Localising the lesion

Question 1

areflexia

Answer 1

nerve root
peripheral nerve lesion
note: ankle jerks may be absent in older people

Question 2

LMN lesion

Answer 2

muscle atrophy
muscle weakness
areflexia
muscle cramps and pain
fasciculations

Question 3

UMN lesion

Answer 3

hyperreflexia
extensor plantar response
hypertonia
hypokinesia of movement
little or no muscle wasting
patterned weakness

Question 4

some functions of CN VII

Answer 4

contraction of the stapedius muscle

cutaneous supply to external ear

Question 5

the cerebellum

Answer 5

coordinates movement

maintains equilibrium and muscle tone

Question 6

signs of cerebellar dysfunction

Answer 6

nystagmus

ataxia

Question 7

cerebellar signs - DANISH

Answer 7

Dysdiadochokinesis
Ataxia
Nystagmus
Intention temor
Slurred speech
Hypotonia

Question 8

myopathic patterns of weakness

Answer 8

atrophy +
no fasciculations
increased tone (may not be)
proximally distributed
reflexes ++/+
flexor plantars

Question 9

myasthenia gravis

Answer 9

anti acetylcholine receptor antibodies

disorder of neuromuscular transmission

Question 10

cavernous sinuses

Answer 10

most centrally located dural sinus (found near pituitary)
receive venous blood from facial veins
internal carotid and CN III-VI and parts of I & II run through the cavernous sinus
infections from the face, nose and tonsils can spread easily

Question 11

cavernous sinus thrombosis

Answer 11

potentially life threatening
Sx include:
Severe headache
Swelling, redness, or irritation around one or both eyes
Drooping eyelids
Inability to move the eye
High fever
Pain or numbness around the face or eyes
Fatigue
Vision loss or double vision

Question 12

red flags in back pain

Answer 12

neuro:
sphincter or gait disturbance
saddle anaesthesia
progressive motor loss

other:
non-mechanical pain at rest
fever or weight loss
age <20 or >50
thoracic pain
PH Ca
HIV