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YEAR 3 MED 2.0 > Module 3C Neurology and Ophthalmology - OSCEs > Flashcards

Module 3C Neurology and Ophthalmology - OSCEs Flashcards

1
Q

What symptoms to ask about in an ophthalmic history?

A
  • Visual disturbance
  • Red eye
  • Discharge/watering
  • Dry/gritty
  • Itching
  • Photophobia
  • Swelling or tenderness
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2
Q

Ophthalmic history - Red flag features + conditions

A

Features:
- Eye pain
- Photophobia
- Visual disturbances - flashing lights
- Red-eye
- Trauma

Conditions:
- AACG
- Uveitis
- Aggressive keratitis / Bacterial keratitis
- Temporal arteritis / GCA

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3
Q

What conditions are relevant to ophthalmic disease (PMH)

A
  • Diabetes mellitus
  • Hypertension
  • Autoimmune conditions (e.g. RA, ankylosing spondylitis, SLE) - dry eyes and uveitis
  • Atopy (asthma, allergic rhinitis, eczema)- allergic conjunctivitis and keratitis (eyedrops containing beta-blockers are also contraindicated in asthma)
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4
Q

What is used to measure intraocular pressure + what is a normal intraocular pressure?

A
  • Goldmann applanation tonometry
  • 10-21 mmHg
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5
Q

Basic surface eye anatomy

A
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6
Q

Description + diagnosis + management

  • Symptoms: headache, vomiting, pain, redness, blurry vision, and halos
A
  • Red sclera, eye is glossy/opaque, fixed dilated pupil
  • Acute angle closure glaucoma (AACG)
  • Refer to ophthalmology, laser iridotomy +/- IV acetazolamide
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7
Q

Open-angle glaucoma often looks like a normal eye, how would you measure the iridocorneal angle + what treatment would you give?

A
  • Gonioscopy - to measure iridocorneal angle
    .
    Management:
    1. 360 Selective laser trabeculoplasty
    2. Eye drops - prostaglandin analogues, eg. latanoprost
    (prostaglandin analogues improve uveoscleral outflow)
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8
Q

Description + Diagnosis + Management

  • Symptoms: pain, photophobia, lacrimation, blurry vision
A
  • Stained blue with Fluorescein stain, can see green pattern
  • Herpes simplex keratitis (or dendritic corneal ulcer)
  • Antiviral eye drops (acyclovir)
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9
Q

Description + Diagnosis + Management

  • Symptoms: blurry vision, bloodshot eye, photophobia, lacrimation
A
  • Opacity in cornea
  • Corneal ulcer (aka. keratitis)
  • Antibiotic, antiviral, or antifungal (depends on cause) +/- topical corticosteroids (for inflamm)
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10
Q

Description + Diagnosis + Management

  • Symptoms: trigeminal nerve distribution, fever, eye pain, redness, decreasing vision
A
  • Shingles spread to eye
  • Herpes zoster ophthalmicus
  • oral acyclovir 5 times a day for 7 days
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11
Q

Description + Diagnosis + Management

  • Symptoms: cloudy vision, faded colours, can’t see well at night
A
  • Cloud patches over lens
  • Cataracts
  • Lens removal and replacement (surgery)
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12
Q

Description + Diagnosis + Management

  • Symptoms: pupils do not respond to the light reflex but they do get smaller on accommodation (light-near dissociation)
A
  • Pupils are small/constricted
  • Argyll-Robertson pupil
  • IV benzylpenicillin (or if pen allergic - ceftriaxone) 10-14 days infusion

(neurosyphilis is usually the cause)

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13
Q

Description + Diagnosis + Management

  • Symptoms: affected pupil does not constrict in light but does constrict on accommodation
A
  • Pupils are dilated
  • Holmes-Adie pupil
  • Pilocarpine drops (miotics) +/- tinted lenses (to reduce discomfort in bright environments.)
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14
Q

Description + Diagnosis + Management

  • Symptoms: swelling, redness, irritation
A
  • Redness of bits of sclera
  • Episcleritis
  • NSAIDs (topical/oral) +/- topical steroids (refractory cases)
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15
Q

Description + Diagnosis + Management

  • Symptoms: very painful and tender to touch
A
  • Redness all over eye
  • Scleritis
  • NSAIDs +/- steroids
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16
Q

