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4th Year Neurology > Classic Presentations > Flashcards

Classic Presentations Flashcards

1
Q

Back pain made worse on movement and relieved by rest

A

Mechanical back pain

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2
Q

Shooting neuralgic pain down a dermatomal distribution in the arms / weakness and loss of reflexes in myotomes of arms

A

Cervical disc prolapse

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3
Q

Shooting neuralgic pain down a dermatomal distribution in the legs / weakness and loss of reflexes in myotomes of legs

A

Lumbar disc prolapse

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4
Q

Lower back pain with absent ankle reflexes +/- saddle paraestheisa, painless urinary retention, fecal and urinary incontinence, bilateral sciatica and genital numbness or erectile dysfunction

A

Cauda equina

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5
Q

A 60 year old obese man who used to work as a builder presents with burning leg pain precipitated by standing and worse on mobilising. The pain is less on walking uphill or with lumbar flexion and pedal pulses are preserved.

A

Lumbar spinal stenosis / spinal claudication

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6
Q

A 60 year old patient presents with slow onset stiffness and pain in the neck which can radiate to the shoulders and the occiput

A

Cervical spondylosis

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7
Q

A patient presents with bilateral ‘numb clumsy hands’, gait disturbance, pain in a non-dermatomal distribution, hyperreflexia and +ve Babinski’s sign

A

Cervical myelopathy

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8
Q

Trauma to spine has caused:

  • Paralysis below level of injury (corticospinal tract)
  • Loss of pain and temperature below the level of injury (lateral spinothalamic tract)
  • Preserved proprioception and vibration sensation (dorsal columns)
A

Anterior cord syndrome

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9
Q

Trauma to spine has caused loss of all motor and sensory modalities affected below the lesion

A

Cord transaction (complete spinal cord lesion)

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10
Q

Trauma to spine has caused:

  • Ipsilateral loss of motor function (corticospinal), proprioception and vibration sensation (dorsal columns) below the lesion
  • Contralateral loss of pain and temperature sensation (spinothalamic) beginning at 1 or 2 segments below the lesion
A

Brown-Sequard Syndrome (Cord Hemisection)

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11
Q

An acute extension injury has caused bilateral upper limb weakness that is greater than lower limb weakness and “Cape-like” spinothalamic sensory loss (pain and temperature). Dorsal columns are preserved

A

Central cord syndrome

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12
Q

A tumor in which lobe of the brain would classically cause personality change?

A

Frontal lobe

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13
Q

A tumour in which lobe of the brain would classically cause memory deficits?

A

Temporal lobe

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14
Q

A tumour in which lobe of the brain would classically cause:

  • Dyscalculia (difficulty with maths), dysgrapha (difficulty with writing), finger agnosia (inability to distinguish fingers) and left-right disorientation if the DOMINANT lobe is affected or
  • Neglect (deficit in awareness of one side of the body), dressing apraxia and constructional apraxia if the NON-DOMINANT lobe is affected
A

Parietal lobe

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15
Q

A tumour in which lobe of the brain would classically cause contralateral homonymous hemianopia and/or visual hallucinations

A

Occipital

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16
Q

A tumour in which lobe of the brain would classically cause ipsilateral ataxia, N&V, dizziness, slurred speech and intention tremor

A

Cerebellum

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17
Q

A 30 year old patient presents with vertigo, tinnitus and unilateral sensorineural hearing loss. What kind of tumour would cause this?

A

Acoustic Neuroma/Vestibular Schwannoma

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18
Q

A patient presents with a thunderclap headache, neck stiffness, photophobia, N&V and collapse

A

Subarachnoid haemorrhage

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19
Q

A patient has a stroke that is purely motor or purely sensory or an ataxic hemiparesis (weakness and ataxia on the same side) that affects any two of face arm and leg

A

Lacunar infarct (LACI)

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20
Q

A patient presents with:

  • Higher cerebral dysfunction (e.g. dysphasia, visuospatial disturbances, decreased level of consciousness)
  • Homonymous visual field defect
  • Ipsilateral motor and/or sensory deficit of at least two areas (out of face, arm and leg)
A

Total anterior circulation infarcts (TACI)

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21
Q

A patient presents with a stroke that causes any of the following:

