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Finals Revision > Functional Localisation > Flashcards

Functional Localisation Flashcards

1
Q

CNS lesion inspection

A

limb posture

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2
Q

CNS lesion tone

A

increased spasticity (velocity dependent increased tone)/clonus (persistent ankle jerk)

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3
Q

CNS lesion pattern of weakness

A

Decreased hemisphere: contralateral hemiplegia

Spine: below lever of lesion. pyramidal pattern

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4
Q

CNS lesion reflexes

A

increased

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5
Q

CNS lesion plantar response

A

extensor

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6
Q

CNS lesion sensory

A

hemisphere: hemisensory
spine: below the level of the lesion

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7
Q

PNS lesion inspection

A

(distal) wasting/ fasciculation (damage to motor nerves)

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8
Q

PNS tone

A

Decreased

  • Excessive flopping of foot in log rolling
  • Foot dragging up bed
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9
Q

PNS pattern of weakness

A

Decreased

Peripheral neuropathy: Distal weakness

Root/ plexus (C5-T1 for upper)/ mononeuropathy: dependent on innervated muscles

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10
Q

PNS reflexes

A

decreased

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11
Q

PNS plantar response

A

flexor (if no sensation then there may be a muted response)

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12
Q

PNS sensory

A

peripheral neuropathy: glove and stocking

root/plexus/mononeuropathy: dependent (root= dermatomal)

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13
Q

NMJ inspection

A

additional ptosis or ophthalmoplegia

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14
Q

NMJ tone

A

normal or decreased

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15
Q

NMJ pattern of weakness

A

normal

fatiguability

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16
Q

NMJ reflexes

A

normal or decreased (only if long-standing process with wasting and weakness)

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17
Q

NMJ plantar response

A

flexor

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18
Q

NMJ sensory

A

none

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19
Q

muscle lesion inspection

A

proximal wasting

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20
Q

tone inspection

A

normal or decreased

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21
Q

pattern of weakness muscle

A

decreased strength
proximal weakness
symmetrical
difficulty rising from chair without using arms

22
Q

reflexes in muscle pathology

A

normal or decrease

23
Q

plantar response in muscle pathology

A

flexor

24
Q

sensory in muscle lesion

A

none

25
Q

how to examine NMJ

A

> demonstrate you understand fatiguability
- Fixed horizontal gaze for 20 seconds (looking for start of drooping, particularly on one side, then look to see if one eyelid is lower than other)

  • Fixed horizontal gaze for 20 seconds, then report if there is any double vision, both horizontal and vertical, are images getting further apart?
  • Sustained counting (dysarthria) West register street, count to 50, repeat west register street
  • Shoulder abduction before and after repetitive movements, do 20 movements on one side then test for shoulder abduction again. Is there now weakness on one side?
  • Also examine for facial weakness- test CN VII, test for neck weakness
26
Q

nature of essential tremor

A

Postural
Generally symmetrical

History of relatively young onset, 50% have FHx of the same.
Should be a response to alcohol.

27
Q

nature of cerebellar tremor

A

Action/intention tremor

May be asymmetrical or symmetrical (depending on pathology)

28
Q

nature of extra-pyramidal tremor

A

Rest

Asymmetrical

29
Q

tone in tremor

A

essential- normal
cerebellar- reduced/normal
extrapyramidal- increased

30
Q

cerebellar features

A

DANISH

D ysdiadokinesis
A taxia
N ystagmus
I ntention
S lurred speech
H eel shin
31
Q

how to examine for dysdiadokineses

A

rapid alternating movements- difficulty trying to initiate movements

32
Q

examination for ataxia

A

(ask patient to walk, is there a wide based short stepping gait. Are they able to heel toe walk?)

33
Q

how to examine for nystagmus

A

just test horizontal movements, follow finger.

Might be physiological nystagmus at extremes of gaze but should be symmetrical.

Look for saccadic eye movements- look ahead eye movements, look quickly from fist to palm- looking for jerkiness and an intention tremor of eyes

34
Q

how to test for intention tremor

A

finger nose testing

35
Q

examination in resting tremor

A
  • Bradykinesia- one side and then the other. Pincer grasp in air, 20 times.
  • Rigidity- Supinator pronator movements. If not certain use synkinesis- movement of another body part. Tap with one hand while testing tone on other side. Cogwheeling.
  • Tremor- rest hands down on knees, is there a pill rolling tremor. If they are suppressing it, get them to count backwards.
  • Postural instability- shuffling gait, bit of difficulty turning, reduced arm swing.
    Test of retropulsion, stand with back to couch- sit, stand up and then give them a pull backwards.
36
Q

where does VZV lie

A

sensory ganglion

37
Q

what does HSV cause

A

viral encephalitis (temporal lobe)

38
Q

what does polio affect

A

anterior horn cell

39
Q

what can measles cause

A

subacute sclerosing panencephalitis

40
Q

what does JC virus cause

A

pml

41
Q

what is bright in T1 sequence

A

fat

42
Q

what is bright in T2 sequence

A

demyelination and CSF

43
Q

common presentations of MS

A

optic neuritis

transverse myelitis

44
Q

treatment of MS

A

acute: steroids

long-term; immunomodulatory treatments (copaxone/IFN/tysabri)

45
Q

subdural haematoma

A

crescent moon shape, might cross midline.

Venous haemorrhage. Most common mechanism- trauma.

May be insidious, worsening headache

46
Q

extradural haematoma

A

lens shape, arterial bleed.

Mechanism: trauma or after surgery.

Acute presentation: skull fracture and altered mental status.

47
Q

subarachnoid haemorrhage

A

subarachnoid space, anywhere where there is CSF there is blood.

Predominately arterial.

Acute onset worst headache of life.

Spontaneous ruptures of peri-aneyurysms around circle of willis. Can be traumatic.

48
Q

intraparenchymal haemorrhage

A

blood within the hemispheres themselves.

Mechanism: high blood pressure, AV malformation, tumour.
Arterial or venous.
Acute sudden onset nausea, vomiting

49
Q

monroe kellie hypothesis

A

CPP= MAP- ICP

50
Q

cushings reflex

A
  • Raised ICP= low cerebral blood flow, cerebral ischaemia, acidosis
  • Sympathetic response= vasoconstriction, raised MAP to increase CPP
  • Baroreceptors in the neck lead to reflex bradycardia
  • HIGH BP and BRADYCARDIA= cushings reflex

Finals Revision (29 decks)

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