Description + Diagnosis + Management

  • Symptoms: swelling, tenderness, very painful, decreased vision, painful and restricted eye movement, unwell (headache, malaise)
A
  • Infection within the orbit (posterior to the orbital septum) / infection of soft tissue in eye socket
  • Orbital cellulitis
  • IV antibiotics (broad-spectrum) +/- surgical drainage for abscesses (hospital admission)
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17
Q

Description + Diagnosis + Management

  • Symptoms: eyelid swelling, redness, tenderness, no vision changes
A
  • Infection of tissues anterior to the orbital septum (eyelid and skin around eye)
  • Periorbital cellulitis
  • Oral antibiotics
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18
Q

Description + Diagnosis + Management

  • Symptoms: lacrimation, itchiness, burning, discharge
A
  • Red eyes, yellow discharge
  • Bacterial conjunctivitis
  • Antibiotic eye drops (broad-spectrum)

(chloramphenicol (until 48hrs after symptoms resolve) or fusidic acid (5 days))

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19
Q

Description + Diagnosis + Management

  • Symptoms: sore eyelids, gritty, flakes or crusting
A
  • Crusting of eyelids, some redness associated
  • Blepharitis
  • Lid hygeine (warm compress) +/- antibitoic creams
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20
Q

Description + Diagnosis + Management

  • Symptoms: hard swelling, tender, watery eyes
A
  • Cyst on eyelid
  • Meibomian cyst
  • Warm compress and massage
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21
Q

Eye conditions - What can you give for general management, relax the eye muscles/dilate pupil, and inflammation?

A
  • lubricating eye drops
  • cycloplegic drops (e.g., cyclopentolate 1%) for pain relief and to prevent synechiae
  • topical steroids (eg. prednisolone acetate 1%, dexamethasone implant)
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22
Q

Findings on an eye examination:

  • Periorbital erythema/swelling
  • Eyelids
  • Eyelashes
  • Pupils
  • Conjunctival injection
  • Cornea
  • anterior chamber
  • Discharge
A
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23
Q

Causes of red eye (painless and painful)

A
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24
Q

Causes of absent red reflex (fundal reflex) - Adults and Children

A
  • Adults: cataracts, vitreous haemorrhage, and retinal detachment
  • Children: congenital cataracts, retinal detachment, vitreous haemorrhage and retinoblastoma
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25
Q

What is used to dilate the pupil in a fundoscopy exam + how does it work?

A

Tropicamide 1% - short-acting mydriatic drops

(relaxes the pupillary sphincter muscle)

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26
Q

Aniscoria seen in a fundoscopy examination - what does a larger pupil indicate and what does a smaller pupil indicate?

A
  • larger pupil = oculomotor nerve palsy
  • smaller pupil = Horner’s syndrome
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27
Q

What further investigations would you do after completing a fundoscopy examination?

A
  • Blood pressure (for hypertensive retinopathy)
  • Amsler chart (assess for metamorphosis - AMD)
  • Cranial nerve exam
  • Retinal photography
  • Capillary blood glucose (diabetic retinopathy)
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28
Q

Describe the Snellen chart measurement and how the numbers work - eg. 6/6 (20/20), 6/20 etc. and 6/12 (-2) + what you do if the pt has poor vision

A
  • Visual acuity is recorded as chart distance (numerator) [either 6m or 20ft] over the number as the denominator (which is the distance a ‘normal’ person would be able to see the letter at)
  • eg. 6/20 —> pt can see the letters at 6m away the same as normal can see 20m away from chart
    • 6/60 = top line
  • If they can read the line but get two letters wrong for example it would be 6/12 (-2)
  • if the pt gets more than 2 letters wrong then the previous line should be recorded as their acuity
  • Poor vision: 6m, then 3m, then 1m, then counting fingers (CF), then hand movements (HM), then perception of light (PL)
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29
Q

Causes of reduced visual acuity

A
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30
Q

Explain these visual field defects

  • Bitemporal hemianopia
  • Homonymous hemianopia
  • Scotoma
  • Monocular vision loss
A
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31
Q

Pathophysiology of RAPD / the pupillary reflex

A
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32
Q

Actions of extraocular muscles

A
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33
Q

Cover test - which direction will the eye move relating to the type of strabismus (squint)