  • Ipsilateral cranial nerve palsy with contralateral motor and/or sensory deficit
  • Bilateral motor and/or sensory deficit
  • Cerebellar dysfunction
  • Isolated homonymous visual field defect
  • Cortical blindness (total or partial loss of vision in a normal-appearing eye)
A

Posterior circulation infarcts (POCI)

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22
Q

A patient presents with a headache, a focal neurological defect and decreased concious level but no photophobia or neck stiffness

A

Intracerebral haemorrhage

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23
Q

A young obese female presents with a throbbing headache, worst first thing in the morning, relieved on standing. On examination she has bilateral papilloedema

A

Idiopathic intracranial hypertension

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24
Q

A patient presents with orthostatic headaches (headache while vertical - relieved by lying down) +/- upper body pain, visual field abnormalities, dizziness, muffled hearing etc

A

Spontaneous intercranial hypotension

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25
Q

A young woman presents with unilateral progressive vision loss over 48hrs with pain behind eye exacerbated with eye movements, dyschromatopsia, central scotoma and RAPD on examination

A

Optic neuritis

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26
Q

A patient experiences a sudden, profound, painless visual loss. On examination the retina is pale and swollen

A

Ischaemic optic neuropathy

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27
Q

A patient presents with ipsilateral miosis (constricted pupil), ptosis (drooping upper eyelid), anhidrosis (excessive sweating) and increased warmth and redness

A

Horner’s Syndrome

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28
Q

A patient presents with unilateral anisocoria (affected pupil is larger), blurring on near vision, an absent light reflex and slow near reflex

A

Adie’s Pupil

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29
Q

A patient with diabetes presents with bilateral, irregular, small pupils

A

Argyll pupil

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30
Q

A patient presents with horizonal diplopia worse on distance and increased on looking to one side. On examination abduction is limited in one eye

A

CN VI (abducens nerve) palsy

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31
Q

A patient presents with horizonal diplopia worse on distance. On examination abduction is limited in one eye

A

CN VI (abducens nerve) palsy

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32
Q

A patient presents with vertical diplopia. They have a contralateral downward head tilt to compensate. On examination they have an ipsilateral higher eye (i.e., hypertropia) and excyclotorsion (the affected eye deviates upward and rotates outward)

A

CN IV (trochlear) nerve palsy

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33
Q

A patient who has been hit in the head has a brief loss of consciousness followed by a period of consciousness and awareness followed by rapid deterioration

A

Extradural haematoma

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34
Q

An elderly person presents with a 4 week history of headache, confusion, weakness and cognitive dysfunctions following a fall

A

Subdural haematoma

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35
Q

A child presenting with failure to thrive is found to have dilated scalp veins, increased head circumference, impaired upgaze and ‘setting sun’ appearance of the eyes (downward deviation of the globe on lid retraction)

A

Hydrocephalus

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36
Q

A patient has two separate diagnoses of dementia and urinary incontinence but you notice they also have an ataxic gait. What condition could account for all three?

A

Normal pressure hydrocephalus

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37
Q

A young woman presents with a headache that is a unilateral, throbbing pain that’s worse on movement +/- photophobia, phonophobia and nausea

A

Migraine (without aura)

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38
Q

A patient presents with recurrent bilateral headaches and describe the pain as ‘pressing’. There are no additional symptoms

A

Tension type headache

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39
Q

A 35 year old man presents with severe unilateral headaches in a trigeminal distribution. They last a couple of hours and occur at the same time each day. He experiences a few attacks each day for a few weeks and then has a few months symptom free

A

Cluster headaches

40
Q

A 55 year old woman presents with a severe unilateral headache in a trigeminal distribution that lasts for under an hour and happens up to 40 times a day

A

Paroxysmal hemicrania

41
Q

A patient experiences short (<2 minutes), unilateral headaches +/- red eyes and tearing

A

SUNCT

42
Q

A patient experiences short (<2 minutes), unilateral headaches in a trigeminal distribution +/- red eyes and tearing

A

SUNCT

43
Q

A 60 year old woman experiences severe, stabbing unilateral pain lasting around a minute in a trigeminal distribution, triggered by light stimulus

A

Trigeminal neuralgia

44
Q

A patient presents with the classic triad of headache, neck stiffness and fever

A

Meningitis

45
Q

A patient presents with insidious onset of fever, mental status change, seizures and focal neurological defects

