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Will's Clinical Exam > Brian's Cards > Flashcards

Brian's Cards Flashcards

1
Q

Pes Cavus (Description + Pathology)

A

Description:
- High arch of the sole of foot, claw toes
- Some degree of atrophy of muscles

Pathology
- Long standing LMN peripheral neuropathy (think CMT)
- Freidrich’s ataxia
- Spinocerebellar problems

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2
Q

Charcot Marie Tooth

A

PES Cavus, foot drop, distal muscle atrophy in legs > arms, diminished reflexes, sensory neuropathy

Autosomal dominant
Suspect in people in 20s/30s
Type of Hereditary motor and sensory neuropathy
- Pes Cavus
- Foot drop due to weakness (high steppage gait, orthotics)
- Distal muscle weakness and distal atrophy in legs > arms (inverted champagne bottle) - below elbow and middle third of thigh
- Peripheral sensory neuropathy
- Diminished reflexes in the limbs

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3
Q

Neuropathies - Motor>Sensory

A
  1. ADIP/CIDP
  2. Neuromuscular junction disorders
  3. Motor neurone disease
  4. Hereditary motor and Sensory neuropathy (CMT)
  5. Diabetes Mellitus
    Rarer: Lead poisoning, acute intermittent porphyria, multifocal motor neuropathy
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4
Q

CIDP

A

Chronic Inflammatory demyelinating polyradiculoneuropathy

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5
Q

Neuropathies - Predominantly Sensory

A
  1. Diabetes Mellitus
  2. Paraneoplastic
  3. Paraproteinaemia
  4. Vitamin B6 intoxication
  5. Sjogren’s syndrome
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6
Q

Painful Peripheral Neuropathy

A
  1. Diabetes
  2. Alcohol
  3. B12 or B1 deficiency
  4. Drugs - chemotherapy, arsenic, thallium
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7
Q

Mononeuritis Multiplex Causes

A

Acute (Usually vascular)
1. Diabetes
2. Polyarteritis nodosa or Connective tissue disease

Chronic
1. Multiple compressive neuropathies (joint-deforming arthritis)
2. Sarcoidosis
3. Acromegaly

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8
Q

Fasiculations Causes

A
  1. Benign idiopathic
  2. Motor neurone disease
  3. Motor root compression
  4. Spinal Muscular Atrophy
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9
Q

Upper Trunk Palsy (C5/C6)

A

Loss of Shoulder movement and elbow flexion, hand in waiter’s tip position
Sensory loss over lateral arm and forearm, and over thumb

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10
Q

Lower Trunk Palsy

A

True claw hand with paralysis of all intrinsic muscles
Sensory loss along ulnar side of hand and forearm
Horner’s Syndrome

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11
Q

Ataxia + UMN signs

A
  1. Spinocerebellar ataxia
  2. Friedrich’s ataxia
  3. Demyelination such as MS
  4. Stroke or injury to brainstem and spinocerebellar tracts
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12
Q

Mixed Upper and Lower MN SIgns

A

Motor Neurone Disease
Syringomyelia
Multiple pathologies
Cervical myelopathy

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13
Q

Wasted Hand

A
  1. Peripheral Nerve lesions - Median, Ulnar, Brachial Plexus, CMT
  2. Anterior Horne Cell Disease (MND, Polio, SMA)
  3. Myopathy
  4. Spinal Cord Lesions
  5. Nutritional, disuse, ischaemia
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14
Q

Proximal Myopathy

A
  1. Drugs - Steroids, statins, fibrates
  2. Toxins - Alcohol
  3. Diabetic amyotrophy
  4. Thyroid disease
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15
Q

