pseudoclaudication and herniated disc can contribute (sciatica) Spondylolisthesis - ANSWER-BLANK involves a slipped vertebrae (forward movement of vertebra usually) that causes a narrowing opening for the spinal nerve to exit. Most common in the lumbosacral region (sciatica) Standing exam, ability to walk on heels and toes - ANSWER-BLANK assesses the posterior and anterior muscle groups Straight Leg Raise Test (Lasegue Test); Lumbar radiculopathy; DF ankle and flex spine - ANSWER-BLANK is sensitive but not specific, pain between degrees 30-70 elevation can indicate BLANK. Can BLANK to increase the sensitivity Tibialis posterior - ANSWER-The peroneus brevis can be overpowered by BLANK Tibialis posterior tendon transfer - ANSWER-BLANK is an out-phase transfer and acts as an antagonists for the PB tendon. Transferred through the interosseous membrane to the dorsolateral foot Triple arthrodesis - ANSWER-BLANK is an excellent salvage procedure and indicated for rigid CMT deformity, DJD and correction of deformity by positioning the joints for de- rotation of calcaneus under talus Tumor, spinal stenosis - ANSWER-If there is gradual pain in the leg this could indicate BLANK cause of sciatica? Type 1 CMT - ANSWER-Motor and sensory deficits are more severe in BLANK Type 2 CMT - ANSWER-BLANK involves axonal neuropathy with normal or near normal nerve conduction velocity, but magnitude of impulse is decrease. Less disabling/less sensory loss. Presents later in life (4-5th decade) Type 3 CMT - ANSWER-BLANK is the most severe form, has infantile onset and associated with severe demyelination with delayed motor skills. X-linked inheritance of type 1 CMT - ANSWER-BLANK is less common and more severe form seen at earlier age,