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PAN- Neurology > Hani Revision Book > Flashcards

Hani Revision Book Flashcards

1
Q

What are the upper motor neuron signs?

A

Hypertonia
Hyperreflexia
Weakness with no wasting
Clonus and upgoing plantars

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2
Q

What are the lower motor neuron signs?

A 
Reduced tone
Weakness
Wasting
Fasciculations
Hyporeflexia
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3
Q

What are the key functions of the frontal lobe?

A

Personality
Emotions
Broca’s area for speech formation
Precentral gyrus/premotor cortex

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4
Q

What are the key functions of the temporal lobe?

A

Memory

Wernicke’s area- language reception/comprehensions

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5
Q

What are they key functions of the occipital lobe?

A

Vision

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6
Q

What are the key functions of the parietal lobe?

A

Postcentral gyrus/Primary sensory cortex

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7
Q

What tract do the majority of motor pathways run in? Where does decussation take place?

A

Corticospinal tract-
Decussation takes place at the medulla. Begins at the precentral gyrus (motor cortex in frontal lobe) and descends in the internal capsule, decussating at the medulla. Runs along the lateral corticospinal tract to the ventral horn where it synapses with the postsynaptic neuron.

Note- Fibres that innervate axial muscles decussate in the spinal cord and descend via the anterior corticospinal tract

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8
Q

Where does the corticospinal tract decussate?

A

At the medulla

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9
Q

Where does the corticospinal tract begin?

A

Precentral gyrus or primary motor cortex

It’s in the frontal lobe

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10
Q

What does the spinothalamic tract carry?

A

Pain and temperature and crude touch- involves three neurons leading to the postcentral gyrus. (Temporal lobe)

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11
Q

Describe the route of the spinothalamic tract?

A

First order neuron synapses with second order neuron at the dorsal horn (first order neuron ascends 1-2 levels via lissauer’s fasciculus)
Second order neuron crosses to the other side via the anterior white commissure, then ascends via the spinothalamic fasciculus
Synapses with third order neuron at the thalamus
Third order neuron to the postcentral gyrus (sensory cortex)

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12
Q

What is the arrangement of the sensory cortex?

A

It’s upside down- feet are at the top and middle, face is lateral and lower down

Both are responsible for contralateral side

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13
Q

Where does the spinothalamic tract decussate?

A

The second order neuron decussates in the spinal cord via the anterior white commissure

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14
Q

Where does the corticospinal tract decussate?

A

The medulla- this is the upper motor neuron which descends from the precentral gyrus/motor cortex.

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15
Q

What does the dorsal column carry?

A

Position/Proprioception
Vibration
Fine touch

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16
Q

Where is the dorsal column found in the spinal cord?

A

Posterior spinal cord

Dorsal = Back

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17
Q

Which column carries coarse touch?

A

Spinothalamic

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18
Q

Which column carries fine touch?

A

Dorsal column

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19
Q

Describe the route of the dorsal columns

A

Carries proprioception, vibration and fine touch

First neurons- Neurones run from receptors to the dorsal horn. Ascend via the dorsal columns (Gracile and Cuneate Fasciculus) to the medulla to synapse with cuneate or gracile nucleus.

Decussation occurs at the medulla to the other side by second order neuron.

Then to the ventral posterolateral nucleus in thalamus

Then to the sensory cortex via third order neuron.

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20
Q

Where do the dorsal columns decussate?

A

Medulla oblongata

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21
Q

Where does the corticospinal tract decussate?

A

Medulla

22
Q

Where does the spinothalamic tract decussate?

A

At the spinal cord via the anterior white commissure

23
Q

Outline what the spinothalamic tract and dorsal columns carry

A

Spinothalamic- Pain, Temperature, Coarse Touch
Dorsal- Proprioception, Vibration, Fine touch

STC- Sit to crap
DPF- Dogs poo fast

24
Q

Where is the cortical area for speech located in most people?

A

The left side

60-70% of left handed people it is on the left side

25
Q

What is the difference between dysphasia, dysarthria and dysphonia?

A

Dysphasia is a failure to comprehend or produce speech
Dysarthria is a failure to articulate to create clear speech, slurring words for example
Dysphonia is a failure to create the normal sounds of speech- e.g. hoarse voice

26
Q

Where is Wernicke’s area?

A

Superior temporal gyrus

27
Q

Where is Broca’s area?