A
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34
Q

Causes of anosmia

A
  • Mucous blockage —> preventing odours from reaching the olfactory nerve receptors
  • Head trauma —> can result in shearing of the olfactory nerve fibres
  • Congenital anosmia
  • Parkinson’s —> anosmia is an early feature
  • COVID-19
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35
Q

Actions of extraocular muscles

A
  • Superior rectus: Primary – elevation
  • Inferior rectus: Primary – depression
  • Medial rectus: Adduction of eyeball
  • Lateral rectus: Abduction of eyeball
  • Superior oblique: Depresses, abducts and medially rotates
  • Inferior oblique: Elevates, abducts and laterally rotates
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36
Q
A
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37
Q

Trigeminal nerve branches + what does each supply?

A
  • Ophthalmic (V1) —> forehead, upper eyelids, and eyes
  • Maxillary (V2) —> middle of face (including cheeks, nose, lower eyelids, upper lip/teeth, and gums)
  • Mandibular (V3) —> lower face (including jaws, lower lip/teeth, and gums) + has a motor branch that enables chewing, biting, and swallowing
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38
Q

Facial nerve branches

A

TZBMC

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39
Q

Facial nerve movements, what muscle is tested in each?

  • Raised eyebrows
  • Eyes closed
  • Blow cheeks out
  • Smile (show teeth)
  • Purse lips (whistle)
A
  • Raised eyebrows - frontalis
  • Closed eyes - orbicular oculi
  • Blown out cheeks - orbicularis oris
  • Smiling - levator anguli oris and zygomaticus major
  • Pursed lips (whistle) - orbicularis oris and buccinator
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40
Q

Causes of sensorineural hearing loss and conductive hearing loss

A
41
Q

When testing CN XII (hypoglossal), which side does the tongue deviate in a left-sided lesion?

A

hypoglossal nerve palsy causes atrophy of the ipsilateral half of tongue and deviation to side of lesion

42
Q

After completing a cranial nerve examination, what further tests would you do?

A
  • Full neurological examination including the upper and lower limbs
  • Neuroimaging (eg. MRI head) —> if concerns about space-occupying lesions or demyelination
  • Formal hearing assessment (including pure tone audiometry) —> if there are concerns about vestibulocochlear nerve function
43
Q

What do you look for on general inspection in a neurological examination (upper/lower limb examination)

A
44
Q

In an upper limb neuro examination, what does a +ve pronator drift indicate? + what muscles are involved to cause this?

A
  • +ve if forearm pronates - indicates a contralateral pyramidal tract lesion
  • Pronation occurs because, in the context of an UMN lesion, the supinator muscles of the forearm are typically weaker than the pronator muscles.
45
Q

When examining tone in an upper limb neuro examination, what does spasticity and rigidity indicate/associated with?

A
  • Spasticity - associated with pyramidal tract lesions (eg. stroke)
  • Rigidity - associated with extrapyramidal tract lesions (eg. parkinsons)

(both are increased tone)

46
Q

What scale is used to assess muscle power?

A

Power is graded 0 to 5 using the MRC muscle power scale

47
Q

For each movement - myotome + nerve + muscles involved

  • Shoulder abduction
  • Shoulder adduction
  • Elbow flexion
  • Elbow extension
  • Wrist extension
  • Wrist flexion
  • Finger extension
  • Finger abduction
  • Thumb abduction
A
  • Shoulder abduction (C5 - axillary nerve) - deltoid (primary) and other shoulder abductors
  • Shoulder adduction (C6/C7 - thoracodorsal nerve) - teres major, latissimus dorsi, and pectoralis major
  • Elbow flexion (C5/C6 - musculocutaneous and radial nerve) - biceps brachii, coracobrachialis, and brachialis
  • Elbow extension (C7 - radial nerve) - triceps brachii
  • Wrist extension (C6 - radial nerve) - extensors of the wrist
  • Wrist flexion (C6/C7 - median and ulnar nerve) - flexors of the wrist
  • Finger extension (C7 - radial nerve) - extensor digitorum
  • Finger abduction (T1 - ulnar nerve) - First dorsal interosseous (FDI), Abductor digiti minimi (ADM)
  • Thumb abduction (T1 - median nerve) - abductor pollicis brevis
48
Q

What pattern of muscle weakness is seen in UMN lesions? and what pattern of muscle weakness is seen in LMN lesions?

