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Finals Revision Lectures > Mirza's Cases > Flashcards

Mirza's Cases Flashcards

1
Q

What lesion is down and out pupil?

A

3rd nerve palsy

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2
Q

What are the causes of a 3rd nerve palsy?

A 
Surgical = SOL, posterior communicating artery
Medical = Diabetes, HTN, MS
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3
Q

Does the pupil dilate early or late in surgical 3rd nerve palsy?

A

Early, due to the parasympathetic fibres running along the outside of the nerve

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4
Q

What investigations would you like in a 3rd nerve palsy?

A

Blood pressure and blood sugars to assess for medical causes

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5
Q

A patient has a unilateral ptosis on their right side, what are the differentials?

A

Horners = small pupil

Myasthenia = normal pupil

3rd nerve palsy = dilated pupil

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6
Q

Causes of a bilateral ptosis?

A

Myasthenia graves

Dystrophia myotonica

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7
Q

How would a 6th nerve palsy present?

A

Inability to abduct the affected sides eye

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8
Q

Causes of a 6th nerve palsy?

A

HTN, diabetes

MS

Raised ICP

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9
Q

What are the signs of raised ICP?

A

Earliest sign is loss of retinal vein pulsation, latest is papilloedema

Cushings triad = Bradycardia, HTN, irregular breathing

Reduced GCS

6th nerve palsy - gets pinched at the petrous temple bone

3rd nerve palsy

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10
Q

When do you get double vision in a 6th nerve palsy vs a 4th?

A

6th is when looking towards the affected side
Outer image comes from the affected eye, disappears on closing that eye .

4th is when looking down and inwards

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11
Q

Patient has hypertonia in both legs, reduced power, increased reflexes and clonus. Ddx?

A

Cord compression

Cervical spondylosis

MS

MND

CVA

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12
Q

What is spasticity vs rigidity?

A

Rigidity is the same throughout

Spasticity = clasp like, difficult to initiate then eases off. Extensors in lower limbs and flexors in upper limbs.

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13
Q

Patient has cord compression after our lower limb exam before, what else do we want to do and what questions should we ask?

A

Check sensory levels and examine upper limbs + cranial nerves

Examine sacral sensation

Ask: Any urinary incontinence, or faecal incontinence. Have they noticed any change in the sensation when weeing?

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14
Q

Ddx for wasting of the thenar and hypothenar eminences?

A

Bilateral:

  • Rheumatoid
  • Cervical spondylosis
  • MND
  • CMT
  • Syringomyelia

Unilateral:

  • Cervical rib
  • Pancoasts
  • Brachial plexus trauma
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15
Q

Three reasons for a CXR in a stroke patient?

A

Risk of aspiration pneumonia

Lung malignancy can metastasise to the brain

Enlarged heart = CCF and HTN

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16
Q

What are the features of neurofibromatosis 1?

Which chromosome affected?

A

Cafe au lait spots
Axillary freckling
Fibromas = subcutaneous, and plexiform
Eye = Lisch nodules (brown iris hamartomas)

Neoplastic change in 10% e.g. Phaeo’s, meningiomas
Orthopaedic scoliosis
IQ reduced
Renal = RAS = HTN

Chr 17

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17
Q

How many cafe au last spots is diagnostic and how big should they be?

A

6

> 15mm

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18
Q

What are the features of neurofibromatosis 2 and chromosome?

A

Bilateral acoustic neuroma = SNHL

Chromosome 22

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19
Q

Types of facial nerve palsy?

A

UMN is forehead sparing

LMN is everything:

  • Bells palsy = unknown aetiology
  • Ramsay hunt syndrome is reactivation of varicella zoster virus in the geniculate ganglion of CN8
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20
Q

What else to examine / ask about?

A

Change in taste as facial does anterior 2/3rds of the tongue (via the chord tympani branch of CN7)

Examine ear for any rash

Ask about any extremely loud sounds (hyperacusis due to the stapedius branch of CN7)

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21
Q

Extracranial branches of facial nerve?

A 
Temporal
Zygomatic
Buccinator
Marginal mandibular
Cervical branch
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22
Q

How do you localise a facial palsy?

A

If symptoms of CN7 + 6 = pons

If symptoms of CN7 + 5 + 8 = cerebello-pontine angle
- For cranial nerve 5 can test corneal reflex (afferent branch is trigeminal, so if both eyes don’t close it is this)

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23
Q

Types of CMT, and how to differentiate?

A

Hereditary sensory and motor neuropathy
Autosomal dominant

CMT1 = commonest, demyelinating lesion = velocity <38m/s

CMT2 = Axonal pathology, velocity >38m/s

24
Q

PC in CMT?

