conditions

Question 1

A patient was shot on the left side from afar and had first aid to contain blood loss. He was subsequently taken to hospital in an ambulance. Upon examination at the hospital, an F1 medical doctor performed ‘an incomplete examination’. All the left finger nails and their adjacent skin had full sensation. The posterior surface of the left wrist had no sensation and the left brachioradialis muscle tendon had no reflex. The lateral surface of the left shoulder was flaccid on palpation during left shoulder abduction.
What single neurological structure was damaged?

Answer 1

both axillary and radial nerves are injured

therefore leads me to think the posterior cord damage paralysing the radial and axillary nerves

Question 2

Radicular shoulder pain suggest C5, C6 involvement
Left sided weakness, reduced reflexes in left arm brisk reflexes in left leg suggest UMN in corticospinal tract and LMN lesion close to C6 root
Bilateral sensory change C7-C8 dermatomes
Insidious onset typical of expanding mass

whats the problem

Answer 2

nerve sheath tumour

Question 3

acute hostly of unable to move arms initially from trauma with bilateral radiculopathy

left hemiplegia
right tricep weak
pain sensation lost on right side C5-C7

left fasicultions
left arm weakness
left upper and lower limb spas city
reflexes increasing

Answer 3

central cord syndrome of CC7

Question 4

Hoarse voice – which nerve supplies the vocal cords?
What nerves are responsible for swallowing function?
Which muscles are weak to cause weak shoulder shrug and weak head turn? Which nerve supplies these?
Which foramen?
Likely diagnosis?

Answer 4

Recurrent laryngeal from the Vagus
Glossopharyngeal and Vagus

Trapezius and Sternocleidomastoid.Accessory nerve.

Jugular Foramen
Metastatic cancer spread to skull base – specifically the Jugular foramen.

Question 5

A patient was involved in a road traffic accident. Four weeks later, he still had an absent right patella tendon reflex and could not perform right hip flexion. Furthermore, he had flaccid paralysis of the right gracilis and adductor magnus muscles. The L1 and L2 dermatomes had no sensations and the medial side of the right big toe had no sensory supply.
What damage to one structure resulted in the above signs and symptoms?

Answer 5

Trauma to the lumbar plexus/psoas muscle containing the lumbar plexus. The obturator, femoral, iliohypogastric and ilioinguinal nerves have been paralysed as a result.