mr carroll

Question 1

How does a myopathy present?

Answer 1

hard to walk, tripping, shaving difficulty, muscle ache, struggle with stairs
O/E is muscle weakness

Question 2

What are the causes of a myopathy?

Answer 2

corticosteroids/ iatrogenic Cushing’s (steroids aree used for cancer, post transplant, autoimmune, severe respiratory disease etc), thyroid, MG, MS, LES, GBS, electrolyte deficiencies, statins and dystrophies

Question 3

What are the different patterns of muscle weakness?

Answer 3

• distal (peripheral nerve problem)
• proximal (myopathy)
• global weakness
• pyramidal

Question 4

How does myasthenic syndrome present?

Answer 4

Fatigueability so struggle to perform reptitive actions

Question 5

What is the autoimmune problem that causes myasthenic syndrome?

Answer 5

lambert eaton syndrome

Question 6

What can be damaged when relocating a dislocated arm?

Answer 6

axillary nerve

Question 7

How does carpal tunnel syndrome present?

Answer 7

radiates up to elbow, worse in morning- shake off
Pt speak- They may drop objects, struggle open jars (thenar weakness)
Numbness in thumb, index and middle finger
Examination may be normal
weakness of the LOAF muscles (lateral lumbricals, opponens pollicis, abductor pollicis brevis and flexor policis brevis

Question 8

What is mononeuritis multiplex?

Answer 8

asymmetrical peripheral neuropathy

Question 9

What is the commonest cause of peripheral neuropathies?

Answer 9

diabetes mellitus

Question 10

What is carpal tunnel syndrome?

Answer 10

A mononeuropathy

Question 11

What do you find on examination of a peripheral neuopathy?

Answer 11

Loss vibration, on observation can see trophic changes (thin, shiny, dry, hair loss, deformed nails, pigmented skin)

Question 12

What is a radiculopathy?

Answer 12

Radiculopathy, also commonly referred to as pinched nerve, involves damage to a nerve root. It is set of conditions (so a syndrome) in which one or more nerves are affected and do not work properly (a neuropathy). This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles.

Question 13

What are the different types of gaits?

Answer 13

• ataxic- cerebellum- wide based
• foot drop is a high steppage gait
• hemiplegic gait (hand to chest and extension of leg)- stroke
• antalgic gait
• waddling gait-proximal myopathy
• scissoring gait- spastic paraparesis
• functional gait- don’t fall, bizarre looking

Question 14

What is radicular pain?

Answer 14

Where pain is radiated along the dermatome of a nerve due to inflammation of the nerve root (radiculopathy) at its connection to the spinal column eg sciatica
It is sharp in character

Question 15

What are the three types of radiculopathy?

Answer 15

cervical, thoracic and lumbar

Question 16

How can a radiculopathy present?

Answer 16

Sensory loss and pai in dermatome region.
weakness
loss of reflexes

Question 17

Describe the different radiculopathies

Answer 17

Cervical radiculopathy is pressure on one of the nerve roots in your neck. It can cause weakness, burning or tingling, or loss of feeling in your shoulder, arm, hand, or finger.
Thoracic radiculopathy happens when there’s a pinched nerve in the upper back portion of your spine. This causes pain in your chest and torso. It’s uncommon and can be mistaken for shingles.
Lumbar radiculopathy is pressure on one of the nerve roots in your lower back. It can cause hip pain and sciatica, or shooting pain in your leg. Incontinence, sexual dysfunction, or paralysis can also occur in severe cases.

Question 18

What is sciatica?

Answer 18

pain that flows from your lower back through your buttock area and into your lower limbs.
Pins and needles and weakness in lower limbs.
Incontinence if is cauda equina syndrome.

Question 19

What is cauda equina syndrome?

Answer 19

saddle anaesthesia, incontinence and bilateral leg pain/numbness/weakness

Question 20

What can cause a radiculopathy/ myelopathy?

Answer 20

herniated disc
OA (or any arthiritis) - spondylosis is OA of the vertebral joint spaces
tumour
cyst
trauma
spinal stensosis with age (narrowing of spinal canal)
osteophytes (bony lumps on spine, often associated with OA)
abscess/infection

Question 21

How is a radiculopathy diagnosed?

Answer 21

Xray, MRI, EMG, nerve conduction

Question 22

What is the management for a radiculopathy?

Answer 22

PT
surgery
pain meds

Question 23

What is cervical spondylosis?

Answer 23

Cervical spondylosis is chronic cervical disc degeneration with herniation of disc material, calcification and osteophytic outgrowths.
It may cause:
Radiculopathy due to compression, stretching or angulation of the cervical nerve roots.
Myelopathy due to compression, compromised blood supply or recurring minor trauma to the cord.

