key Flashcards
Causes of third nerve palsy (PHD)
Posterior communicating artery aneurysm (painful- neurosurg emergency) Hypertension Diabetes \+MS \+trauma \+bleed \+tumour
Surgical third nerve palsy - when does pupil dilate early or late
EARLY
- due to PS nerves on outside of eye getting compressed early
- whereas in diabetes (medical third n palsy) it happens from inside to out
Horners S triad
Ptosis
Miosis
Anhidrosis
Enopthalmos
Causes of Ptosis - unilateral or bilateral
Unilateral = HS, 3rd N Palsy, Myasthenia , congenital
Ptosis + pupil sizes
Large pupil = 3rd N Palsy
Small pupil = Horners S
Normal pupil = Myasthenia, dystrophia myotonica
Abducens nerve palsy
LR - supplied by 6th CN Causes: Similar to 3rd N P -HTN -DM -MS -RAISED ICP
Raised ICP signs
loss of retinal vein pulsation, Cushings triad – HTN, Bradycardia, Kussmaul Breathing, focal seizures, LoC
Raised ICP late sign in eye
papilloedema on fundoscopy
why is 6th n commonly affected by raised ICP
long intracranial tract
UMN spasticity vs rigidity
Spasticity = velocity dependent, increased tone occurs early on, flexors in UL>extensors in LL Rigidity = tone increased THROUGHOUT, velocity independent
Causes of UMN signs - MCMC
Multiple Sclerosis
Cord compression
MND
Cx Spondylosis
Causes of wasting of small muscles of gold - BILATERAL
Rheumatoid arthritis
Cervical Spondylosis
Rare - CMT, syringomyelia, bilateral cervical ribs
Causes of wasting of small muscles of gold - UNILATERAL
Pancoast Tumour
Brachial plexus trauma
Cervical rib
Patient with a stroke, 3 reasons for a CXR
- Aspiration pneumonia
- Lung cancer - mets
- Enlarged heart - CCF, HTN
Signs of a facial palsy
- test facial muscles
- loss of lacrimation (Schirmer’s test)
- stapedius reflex
With a facial palsy what else would you want to examine
- ears for HZ (Ramsay Hunt Syndrome) and acute otitis media
- parotids
- tongue (anterior 2/3)
With a facial palsy , what 2 qs should you ask
Hyperacusis (incr in sound) + taste change
FN palsy + 6th CN
pons lesion
FN palsy + 5th + 8th CN
Cerebellopontine angle
-early sign = loss of corneal reflex
Psoriasis complications in the nails (POSH)
Pitting
Onycholysis
Subungual hyperkeratosis
Haemorrhages (splinter)
Psoriasis other parts of the body affected
Hands
Hip (sacroillitis)
Knee (Oligoarthritis)
RARE - arthritis mutilans
Lichen Planus associated phenomenon
Koebners phenomenon
Koebners phenomenon causes (VPLW)
Vitiligo
Psoriasis
Lichen planus
+Warts
Complications of MI (FAM)
Failure
Arrythmias
Murmurs
Cardiac causes of syncope other than Aortic Stenosis
Arrythmias
- Bradyarrythmias: heart block, bradycardia
- Tachyarrythmias: SVT, VT, VF
Causes of Snycope (other than vasovagal- IMP to think about this) x 6
PE Ectopic AAA Aortic dissection MI SAH
Aortic Stenosis Sx ASS
Angina
Syncope
SOB
signs of clinically severe AS
Soft S2
Narrow pulse pressure
How to differentiate A Stenosis from A Sclerosis
No radiation
Normal pulse
Normally elderly
Causes of raised JVP
Right sided HF Fluid overload SVC obstruction Complete heart block Pericardial Effusion CCF Tricuspid regurgitation
SVC obstruction JVP signs
Engorgement
non pulsatile
Cx of Prosthetic heart valve : FIBAT
Failure Infection - IE Bleeding - Warfarin or site Anaemia - MAHA Thromboembolic - PE
Other causes of irregularly irregular pulse
AF
A flutter with variable block
Multiple ventricular ectopics
Mitral stenosis define
LOW PITCHED RUMBLING MID – DIASTOLIC MURMUR, BEST HEARD IN MITRAL AREA, WITH PT IN LEFT LATERAL POSITION, ON EXPIRATION
How breath accentuates murmur
Left sided murmurs louder on EXPIRATION
Right sided murmurs louder on INSPIRATION
Cx of Mitral Stenosis
pulmonary hypertension
signs of pulmonary hypertension
LOUD P2
L Parasternal heave
Graham Steele Murmur (early diastolic murmur due to pulmonary regurg)
