CN and Opthalmology Flashcards
Conditions that affect all CN (7)
Diabetes mellitus MS Tumours Sarcoid Vasculitis Systemic lupus erythematosus Syphilis
Anosmia differentials (5)
Ageing Traumatic Brain Injury Parkinson’s Alzheimer’s Tumour
In which patients is anosmia more likely to be due to a tumour
Young patients
What is supposed to be prodromal of Parkinsons
Change in sense of smell
Which disease is a change in sense of smell meant to be prodromal of
Parkinsons
What suggests loss of vision due to MS (3)
Over a few hours
Painful
Young
What does sudden loss of vision suggest the cause is
An infarct
What are the differentials for loss of visual acuity (7)
Refractive error Ocular Media cataracts diabetes Retina age related macular degeneration diabetic retinopathy Optic neuropathy MS ischaemia
Which reason for loss of visual acuity is often bilateral
Age related macular degeneration
What is pink eye known as
Conjunctival hyperaemia
Bacterial conjunctivitis signs (4)
Unilateral
Thick discharge
Reduced vision
Urethritis/vaginal discharge
Viral conjunctivitis signs (4)
Bilateral
Watery discharge
Normal vision
Signs of viral infection (fever/lymphadenopathy)
Causes of allergic conjunctivitis (3)
pollen
dust
Chemical scents
What type of reaction is allergic conjuctivitis
T1 hypersensitivity IgE mediated
Which Ig is allergic conjunctivitis
IgE
If a patient complains of visual halos what does this suggest
Cataracts
What must you rule out in an acutely red painful eye
Closed angle glaucoma
What sign is seen on opthalmoscopy of glaucoma
Cupping of the optic disc
4 features of open angle glaucoma
Bi/unilateral
Onset
Pain
Associated symptoms
Bilateral
Progressive visual loss
Initially asymptomatic
Mild nonspecific symptoms
7 features of closed angle glaucoma
Bi/unilateral
Onset
Pain
Associated symptoms (4)
Unilateral
Sudden onset
Severely painful
N&V, cloudy cornea, head, dilated pupil
Anterior or posterior uveitis is associated with AI disease
Anterior
Which diseases are associated with and which type of uveitis (6)
Anterior
seronegative spondyloarthropathies, RA, sarcoidosis, SLE, IBD and Bechet’s
Anterior or posterior uveitis is associated with infective disease
Posterior
Infective causes of (and which type of) uveitis (6)
Posterior
CMV, EBC, VZV. Bacteria like syphilis and TB,
Difference between anterior and posterior uveitis (3)
Anterior:
Associated with AI conditions
Painful ocular hyperaemia
Increased lacrimation and photophobia
Posterior:
Infective causes
Painless
Floaters and scotomata
Prechiasmal main causes of loss of visual field (2)
Ischaemia
Inflammation
Chiasmal main causes of loss of visual field (2)
Pituitary tumour
Craniopharyngioma
Which lobe is damaged in neglect syndrome
Contralateral parietal lobe
Which 4 reflexes can you test in the eye
Direct pupillary
Consensual pupillary
Swinging light
Accommodation
Which nerve detects light
Optic
Which nerve/s constrict the pupil
Parasympathetic and oculomotor
Which nerves are responsible for dilatation
Sympathetic
Which diseases have a Marcus Gunn pupil
Optic neuritis
Also optic neuritis MS
Horners differentials (3)
Carotid artery dissection
Pancoast tumour
Brainstem stroke/tumour
Triad in Horner’s (3)
Ptosis
Miosis
Anhidrosis
Why is there is miosis and ptosis in Hormers
Ptosis as sympathetic supply is disrupted
Miosis as parasympathetic constriction of pupil is now unopposed
How can a brainstem stroke give Horner’s
Sympathetic supply originates from hypothalamus and travels down brainstem, so therefore brainstem stroke or tumour can give Horner’s
Cause of medical third nerve palsy
DM
Cause of surgical third nerve palsy
Raised ICP
Rupture of aneurysm
What is internuclear ophthalmoplegia a sign of (2)
MS
Stroke
Corneal reflex afferent and efferent arms
Corneal reflex (afferent: V1, efferent VII)
Jaw jerk reflex afferent and efferent arms
Jaw-jerk (afferent: V3, efferent: motor V)
Causes of Bells palsy (4)
idiopathic
compression of facial nerve within the facial canal
inflammation, e.g. viral infection
herpes simplex type 1 or varicella zoster
RF for Bells palsy
Diabetes
Which virus can result in Bells palsy
HSV1
Ix for Bells palsy
Serology
Mx of Bells palsy
Prevent corneal abrasions
Steroids - prednisolone
What is Ramsay Hunt syndrome
LMN facial nerve palsy due to varicella zoster
What causes Ramsay Hunt syndrome
Varicella zoster
