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