Chronic limb and back problems

Question 1

What is spasticity?

Answer 1

Stiff/rigid muscles

Question 2

What are brisk reflexes?

Answer 2

More active reflexes than usual

Question 3

What is clonus?

Answer 3

Muscular spasm involving repeated, often rhythmic, contractions

Question 4

What are some differentials for a tremor?

Answer 4

• Essential tremor
• Dystonic
• Parkinson’s Disease (unilateral and at rest)
• Neuropathic tremor (in presence of neuropathy)
• Medication side-effect (eg, valproate, beta-blockers, salbutamol, lithium)
• Endocrinopathy (Eg, thyrotoxicosis)
• Cerebellar

Question 5

What are some different types of tremor?

Answer 5

• Cerebellar: Action + Intention component + other “DANISH”
• Wilson’s: Consider if <40y.o., proximal “wing-beating” tremor, asscoiated PDism/dystonia
• Physiologic: High freq., low amplitude, worsened by stress/caffeine/poor sleep, improved by relaxation
• Psychogenic: Explosive onset +/-trigger, unusual features, entrainment, distractible, history of functional disorders
• Holmes: Irregular, mixture of rest, posture and action tremor, proximal, lesion thalamus to midbrain

Question 6

What can asking the patient to draw a spiral reveal about their tremor?

Answer 6

It can help diagnose:

Parkinson’s: spiral will be tight and small
Essential tremor: wobbly lines
Functional: all over the place

Question 7

What are some differentials for progressive bilateral leg sensory disturbance with back pain?

Answer 7

Neuropathy / plexopathy
Radiculopathy
Intrinsic “intramedullary” cord lesion
Extrinsic “extramedullary” cord lesion
Parasagittal brain lesion

(cord compression)

Question 8

What is quadrantanopia?

Answer 8

Loss of vision in 1/4 of the visual field

Question 9

What is the presentation of optic neuritis?

Answer 9

Occurs when selling damages the optic nerve

Acute, unilateral, painful, vision loss

Often because of MS, especially if there appear to be relapses

Question 10

What is Brown-Sequard syndrome?

Answer 10

When a lesion in the spinal cord causes weakness or paralysis on one side of the body and a loss of sensation on the opposite side

Question 11

What is the typical history for a neuropathy?

Answer 11

Distal
Sensory > Motor
Slowly progressive
Chronic

Question 12

What does stocking-glove presentation mean?

Answer 12

That neuropathies begin in the most distal areas (either the feet or hands)