Ipad Questions Flashcards
3rd nerve palsy
Ptosis
Down and out at rest
Big pupil - if damage to PNS via Edinger-Westfall nucleus or external compression
PCOM aneurysm
Uncal herniation
Diabetic infarct (pupil sparing)
Nuclear (brainstem) lesions - often bilateral
Benign Essential Tremor
Autosomal dominant Both upper limbs Worse with outstretched arms (postural) Improves with alcohol Improves with rest
Commonest cause of head tremor (“titubation”)
Management:
- Propranolol
- Primidone
6th nerve palsy
Failure of abduction (lateral gaze)
Or just double vision looking one wayw
4th nerve palsy
Commoner in children (head trauma at birth)
Double vision on reading
Fall over walking downstairs
Down and in is the problem - Vertical diplopia
Long term –> head tilt to compensate (bielschowsky tilt)
Usually traumatic
Longest nerve as comes out back of brainstem and around
Congenital Horner’s
Associated with heterochromia (different coloured eyes)
Prob with development pf something in cord
Causes of horners
Brain, stem down to T1 - stroke, MS, tumour
Cervical chain from t1 up - tumour in lung or thyroid, goitre
Carotid dissection
Cavernous sinus
Superior orbital fissure??
Painful, pupil involving 3rd nerve palsy
Aneurysm of PCA pressing on occulomotor nerve
If bleed –> SAH (xanthochromia on LP)
Refer to neurosurgeons
Holmes Adie pupil
Dilated pupil
Anisocoria
Changes with ambient light but no acute light response - “tonic pupil”
Accomodation occurs but may be slow
Idiopathic problem with post ganglionic Parasympathetic NS
Can occur secondary to trauma, inflammation, infection, tumour
Holmes-Adie syndrome = with hyporeflexia and diaphoresis (sweating)
Ulnar Nerve Palsy
Bent little and ring fingers = ulnar claw (loss of medial lumbricals) when asked to straighten hand
Small muscle wasting of hand but NOT thenar eminence
Sensory change in palmar little and half of ring finger
?Froment’s sign - opposing thumb the index finger flattens
Radial Nerve Palsy
Wrist and finger drop - long extensors of the hand and fingers
No wasting in the hand
Median Nerve Palsy
Thenar wasting
High median lesion –> median claw when asked to make a fist = hand of benediction - can’t bend index and middle in due to loss of long flexors of the lateral fingers and the lateral lumbricals
Causes of spastic paraparesis
Cord compression - emergency!
Cervical spondylosis
MS
Motor neuron disease
Stroke
Right eye deviated medially
Can’t look laterally
Diplopia maximal on looking right
6th nerve palsy
Causes of a 6th nerve palsy
Diabetes, hypertension
MS
Raised ICP
Earliest sign of raised ICP in fundi
Loss of retinal vein pulsation
Cushing’s Triad
Hypertension
Bradycardia
Abnormal respiration
Signs of raised ICP
Signs of raise ICP
Cushing's triad Loss of retinal vein pulsation, then papilloedema Vomiting, especially in the morning Headache 6th nerve palsy 3rd nerve palsy
Wasting of the small muscles of the hand - causes
Bilateral
- rheumatoid
- cervical spondylosis
- motor neuron disease
- charcot marie tooth
- syringomielia
- bilateral cervical ribs
Unilateral causes
- pancoasts
- brachial plexus trauma
- cervical rib
Neurofibromatosis Type 1
Von Recklinghausen
AD on chr 17
Neurocutaneous: Cafe au lait spots (6 or more, over 15mm), axillary /neck/groin freckling,
Lisch nodules in the iris (hamartomas seen with slit lamp)
More than 2 dermal NFs
Nodular NF (nerves)
Optic glioma
Fundal changes
Neurofibromas on nerve tissue which may cause compression
Associated with: Hypertension Scoliosis 10% malignant transformation Behavioural abnormalities, learning difficulties
Rare associations:
phaeo
Renal artery stenosis
Neurofibromatosis Type 2
AD on chr 22
Bilateral 8th nerve palsy
Acoustic neuromas
Crowe’s sign
Axillary freckling
As seen in neurofibromatosis type 1
What is Fredrich’s ataxia?