A
  • UMN lesions- cause a ‘pyramidal’ pattern of weakness that disproportionately affects upper limb extensors and lower limb flexors (i.e. upper limb extensors are weaker than flexors in an upper limb neurological assessment) - think of typical stroke pt who has flexed arm and circumduction gait
  • LMN lesions- cause a focal pattern of weakness, with only the muscles directly innervated by the damaged neurones affected.
49
Q

For each reflex - nerve root tested + name of tendon

  • Biceps reflex
  • Supinator
  • Triceps reflex
A
  • Biceps reflex (C5/C6) - biceps brachii tendon (medial aspect of antecubital fossa)
  • Supinator (C5/C6) - brachioradialis tendon (posterolateral aspect of wrist)
  • Triceps reflex (C7) - triceps tendon (superior to olecranon process of the ulna)
50
Q

What type of reflexes are seen in UMN lesions and LMN lesions? (ie. hyperreflexia or hyporeflexia)

A
  • Hyperreflexia - UMN lesions (eg. stroke, spinal cord injury)
  • Hyporeflexia - LMN lesions (eg. brachial plexus pathology or other peripheral nerve injuries)
51
Q

Testing upper limb dermatomes - where would you touch for each of the dermatomes?

A

C5:the lateral aspect of the lower edge of the deltoid muscle (known as the “regimental badge”).

C6:the palmar side of the thumb.

C7:the palmar side of the middle finger.

C8:the palmar side of the little finger.

T1:the medial aspect antecubital fossa, proximal to the medial epicondyle of the humerus.

52
Q

When assessing dermatomes, what tracts/columns are being assessed in:

  • light touch
  • pin-prick
  • vibration sense
A
  • Light touch (dorsal columns and spinothalamic tracts)
  • Pin prick (spinothalamic tract)
  • Vibration sensation (dorsal columns)
53
Q

What patterns of sensory loss are seen in:

  • Mononeuropathies
  • Peripheral neuropathy
  • Radiculopathy
  • Spinal cord damage
  • Thalamic lesions
  • Myopathies
A
  • Mononeuropathiesresult in a localised sensory disturbance in the area supplied by the damaged nerve.
  • Peripheral neuropathytypically causes symmetrical sensory deficits in a ‘glove and stocking’ distribution in the peripheral limbs. The most common causes of peripheral neuropathy are diabetes mellitus and chronic alcohol excess.
  • Radiculopathyoccurs due to nerve root damage (e.g. compression by a herniated intervertebral disc), resulting in sensory disturbances in the associated dermatomes.
  • Spinal cord damageresults in sensory loss both at and below the level of involvement in a dermatomal pattern due to its impact on the sensory tracts running through the cord.
  • Thalamic lesions(e.g. stroke) result in contralateral sensory loss.
  • Myopathiesoften involve symmetrical proximal muscle weakness.
54
Q

When assessing coordination, what would patients with cerebellar pathology exhibit on:

  • finger-to-nose test
  • dysdiadochokinesia
A

Finger-to-nose:
- Dysmetria (over/undershooting the target)
- Intention tremor

Dysdiadochokinesia:
- may struggle to carry out task (movements slow and irregular)

55
Q

After completing an upper or lower limb neuro examination, what further assessments/investigations would you like to do?

A
  • Full neurological examination (including cranial nerves, lower/upper limbs, and cerebellar assessment)
  • Neuroimaging (eg. MRI spine and head)
56
Q

What does UMN and LMN consist of?

A

UMN = brain or spinal cord

LMN = nerve roots, peripheral nerve, neuromuscular junction, or muscle

57
Q

Describe these gait abnormalities

A

Apraxia

58
Q

Romberg’s test is based on the premise that a patient requires at least two of the following three senses to maintain balance whilst standing:

A
  • Proprioception:the awareness of one’s body position in space.
  • Vestibular function:the ability to know one’s head position in space.
  • Vision:the ability to see one’s position in space.
59
Q

What does Romberg’s test assess?