A

Encephalitis

46
Q

After an infection a patient presents tingling that progresses into pain in a glove and stocking distribution. This evolves into progressive paraplegia over days

A

Guillain-Barre syndrome

47
Q

A 35 year old woman complains of numbness and weakness in her limbs. She also complains of problems with bladder control and instability while walking. On examination she has mild spasticity and hyperreflexia

A

Multiple sclerosis

48
Q

A 70 year old woman becomes increasingly forgetful and disoriented. An MRI shows atrophy of temporal/parietal lobes

A

Alzheimer’s disease

49
Q

A patient presents with memory problems and recurrent well-formed visual hallucinations. These symptoms began developing at around the same time as the patient began to develop an ataxic gait and pill rolling tremor

A

Lewy Body dementia

50
Q

A 40 year old man has become increasingly depressed and aggressive. His executive function has decline and he has started to have involuntary jerks of his muscles

A

Huntington’s disease

51
Q

A 55 year old patient has been reported to be ‘acting oddly’. Collateral history states they have become increasingly rude and impulsive. The patient does not believe anything is wrong

A

Pick’s Disease/Fronto-temporal dementia

52
Q

A 65 year old man with a history of hypertension has been reported to have significant drops in cognition in a stepwise progression

A

Multi-Infarct dementia/Vascular dementia

53
Q

A patient presents as being ‘unsteady of their feet’. On examination you note they have rigidity, bradykinesia, postural instability and a pill rolling tremor

A

Parkinson’s disease

54
Q

A patient with a >1 year history of bradykinesia, gait abnormalities and pill rolling tremor develops hallucinations and memory problems

A

Parkinson’s disease dementia

55
Q

During an emotionally charged argument, 60 year old patient experienced sudden onset of memory loss and confusion. They were disorientated to time and place but remembered who they and their family were. When the episode was over they had no memory of the event

A

Transient global amnesia

56
Q

A patient presents with fatigue type weakness that’s worse throughout the day. They describe their eyes drooping by the end of the day and choking after a big meal. Their limb weakness is mainly proximal

A

Myasthenia gravis

57
Q

On examination, a young boy is noted to have Gower’s sign and progressive muscle weakness

A

Duchenne’s muscular dystrophy

58
Q

A 30 year old woman presents with symmetrical proximal weakness and pain

A

Polymyositis

59
Q

A 30 year old woman presents with symmetrical proximal weakness and pain. She is also noted to have a v-shaped rash on her chest, gottron’s papules, a heliotrope rash and shawl sign

A

Dermatomyositis

60
Q

A 60 year old man presents with asymmetrical distal muscle weakness with thumb sparing

A

Inclusion body myositis

61
Q

A patient who is training for a marathon presents with muscle pain and weakness. They also describe brown urine. Blood tests show a raised CK

A

Rhabdomyolysis

62
Q

A patient presents with both upper and lower MN features that started in one limb and then spread to the other limbs and trunk

A

Amyotrophic lateral sclerosis (ALS)

63
Q

A 70 year old woman presents with dysarthria (difficult or unclear articulation of speech), dysphagia, choking and random outbursts of laughing/crying. Examination shows a fasciculating tongue

A

Progressive bulbar palsy (PBP)

64
Q

A patient presents with slowly progressive tetraparesis (all four limbs are weak) and pseudobulbar palsy (inability to control facial movements). There are no LMN features

A

Primary lateral sclerosis (PLS)

65
Q

A patient presents with purely LMN symptoms that start in one limb and then spreads

A

Progressive muscular atrophy

66
Q

A patient has been seizing for >30 minutes

A

Status epilepticus

67
Q

A child seems to regularly ‘zone out’ and are completely unrousble during these episodes. They freeze in place but tone is preserved and there is no fall. Afterwards they return to their previous activity as if nothing happened and are not confused.