Question 24

How does cervical spondylosis present? (rememeber is like a pre-cursor to cervical myelopathy)

Answer 24

sx:
Cervical pain and stiffness worsened by movement.
Referred pain (occiput, between the shoulder blades, upper limbs).
Retro-orbital or temporal pain (from C1 to C2).
Vague numbness, tingling or weakness in the upper limbs.
Poor balance.

Signs
Limited range of movement (forward flexion, backward extension, lateral flexion and rotation to both sides).
Minor neurological changes like inverted supinator jerks (unless complicated by myelopathy or radiculopathy).
Poorly localised tenderness.
(SUSPECT radiculopathy is unilateral and signs limited to one dermatome)

Question 25

What is a myelopathy?

Answer 25

Myelopathy (aka spinal cord compression) describes any neurologic deficit related to the spinal cord. When due to trauma, it is known as (acute) spinal cord injury. When inflammatory, it is known as myelitis.
The most common type is cervical myelopathy

Question 26

How does a cervical myelopathy present?

Answer 26

Neck pain and stiffness (affecting the neck, upper or lower limbs)
Tingling
Numbness
Weakness
Dropping things
Hand clumsiness (eg, buttoning a shirt, texting, holding cutlery)- fine movement loss is usually first sign
Balance problems
Difficulty walking- feel weighed down and lead like
Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition
Hoffman’s sign positive

Question 27

What are the causes of a myelopathy?

Answer 27

Same as radiculopathy

Question 28

What are the signs of a myelopathy?

Answer 28

SIGNS before symptoms
long tract (aka UMN signs) 
vertebral pain (back pain) plus radiculopathy (pain radiating down a dermatome)

Question 29

What are the signs of cerebellar disease?

Answer 29

Cerebellar hemisphere lesions cause peripheral (‘finger-nose ataxia’)
Cerebellar vermis lesions cause gait ataxia

wide based ataxia
intention tremor
past-pointing - pointing beyond the finger in the finger-nose test
dysdiadochokinesis - this feature is shown when the patient is slow and uneven in attempting fast hand movements, e.g. tapping the right hand fast on the back of the left hand
nystagmus - coarse and slow; worst on looking to the side of the lesion
truncal ataxia - tends to fall on the same side
hypotonia and pendular reflexes

Question 30

Give some causes of cerebellaer ataxia

Answer 30

inherited, tumour, infection (cerebellitis), stroke, MS, alcohol, thyroid, gluten

Question 31

Name some inherited forms of cerebellar ataxia

Answer 31

autosomal recessive – Friedreich’s ataxia and ataxia-telangiectasia
autosomal dominant – episodic ataxia and some cases of spinocerebellar ataxia

Question 32

What is bells palsy?

Answer 32

a palsy of the facial nerve:

Weakness of the muscles of facial expression and eye closure. The face sags and is drawn across to the opposite side on smiling. Voluntary eye closure may not be possible and can produce damage to the conjunctiva and cornea. forehead NOT spared

Question 33

How is bells palsy treated?

Answer 33

Prednisolone should be given to patients over the age of 16 presenting within 72 hours

Question 34

What is ramsay hunt syndrome?

Answer 34

basically like bells palsy + a blistered rash + pain often secondary to chickenpox

Question 35

third nerve palsy vs horners

Answer 35

Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner’s

Question 36

palsy of third vs fourth vs sixth CN?

Answer 36

III -> Palsy results in: ptosis; ‘down and out’ eye; dilated, fixed pupil
IV -> Palsy results in defective downward gaze → vertical diplopia
VI -> Palsy results in defective abduction → horizontal diplopia

Question 37

extradural vs subdural haemorrhage?

Answer 37

subdural (between brain + dura)- bridging veins; shaken baby; atrophy of brain eg alcoholics or dementia; crescent shape on CT

extradural- lucid interval; between the skull and the dura; biconvex.

Question 38

Describe transverse myelitis

Answer 38

Type of myelopathy, can be caused by autoimmune things eg MS:
Acute transverse myelitis presents with an acute episode of weakness or paralysis of both legs, with sensory loss and loss of control of bowels and bladder. Commonly there is associated back or leg pain

Question 39

What are the difference in clinical signs between cord compression and cauda equina syndrome?

Answer 39

Cauda equina compression causes flaccid paralysis (low tone) with loss of reflexes.

Cord compression usually causes spastic paralysis (high tone) with brisk reflexes.

Both cause sensory and power loss.