A
  • Used to assess for loss of proprioception or vestibular function (sensory ataxia)
  • ie. screens for non-cerebellar causes of balance issues
60
Q

Romberg’s test:

  • causes of proprioceptive dysfunction
  • causes of vestibular dysfunction
A
  • Causes of proprioceptive dysfunction - joint hypermobility (e.g. Ehlers-Danlos syndrome), B12 deficiency, Parkinson’s disease, and ageing (known as presbypropria)
  • Causes of vestibular dysfunction - vestibular neuronitis and Ménière’s disease
  • .
61
Q

Spasticity and rigidity - which one is velocity-dependent and what is meant by this term?

A

Spasticity (”velocity-dependent”) - associated with pyramidal tract lesions (eg. stroke)

  • velocity-dependent - the faster you move the limb, the worse it is
62
Q

For each movement - myotome + nerve + muscles involved

  • Hip flexion
  • Hip extension
  • Knee flexion
  • Knee extension
  • Ankle dorsiflexion
  • Ankle plantar-flexion
  • Big toe extension
A
  • Hip flexion (L1/L2) - iliopsoas
  • Hip extension (L5/S1/S2 - inferior gluteal nerve) - gluteus maximus
  • Knee flexion (S1 - sciatic nerve) - hamstrings
  • Knee extension (L3/L4 - femoral nerve) - quadriceps
  • Ankle dorsiflexion (L4/L5 - deep peroneal nerve) - tibialis anterior
  • Ankle plantar-flexion (S1/S2 - tibial nerve) - gastrocnemius, soleus
  • Big toe extension (L5 - deep peroneal nerve) - extensor hallucis longus
63
Q

For each reflex - nerve root tested + name of tendon

  • Knee jerk
  • Ankle jerk
  • Plantar reflex (Babinski) - no tendon - but what is an abnormal/Babinski sign?
A
  • Knee jerk (L3/L4) - patellar tendon
  • Ankle jerk (S1) - Achilles tendon
  • Plantar reflex/Babinski (L5, S1) - extension of big toe and spread of the other toes –> suggests UMN lesion
64
Q

Lower limb dermatomes and where you would touch to test sensation for each of the following:

  • L1
  • L2
  • L3
  • L4
  • L5
  • S1
A
  • L1:inguinal region and the very top of the medial thigh
  • L2:middle and lateral aspect of the anterior thigh
  • L3:medial aspect of the knee
  • L4:medial aspect of the lower leg and ankle
  • L5:dorsum and medial aspect of the big toe
  • S1:dorsumand lateral aspect of the little toe
65
Q

Upper limb dermatomes and where you would touch to test sensation for each of the following:

  • C4
  • C5
  • C6
  • C7
  • C8
  • T1
A
  • C4: just above shoulder
  • C5:the lateral aspect of the lower edge of the deltoid muscle (known as the “regimental badge”).
  • C6:the palmar side of the thumb.
  • C7:the palmar side of the middle finger.
  • C8:the palmar side of the little finger.
  • T1:the medial aspect antecubital fossa, proximal to the medial epicondyle of the humerus.
66
Q

Does joint proprioception involve the spinothalamic tracts or the dorsal columns?

A

Dorsal columns

67
Q

Plexuses and what they innervate:

  • Cervical plexus
  • Brachial plexus
  • Lumbosacral plexus
A
  • Cervical plexus (C1-C4) - innervates diaphragm, shoulders, and neck
  • Brachial plexus (C5-T1) - innervates upper limbs
  • Lumbosacral plexus (L2-S4) - innervates lower extremities
68
Q

In neurology, we need to first think of where the lesion could be, in simple terms where could a lesion be and what pattern of weakness (symmetrical/bilateral OR asymmetrical/unilateral) would be associated?

  • Brain
  • Spinal cord
  • Nerve root
  • Periphreal nerves
  • NMJ
  • Muscles
A
  • Brain - asymmetrical/unilateral
  • Spinal cord - symmetrical/bilateral (everything is close together in spinal cord so it is rare to have one specific area affected to cause unilateral symptoms)
  • Nerve root - usually unilateral
  • Peripheral nerves - symmetrical + distal (glove and stocking)
  • NMJ - Symmetrical
  • Muscles - myopathies are usually proximal and symmetrical
69
Q

What does the onset of symptoms suggest about the cause of the symptoms?