A

Absence seizures

68
Q

A child has recurrent episodes of completely losing muscle tone

A

Atonic seizure

69
Q

A patient presents with the triad of confusion, ataxia and nystagmus

A

Wernicke’s encephalopathy

70
Q

A known alcoholic presents with anterograde amnesia, confabulation, ataxia, nystagmus and opthalmoplegia (paralysis of the muscles within or surrounding the eye)

A

Wernicke–Korsakoff syndrome

71
Q

A patient presents with unilateral LMN facial weakness that developed over 24-48hrs

A

Bell’s palsy

72
Q

A patient on typical antipsycotics develops rigidity, akinesia (either bradykinesia or hypokinesia) and a pill-rolling tremor

A

Drug induced parkinsonism

73
Q

A patient presents with axial akinesia and rigidity, loss of balance, forgetfulness, dysarthria and loss of eye movements. MRI shows midbrain atrophy with hummingbird sign

A

Progressive supranuclear palsy

74
Q

A patient with a significant vascular history presents with parkinsonism with more problems with gait than tremor and more problems in the lower body. The progression of their disease is very slow and they have a poor response to levodopa

A

Vascular parkinsonism

75
Q

A paediatric patient presents with a >1 year history of motor (eg blinking) and phonetic (eg throat clearing)/vocal (eg barking) tics

A

Gilles de la tourette syndrome

76
Q

A patient presents with wild, flinging movements of one arm/leg

A

Hemiballism

77
Q

A patient reports feeling the urge to move their legs at night that is only relieved by getting up and walking about

A

Restless leg syndrome

78
Q

A patient has a lobar (simple partial/focal) seizure that causes stiffness/twitching/spasms. The seizure occurred in which lobe?

A

Frontal

79
Q

A patient has a lobar seizure that causes tingling/numbness/pain. The seizure occurred in which lobe?

A

Parietal

80
Q

A patient has a lobar seizure that causes flashing lights/hallucinations. The seizure occurred in which lobe?

A

Occipital

81
Q

A patient has a lobar seizure that causes a change in moot/behaviour and a rising epigastric sensation. The seizure occurred in which lobe?

A

Temporal

82
Q

A patient presents with a history of having episodes of repetitive lip smacking/fiddling/walking etc. When the episode is over they have no recollection of it

A

Focal impaired awareness seizure (complex focal seizure)

83
Q

A 13 year old develops sudden, shock like jerks just after waking. They remain conscious during these episodes and it only lasts a fraction of a second

A

Muoclonic seizure/juvenile myoclonic epilepsy

84
Q

A child experiences a seizure where their muscles spasm and jerk but there was no stiffness at the beginning of the episode. What type of seizure is this?

A

Clonic seizure

85
Q

A patient experiences a seizure where they lose consciousness and fall to the ground. They extend their neck and arch their back but do not jerk. What kind of seizure is this?

A

Tonic seizure

86
Q

A patient experiences a seizure where they lose consciousness and go stiff followed by rapid contracting and relaxing of muscles. What kind of seizure is this?

A

Tonic clonic seizure

87
Q

A patient presents with dysphagia, slow speech and a brisk jaw jerk reflex

A

Pseudobulbar palsy

88
Q

A <10 year old patient presents with severe cramping pain soon after starting an exercise. A short period of rest allows them to continue. CK levels are elevated

A

McArdle disease

89
Q

A patient has grip myotonia and foot drop, facial weakness, ptosis, opthalmoplegia and bilateral christmas tree cateracts, hollowing of the temples and early frontal balding. One of their parents had the same symptoms.

A

Myotonic dystrophy

90
Q

A patient with small cell lung cancer (OR an autoimmune condition) experiences insidious onset of weakness in proximal muscles. Lower extremities are more affected and they have a waddling gait. They also have autonomic features (dry mouth, postural hypotension etc) and diminished deep tendon reflexes

A

Lambert-Eaton myasthenic syndrome

91
Q

A patient presents with rapidly progressing dementia, ataxia and myoclonic jerks. CSF analysis shows elevated 14-3-3 protein

A

Creutzfeldt-jakob disease

92
Q

A patient has a headache that occurs on coughing. It is sharp, bilateral and only lasts a short duration

A

Primary cough headache (usually has an underlying cause like a chiari malformation, aneurysm etc)

93
Q

A patient experiences a dull, aching pain in the occipital region during sex that increases with activity)

A

Primary sexual headache - early coital cephalgia

94
Q

A patient experiences a severe headache during orgasm

A

Primary sexual headache - post-coital cephalgia

95
Q

A middle-aged patient presents with involuntary movements of the head to one side

A

Cervical Dystonia

4th Year Neurology (13 decks)

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