A

Often presents with small muscle wasting of the hands.
Walking difficulty = high stepping gait and foot drop

Reduced reflexes, muscle strength and sensation

Pes Cavus

25
How does Friedrich's ataxia commonly present?
Spina-Cerebellar degeneration = cerebellar signs e.g. ataxia
26
Non-neurological signs of Friedrich's ataxia?
Pes cavus Cardiac = HOCM DM
27
How does MND commonly present?
Fasciculations
28
Describe a psoriatic rash?
Salmon pink circular discoid patches, with silver discolouration on flexor surfaces and buttocks
29
Where else would you examine for psoriasis?
Scalp and behind the ears Nails = pitting, onycholysis Joints
30
What is the koebner phenomenon?
Purple lesions associated with scarring
31
MI complications?
``` Short term: - VF RCA = sinus bradycardia, 1/2 HB - LAD = Complete heart block - MR due to papillary rupture - Dresslers ``` Long term: - Arrhythmias - MI - CCF
32
Triad of Parkinson's?
Bradykinesia Pill rolling tremor Rigidity
33
What're the Parkinson's plus syndromes?
MSA, corticobasal degeneration and PSP
34
Signs of PSP?
Supranuclear gaze and postural instability Rocket sign, ask them to get up out of the chair and they shoot up
35
What three conditions make up MSA, and signs?
Olivopontocerebellar atrophy Shy-drager Striatonigral degeneration Autonomic dysfunction = postural hypotension, bladder dysfunction Cerebellar signs Rigidity > tremor
36
Extra-articular features of rheumatoid?
Atlanto-axial instability due to weakening of the transverse ligament holding odontoid of C2 against anterior arch of C1 Nodules Anaemia Splenomegaly in Felty's Fibrosis and pulmonary nodules
37
Clinical features of Pagets?
Bowed legs, frontal bossing Joint pain Hearing loss
38
What do people with Paget's die from?
High output heart failure As bones become larger = bigger capillary network = big volume = big heart
39
If you have a mix of UMN, and LMN with no sensory what is it?
MND
40
Causes of hypoglycaemia?
SAILS Q ``` Sulphonylureas Alcohol Insulin OD Liver disease Sepsis Quinines ```
41
What is Addison's and signs?
Primary adrenal failure = low cortisol so high ACTH Low sodium and high potassium Postural hypotension, vitiligo, hypoglycaemia, hyper pigmentation as excess ACTH = POMC
42
Causes of Addison's?
Autoimmune is commonest in UK TB is commonest worldwide Amylodiosis
43
Investigations for Addisons? Mx?
Lying and standing BP Synacthen test Glucose Steroids IV hydrocortisone fast and fluids Then long term hydrocortisone and fludrocortisone
44
What murmur is ejection systolic? Classic signs?
Aortic stenosis Syncope, exertion dyspnoea and angina Radiates to carotids Slow rising pulse, and narrow pulse pressure
45
Investigations for AS? Mx for AS?
TTE is definitive ECG = LAD and LVH (Tall R wave in V5/6, Deep S in V1/V2) MDT Cons = Diet, exercise, weight Medical = Mx any co-morbidities Surgical: - Asymptomatic valve replacement if EF <50% - Symptomatic - low risk = aortic valve replacement - high risk surgical patient = TAVR Long term anticoagulation if mechanical valve aiming for 3-4 Long term IE prophylaxis
46
What is an EDM? What does it change to when severe? Signs?
Aortic regurgitation Low pitched mid-diastolic murmur = AUSTIN FLINT LVF = orthopnea, PND, exertion dyspnoea Collapsing pulse De Mussets Quinckes
47
Management of aortic regurgitation?
Severe asymptomatic: - EF > 50 = vasodilator therapy Symptomatic or asymptomatic EF <50: - Aortic valve replacement / TAVR
48
Blowing PSM? Features?
Mitral regurgitation Exertional dyspnoea Angina Radiates to axilla Soft S1
49
Causes of aortic stenosis?
Valvular causes = True congenital defect, calcificaition, rheumatic fusion Sub-valvular = LV hypertrophy
50
Causes of aortic regurgitation?
Acute = IE and aortic dissection Chronic = Bicuspid valve and rheumatic heart disease
51
Causes of mitral regurgitation?
Acute = papillary muscle rupture post-MI, IE, rheumatic fever Chronic = Mitral valve prolapse, LV dilation (AR, AS, HTN, dilated cardiomyopathy) , calcification
52
Investigations and management of MR?
Acute MR = Valvuloplasty or annuloplasty Chronic - EF >60 = ACEI and BB Chronic EF <60 / symptomatic = Medical and surgical
53
MDM? Signs?
Mitral stenosis Dyspnoea Angina Opening snap, tapping apex Low pitched rumbling
54
Investigations and Mx of mitral stenosis?
Ix = ECG: - AF - LAH = bifid p wave / p-mitrale - Also see RVH due to pulmonary congestion = Tall R in V1/V2, deep S in V5/V6. Echo Mx: - Mild disease = No therapy - Symptomatic = Valve repair / replacement
55
Late systolic murmur with systolic click?
Mitral valve prolapse (barlow syndrome) ``` Medical = Aspirin / warfarin, BB's Surgical = Mitral valve repair ```
56
Causes of heart failure?
Myocardial damage = Infarction, toxins e.g. anabolic steroids, infiltration

Finals Revision Lectures (2 decks)

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