AR inheritence
Spinocerebellar degeneration
Spine –> upper and lower MN signs = weakness and wasting
Cerebellar signs
Motor Neuron Disease
Degeneration of the anterior horn cells
Commonly presents with fasciulations
Joints affected in psoriatic arthritis
Hands
Hips (sacroilitis)
Knees
Oligoarthritis
Also arthritis mutilans - erodes joint, pencil in cup appearance?
Lichen Planus
Purple papules
Inside of wrists
White patch on buccal mucosa
Demonstrates Koebener phenomenon
What is the Koebener phenomenon?
Rash occurs at site of trauma
Vitiligo
Psoriasis
Lichen planus
Warts
Complications Post MI
Failure Arrhythmias - AF, heart block (inferior MI), VT/VF and sudden death Murmurs -- Mitral regurgitation -- VSD -- tricuspid regurg
Ventricular aneurysm
Pericarditis
Dressler’s syndrome
Cardiac causes of syncope
Aortic stenosis
Arrhythmias - AF, SVT, heart block, VT/VF
Tamponade
Chest pain + systolic murmur
Mirza
Aortic stenosis
Palpitations and murmur
Mirza
Mitral regurg??
Complications of a prosthetic valve
Failure Infection Bleeding - warfarin Anaemia - haemolysis Thromboembolic
Causes of an irregularly irregular pulse
AF
Atrial flutter with a variable block
Multiple ventricular ectopics
Poor prognostic factors in rheumatoid
Young at onset
Female
Rheumatoid factor positive
(More on Mirza’s slide)
Can’t see a red reflex
Tumour
Opacified lens
Retinal detachment
Vitreous haemorrhage
(False eye)
Causes of a pigmented retina
Retinitis pigmentosa Racial variation Choroido retinitis (toxoplasmosis) Laser burns (diabetic retinopathy treatment) Melanoma
Indications for Pulmonary Lobectomy
Cancer and benign tumours
Bronchiectasis
Congenital abnormalities
Infection
- Chronic lung abscess
- TB
- Fungal infection (life threatening haemoptysis in Aspergillosis)
Causes of Bronchiectasis
Genetic - CF, Kartagener’s (Marfan’s)
Chronic lung disease - COPD
Chronic systemic disease - Rheumatoid (1/3 pts), IBD
Secondary to obstruction - foreign body, tumour, lymph nodes
Secondary to infection - TB, pertussis, measles
Secondary to damage - recurrent aspiration
Hypogammaglobulinaemia (this is the treatble cause!!)
Allergic bronchopulmonary aspergillosis
Allergic Bronchopulmonary Aspergillosis
Aspergillus triggering ++immune response
- mucus plugging
- serum eosinophilia
- raised IgE and IgG (precipitins)
Usually presents as loss of symptom control in an asthmatic
Management: long term steroids and antifungals
Lobectomy or Pneumonectomy?
Thoracotomy + chest drain below OR 3 port VATS
Lobectomy = local flattening of ribs, locally reduced expansion and air entry. Otherwise hyper-resonant as remaining lung expands to fill the cavity.
Pneumonectomy = this side fills with fluid, so like a giant effusion - stony dull with decreased expansion, air entry and vocal resonance. Trachea and apex beat displaced.
Causes of a Thoracotomy Scar
Lungs: pneumonectomy, lobectomy
Heart: valve repair, thoracic aorta
Oesophageal procedures
Diaphragmatic repair
Anterior spinal tumour excision
Latissimus dorsi flaps
Dark skinned
Persistent dark brown bruise-like lesion
Palms, soles, under nails, buccal mucosa (hairless areas)
Acral lentiginous melanoma
5% of all malignant melanoma BUT 50% of mm in dark skinned people
Poor prognosis as goes unnoticed
Dark, flat, irregular lesion
Itching, bleeding and growing
Caucasian woman
Sun exposed areas
Superficial spreading melanoma
Commonest malignant melanoma
Usually in pre-existing mole, can be de novo
Nodular pigmented lesion
De novo (not in an existing mole)
Grow rapidly
Extend deep
Nodular melanoma
Most aggressive type of malignant melanoma
Pigmented sun-damaged skin
Progress over years into lesion with nodules or irregular border
Lentigo maligna melanoma
