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Clinicals > Neuro > Flashcards

Neuro Flashcards

1
Q

Cerebellar causes

A

VINDICATE:

Vascular: stroke
neoplastic: NB
degen: FA
Drug/siatrogenic: phenytoin
C..CP
AI: MS
Trauma
Endo: Wilsons, nutritional Vit E

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2
Q

signs of neuro chronicity

A

wasting
deformity
contractures
AFOs well worn
growth asymmetry

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3
Q

paresis vs plegia

A

paresis = weakness
plegia = can’t move

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4
Q

cognitive impairment phrase

A

= “behave younger than I expect”

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5
Q

pes cavus = what DDx

A

spinocerebellar lesion (friedrich’s)
peripheral nerve (CMT)
spinal lesion e.g. spina bifida

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6
Q

Exam signs of myotonic dystrophy

A

myotonic facies - droopy mouth, expressionless (squeeze eyes)
make fist and release
percussion myotonia

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7
Q

types of gait + where is the lesion?

A
  1. hemiplegic (swinging, one arm in) = unilateral spinal/brain
  2. diplegic (both legs swing, adducted) = spinal e.g. transverse myelitis / brain e.g. CP
  3. ataxic (broad based) = cerebellar (with bad turning) / vestibular / sensory
  4. myopathic i.e. high stepping gait = ankle DF weakness from L4, L5, S1 from common peroneal palsy / radiculopathy / polyneuropathy e.g. CMT
  5. myopathic i.e. Trendelenburg (waddling with circumduction) = DMD, BMD, myotonic dystrophy / systemic disease e.g. thyroid, dermatomyositis
  6. choreoform (writhing) = HD, CP, Wilsons
  7. antalgic
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8
Q

Diplegic gait

A

Brain - PVL causing CP!!
Spine - inflammatory e.g. transverse myelitis, congenital e.g. spina bifida, tumour, trauma

Hereditary spastic diplegia

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9
Q

Toe walking gait vs can’t toe walk suggests?

A

Toe walking = DISTAL strength

Can’t toe walk = PF (S1) weakness e.g. CMT
Toe walking = BMD/DMD, CP/spasticity

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10
Q

Can’t heel walk suggests?

A

DF weakness (L5) - CMT!!!, DMD, CP

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11
Q

horner’s sign and causes

A

= ptosis, miosis and anhidrosis

  1. post-cardiac surgery
  2. NB
  3. NF
  4. tumour
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12
Q

ptosis + large pupil vs small pupil
or just ptosis

A

ptosis + large pupil = CNIII palsy
ptosis + small pupil = Horner’s

ptosis e.g. MG, congenital ptosis, dystrophies

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13
Q

causes of unilat vs bilat SNHL

A

unilat e.g. acoustic neuroma, trauma
bilat
1. genetic e.g. connexin
2. syndromic e.g.
3. toxins/drugs e.g. gentamicin
4. infection e.g. rubella / CMV
5. meniere’s

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14
Q

DDx of nystagmus

A
  1. cerebellar
  2. vestibular
  3. congenital
  4. physiological
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15
Q

CNIII, IV, VI palsies

A

III = down and out with ptosis and large pupil
IV = up and in, head tilts away from side of lesion
VI = in

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16
Q

cortical blindness = ?

A

loss of vision but pupillary reflex (CNII) intact

17
Q

cataracts DDx

A

Congenital:
CMV
Turner
T21

Acquired:
Steroid
Alport

18
Q

DDx of ophthalmoplegia

A

UMN - demyelination, tumour, vascular
LMN - nerve e.g. GBS/Bell’s/ICP, NMJ, muscle