Which other nerves can Ramsay Hunt syndrome affect and what can that cause
other cranial nerves like 8 – giving deafness and vertigo, also results in pain and vesicles on tongue, hard palate
Which age does Ramsay Hunt affect
Over 60
Which disease is caused by a reactivation of chicken pox (Varicella Zoster)
Ramsay Hunt syndrome
Forehead affected facial droop is caused by…
Bells palsy
Does UMN or LMN problems allow forehead sparing
UMN e.g. strokes for example
Which test is Rinne and which is Webers
Webers is in the middle of your forehead
Describe the results of a Webers test
Should normally be audible equally from both sides
In conductive hearing loss it is louder towards the deficit
In sensorineural loss it lateralises away from the deficit
Describe the results of a Rinne’s test
AC > BC
If BC > AC there is a conductive hearing problem and we use Weber to figure out which ear and if there is a combined loss
If Rinne in both ears is normal but Weber lateralises towards an ear what does that suggest
Sensorineural loss in the opposite ear
Causes of conductive hearing loss (3 external auditory canal, drum, 2 middle ear, oval window))
EAC
Wax
Foreign body
Otitis externa
Drum
Perforation
Middle ear
Acute otitis media
Serous otitis media
OW
Otosclerosis
Ways you can have sensorineural hearing loss (5)
Inflammation Tumour Ototoxic drugs Trauma Menieres disease
Examples of ototoxic drugs (3)
Aminoglycoside (gentamycin) antibiotics
Aspirin (overdose)
Loop diuretics
Examples of tumour causing sensorineural hearing loss
Acoustic neuroma
What causes of inflammation can cause sensorineural hearing loss (4)
Meningitis
MMR
Neurofibromatosis T1: Inheritance Gene Chromosome Presentation (5) Other features (3)
Inheritance Autosomal Dominant Gene NF1 Chromosome 17 Presentation Café-au-lait spots Freckling in skin folds Neurofibromas Lisch nodules Spinal scoliosis Other features Short stature Mild intellectual disability
Main 5 presentations of neurofibromatosis T1
Café-au-lait spots Freckling in skin folds Neurofibromas Lisch nodules Spinal scoliosis
Neurofibromatosis T2: Inheritance Gene Chromosome Presentation (3) Other features (2)
Autosomal Dominant NF2 22 Sensorineural hearing loss Bilateral acoustic neuromas Symptomatic by age 20 No/fewer café-au-lait spots Tinnitus/vertigo possibly
Main 3 presentations of neurofibromatosis T1
Sensorineural hearing loss
Bilateral acoustic neuromas
Symptomatic by age 20
What is the triad of Menieres disease
sensorineural hearing loss, vertigo and tinnitus
What result suggests sensorineural loss in the right ear
Normal Rinne in both ears and Weber lateralises left
What result suggests sensorineural loss in the left ear
Normal Rinne in both ears and Weber lateralises right
What result suggests conductive loss in the right ear
Rinne right BC>AC
Weber lateralises right
What result suggests conductive loss in the left ear
Rinne left BC>AC
Weber lateralises left
What result suggests combined conductive and sensorineural loss in the left ear
Rinne left BC>AC
Weber lateralises right
What result suggests combined conductive and sensorineural loss in the right ear
Rinne right BC>AC
Weber lateralises left
What does a negative Rinnes test suggest
Conductive loss
What does a Webers test suggest
Sensorineural loss
Bulbar palsy: Gag reflex Tongue (2) Palatal movement Jaw jerk Speech Emotions Other:
Gag reflex – absent Tongue – wasted, fasciculations Palatal movement – absent Jaw jerk – absent or normal Speech – nasal Emotions – normal Other – signs of the underlying cause, e.g. limb fasciculations.
Pseudobulbar palsy: Gag reflex Tongue Palatal movement Jaw jerk Speech Emotions Other:
Gag reflex – increased or normal
Tongue – spastic
Palatal movement – absent
Jaw jerk – increased
Speech: “a monotonous, slurred, high-pitched, ‘Donald Duck’ dysarthria”
Emotions – labile
Bilateral upper motor neuron (long tract) limb signs
Which is LMN disease bulbar or pseudobulbar palsy
Bulbar
Which is UMN disease bulbar or pseudobulbar palsy
Pseudibulbar
Causes of pseudo bulbar palsy (3)
Stroke of internal capsule
MS
Motor neuron disease
Causes of bulbar palsy (2)
Motor neuron disease
Guillain-Barre
Which nerves are affected in bulbar palsy
V VII X XI XII
Which nerves are affected in bulbar palsy
X XI XII
Which changes emotions and how does it change them, bulbar or pseudo bulbar palsy
Pseudobulbar has labile emotions