Myotonic Dystrophy

A
  • Frontal Baldness
  • Wasting of fascial musculature - temporalis/masseter, sternomastoid atrophy
  • Partial ptosis
  • Difficulty opening eyes after forceful closure
  • Palatal, pharyngeal and tongue involvement - dysarthria, nasally speech
  • Neck flexion weakness
  • Impaired handshake (grip myotonia w/ impaired relaxation)
  • Generalised weakness in voluntary muscles of arms and legs
  • Forearm muscle wasting
  • Thenar tap causes contraction + slow relaxation (percussion myotonia)
    May have subtle peripheral sensory neuropathy/foot drop
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16
Q

Fascioscapulohumeral dystrophy

A
  • Expressionless face
  • Similar to myotonic dystrophy without ptosis or frontal balding
  • Muscle weakness in face, shoulder, distal legs
  • Muscle atrophy in face - difficulty with eye closure, smiling, pursing lips
  • No ophthalmoplegia
  • Shoulder weakness due to scapula winging - get patient to press on wall
  • Biceps + triceps weakness but deltoid spared
  • Spared wasting of the forearm
  • Tibialis anterior muscle weakness is characteristic
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17
Q

Inclusion Body Myositis

A

Symmetrical proximal weakness. Asymmetrical distal weakness
- Classically - upper limb distal weakness, lower limb proximal weakness
Quadriceps particularly weak compared to other groups in legs
Forearm flexor weakness, handgrip weakness
Scalloping weakness in medial forearm
Distal DIP finger flexion weakness is often first sign
Can have weakness in eye closure. No oculomotor involvement

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18
Q

UMN Weakness: Face and arms > Legs

A

MCA Territory

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19
Q

UMN Weakness: Legs > Face and arms

A

ACA territory

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20
Q

Subcortical signs

A

Face/Arms/Legs equally effected
Pure motor stroke = lacunar lesion
Pure sensory = thalamic lesion
Mixed motor and sensory - Thalamus and Internal Capsule

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21
Q

Brown-Sequard

A

Ipsilateral UMN weakness. Ipsilateral vibration + proprioception deficit
Contralateral pain + temperature deficit
Ipsilateral LMN weakness and complete sensory loss at level of lesion

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22
Q

Syringomyelia

A

Begins asymmetrically
Atrophy in the neck, shoulder, arms, small muscles of hand
Sensory deficit in ‘cape’ distribution over shoulders, neck, trunk, distal hands
Clasically segmental LMN at level of lesion, UMN below lesion

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23
Q

Spinothalamic

A

Pain and Temperature

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24
Q

Corticospinal Tract

A

Muscle power

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25
Q

Spinocerebellar

A

Unconscious proprioception

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26
Q

Dorsal Column

A

Conscious vibration, proprioception

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27
Q

Anterior Spinal Artery Infarct

A

Only dorsal comuln is intact (vibration + propcrioception)
Motor, pain, temeprature deficity below lesion

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28
Q

Posterior Spinal Artery Infarct

A

Light touch, vibration, proprioception deficit below the lesion

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29
Q

Extra-Pyramidal

A

No direct control of motor cortex
- Regulation of motor activity, muscle tone, emotional and associative movement

30
Q

Pyramidal weakness

A

Weakness of UL extensors and LL flexors

31
Q

Polio

A

Often unilateral, lower limbs effected
LMN pattern. May have pes cavus
No sensory involvement

32
Q

Motor Neuron Disease

A

Mixture of UMN and LMN signs
No sensory involvement
Asymmetry in weakness
Fasciculations
Thenar eminence wasting (split hand)
Bulbar + pseudobulbar signs
Does not effect eye movement

33
Q

UL Myotomes

A

Shoulder abduction - C5 (Axillar)
Elbow Flexion - C5/C6 (Musculoskeletal)
Elbow Extension/Wrist Extension - C6/C7 (radial)
Wrist Flexion - C7/C8 (Median)
Finger flexion/extension - C8 (Median/Radial)
Finger abduction/adduction - T1 (Ulnar)

