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Oxford Clinical Cases > Limb weakness > Flashcards

Limb weakness Flashcards

1
Q

The technical term for a ‘clumsy’ limb

A

Ataxia

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2
Q

2 key things to establish with acute limb weakness

A

Time course

Location of the lesion

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3
Q

Sudden onset of limb weakness =>

A

CVA
Trauma (e.g. displaced cervical fracture)
Could also be in various parts of the nerve pathway -> acute limb ischaemia, Todd’s palsy, spinal cord prolapse!

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4
Q

Chronic onset limb weakness =>

A

Slow growing tumour

MND

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5
Q

Slow onset limb weakness (hours -> days) =>

A

Gillian-Barre
MS
Subdural haematoma

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6
Q

Spinal cord disease

A

Prolapse
Infarction
Spinal canal stenosis

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7
Q

Altered sensation and paralysis peripheral -> central =>

A

GBS

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8
Q

Where does GBS affect in the nerve pathway?

A

Nerve root

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9
Q

Causes of gradual onset limb weakness (chronic)

A

Diabetes
Myasthenia
Vit B12 deficiency
Tumour

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10
Q

Window for thrombolysis

A

4.5hr

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11
Q

How can you tell the lesion is in the brain?

A

Cognitive signs such as speech or vision issues

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12
Q

Gradual onset headache =>

A

Slow growing tumour

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13
Q

Seizure or LOC with limb weakness =>

A

Haemorrhage
Todd’s paresis
Hypoglycaemia

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14
Q

Hemiparesis with back pain =>

A

Disc prolapse

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15
Q

Unilateral headache and limb weakness =>

A

Hemiplegic migraine

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16
Q

3 main RF for stroke

A

Previous stroke/TIA
AF
Atherosclerotic RF e.g. obesity, HTN, diabetes smoking

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17
Q

UMN signs

A

Increased tone
Brisk reflexes
Upgoing plantars (Babinski sign)
Clonus

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18
Q

LMN signs

A

Reduced tone
Absent reflexes
Fasciculations
WASTING

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19
Q

Broca’s area affects…

A

Articulation of speech

Know what to say but can’t say it

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20
Q

Wernicke’s area affects….

A

Comprehension of speech

Can speak fluently but its nonsense

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21
Q

Complete blindness in one eye suggests…

A

Lesion in optic nerve

Optic neuritis

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22
Q

Homonymous hemianopia suggests…

A

Lesion in the optic chiasm (if bitemporal)

One side => in the cortex (localising sign)

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23
Q

Eye deviating TOWARDS the weak side =>

A

Brain stem lesion

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24
Q

Eye deviating away from the weak side =>

A

Cortical lesion

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25
Q

Non-forehead sparing weakness =>

A

Problem with facial nerve itself (Bell’s palsy)

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26
Q

If the weakness is greater in the arm than the leg, which bit of the motor cortex is it affecting?

A

Lateral homunculus

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27
Q

Which artery supplies the lateral part of the primary motor cortex?

A

Middle cerebral artery

28
Q

Which artery supplies the medial primary motor cortex?

A

Anterior cerebral artery

29
Q

How long do TIA usually last?

A

<1 hour

30
Q

Definition of TIA

A

Symptoms and signs of stroke that resolve in <24hr

31
Q

First-line investigations of stroke

A 
CT head 
FBC
Blood glucose (hypoglycaemia)
Blood clotting (emboli)
ECG (AF)
32
Q

Which metabolic abnormality can mimic stroke?

A

Hypoglycaemia

33
Q

Main treatment for haemorrhagic stroke

A

Supportive therapy to aid rehabilitation

34
Q

What is the management of an ischaemic stroke outside of the 4.5hr thrombolysis window

A

Anti-platelet drugs (ASPIRIN!) Given as soon as haemorrhagic stroke is excluded
Stroke ward admission
VTE prophylaxis

35
Q

Ix to do for patients after initial stroke management

A

ECG for AF/arrhythmia causing emboli

Carotid artery doppler looking for any stenosis

36
Q

Complications of stroke

A

Aspiration pneumonia
Pressure sores
VTE and recurrent stroke

37
Q

Which type of therapist should review stroke patients?

A

SALT

38
Q

What is the cut off for carotid endarterectomy?

A

> 70%!

39
Q

Who performs carotid endarterectomy?

A

Vascular surgeons

40
Q

Acronym for stroke drug prophylaxis

A

ASA
Antiplatelet (e.g. clopidogrel) (if you start this, no need for the aspirin aswell)
Statin
ACEi

41
Q

Which drug should be prescribed for ALL TIA patients?

A

300mg aspirin

42
Q

Which scoring system is used in TIA?

A

ABCD2

43
Q

Drug to control rate in AF

A

Bisoprolol

44
Q

Drug to reduce clotting risk in AF

A

Warfarin or modern drugs such as rivoroxaban

45
Q

Aspirin and clopidogrel affect which part of the clotting pathway

A

Platelet aggregation

46
Q

Name for clots that form due to stasis are called ….

A

Red clots

Rich in RBC and fibrin

47
Q

Prophylaxis of red clots from stasis is through use of

A

Fibrin mesh inhibitors = clotting cascade

= rivoroxaban and warfarin!

48
Q

Name of clots from ruptured plaques…

A

White clots

Rich in platelets!!!!!

49
Q

Prophylaxis of white clots from ruptured plaques is through use of…

A

Platelet aggregation inhibitors
Clopidogrel
Aspirin

50
Q

What do rivoroxaban and warfarin prevent?

A

Formation of fibrin mesh

Help to prevent VTE and atrial clots

51
Q

What do clopidogrel and aspirin prevent?

A

Platelet aggregation after ruptured atherosclerotic plaques

Help to prevent myocardial infarction and ischaemic stroke

52
Q

What is the 300mg aspirin prescribed for in stroke patients?

A

To prevent emboli

53
Q

What do you compare the CHADsVASc score against to determine if anticoagulation is wise?

A

HAS BLED

54
Q

Presentation of cord compression

A

Bilateral sensory loss
Weakness
UMN signs
Presentation building over a few days (subacute)

55
Q

Causes of cord compression

A

Disc herniation
Spondylolisthesis
SOL (abscess, tumour, haematoma)

56
Q

Investigation of cord compression

A

Spinal MRI

57
Q

Ix for MS

A

Spinal MRI looking for plaques

Lumbar puncture looking for oligoclonal bands

58
Q

Humerus fracture can cause damage to which nerve?

A

Ulnar nerve

59
Q

Which scale is used to grade limb weakness?

A

MRC scale

60
Q

Hemiparesis means…

A

Half body weakness

61
Q

Quadraplegic means

A

Complete paralysis of all 4 limbs

62
Q

Nerve root responsible for ankle jerk

A

S1/S2

63
Q

Nerve root responsible for knee jerk

A

L3/L4

64
Q

Nerve root for biceps

A

C5/C6

65
Q

Nerve root for triceps

A

C7/C8

66
Q

Nerve that innervates the bicep

A

Musculocutaneous nerve

67
Q

Nerve that innervates the badge area of the arm and teres minor

A

Axillary nerve

Oxford Clinical Cases (11 decks)

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