CLINICAL CN Exam Yellow Q's Flashcards
Describe the gait in foot drop. What neurological lesion results in “foot drop”?
- High steppage gait is seen in foot drop by raising the thigh up in an exaggerated fashion whilst walking, as if climbing the stairs. For example, dragging the foots and toes, scraping of the toes across the group and uncontrolled slapping of the toes against the ground.
- Neurological lesion of the peroneal/common fibular nerve result in foot drop
Hemiplegia
- Paralysis on one side of the body
Diplegia
- paralysis of corresponding parts on both sides of the body, typically affecting the legs more severely than the arms
Paraplegia
Complete or incomplete paralysis affecting the legs and possibly also the trunk, but not the arms.
Quadriplegia
Paralysis caused by illness or injury that results in the partial or total loss of use of all four limbs and torso
In a patient with hemiplegia describe the difference in posture between the upper limb and lower limb. Why does this occur?
- Posture of upper limb: Abnormal posture with adduction of the shoulder, flexion in the elbow, wrist and fingers. The tone is increased. The power is weak especially on extension. The co-ordination and sensation are normal.
- Posture of lower limb: Abnormal posture with external rotation and extension. The tone of the affected leg is increased. The muscle power is weak. The sensation may be abnormal if the sensory cortex is also involved. On walking the foot tends to circumduct and rotate in a semi-circle with each step.
Outline the MRC Scale for grading muscle strength
- This is a reliable and validated scale for assessing muscle weakness out of 5.
- Each muscle is graded as follows:
0. No movement
1. Flicker is perceptible in the muscle
2. Movement only if gravity eliminated
3. Can move limb against gravity
4. Can move against gravity and some resistance exerted by examiner
5. Normal power
Define proximal myopathy. What actions would the patient have difficulty with? Which diseases is this associated with?
- Proximal myopathy: Presentation of symmetrical muscle weakness of proximal upper and/or lower limbs
- Difficult actions: Rising from chairs, climb stairs, brushing hair
- Associated diseases: Thyroid diseases, osteomalacia
If a patient had polio affecting his left leg, what signs would you expect to elicit and why?
Non-paralytic symptoms: Pain/stiffness in left leg
AND
Paralytic symptoms: Loose/floppy limbs, muscle pain, loss of reflexes, deformed limbs, severe spasms, sudden paralysis
Why? The virus attacks the nervous system LMNs (i.e. reflex loss, fasciculations, tone loss)
Define the term clonus. In what conditions might you be able to elicit clonus?
- Clonus definition: muscular spasm involving repeated, often rhythmic, contractions.
- Causes: MS, Huntington disease, damage to the spinal cord, meningitis
UMN sign
Describe a grading system for reflex response
- Reflexes are graded using a 0 to 4+ scale: o 0: Absent o 1+: Hypoactive o 2+: normal o 3+: Hyperactive, without clonus o 4+ : Hyperactive, with clonus
—2 is normal—-
What is Babinki’s sign?
- The reflex is normal in infants when the sole of the foot is firmly stroked and the hallux moves upwards whilst the remaining toes fan out
aka Extensor plantar response
What is a “superficial reflex”? Give 3 examples
- Definition: Any withdrawal reflex elicited by noxious/tactile stimulation of the skin, cornea or mucous membrane
- Examples: abdominal, cremasteric reflex, corneal
UMN lesion S/S
Atrophy: No Fasciculation: No Weakness: Yes Reflexes: increased Tone: Increase
LMN lesion S/S
Atrophy: Yes Fasciculation: Yes Weakness: Yes Reflexes: Decreased Tone: Decrease
Paraesthesia
Paraesthesia: An abnormal sensation, typically tingling or “pins and needles” caused chiefly by pressure on or damage of peripheral nerves
Allodynia
- Allodynia: Central pain sensitization (increased response to pain) following painless, often repetitive, stimulation. Can lead to the triggered of a pain response from stimuli which do not normally provoke pain
Glove and stocking pattern?
LMN lesion presents as….
- A pattern of peripheral nerve disease characterised by a relatively sharply demarcated loss of pain, touch, temperature, pressure and vibration sensation. Accompanied by weakness, muscular atrophy and loss of tendon reflexes
Fasciculation, cause?
Fasciculation, cause?
- Benign fasciculation syndrome due to overactivity of the nerves associated with the twitching muscle. Possibly due to fatigue, anxiety or a pinched nerve.
- Due to spontaneous depolarisation in LMN
2 conditions that can cause bilateral wasting of the small muscles of the hands
- Syphilis
- Rheumatoid arthritis
In what conditions might “tone” be increased or decreased?
In what conditions might “tone” be increased or decreased?
- Increase: Upper motor lesion due to injury or disease
- Decrease: Down syndrome, cerebral palsy, achondroplasia, tay sach’s sieases
Define the term deep tendon reflex.
Define the term deep tendon reflex.
- The tonic contraction of the muscles in response to a stretching force, due to stimulation of muscle proprioceptors
In muscle reflex what fibres are the afferents and efferent?
Afferents:
Group 1a fibre: From GTO
Group 1b fibre: From spindle
Efferents:
Alpha MN: To motor end plate and voluntary muscle
Gamma MN: To the intrafusal fibres in spindle
Which common disease may result in impaired vibration sense?
- Guillain Barre syndrome
- Vertebral artery dissection
- Vit E deficiency
What do you understand by the term mononeuritis multiplex?
- Painful, asymmetrical asynchronous sensory and motor peripheral neuropathy involving isolated damage to at least 2 separate nerve areas
- As condition progresses, symptoms worsen and become more symmetrical
What are the features of a cerebellar syndrome/ataxia?
- Dyssynergia: Uncoordinated and abrupt movements
- Dysmetria: Uncoordinated movement that results in limb to over or undershoot
- Dysdiadochokinesia: Cannot perform rapid, alternating movements
- Dysarthria: Difficult/ unclear articulation of speech
- Ataxia of stance or gait
Define the presentation of extrapyramidal syndrome.
o Acute/ Tardive dyskinesia’s: impaired voluntary movement
o Dystonic reactions: Abnormal muscle tone leading to abnormal posture and muscle spasm
o Parkinsonism (Due to Dop decrease)
o Akinesia: Loss or impairment of voluntary movements
o Akathisia: Agitation, stress or restlessness state
o Neuroleptic malignant syndrome
What is the commonest cause of tremor at rest and on action?
- At rest: Parkinson’s disease e.g. pinrolling tremor
- On action: Benign tumour, cerebellar tumour
Distal muscle wasting can cause a classic appearance in the legs of “inverted champagne bottles” What condition most typically causes this?
- Charcot-Marie-tooth disease
Name 2 conditions which would give a mixture of upper motor neurone and lower motor neurone signs.
- ALS (amyotrophic lateral sclerosis)
- Paralytic Poliomyelitis