  • sudden
  • days/weeks
  • months
  • years
A
  • Sudden - vascular
  • Hours/Days/weeks - Inflammation/Infection
  • Months - Neoplastic
  • Years - Neurodegenerative
70
Q

Primary causes of headaches VS Secondary causes of headaches

A
70
Q

Headache red flags

A
  • Raised ICP signs - nausea/vomiting/Valsalva manouvre/focal neuro signs
  • Meningism - fever/neck stiffness/rash
  • Sudden + severe - SAH
  • GCA - temporal tenderness/hard on palpation…
  • Trauma - bleed?
  • Hx of cancer - metastases
71
Q

What side would the uvula deviate if there is a left side vagus nerve lesion + which muscles are involved?

A
  • Uvula deviates towards unaffected side - affected side’s muscles are paralysed/weak, therefore functioning muscles on contralateral side pull uvula towards them
  • due to paralysis of the palatopharyngeal muscles
72
Q

Using a typical appearance of a stroke (eg. arm flexed, leg extended/circumduction gait), describe the pyramidal (corticospinal tract) pattern of weakness

A
  • Upper body - weakness predominantly affects extensors, leading to a flexor posture (e.g. flexed elbow/wrist/fingers)
  • Lower body - weakness predominantly affects flexors, leading to an extensor posture (e.g. extended knee and plantarflexed foot)
73
Q

Monroe-Kellie doctrine (raised ICP)

A
  • The cranium, enclosing the brain, forms a fixed space comprising three components : blood, CSF, and brain tissue
  • These components remain in a state of dynamic equilibrium, therefore any increase in any one of them results in a compensatory decrease of the other two
  • Once the other compartments have reached their point of maximum compensation, any further increase in the size of one results in increased intracranial pressure.
74
Q

GCS score - what is lowest/highest/requires intubation?

A
  • 3= lowest = completely unresponsive
  • 15 =highest = fully alert
  • ≤ 8 —> intubation
75
Q

What is the corpus callosum?

A
  • bundle of nerve fibers that connects the right and left sides of the brain
  • (largest white matter structure in the brain - think MS affects myelin)
  • responsible for allowing the two hemispheres to communicate with each other
76
Q

Key symptoms of bacterial meningitis + key sign for meningococcal meningitis

A
  • Symptoms - headache, fever, neck stiffness, and photophobia
  • Sign: petechial rash (non-blanching)
77
Q

Investigations for suspected bacterial meningitis + diagnostic test

A
  • CSF (gram stain, culture)
  • Blood cultures - to guide antibiotics
  • Diagnosis: gram stain + CSF culture / bacterial PCR
78
Q

Risk factors for TB meningitis

A
  • exposed to pulmonary TB
  • areas of high prevalence / homelessness / immunosuppression
79
Q

Main cause of fungal meningitis (rare)

A

untreated HIV infection (very immunosuppressed)

80
Q

Causes of Guillian Barre

A
  • CMV (cytomegalovirus)
  • EBV
  • campylobacter jejuni
81
Q

Peripheral pattern of weakness (LMN lesions) - Give differential for each short hx

  1. fatigable weakness, affects extraocular/bulbar muscles first, improves with rest, associated with thymoma
  2. proximal weakness, improves with repeated use, associated with small cell lung cancer
  3. descending paralysis, dilated pupils, respiratory involvement
A
  1. Myasthenia gravis
  2. Lambert-Eaton myasthenic syndrome (LEMS)
  3. Botulism
82
Q

Peripheral pattern of weakness (LMN lesions) - Give differential for each short hx

  1. inflammatory myopathies, painful proximal weakness, heliotrope rash in dermatomyositis
  2. progressive weakness, Gower’s sign (children)
A
  1. Polymyositis / Dermatomyositis
  2. Muscular dystrophies
    - Duchenne - more severe, progresses faster, occurs < 5yrs old
    - Becker - symptoms appear in teens/early adulthood
83
Q

Peripheral pattern of weakness (LMN lesions) - Give differential for each short hx

  1. ascending paralysis, areflexia, post-infectious
  2. glove-and-stocking sensory loss, distal weakness, diabetic pt
  3. progressive distal weakness, pes cavus, foot drop
  4. subacute combined degeneration – sensory ataxia, UMN + LMN signs
A
  1. Guillain-Barré Syndrome (GBS)
  2. Diabetic polyneuropathy
  3. Charcot-Marie-Tooth disease
  4. B12 deficiency
84
Q