A

Inferior frontal gyrus

28
Q

What connects Broca’s area and Wernicke’s area?

A

Arcuate fasciculus

29
Q

What cranial nerves are important in speech?

A

Glossopharyngeal
Vagus- Controls Larynx
Hypoglossal

30
Q

What is important to assess when checking speech?

A

Reception and Fluency

Ability to form words and specific sounds

31
Q

What needs to be done to check for receptive aphasia?

A

Three step command- e.g. take this piece of paper, fold it in half and put it under the table

32
Q

How can you test for speech fluency?

A

Ask some questions that require a bit of a response

33
Q

Outline a speech examination

A

WIPE
Check examination is fair: patient can hear you? wears dentures? speaks english?

Ask a few questions
Write a sentence (expressive dysphasia test)
Repeat a sentence after me (conductive dysphasia)
Three step instruction (receptive dysphasia)
Name objects (nominal dysphagia)
Sounds: Ma Ma Ma (CNVII), La La La (CNXII), Ka Ka Ka (CNIX, X)
Say Baby Hippopotamus, British Constitution
Ask to cough
Count down from 20 to 1 in one breath (tests fatigability)

https://www.youtube.com/watch?v=4t9OYmcCZ6U

34
Q

What is done to test for conductive dysphagia?

A

Repeat a sentence after you- lesion of the arcuate fasciculus which causes issues when trying to communicate between Wernicke’s and Broca’s

35
Q

What sound can check for cranial nerve lesions?

A

Ma Ma Ma- Facial Nerve
Ka Ka Ka- Vagus and Glossopharyngeal
La La La- Hypoglossal

36
Q

How do you check for nominal dysphasia?

A

Ask the patient to name things

37
Q

How do you check for conductive dysphagia?

A

Ask the patient to repeat a sentence

38
Q

Where is a problem located if it causes dysphonia?

A

The vocal cords

39
Q

What does a lesion of Wernicke’s area cause?

A

Receptive aphasia

Tested by asking them to do a three step action

40
Q

What does a lesion of Broca’s area cause?

A

Expressive aphasia

Tested by asking them to write a sentence, or just normal speech makes no sense

41
Q

What is the grading for muscle weakness?

A 
0= No visible contraction
1= flicker of contraction
2= movement with gravity reduced
3= movement against gravity
4= movement against partial resistance
5= normal power

Always test side to side and then compare

42
Q

What should you do if struggling to elicit reflexes?

A

Ask the patient to clench their teeth
Or pull their hands apart

Do this after two failed attempts

43
Q

What frequency of tuning fork is used to test vibration sensation?

A

128 Hz

256 or 512 is used for Wernicke’s or Broca’s

44
Q

What is seen in a hemiplegic gait?

A

Lower limb is moved in a semicircle with foot dropping and ragging of the big toe. Lack of arm swing on one side and arm is held in a flexed position close to the chest.

https://www.youtube.com/watch?time_continue=41&v=y160w4sAQNw

45
Q

What is seen in a spastic gait?

A

Stiff, scissor gait with legs crossing in front of each other while walking. Swinging out of both sides.

https://www.youtube.com/watch?v=eLuxTFHoZAA

46
Q

What is seen in an ataxic gait?

A

Broad based gait- like they’re drunk and trying to balance. Difficulty with heel to toe test.

Due to impairment of proprioception and vibration. Often due to B12 deficiency.

47
Q

What is seen in a parkinson’s gait?

A

Shuffling gait with small steps. Lack of arm swing and arms are held in a fixed position.

48
Q

What is seen in a high stepping/steppage gait?

A

Patient lifts the legs up high to prevent the toes dragging- this is due to a foot drop. Occurs with damage to the common fibular nerve resulting in inability to dorsiflex.

49
Q

What is seen in a waddling gait?

A

Lumbar lordosis and the patient’s legs are wide apart. Trunk moves from side to side with the pelvis dropping- usually due to hereditary muscular dystrophies.

50
Q

What causes gait apraxia/lower body parkinsonism?

A

Diffuse cerebrovascular ischaemia- small vessel disease

It appears as patients with difficulty starting to walk with small, shuffling steps.

51
Q

What is the most common complication of a lumbar puncture?

A

Post-LP headache

Worse on sitting and standing and usually resolves spontaneously in 7 to 10 days.

PAN- Neurology (10 decks)

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