34
Q

Orthotic

A

Peripheral Nerves issue

35
Q

Femoral Nerve Injury

A

Motor - Hip flexion and knee extension
Sensory - Medial aspect of thigh

36
Q

Sciatic Nerve Injury

A

Motor - Weakness of Knee flexion, loss of power in all muscles below knee - foot drop
Sensory - Below knee sensation and posterior thigh

37
Q

Tibial Nerve Injury

A

Motor - Plantar Flexion, foot inversion
Sensory - Sole of foot

38
Q

Common Peroneal

A

Motor - Dorsiflexion (deep branch), eversion of foot (superficial branch)
Sensory - Between big toe and second toe (deep), lateral aspect and dorsum of foot (superficial)

39
Q

Foot Drop

A

L4/L5, Sciatic Nerve, Common Peroneal Nerve

40
Q

Myasthenia Gravis

A

Ocular symptoms most common - Ptosis, diplopia, ophthalmoplegia
Subtle facial weakness
Bulbar weakness
Limb girdle weakness
Fatigability

41
Q

Lambert Eaton

A

Proximal weakness, improvement with movement
Areflexia
Autonomic features (postural hypotension)

42
Q

Cerebellar vs Dorsal Column Ataxia

A

Cerebellar - Gait present constantly, arm drift, past pointing, disdiadochokinesis. Normal sensation. Poor heel to shin. Nystagmus and slurred speech

Dorsal Column - Gait worse when eyes closed. Sometimes dysdiadochokinesis, otherwise sensation reduced with vibration + proprioception

43
Q

Friedreich’s Ataxia

A

AR ataxic problem
Atrophy of cerebellum and associated motor + sensory tracts, also involves peripheral nerves
- Ataxic gait
- BL cerebellar signs
- Posterior column loss in the limbs
- UMN signs in the limbs
- Peripheral neuropathy
- Pes Cavus
- Cardiomyopathy + kyphoscoliosis + diabetes

44
Q

Spinocerebellar Ataxia

A

AD or trigplet repeat
- Ataxic gait
- Nystagmus
- Ataxic dysarthria
- Loss of fine coordination
- Truncal and peripheral incoordination

45
Q

Multiple Cranial Nerve Palsies

A

Malignancy - Nasopharyngeal carcinoma
Chronic meningitis
Miller-Fisher Variant of AIDP
Brain Stem Lesions
Trauma
Myasthenia Gravis

46
Q

Bulbar Palsy

A

LMN IX, X, XII
Tongue fasiculations + wasting
Nasal speech
Absent jaw jerk and gag reflex

MND, AIDP, Polio, Brainstem infarct

47
Q

Pseudobulbar Palsy

A

UMN IX, X, XII
Tongue - Small, stiff, spastic
Spastic dysarthria (hard and slow to get out words)
Increased Jaw jerk, normal/increased gag reflex

MND, Parkinsons, MS, PSP

48
Q

Bilateral UMN signs

A

B12 deficiency
Demyelination
HSP
Bilateral brain or spinal cord pathology
MND
Two diagnoses

49
Q

UMN signs + Cranial Nerve Lesions

A

Motor Neuron disease
Multiple sclerosis

50
Q

Massive Hepatomegaly

A
  1. Metastases
  2. Alcoholic liver disease with fatty infiltration
  3. Myeloproliferative disease
  4. Right heart failure
  5. Hepatocellular carcinoma
51
Q

Moderate Hepatomegaly

A

Causes of massive hepatomegaly (Mets, alcohol + fat, myeloproliferative, RHF, HCC) and:
1. Fatty liver - obesity, DM, toxins
2. Haematological disease - CML, lymphoma
3. Haemochromatosis

52
Q

Mild Hepatomegaly

A

Causes of Massive and Moderate
1. Hepatitis
2. Cirrhosis
3. Infiltrative and granulomatous disorders

53
Q

Firm and irregular liver

A
  1. Cirrhosis
  2. Metastatic disease
  3. Hyatid disease, granuloma, amyloid cyst
54
Q

Tender Liver

A
  1. Hepatitis
  2. Rapid liver Enlargement - RHF, Budd-Chairi
  3. Hepatocellular carcinoma
55
Q