Peripheral pattern of weakness (LMN lesions) - Give differential for each short hx

  1. sciatica, weakness in affected myotome, pain radiating along a nerve root
  2. saddle anaesthesia, bowel/bladder dysfunction – urgent referral!
A
  1. Cervical or lumbar radiculopathy
  2. Cauda equina syndrome
85
Q

Central pattern of weakness (UMN lesions) - Give differential for each short hx

  1. sudden-onset focal neurological deficit, unilateral weakness, speech disturbance, visual field defect, sensory loss, hx of TIA / atrial fibrillation
  2. sudden-onset and severe headache, nausea/vomiting/seziures, reduced GCS, hx of hypertension / anticoagulation use
A
  1. Ischaemic stroke (MCA, ACA, PCA syndromes)
  2. Haemorrhagic stroke (intracerebral haemorrhage, SAH)
86
Q

Central pattern of weakness (UMN lesions) - Give differential for each short hx

  1. optic neuritis, sensory symptoms, UMN signs, Lhermitte’s sign
    Internuclear ophthalmoplegia
A
  1. Multiple Sclerosis (MS)
87
Q

Central pattern of weakness (UMN lesions) - Give differential for each short hx

  1. Bilateral symptoms below lvl of lesion

(Bilateral paralysis + pain/temp loss, Preserved proprioception/vibration (dorsal columns spared))

A
  1. Spinal cord lesion

(Anterior cord syndrome)

88
Q

Central pattern of weakness (UMN lesions) - Give differential for each short hx

  1. progressive asymmetric weakness, fasciculations, no sensory loss (mixed LMN + UMN signs)
A
  1. MND - Amyotrophic lateral sclerosis (ALS)
    - bulbar onset = worse prognosis
    .
89
Q

Give a differential for each of the movement disorder hx

  1. resting tremor, rigidity, bradykinesia, postural instability, Parkinsonian gait
  2. chorea, personality change, dementia
  3. bilateral action tremor, improves with alcohol
A
  1. Parkinson’s disease
  2. Huntington’s disease
  3. Essential tremor
90
Q

Give a differential for

  • ataxia, dysmetria, and intention tremor
A

Cerebellar disorders:
- Stroke, tumour, MS affecting cerebellum
- Alcoholic cerebellar degeneration (midline ataxia, gait instability)
- Friedreich’s ataxia (early-onset ataxia, cardiomyopathy, pes cavus)

91
Q

Cerebellum symptoms - DANISH

A
  • Dysdiadochokinesia
  • Ataxia (gait and posture)
  • Nystagmus - vertical nystagmus
  • Intention tremor
  • Slurred, staccato speech
  • Hypotonia/heel-shin test
92
Q

“Blackouts” - differentials

A
  • Seizure (epileptic)
  • Syncope (cardiogenic)
  • Hypoglycaemic episode
93
Q

What are some causes of cerebellar problems?

(need to add more?)

A
  • Excessive alcohol hx
  • Genetic predisposition - ie. cells of the cerebellar just degenerate faster than other cells in the body
  • Autoimmune process
94
Q

Peripheral neuropathy differentials

A
  • Alcohol
  • Diabetes
  • Hypothyroid
  • Vitamin deficiencies (B12/folate, B1/thiamine)
95
Q

What is shown (3 findings + causes)

A

3rd nerve palsy
- left eye is in a ‘down and out’ position due unopposed action of SO and LR
- there is also a ptosis due to loss of innervation to levator palpebrae superiors
- and mydriasis due to loss of innervation to sphincter pupillae
.
- Causes: compression from tumour, PCA aneurysm, trauma, infection

96
Q
A

Trochlear nerve palsy
- only innervates SO - results in vertical diplopia when looking inferiorly due to loss of pulling the eye downwards
- pts may try and compensate by tucking their chin in and tilting head forwards
.
- Causes: vascular disease (diabetes), aneurysm

97
Q
A

Abducens nerve palsy
- only innervates LR - results in unopposed adduction of eye, leading to a convergent squint
- pt will have horizontal diplopia
.
- Causes: tumour, MS, injury

YEAR 3 MED 2.0 (14 decks)

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