19
Q

foot drop causes

A
  1. CMT
  2. common peroneal palsy
  3. L5/S1 nerve palsy
20
Q

CMT vs FA

A

both ataxic, loss of proprioceoption and vibration, pes cavus

FA Romberg’s positive

21
Q

hemiplegia DDx

A

VINDICATE

V: vascular
- vessels e.g. Moya Moya, Sturge Weber, NF
- cardiac
- haem e.g. sickle cell
I: infection - inflammatory e.g. encephalitis
N: neoplasm
C: congenital - will get facial sparing
A: autoimmune
T: trauma
E: endocrine/metabolic

22
Q

what level of LL flexion corresponds with what nerve root? e.g. in spina bifida

A

hip flexion = L1/2
knee flexion = L3/4
ankle DF = L4/5
*saddle area = S3 and below i.e. incontinence

23
Q

key areas to look for in spina bifida

A

HC
neck - VP shunt
back - scoliosis
nystagmus
incontinence (say to look for anal tone)
percuss for bladder
abdo reflex
pressure areas

24
Q

hemiplegia - how to tell where the level of the lesion is?

A

facial weakness side:
cortical = same side as lesion
subcortical = same side
brain stem = opposite side
spine = no facial features

25
Q

key features of SMA on exam

A

tongue fasciculations
prox weakness
FACE AND EYE NORMAL
no reflexes
Ix - SMN1/2 gene

26
Q

key features of MG on exam

A

fatiguability
ptosis
facial weakness
bulbar involvement
+/- prox weakness

Ix - tensilon test

27
Q

peripheral polyneuropathy DDx

A

CMT
FA
Iatrogenic e.g. vincristine
GBS

28
Q

If its UMN, think…? If its LMN, think…?

A

UMN - brain v brainstem v spinal cord?
diplegia - PVL, spina bifida, or rest of vindicate
hemiplegia - VINDICATE
spina bifida - where’s the lesion?

LMN
1) ant horn = SMA
2) nerve = CMT/FA/iatrogenic
3) NMJ = MG
4) muscle = myopathy/dystrophy

29
Q

if you think its myopathy/dystrophy - what else to examine/ask for?

A
  1. cardiac
  2. scapulae / trendelenburg - pelvic girdle
  3. gower
  4. wasting and pseudohypertrophy of calves
  5. gait - toe walking
  6. scoliosis
  7. face - dystrophy face is fine, congenital myotonic dystrophy = myopathic faces, myopathy face is bad
  8. CK
  9. gene panel
  10. muscle biopsy
30
Q

basically only causes of distal weakness

A

peripheral neuropathy
SMA
congenital myotonic dystrophy

31
Q

cerebellar signs

A

nystagmus
dysarthria
past pointing
intention tremor
dysdiadochokinesia
upward drift pronator
truncal araxia
broad based gait / ataxic gait

32
Q

additional things to ask for in a cerebellar patient

A

eyes - slit lamp HF
abdomen - NB, hepsplen for metabolic
bloods - nutritional e.g. Vit E, copper/ceruloplasmin, metabolic, urinary VA/MVA
genetics - GA panel

33
Q

signs of FA

A
  1. cerebellar
  2. HCM
  3. hearing loss
  4. pes cavus, romberg’s positive
  5. LL weakness, no reflexes, no sensation/vibration

Ix: triplet repeat study

34
Q

ataxia DDx

A
  1. cerebellar
    - genetic: AT vs FA
  2. vestibular
    - acute labyrinthitis
  3. neuropathy
    - iatrogenic e.g. vinc
    - CMT
    - diabetes
  4. loss of proprioception
    - B12, hypothyroid
35
Q

Ix for floppy weak vs floppy strong

A

floppy weak and areflexic = neuromuscular
CK
nerve conduction /muscle studies
genetic - SMA1/2, congenital myotonic dystrophy

floppy strong = central: congenital vs acquired??
MRI/CT - HIE!!, vascular / tumour
endocrine - TFTs
metabolic - metabolic screen
genetic - PWS
infectious

36
Q

facial weakness ddx

A

unilat - bell’s or stroke (forehead spared)
bilat - myotonic dystrophy, FSHD, GBS, CP, MG

Clinicals (5 decks)

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