Pusatile liver

A
  1. TR
  2. HCC
  3. Vascular abnormalities
56
Q

Bilateral Renal Masses

A
  1. Polycystic kidneys
  2. Bilateral hydronephrosis
  3. B/L RCC
  4. B/L Renal Vein Thrombosis
  5. Infiltration and acromegaly
57
Q

Unilateral Renal Masses

A
  1. Renal Cell Carcinoma
  2. Hydronephrosis or pyonephrosis
  3. Polycystic kidney
  4. Acute renal vein thrombus
58
Q

If suspect Polycystic Kidneys

A
  1. Check for hepatomegaly
  2. Check blood pressure
  3. Look for anaemia (and ask for urinalysis)
  4. Parietal drift
  5. Mitral Valve Prolapse

Ask about intracranial aneurysm screening

59
Q

RIF Mass

A
  1. Appendiceal abscess
  2. Caecal carcinoma
  3. Crohn’s disease
  4. Psoas abscess
  5. Pelvic organ - ovarian tumour or cyst
60
Q

LIF Mass

A
  1. Faeces
  2. Carcinoma of sigmoid or descending colon
  3. Diverticular disease
  4. Psoas abscess
  5. Pelvic organ - ovarian tumour or cyst
61
Q

Upper Abdominal Masses

A
  1. Retroperitoneal lymphadenopathy
  2. Abdominal aortic aneurysm
  3. Carcinoma of stomach or transverse colon or pancreas
62
Q

Massive Splenomegaly

A
  1. Chronic myeloid leukaemia
  2. Myelofibrosis
  3. Lymphoma of spleen, hairy cell leukaemia, malaria
63
Q

Moderate causes

A
  1. Massive causes (Haem: Chronic myeloid leukaemia, myelofibrosis, lymphoma of spleen, malaria)
  2. Portal hypertension
  3. Lymphoma
  4. Leukaemia
  5. Thalassaemia
64
Q

Mild Splenomegaly

A
  1. Haem + portal hypertension
  2. Other myeloproliferative disorders (PRV, ET)
  3. Haemolytic anaemia
  4. Megaloblastic anaemia
  5. Infection (hepatitis, endocarditis, EBV), CTD (RA, SLE, PAN), infiltration
65
Q

Hepatosplenomegaly

A
  1. Chronic liver disease with portal hypertension
  2. Haematological disease - myeloproliferative, lymphoma, leukaemia
  3. Infection - viral hepatitis, glandular fever, CMV
  4. Infiltration
  5. CTD
  6. Acromegaly
  7. Thyrotoxicosis
66
Q

Spleen vs Kidney

A

Spleen has no upper border
Spleen is dull to percussion
Spleen moves infero-medially on inspiration
Splenic notch
Spleen is not ballotable
Friction rub occasionally over spleen

67
Q

Kidney vs Spleen

A

Can get above a kidney
Kidney resonant to percussion
Kidney moves inferiorly on respiration
No splenic notch
Kidney is ballotable
No friction rub

68
Q

Upper Lobe Fibrosis

A

SCART-H
- Silicosis + Sarcoidosis
- Coal Worker’s Pneumoconiosis
- Ank Spond related + Allergic Broncho-pulmonary aspergillosis
- Radiotherapy
- Tuberculosis
- Histiocytosis

69
Q

Lower Lobe Fibrosis

A

BRASI-D
- Bronchiectasis
- Rheumatoid Arthritis
- Asbestosis
- Scleroderma
- Idiopathic Pulmonary Fibrosis
- Drugs: Methotrexate, Bleomycin, amiodarone, nitrofurantoin

70
Q

Subacute Combined Degeneration of the Cord

A

UMN signs
Extensor plantar response
Peripheral Neuropathy causing loss of knee or ankle jerks
Symmetrical posterior common loss

Will's Clinical Exam (5 decks)

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